Mostrando entradas con la etiqueta Endodontics. Mostrar todas las entradas
Mostrando entradas con la etiqueta Endodontics. Mostrar todas las entradas

lunes, 9 de junio de 2025

Pulpotec® in Pulpotomy: Composition, Indications, Protocol & Clinical Pros and Cons

Pulpotec

Pulpotec® is a radiopaque, non‑resorbable medicament widely used for pulpotomy/pulpitis treatment in vital primary and immature permanent molars, as well as for emergency root canal dressings.

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This in-depth article reviews its composition, clinical indications, advantages, disadvantages, and a standardized application protocol. Information is supported by recent clinical evidence.

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1. Composition
Pulpotec® is a two-part resinous paste comprising:

➤ Powder: polyoxymethylene, iodoform, and zinc oxide.
➤ Liquid: dexamethasone acetate, formaldehyde, phenol, guaiacol, and excipients.

These components combine to yield antimicrobial, anti-inflammatory, hemostatic, and soothing effects.

2. Indications
Pulpotec® demonstrates broad clinical applications:

➤ Primary molars: vital or mildly infected, including cases with abscess when pulpotomy is indicated.
➤ Immature permanent molars: to facilitate continued root development.
➤ Permanent molars in adults: pulpitis treatment or as a prep for abutments in prosthetics.

It is also effective in emergency intracanal dressings to relieve pain and swelling across multiple appointments.

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3. Advantages
Clinical studies support Pulpotec® due to its:

➤ High success rates: Clinical success of 93–100% and radiographic success of 83–100% in pulpotomies; compared favorably with MTA and formocresol.
➤ Rapid symptom relief: 80–100% of patients report immediate pain reduction; flare-ups post-op are rare (~1%).
➤ Ease of use and efficiency: Simplifies emergency endodontic treatment and supports long-term pulp health.

4. Disadvantages
Potential drawbacks include:

➤ Non‑resorbability: This may complicate exfoliation in primary molars.
➤ Formaldehyde content: Concerns over toxicity and rare allergic reactions.
➤ Limited histological regeneration: It promotes sclerosis rather than dentin bridge formation.
➤ Need for coronal seal: Success depends on proper restoration to prevent microleakage.

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5. Step-by-Step Clinical Use Protocol

Step 1. Diagnose pulpitis suitable for vital pulp therapy.
Step 2. Anesthetize and isolate the tooth (rubber dam recommended).
Step 3. Access and remove coronal pulp to canal orifice level.
Step 4. Irrigate with 5% NaOCl; dry chamber.
Step 5. Prepare a salin-damped sterile cotton pellet; confirm bleeding control.
Step 6. Insert Pulpotec® paste into chamber (or canal up to ~5 mm from apex in root-filled cases) using a file.
Step 7. Place a dry cotton pellet and temporary restorative material (e.g., IRM/Cavit).
Step 8. Schedule recall after 7 days; proceed to definitive restoration—ideally stainless steel crown or adhesive restoration.
Step 9. Evaluate post-op pain at intervals (8 h, 24 h, 48 h, 3 d, 1 wk).

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6. Clinical Evidence

➤ Prospective RCT (860 teeth): Pulpotec® intracanal dressing reduced incidence of inter-appointment flare-up to 1.16% at 24 h and 0.69% at 48 h, with complete pain relief by 7 days.
➤ Comparative pediatric studies:
° Pulpotec® and MTA showed 100% clinical success at 3–9 months; radiographic success favored Pulpotec® (100%) over MTA (92.9%) and formocresol (78.6%).
° At 24 months, radiographic success was 94.3% for Pulpotec®, 91.2% for MTA, 83.3% for formocresolile cotton pellet; confirm bleeding control.

💡 Conclusion
Pulpotec® is an effective and efficient pulpotomy and intracanal medicament providing high clinical and radiographic success, rapid pain relief, and broad indications. However, formaldehyde content and non-resorbability in primary teeth demand careful case selection and precise restoration. Clinicians should weigh its benefits and limitations against alternatives such as MTA or Biodentine.

📚 References

✔ Al-Dahan, Z. A. A., Zwain, A. M., & Haidar, A. (2013). Clinical and radiographical evaluation of pulpotomy in primary molars treated with Pulpotec®, Formocresol, and Mineral Trioxide Aggregate (MTA). Journal of Bagh College Dentistry, 25(4), 164–170.

✔ Faraj, B. M. (2013). Four years of clinical experience with the efficacy of Pulpotec® as a root canal dressing for the management and control of odontogenic pain: A prospective randomized clinical trial. Open Access Emergency Medicine, 12(4), 280–283.

