Friday, August 22, 2014

Non-vital pulpotomy

Fig. 6  Stainless steel crowns make ideal restorations for compromised deciduous molars.
Table 2  Paraformaldehyde devitalising paste Paraformaldehyde 1.00 g
Carbowax 1500 1.30 g Lignocaine 0.06 g Propylene glycol 0.5 ml Carmine 10 mg
This technique has been advocated where there is irreversible change in the radicular pulp, or where the pulp is completely non-vital, but where pulpectomy and root canal treatment is considered impractical. The little clinical evidence available suggests a limited prognosis of approximately 50%. At the first visit the necrotic pulp contents are removed as before, and, using small excavators, as much as possible of the radicular tissue.

Beechwood creosote solution (Table 3) on a cotton pledget is sealed into the cavity with a zinc oxide–eugenol dressing.  One to two weeks later the tooth is checked for signs and symptoms. If there is evidence of infection (sinus, pain, swelling or mobility) a further beechwood creosote dressing should be placed. If, however, symptoms have resolved, the tooth may be restored as with the previous pulpotomy techniques.