Pulpotomy/Pulpectomy

Pulpotomy/Pulpectomy

Treating Soft Tooth Tissue with a Gentle Touch

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Pulp is Essential to Growing Teeth

Dental pulp inside your tooth can incur damage due to untreated cavities, trauma and prolonged toothaches (pulpitis). Vital pulp therapy is a treatment that aims to preserve and maintain comprised pulp tissue that isn’t dead. Endodontists treat dental pulp disease with vital pulp therapies such as indirect and direct pulp capping, pulpotomy when inflammation is limited to the crown, or pulpectomy when inflammation has spread to the tooth root. At Southwest Endodontics & Periodontics, Inc., our skilled endodontists combine advanced technology and a compassionate touch to deliver tooth-saving pulp capping, pulpectomy and pulpotomy in Broadview & Macedonia, OH, customized to your unique problem.

Dental Pulp is Essential to a Healthy Smile

Tooth enamel covers a softer, bulky material called dentin. Inside dentin is pulp, which is soft, non-calcified tissue made of blood vessels, nerves and connective tissue. Coronal pulp refers to pulp within the main part of a tooth (crown) above the gum line. Radicular pulp refers to pulp from inside the top of the tooth root to the end tip (apex). Preservation of pulp is important because the vital pulp has several key functions. Pulp plays a role in the ongoing formation of dentin, provides nutritive support to teeth, enables a defensive function, and has a unique reparative capacity. Pulp is a resilient tissue, provided it’s healthy, bacteria are properly managed, and an environment and durable seal are created with materials that ensure its ongoing health. But when pulp inflammation is left untreated, this can lead to pulp death and even loss of the tooth.
carl dental implant patient

What is a Pulpotomy?

Pulpotomy techniques for primary (baby) teeth have been a standard in pediatric endodontics for decades. The goal of a pulpotomy is to preserve the radicular pulp, prevent pain and swelling and ultimately prevent tooth extraction. The infected part of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and the spread of decay. Next, a sedative material is placed in the tooth to prevent bacterial growth and calm the remaining nerve tissue. After a pulpotomy in primary back molars, a stainless steel crown is placed to re-establish normal oral function and continue to hold the space until the child’s permanent tooth erupts. On upper front teeth, either a stainless steel crown or a white esthetic stainless steel crown is used.

Southwest Endodontics & Periodontics, Inc.

Pulpotomy, Step by Step

  • Tooth is numbed with a local anesthetic and sedation if needed
  • Tooth is isolated by placing a rubber sheet (dam) around it
  • Pulp chamber is accessed by creating a small opening in the tooth
  • Pulp tissue is removed
  • Small cotton ball soaked in medication is placed over the pulp chamber opening
  • Temporary filling is placed in the space left in the tooth

Different Sealant Materials

The American Academy of Pediatric Dentistry (AAPD) recommends both formocresol and mineral trioxide aggregate (MTA) for the management of pulp exposure in immature permanent teeth to achieve continued root formation and closure of the apex. Formocresol has been used for vital pulpotomy in primary teeth for over 80 years. Its efficacy has been extensively studied, with clinical success rates ranging from 70–100%. MTA, a hydraulic dental cement derived from Portland cement, was first introduced in the 1990’s as a sealing agent and has achieved similar success rates.

root canal graphic

Pulpotomy in Permanent Teeth

In mature permanent teeth with irreversible pulp inflammation, root canal is typically the treatment of choice. Yet studies confirm that coronal pulpotomy is an evidence-based, safe and predictable treatment for permanent teeth with irreversible pulpitis as a substitute for root canal therapy. One study concluded the success rate was up to 90% in MTA pulpotomy performed in permanent teeth in children that were indicated for root canal therapy. Another study reported success rates of 100% at one year and 92.7% at three years after MTA pulpotomy in mature permanent teeth in which pulp was exposed due to decay.

dental technology

Partial and Complete Pulpectomy

In a partial pulpotomy in Broadview & Macedonia, OH, our endodontists remove superficial infected or irreversibly injured pulp, followed by direct capping of the residual healthy pulp. A complete pulpotomy is often required when the coronal pulp is heavily inflamed or has questionable vitality. During this procedure, inflamed pulp is removed from the chamber, thoroughly disinfected, protected with a layer of bioactive material (e.g., MTA), then the tooth is sealed with a composite restoration.

What is a Pulpectomy?

A pulpectomy is performed when both the coronal and radicular pulp is impacted and no vital pulp remains. We may recommend a pulpectomy in Broadview & Macedonia, OH if your child has a severely infected primary tooth. The procedure is sometimes referred to as a “baby root canal.” In permanent teeth, pulpectomy is the first part of a root canal procedure. The goal of a pulpectomy is to clean the entire root canal, protect it from further infection and prevent tooth extraction. During this procedure, diseased pulp tissue is completely removed from both the crown and the roots. The canals are cleansed, disinfected and primary teeth are filled with a resorbable material. For primary teeth, the final restoration is the same as for a pulpotomy. In permanent teeth, a non-resorbable material is used for the filler, and a crown (either a temporary made of stainless steel, or a permanent made of zirconia or porcelain) is placed.

Pulpotomy vs. Pulpectomy

As mentioned, both of these procedures are used to treat pulp issues in both primary and permanent teeth. A pulpotomy is limited to removal of pulp in the crown of the tooth, while a pulpectomy (similar to the first part of a root canal) involves removing the pulp in both the crown and root canal.
dr lee with gum graft patient

What is Pulp Capping?

When decay is close to the pulp, this procedure preserves dentin in vital, otherwise healthy teeth to prevent pulp exposure. This can be done as a one-step approach or a two-stage approach. During one-stage pulp capping techniques, all or the majority of decay is removed, bioactive material is placed near but not in direct contact with the pulp and the final restoration is placed in one visit. In two-stage or stepwise pulp capping, all decay in tooth enamel is removed, but decayed dentin adjacent to the pulp chamber is left untouched. A medicament is placed over the remaining decay, a temporary restoration is placed and you return two months later for final restoration. Recent studies show survival rate of greater than 90% for permanent teeth after indirect pulp capping, without adverse clinical symptoms or pathologic signs on X-rays. A 2020 study determined that stepwise pulp capping was a safer technique in permanent teeth in children.
This method is reserved for permanent teeth when the pulp is exposed. The AAPD recommends using a direct pulp cap only on a primary tooth when exposure results from mechanical trauma. If exposure results from decay removal, indirect pulp capping or a pulpotomy is performed instead. During this procedure, decay is removed and a sedative material is used to protect the pulp from bacteria until dentin repairs itself. Then a temporary or permanent filling is placed to strengthen the tooth and restore function.

What is Pulp Regeneration?

Pulp regeneration is used to restore diseased or damaged dental pulp and enhance healing. Especially in immature permanent teeth, maintaining pulp vitality is essential for continuous root development and closure of the apex. In these cases, a procedure that replaces damaged pulp tissue with viable tissue can restore the normal function of the pulp-dentin structure. Stem cells derived from the patient’s pulp or bone marrow is combined with nanofiber-based material to create scaffolding upon which the tooth can regenerate.

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