✔ Karrem, M. A. (2012). Clinical and histopathological evaluation of different pulpotomy agents in primary teeth. Iraqi Academic Scientific Journal.

✔ Maslak, E. E., et al. (2020). Pulpotomy efficiency in primary molars: Outcomes of 24‑month randomized clinical trial. Tanta Dental Journal, 17(1), 9–14.

✔ Pulpotec®. (n.d.). Scientific data about Pulpotec® – Swiss solution for pulpotomy. Retrieved from pd-pulpotec.com

✔ Sandhu, S. S., & Nanda, S. (2013). Dental pulp response to collagen and Pulpotec cement. Journal of Conservative Dentistry, PMC3778626.

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viernes, 6 de junio de 2025

Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names

Pulpotomy

Pulpotomy is a conservative dental procedure aimed at preserving the vitality of the radicular pulp after removing the affected coronal pulp. This treatment is common in primary teeth and young permanent teeth.

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Selecting the right medication is crucial for clinical success. Below is an overview of the most commonly used pulpotomy agents, their properties, drawbacks, and commercial names.

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1. Formocresol

➤ Brand Name: Buckley’s Formocresol
➤ Composition: 19% formaldehyde, 35% cresol, 15% glycerin, 21% water
➤ Properties:
° Bactericidal and tissue-fixative agent
° Mummifies remaining pulp tissue
° Easy to handle and low cost
➤ Drawbacks:
° Potentially carcinogenic and mutagenic
° Cytotoxic and allergenic
° Does not promote pulp tissue regeneration
➤ Clinical Notes:
° Although historically effective, its use has declined due to toxicity concerns.

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2. Ferric Sulfate

➤ Brand Name: Astringedent®
➤ Composition: 15.5% aqueous solution of ferric sulfate (pH 1.0)
➤ Properties:
° Effective hemostatic agent
° Forms a protein barrier sealing blood vessels
° Affordable and easy to apply
➤ Drawbacks:
° Does not promote pulp regeneration
° May cause radicular inflammation and resorption
➤ Clinical Notes:
° A less toxic alternative to formocresol, but with variable long-term success.

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3. Calcium Hydroxide (Ca(OH)₂)

➤ Brand Name: Dycal®
➤ Properties:
° Stimulates reparative dentin formation
° Highly alkaline with bactericidal effect
° Biocompatible
➤ Drawbacks:
° May cause superficial pulp necrosis
° Lower success rate in primary teeth
° Tends to dissolve over time
➤ Clinical Notes:
° More suitable for young permanent teeth; limited use in primary dentition.

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4. Mineral Trioxide Aggregate (MTA)

➤ Brand Name: ProRoot® MTA
➤ Composition: Tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide
➤ Properties:
Highly biocompatible
Stimulates dentin formation
Excellent sealing and antimicrobial properties
➤ Drawbacks:
High cost
Difficult manipulation and long setting time
➤ Clinical Notes:
Studies report a 97.9% clinical success rate in pediatric pulpotomies, outperforming other agents.

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5. Biodentine

➤ Brand Name: Biodentine®
➤ Composition: Tricalcium silicate, dicalcium silicate, calcium oxide, calcium chloride, zirconium oxide
➤ Properties:
° Bioactive dentin substitute
° Mechanical properties similar to natural dentin
° Fast setting time and good radiopacity
➤ Drawbacks:
° High cost
° Limited long-term clinical evidence compared to MTA
➤ Clinical Notes:
° A promising MTA alternative with easier handling and shorter setting time.

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6. Zinc Oxide Eugenol (ZOE)

➤ Brand Name: IRM® (Intermediate Restorative Material)
➤ Properties:
° Soothing effect on dental pulp
° Antimicrobial and anti-inflammatory properties
° Easy to handle and inexpensive
➤ Drawbacks:
° Does not induce reparative dentin formation
° May dissolve over time
➤ Clinical Notes:
° Commonly used as a base or sealing material in pulpotomies.

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7. Pulpotec® Paste

➤ Brand Name: Pulpotec®
➤ Composition:
° Powder: Polyoxymethylene, iodoform
° Liquid: Dexamethasone, formaldehyde, phenol, guaiacol
➤ Properties:
° Induces healing of the pulp stump
° Aseptic and quick treatment
° Effective in both primary and permanent teeth
➤ Drawbacks:
° Contains formaldehyde, which has cytotoxic potential
° Not resorbable
➤ Clinical Notes:
° Long-term success reported in studies, though formaldehyde content limits its use in some cases.

