Professional Documents
Culture Documents
CH 17
CH 17
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Contraindications.
1. Teeth with nonrestorable crowns
2. Periradicular involvement extending to the perma-
nent tooth bud
3. Pathologic resorption of at least one-third of the
root with a stulous sinus tract
4. Excessive internal resorption
5. Extensive pulp oor opening into the bifurcation
6. Young patients with systemic illness such as congen-
ital or rheumatic heart disease, hepatitis, or
leukemia and children on long-term corticosteroid
therapy or those who are immunocompromised
7. Primary teeth with underlying dentigerous or follic-
ular cysts
Clinical Procedures: Partial Pulpectomy
Partial pulpectomy can be considered an extension of
the pulpotomy procedure in that the coronal portion of
the radicular pulp is amputated, leaving vital tissue in
the canal that is assumed to be healthy. Although dis-
cussed in the context of nonvital pulp therapy, techni-
cally, it is a vital pulp therapy technique. The decision
to implement the partial pulpectomy is made after
removing the coronal pulp from the chamber and
encountering difficulty with hemorrhage control from
the radicular orice.
Hemorrhage control is achieved with endodontic
broaches used to remove one-third to one half of the
coronal portion of the radicular pulp tissue from the
canals. The canals and chamber are irrigated with
hydrogen peroxide followed by sodium hypochlorite
and then dried with cotton pellets. If hemorrhage is
still impossible to control, all remaining radicular pulp
tissue is to be removed, and the complete pulpectomy
procedure must be implemented.
After successful hemorrhage control from the
amputated radicular pulp, a formocresol-dampened
cotton pellet, squeezed dry, is placed in the pulp cham-
ber for 1 to 5 minutes. The pellet is removed, and a
nonreinforced fast-setting ZOE cement is packed with
pressure into the chamber and canals. A radiograph is
then taken, and if the canals appear to be adequately
lled, a stainless steel crown is placed as a permanent
restoration (Figure 17-20).
Clinic Procedures: Complete Pulpectomy
The child with a necrotic primary tooth presents a con-
siderable challenge for the clinician. In some instances,
the tooth may be totally asymptomatic from a clinical
standpoint. In other instances, the tooth may be acute-
ly or chronically abscessed, mobile and painful, with