ENDODONTICS FOR PRIMARY TEETH

COMPLETE ENDODONTICS FOR PRIMARY TEETH

PULPECTOMY
The instruments and materials needed are:

Exam Kit	Mixing Pad
Operative Kit	Zinc Oxide Powder
Cotton Pellets	Eugenol
Endodontic files and broaches	Lentulo Spiral
Paper Points

Burs: 330, 245, 4, 6, 8 round
Local Anesthesia set-up
Rubber dam set-up

1. Obtain a preoperative radiograph that includes the periapical areas of the tooth to be treated.
   
   
2. The tooth is anesthetized. (If the tooth is non-vital, gingival anesthesia is indicated).
   
   
3. The rubber dam is placed. Floss is placed on the lingual aspect of the clamp.
   
   
4. If the tooth will require a stainless steel crown, the mesial-distal dimension is measured now and noted in the chart for future reference.
   
   
5. An appropriate Class I or II cavity preparation is created at ideal depth and outline form.
   
   
6. The remaining caries are completely excavated with a slow speed round bur or a spoon excavator, first the lateral caries then the deep caries. The preparation is extended to access the pulp chamber, reflecting the coronal anatomy of the pulp.
   
   
7. The roof of the pulp chamber is removed with a slow speed round bur. This is accomplished by placing the bur in the chamber under the dentin roof and moving the handpiece occlusally. No overhanging ledges of enamel or dentin should remain. Care is taken to avoid the sub-pulpal floor. Occasionally remove blood to allow direct visualization of the chamber. Remove any pulpal remnant using a spoon excavator.
   
   
8. The coronal pulp is removed with a sterile sharp spoon excavator or a sterile round bur rotating at low speed.
   
   
9. The pulp in the canals is removed with endodontic barbed broaches and files. Diagnostic measurements of the canals are determined radiographically and the canals are filled to these measurements (ideally ½ to 1mm short of radiographic apex).
   
   
10. The canal is copiously irrigated with sterile water and dried with paper points.
    
    
11. The pulpectomy completed by obturating with a cream past of ZOE introduced into the canal first using a file. It is also "spun-down" into the canals using a lentulo spiral * running counter-clockwise on a slow speed handpiece. The canals are completely filled with ZOE. A post obturation radiograph is obtained to verify adequacy.
    
    
12. The cavity preparation and chamber are filled with glass ionomer cement; a stainless steel crown is placed and checked for occlusion.
    
    
13. Home care instructions are given to patient and parent.

* Rubber stops should be placed on the lentulo spirals 1 mm short of working length to avoid over filling.