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💡 Conclusion
The choice of pulpotomy medication must be based on a careful evaluation of its properties, disadvantages, and available clinical evidence. While formocresol has been widely used, toxicity concerns have led to the rise of safer and more effective alternatives like MTA and Biodentine. The ideal agent depends on factors such as the patient's age, tooth condition, and specific clinical considerations.

📚 References

✔ Holguin Garcia, S. G. (2019). Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática. Revista de Odontopediatría Latinoamericana, 11(1). https://doi.org/10.47990/alop.v11i1.228

✔ Wikipedia. (2025). Pulpotomía. Retrieved from https://es.wikipedia.org/wiki/Pulpotom%C3%ADa

✔ Apuntes De Odontología. (2015). Pulpotomía. Retrieved from https://apuntes-de-odontologia.blogspot.com/2015/04/pulpotomia.html

✔ Studocu. (2018). Terapia Pulpar I – Dra. Andrea Cárdenas Antonieta Montero. Retrieved from https://www.studocu.com/cl/document/universidad-finis-terrae/odontopediatria/terapia-pulpar-i/4935194

✔ Revista Odontopediatría. (2014). Tratamiento Endodóntico no Instrumentado en dientes deciduos. Retrieved from https://backup.revistaodontopediatria.org/ediciones/2014/1/art-6/

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miércoles, 4 de junio de 2025

Clinical Pulpectomy Protocol: Updated Step-by-Step Guide

Pulpectomy

Pulpectomy is a fundamental procedure in pediatric dentistry for treating primary teeth with pulp inflammation or necrosis.

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Its main goal is to eliminate infection, maintain tooth functionality until natural exfoliation, and preserve dental space.

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1. Case Selection

➤ Indications:
° Necrotic pulp or irreversible inflammation.
° Primary tooth with deep caries, abscesses, or fistulas.
° Persistent pain or prolonged sensitivity.
➤ Contraindications:
° Advanced pathological root resorption.
° Severe tooth mobility.
° Loss of bone support or involvement of the permanent tooth germ.

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2. Step-by-Step Procedure

➤ a. Anesthesia and Isolation:
° Administer appropriate local anesthesia (4% Articaine with 1:100,000 epinephrine).
° Place rubber dam isolation to prevent contamination.
➤ b. Caries Removal and Pulp Access:
° Remove caries using high-speed burs and open the pulp chamber to fully expose the canals.
° Rinse with sterile saline solution or 2% chlorhexidine.
➤ c. Instrumentation and Disinfection:
° Instrument canals using manual or rotary files up to the apical limit (2 mm before the radiographic apex).
° Irrigate abundantly with 1–2.5% sodium hypochlorite, followed by saline solution to neutralize.
➤ d. Drying and Obtaining Clean Canals:
° Dry canals with sterilized paper points.
° Confirm absence of necrotic debris or bleeding before obturation.
➤ e. Obturation:
° Select appropriate obturation material:
  • Zinc oxide and eugenol (ZOE): Traditional material.
  • Iodoform-based pastes (Metapex™ or Vitapex™): For better resorption and antimicrobial properties.
  • MTA or Biodentine: In cases with apical perforations or significant bone involvement.
° Insert material using a syringe or condenser, ensuring a hermetic seal.
➤ f. Final Restoration:
° Restore the tooth with suitable material like composite resin or place a stainless steel crown to ensure function and prevent reinfection.

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3. Key Recommendations
° Radiographic Control: Perform preoperative and postoperative radiographs to verify proper sealing.
° Regular Follow-up: Schedule check-ups every 3–6 months to assess treatment success and detect possible complications.
° Material Selection: Prefer biocompatible materials like Metapex™ or Biodentine to improve clinical outcomes.

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4. Conclusions
Pulpectomy is a predictable and effective procedure when performed following a rigorous clinical protocol. The selection of obturation material plays a crucial role in the long-term success of the treatment. With the advancement of materials like Metapex™ and MTA, success rates have significantly improved. However, regular follow-up and appropriate final restoration are essential to ensure the functionality and health of the treated tooth.

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miércoles, 18 de octubre de 2023

Pulpotomy and pulpectomy procedures. Indications and Differences

Oral Cancer

Pulpotomy and pulpectomy are treatments performed on primary teeth that are affected by deep caries and that compromise the dental pulp.

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Clinical and radiological evaluation are necessary to determine appropriate treatment. Pulpectomy is recommended when it is necessary to completely remove the affected dental pulp, and pulpotomy partially removes the dental pulp.

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We share the similarities, differences, indications, contraindications and step-by-step procedures of pulpotomy and pulpectomy.

