Pulpotomy

What is a pulpotomy?

A pulpotomy is a dental treatment in which the infected or inflamed soft tissue (or pulp) of the top (crown) of the tooth is removed but the soft tissue inside the roots of the tooth is left behind. The object is to preserve the tooth, alleviate pain and prevent further extension of the infection. Pulpotomy is typically performed on children's primary (baby) teeth but may be warranted in some instances for young permanent teeth with developing roots.

Why a Pulpotomy is Necessary?

A pulpotomy may be recommended by a dentist if:

• The pulp is affected by deep dental caries.
• A tooth becomes damaged as a result of trauma or fracture.
• In the case of pulpitis, the pulp is inflamed while the infection hasn't spread into the root canals.
• Preserving a baby tooth is only necessary until it falls out naturally.
• When a tooth is young, the treatment must be based on the need to keep the root developing.

How Pulpotomy works?

A pulpotomy usually takes place in one appointment and the following steps are used:

• X-rays and examination: The dentist examines the tooth and takes X-rays to determine if a pulpotomy is necessary.
• Local anaesthesia: Numbing of the area for comfort during procedure.
• Removal of decayed area: The decayed area of the tooth is removed.
• The removal of infected pulp: Removal of the pulp of the crown of the tooth only leaving the root pulp intact.
• Placement of a medicated material: A biocompatible material is placed over the pulp that remains to protect it and promote healing.
• Seal with filling or a dental crown (usually a stainless steel crown in baby teeth) to restore strength and function to the tooth.

A Pulpotomy offers several advantages:

• Soothes tooth sensitivity and pain.
• Preserves the natural tooth.
• Avoids the necessity of having to have teeth removed.
• Chews and speaks appropriately.
• Maintains space in children for permanent tooth.
• Promotes the healthy development of the jaw and teeth.

Who is a good candidate?

A pulpotomy might be appropriate for patients that have:

• Cavities that extend down into the dentine affecting the pulp.
• Root pulp without noticeable severe infection.
• Primary teeth that should not be extracted until they fall out.
• Teeth with dentin formation not completed.
• No important swelling, abscess or large root damage.

Pulpotomy procedure

Pulpotomy is a dental treatment that involves the removal of an infected or inflamed tooth pulp in the crown (top) of the tooth without removing the healthy pulp in the roots of the tooth. It is most commonly used on baby teeth and young permanent teeth to alleviate pain, eliminate infection and to preserve the natural tooth.

Step-by-Step Pulpotomy Procedure:

Initial Examination and Diagnosis

• The dentist will first examine the affected tooth as well as the symptoms. X-rays are made to find out how much decay or injury is present and if the infection has spread to the root canals. Only a pulpotomy is suggested if the root inside the pulp is healthy.

Local Anaesthesia

• A local anaesthetic is administered to numb the tooth and surrounding tissues ensuring the procedure is comfortable and pain-free. Sedation options can also be discussed for children or the patient who is anxious.

Isolation of the Tooth

• The dentist might use a rubber dam to help keep the treatment area dry and away from saliva and bacteria while working.

Tooth Decay Removal

• Any damaged or decayed tooth structure is carefully removed with specially designed dental instruments to reach the pulp chamber.

The removal of the Coronal Pulp

• Gently the infected or inflamed pulp tissue in the crown of the tooth is removed. To preserve the vitality of the tooth, healthy pulp inside the root canals is left unaltered.

Controlling Bleeding

• Dentist uses sterile cotton pellets to control bleeding. Normally, the pulp tissue does not bleed for more than a few minutes. If there is excessive bleeding, this mean that the infection has progressed further into the root and thus other treatment might be required like a root canal or tooth extraction.

Placement of a Medicated Material

A biocompatible medication is covered over the healthy pulp that is remaining to preserve it and promote healing. Common materials include:

• Mineral Trioxide Aggregate (MTA)
• Biodentine
• Calcium silicate-based materials

These materials close the pulp and promote formation of protective dentin.

Sealing the Tooth

• A filling material is placed in the pulp chamber to keep the bacteria from getting back in the tooth.

A Dental Crown is placed in the mouth

• Normally, particularly in the case of baby molars, your dentist fits a stainless steel crown to make the tooth stronger and to shield it from any additional cracks or cavities. Depending on the severity of the damage, permanent teeth can be treated with a tooth-colored filling or a custom crown.

Pulpotomy vs Pulpectomy

Pulpotomy and pulpectomy are both dental procedures that can be used to treat infected or damaged tooth pulp. They differ, however, in the amount of pulp that is being removed and when they are recommended. A pulpotomy is performed when the pulp is healthy in the roots but a pulpectomy is performed if the pulp is healthy in the crown but not healthy in the root.

What is a Pulpotomy?

The pulpotomy procedure is performed to remove the infected or inflamed pulp in the crown of the tooth. Pulp that is healthy in the root canals remains intact and the tooth is kept alive.

