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