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📌 Watch video 1 "PULPOTOMY AND PULPECTOMY. DEFINITION.INDICATIONS.CONTRAINDICATIONS."


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📌 Watch video 2 "WHAT IS THE DIFFERENCE BETWEEN A PULPECTOMY AND PULPOTOMY?"


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jueves, 16 de junio de 2022

What is the best pulp dressing for pulpotomies in primary teeth? - Review

Pulpotomy

Caries is an infectious process that affects the dental structure and compromises the pulp, putting the vitality and permanence of the tooth at risk. Pulpal therapies in primary dentition have as main objective to maintain the tooth until its natural exfoliation.

Pulpotomy removes the pulp from the pulp chamber and places a dressing to stop bleeding and mummify the entrance to the radicular pulp. This procedure maintains the vitality of the primary tooth.

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Different pulp dressings have been used in pulpotomies, each with different characteristics and properties. The article we share compares all pulp dressings to determine which is the most effective.

Endodontics


👇 READ AND DOWNLOAD THE ARTICLE "What is the best pulp dressing for pulpotomies in primary teeth? - Review" IN PDF 👇



Bossù, M., Iaculli, F., Di Giorgio, G., Salucci, A., Polimeni, A., & Di Carlo, S. (2020). Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature. Journal of clinical medicine, 9(3), 838. https://doi.org/10.3390/jcm9030838

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lunes, 18 de abril de 2022

Manual of diagnosis and pulp treatment in non-vital primary teeth

Pulpectomy

Non-vital teeth are those whose nerves lack vitality and there is no blood flow inside. This may be due to deep caries or dental trauma that irreversibly affects the dental pulp.

A correct history, clinical and radiographic evaluation is necessary in these cases to determine the appropriate treatment for these cases (dental extraction, pulpectomy, lesion sterilization tissue repair).

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We share a guide that helps us identify the signs and symptoms of a non-vital tooth, and evaluates the pulp treatment options in non-vital primary teeth.

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👉 READ AND DOWNLOAD "Manual of diagnosis and pulp treatment in non-vital primary teeth" IN FULL IN PDF👈


Coll JA, Dhar V, Vargas K, et al. Use of Non-Vital Pulp Therapies in Primary Teeth. Pediatr Dent 2020;42(5):337-49.

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martes, 8 de marzo de 2022

Pulpectomy. Step-by-Step Procedure - Access, Preparation, and Obturation

Pulpectomy

Pulpectomy is a dental treatment performed on primary teeth that removes the dental pulp in its entirety. The objective of this procedure is to maintain the dental piece until its natural exfoliation.

To perform this treatment it is necessary to know the anatomy of the primary teeth, as well as experience in the technique, preparation and filling.

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We share the step-by-step procedure of a pulpectomy performed with rotary files. In this video we can observe the opening, chemomechanical preparation and obturation.

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martes, 1 de marzo de 2022

Pulp Therapy Procedures Manual for Primary and Immature Permanent Teeth

Endodontic

Pulp treatments in immature primary and permanent teeth aim to preserve the teeth until natural exfoliation. The pulp treatment to be performed will depend on a correct clinical and radiographic evaluation.

The treatment will depend on the vitality of the pulp, in case it is a vital tooth, pulp capping and pulpotomy can be performed. In non-vital teeth, pulpectomies are performed.

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We share a complete manual that offers us recommendations for the diagnosis and pulp treatment procedure in vital and non-vital primary and young permanent teeth.

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👉 READ AND DOWNLOAD "Pulp Therapy for Primary and Immature Permanent Teeth" IN FULL IN PDF👈


American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:399-407

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viernes, 25 de febrero de 2022

Pulpotomy: Diagnosis, types and procedure

Pulpotomy

Pulpotomy is a dental procedure that is performed on a primary tooth that is observed through an X-ray that the caries is close to the dental pulp. This treatment can be performed on primary dentition as well as permanent dentition.

During the procedure, the caries and the dental pulp are partially removed, thus maintaining the vitality and permanence of the primary tooth in the mouth.

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martes, 22 de febrero de 2022

Apexogenesis: Step by step procedure

APEXOGENESIS

Apexogenesis is a dental treatment that is performed on immature and vital permanent teeth. The objective of this treatment is to allow root growth and apical closure of the tooth.

Apexogenesis is performed on immature teeth with open apices that are affected by caries, trauma, or fractures with pulp exposure. Follow-up and clinical controls are recommended.

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We share a video that explains everything about apexogenesis: definition, indications, contraindications and the step-by-step procedure.

