Pulpectomy in Primary Teeth
Pulpectomy involves the roof removal and the contents of the pulp chamber as to gain access to the teeth root canals that are disinfected, enlarged and debrided. The canals are usually filled with the a material that can reabsorb. Pulpectomy in primary teeth, indications and contraindications of pulpectomy are given below in this article. Read on to know more.
Pulpectomy in Primary Teeth
- Following the treatment, the infectious process must resolve.
- There should be radiographic evidence of a successful filling without gross over-extension or under filling.
- The treatment should permit resorption of the primary root structures and the filling materials at the appropriate time to permit normal eruption of succedaneous tooth.
- Treatment should alleviate and prevent further sensitivity, pain or swelling.
- There should be no external or internal root resorption or other pathology.
Indications of deciduous tooth pulpectomy:
- Strategically important tooth (example, in case of the deciduous second molar where the permanent first molar has not erupted)
- Irreversible pulpitis
- At least 2/3rd of the root length available
- Minimal periapical changes with sufficient bone support
- Internal resorption without any obvious perforation
- Contraindications of deciduous tooth pulpectomay
- Systemic conditions
- Lack of patient cooperation
- Excessive mobility and
- Non-restorable tooth
Primary Root Canal AnatomyTo complete endodontic treatment on primary teeth successfully, the clinician must have a through knowledge of the anatomy of the primary root canal systems and the variations that normally exist.
Primary anteriors:The form and shape of the root canals of the primary anterior teeth resemble the form and shape of the exteriors of the teeth.
Maxillary incisors:The root canals of the primary maxillary central ad lateral incisors are almost round but some what compressed. Normally, these teeth have one canal without a bifurcation. Apical ramifications or accessory canals and lateral canals are rare but do occur.
Mandibular incisors:The root canals of the primary mandibular central and lateral incisors are flattened on the mesial and distal surfaces and sometimes grooved, pointing to an eventual division into two canals. The presence of two canals is seen less than 10% of the time. Occasionally, lateral or accessory canals are observed.
Maxillary and Mandibular Canines:The root canals of the maxillary and mandibular canines correspond to the exterior root shape, a rounded triangular shape with the base toward the facial surface. Sometimes, the lumen of the root canals is compressed in the medial-distal direction. Bifurcation of the canal and accessory canals are rare.
Primary Molars:The primary molars normally have the same number of roots and positions of the roots as the corresponding permanent molars. The maxillary molars have three roots, two facial and one palatal: the mandibular have two roots, mesial and distal. The roots of the primary molars are long slender compared with the crown length and width, and they diverge to allow for a permanent tooth bud formation.
Maxillary first primary molars:The maxillary first primary molars have two to four canals that roughly correspond to the exterior root form with much variation. The palatal root if often round: it is often longer than the two facial roots. Bifurcation of the mesial-facial root into two canals occur in approximately 75% of the maxillary first primary molar.
Maxillary second primary molars:The maxillary primary molar has two to five canals, roughly corresponding to the exterior root shape. The mesial-facial root usually bifurcates or contains two distinct canals. This occurs in approximately 85 to 95 percent of the maxillary second primary molars.
Mandibular first primary molars:The mandibular first primary molar usually has three canals, roughly corresponding to the external root anatomy but may have 3 to 4 canals. It is reported that approximately 75% of the mesial roots contain two canals, whereas only 25% of the distal roots contain more than one canal.
Mandibular second primary molar:The mandibular second primary molar may have two to five canals but usually has three. The mesial root has two canals approximately 85% of the time, whereas the distal root contains more than one canal only in 25% of the times.
Access opening for the primary anterior teeth:Access opening for endodontic treatment on primary or permanent anterior teeth have traditionally been through the side of the lingual surface. This continues to be the surface of choice except for the maxillary primary incisors. Because of the problems associated with the discoloration of endodontically treated primary incisors, it has been recommended to use a facial approach then followed by an acid etch composite restoration to improve aesthetics. The anatomy of maxillary primary incisors is such that access may successfully be made from the facial surface. The only variation to the opening is more extension to the incisal edge than with the normal lingual access in order to give as straight an approach as possible into the root canal.
Access opening for the primary posterior teeth:Access opening into the primary root canals of the posterior teeth are essentially the same as those for the permanent teeth. Some important differences between the primary and permanent teeth are as follows:
- Length and the bulbous shape of the crowns.
- Very thin dentinal wall at the pulpal floor and the root.
- The depth necessary to penetrate into the pulp chamber is quite less than that in the permanent teeth.
- Likewise, the distance from the occlusal surface to the pulp floor of the pulp chamber is much less than in permanent teeth. In primary molars, care must be taken not to grind on the pulpal floor since perforation is likely.
- When the root of the pulp chamber is perforated and the pulp chamber is identified, the entire roof should be removed with a bur. Since the crown of the primary teeth are more bulbous, less extension towards the exterior of the tooth is necessary to uncover the openings of the root canals than in the permanent teeth.