Dr.Lubna Al-MalahPedodontic Lec. 6Shallow or partial pulpotomy 1-If the pulp exposure in a traumatized, immature permanent (open apex) tooth is large2- If even a small pulp exposure exists and the patient did not seek treatment until several hours or days after the injury, or 3-If there is insufficient crown remaining to hold a temporary restoration, the immediate treatment of choice is a shallow pulpotomy or a conventional pulpotomyA shallow or partial pulpotomy is preferable if coronal pulp inflammation is not widespread and if a deeper access opening is not needed to help retain the coronal restoration.'The exposure site should be conservatively enlarged, and 1 to 2 mm of coronal pulp tissue should be removed for the shallow pulpotomy or all pulp tissue in the pulp chamber removed for the conventional pulpotomy. When pulp amputation has been completed to the desired level, the pulp chamber should be thoroughly cleaned with copious irrigation. No visible dentin chips or pulp tissue tags should remain. If the remaining pulp is healthy, hemorrhage will be easy to control with a pledget of moist cotton lightly compressed against the tissue. The pulp should also have a bright reddish pink color and a concave contour. A dressing of calcium hydroxide is gently applied to the vital pulp tissue so that it is in passive contact with the pulp.
Dr.Lubna Al-MalahPedodontic Lec. 6The remaining access opening is filled with a hard-setting, biocompatible material with excellent marginal sealing capability. Then the crown may be restored with a separate bonding procedure.They view the calcium hydroxide pulpotomy as an interim procedure performed solely to achieve normal root development and apical closure.They justify the pulpectomy and root canal filling after apical closure as necessary to prevent an exaggerated calcific response that may result in total obliteration ofthe root canal (calcific metamorphosis or calcificdegeneration).
Dr.Lubna Al-MalahPedodontic Lec. 6There is a high probability that long-term success can be achieved without follow-up root canal if: 1-healthy pulp tissue remains in the root canal2-The coronal pulp tissue is cleanly excised without excessive tissue laceration and tearing3-If the calcium hydroxide is placed gently on the pulp tissue at the amputation site4- If the tooth adequately sealed.PULPECTOMY WITH ENDODONTIC TREATMENTOne of the most challenging endodontic procedures is the treatment and subsequent filling of the root canal of a tooth with an open or funnel-shaped apex. The lumen of the root canal of such an immature tooth is largest at the apex and smallest in the cervical area and is often referred to as a blunderbuss canal. Hermetic sealing of the apex with conventional endodontic techniques is usually impossible without apical surgery. This surgical procedure is traumatic for the young child and should be avoided if possible.