A pulpotomy is recommended when:

• The decay has extended into the pulp, but not into the roots of the tooth.
• Root pulp is healthy.
• Baby teeth must be kept until they fall out on their own.
• A young permanent tooth has an open pulp and an underdeveloped root.

Pulpotomy benefits include:

• Saves the vitality of the tooth.
• Not as invasive as a pulpectomy.
• Shorter treatment time.
• Encourages further growth of new permanent teeth.
• Very successful if done at an early stage.

What is Pulpectomy?

Pulpectomy will remove all pulp tissue from both the crown and root canals. After cleaning and disinfecting the canals, they are filled with a biocompatible material, and the tooth is restored with a filling or crown.

A pulpectomy is advocated when:

• The whole pulp is infected.
• There is irreversible pulp damage.
• There is an abscess or serious infection.
• The root canals will not be retained with a pulpotomy.

A Pulpectomy has several benefits:

• Able to completely clear infected pulp.
• Kills bacteria in the root canals.
• Helps prevent the spread of infection.
• Maintains the tooth if it is not to be extracted.

Key Differences Between Pulpotomy and Pulpectomy

Extent of Treatment

• Pulpotomy: Only removes pulp in the crown.
• Pulpectomy: Entails the removal of all the pulp from crown and roots.

Tooth Vitality

• Pulpotomy: Keeps the living pulp in the roots.
• Pulpectomy: All living pulp is removed.

Complexity

• Pulpotomy: Easier and less complex.
• Pulpectomy: This is more complicated as every root canal needs to be cleaned and filled.

Recovery

• Both procedures are typically effective and recovery will be rapid but a pulpectomy may be slightly more sensitive after the procedure.

Which Procedure to Use?

There are no inherent advantages for either procedure as they are used in different clinical scenarios.

• If the infection is confined to the crown and the root pulp is healthy then a pulpotomy is recommended.
• Consider pulpectomy if the infection is into the pulp and all the pulp needs to be removed to save the tooth.

Pulpotomy primary teeth

A pulpotomy in primary teeth is a dental procedure that is used to treat deep tooth decay or pulpal exposure in the primary teeth while leaving the healthy pulp within the roots of the primary tooth. The process takes out the infected pulp from the crown of the tooth alleviates pain and aids the baby tooth in functioning until it naturally falls out. Primary teeth are essential for correct speech development, proper chewing ability and space for the permanent teeth to erupt in the correct position.

There are many benefits of pulpotomy in primary teeth:

• Helps to alleviate pain and discomfort.
• Cleans and removes infected tissue without destroying healthy pulp.
• Encourages the prevention of infection.
• Preserves the natural baby tooth.
• Chews and speaks appropriately.
• Preserves space for permanent teeth.
• Makes tooth extraction less necessary at a young age.

Conclusion

Pulpotomy is a safe, effective and tooth preserving treatment of the infected or inflamed pulp without compromising the rest of the tooth structure. It is commonly done on a primary (baby) tooth and selected young permanent teeth that would help alleviate pain to prevent infection and keep the tooth in its place until the time is right for it to fall out or continue to develop. A pulpotomy preserves the natural tooth which helps to provide a healthy dental development, proper chewing and speech. Routine dental care is important if you or your child is having persistent tooth pain, tooth sensitivity or a deep cavity. If the infection can be detected early and treated promptly, it can be prevented from progressing and the chances of successfully saving the tooth are increased. Using advanced methods and safe materials, pulpotomy can produce reliable results providing a reliable treatment for long-term oral health.

Pulpotomy in India GetWellGo

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FAQ

Does a pulpotomy hurt?

• No. Pulpotomy is done under local anaesthesia and should not cause pain. After treatment, there may be some mild soreness or sensitivity that will go away in a few days.

How long is a pulpotomy procedure?

• A pulpotomy usually only takes 30 to 60 minutes depending on the tooth in question and the complexity of the case.

Is a pulpotomy the same as a root canal?

• No. A pulpotomy removes only the infected pulp of the crown of the tooth while a root canal will remove all the pulp in the crown and root canals of the tooth and then seal the crown and root canals.

Is pulpotomy an option for adults?

• Yes. While most frequently performed in children, pulpotomies can be done on some permanent teeth in an adult or young patient where the pulp exposure is recent and the root pulp is intact.

How successful is a pulpotomy?

• The success rate for a pulpotomy is high with most cases being over 90% successful when done on correctly selected teeth with a proper restoration such as a dental crown.

What do I do with my tooth after a pulpotomy?

• Brush twice a day, floss regularly and avoid all hard or sticky foods until the tooth is healed; follow up dental check-ups.

Can a pulpotomy prevent a baby tooth from falling out?

• Yes. A pulpotomy will not delay any baby tooth's natural shedding. The treated tooth does not have to be removed and will stay in place until it's ready to fall out so that a permanent tooth can grow in its place.