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lunes, 21 de febrero de 2022

Pulpectomy, everything you need to know: Diagnosis, indications, and filling materials

Pulpectomy

Pulpectomy is a dental procedure that is performed on primary teeth that are affected by an infectious process that totally compromises the dental pulp.

Pulpectomy removes all the dental pulp that is infected or affected by dental trauma. At the time of performing this procedure, a correct clinical and radiographic evaluation is necessary.

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The video that we share details everything related to pulpectomy: diagnosis, indications and contraindications, procedure, recommended filling materials, and the importance of post-treatment follow-up.

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jueves, 23 de diciembre de 2021

Virtual library - Pulp therapy in Pediatric Dentistry

Oral Rehabilitation

The goal of pulp therapy treatment is to keep the primary teeth healthy until the exfoliation stage. In this way, occlusion is preserved, premature loss of space in the jaws is avoided, and chewing or phonation is not affected.

The dental pulp can be affected by an infectious process or by dental trauma, and the pediatric dentist determines what treatment to carry out after a clinical and radiographic evaluation.

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We share a series of articles and videos that show us the different treatments performed on primary teeth (pulpotomy and pulpectomy).


🎯 Scientific Articles, PDF Articles, Videos and more below


Pulpectomy: Clinical Tips and Tricks in Paediatric Dentistry

What is the difference between pulpotomy and pulpectomy?

An update on primary teeth pulpotomy medicaments

Root Canal Treatment for children

Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

Management of Endodontic Emergencies: Pulpotomy Versus Pulpectomy

Dental Treatment: Vital Pulp Therapy for Primary Teeth

What is the difference between apexogenesis and apexification?

PULPECTOMY procedures in primary molar teeth

Pulp Cap and Pulpotomy in Pediatric Trauma Cases

miércoles, 18 de agosto de 2021

Pulp Cap and Pulpotomy in Pediatric Trauma Cases

Pulpotomy

Dental trauma can affect the tooth at different levels, even leading to the total loss of the tooth. When the trauma affects the dental pulp, the case should be evaluated to determine what treatment should be performed.

When the dental pulp is compromised by a lesion, a pulpectomy, pulpotomy or pulp capping can be performed. The objective of these treatments is to keep the primary tooth in the mouth.

We invite you to our English-only dental publishing groups

🎯 WhatsApp Group All Odontology
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🎯 Facebook Group All Odontology

We share a video where Dr. Joe Camp explains the importance of pulp capping and pulpotomy in primary teeth that have suffered dental trauma.

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We share an interesting video that shows us how to perform a pulpotomy step by step, indicating the materials and the steps that we must follow.

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lunes, 16 de agosto de 2021

Pulpotomy of Deciduous Molar - Step by step

Pulpotomy

Pulpotomy is the dental treatment that is responsible for partially removing the dental pulp affected by caries or dental trauma. Unlike the pulpectomy that completely removes the dental pulp.

We invite you to our English-only dental publishing groups

🎯 WhatsApp Group All Odontology
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🎯 Facebook Group All Odontology

To carry out this treatment, a clinical and radiographic evaluation must be carried out to know what the level of involvement of dental caries is. Once this treatment is finished, the restoration of the tooth must be carried out.

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We share an interesting video that shows us how to perform a pulpotomy step by step, indicating the materials and the steps that we must follow.

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lunes, 28 de junio de 2021

Why does pulpitis happen? - Symptoms and treatment

Endodontics

The tooth contains in its interior a soft tissue formed by the dental nerve and blood vessels, and its function is to provide vitality to the tooth. When the dental pulp becomes inflamed it is known as Pulpitis.

We invite you to our English-only dental publishing groups

🎯 WhatsApp Group All Odontology
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🎯 Facebook Group All Odontology

Pulpitis presents a series of symptoms, the most significant being pain when chewing and in other cases spontaneous pain. Dental evaluation is necessary to determine treatment.

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We share a video that explains what the symptoms of pulpitis are, as well as what its treatment and pathology are.

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miércoles, 27 de enero de 2021

Dental Treatment: Vital Pulp Therapy for Primary Teeth

Endodontic

Caries affects the dental pulp in different ways, from mild reactions to pulp necrosis. In pediatric dentistry, different techniques are used to maintain the functions and vitality of the tooth.

We invite you to our English-only dental publishing groups

🎯 WhatsApp Group All Odontology
🎯 Telegram Group All Odontology
🎯 Facebook Group All Odontology

The anatomical characteristics of primary teeth are different from permanent teeth. It is important to know these differences when performing any dental procedure.



We shared a webinar on new pulp treatment techniques in primary teeth, led by dr. Carla Cohn DMD.

Endodontics


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Source: Youtube/ Catapult Education