Pulpotomy
1 = enamel
2 = dentin
3 = pulp cavity with pulp
4 = gingiva
5 = root cement
6 = alveolar bone
7 = alveolar artery
8 = alveolar vein
Alveolar nerve (not shown)
A = tooth crown ; B = tooth root
A pulpotomy (synonym: vital amputation ) is the removal of part of the tooth pulp of a tooth with the aim of maintaining the vitality of the remaining pulp tissue with a therapeutic "bandage" ( direct capping ). The pulp consists of connective tissue with blood and lymph vessels as well as nerve fibers and tomes fibers .
When a carious process develops in a tooth , the bacteria associated with it can cause pulpitis (inflammation of the pulp), which often causes toothache. Damage to the pulp usually requires root canal treatment (endodontic therapy) with complete removal of the pulpic or gangrenous tissue and subsequent root canal filling.
The vital amputation is the most commonly performed endodontic measure in the primary dentition . During the excavation (drilling out) of a deep caries, the pulp often opens in milk teeth. In contrast to root canal treatment in adults, a vital amputation is usually preferred in the deciduous dentition.
variants
In some cases, the radicular pulp (part of the pulp within the tooth root) can remain vital despite carious exposure of the pulp chamber. If the root formation is still incomplete during tooth development, a pulpotomy can keep the radicular pulp viable long enough for the roots to fully develop.
Partial pulpotomy for traumatic exposures
A partial pulpotomy in the event of traumatic exposure is also known as a cvek pulpotomy after its first description. For longer exposure times (2 h up to 48 h), partial pulpotomy should be preferred to direct capping. With an exposure time of more than two to 48 hours, the presence of a vital pulp is a prerequisite. The certainty of success is 94% - 96% regardless of the size of the exposure and the condition of the root growth.
Complete pulpotomy (vital amputation)
For longer exposure times (more than 48 hours) of the exposed pulp, full pulpotomy should be preferred to partial pulpotomy or pulpectomy if there are no symptoms of irreversible pulpitis. The procedure is mainly indicated for teeth with incomplete root growth, which means that the root growth can still come to an end. The certainty of success in maintaining pulp vitality is 60%.
Pulpotomy in adults
The pulpotomy in adults has only historical significance and was mainly used as long as modern endodontic procedures were not yet developed.
variants
Pulpotomy using electrosurgery
Electrosurgery pulpotomy is a non-pharmacological pulpotomy technique with a good success rate. The procedure devitalizes the pulp tissue and creates coagulation necrosis at the amputation site .
Laser pulpotomy
A pulpotomy using an erbium: yttrium-aluminum- garnet laser show hemostatic, antimicrobial and cell-stimulating effects. For pulpotomies of deciduous molars, a total success rate of 78% and a clinical success rate of 93% were found after 24 months.
Medical therapy
Formocresol is used for devitalization and fixation , and iron (III) sulfate for preservation and preservation . For the preservation of the vitality is calcium hydroxide or mineral trioxide aggregate (MTA), Portland cement , tricalcium phosphate (TCP) used. The use of preparations containing formocresol, formaldehyde or glutaraldehyde for pulpotomy is contraindicated due to the proven mutagenicity , carcinogenicity and toxicity as well as for reasons of preventive health protection.
Contraindications
Contraindications are pain, especially night pain, pathological mobility of the tooth or the presence of a fistula . Even with internal and external resorptions, as well as apical or interradicular radiotranslucency, the tooth in question is not suitable for vital amputation. If there are signs of pulp necrosis, such as leakage of pus or exudate from the pulp cavity or root canals, a vital amputation must be avoided and extraction should be considered. Deciduous teeth whose roots are physiologically more than a third resorbed should also no longer undergo vital amputation. Further contraindications are patients with severe general illnesses.
Individual evidence
- ^ S2k guideline therapy of dental trauma to permanent teeth , DGZMK, AWMF registration number: 083-004, as of May 2015. Accessed on February 26, 2019.
- ↑ Z. Bahrololoomi, A. Moeintaghavi et al. a .: Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial. In: Indian journal of dental research: official publication of Indian Society for Dental Research. Volume 19, Number 3, 2008 July-September, pp. 219-223, PMID 18797098 .
- ↑ KC Huth, E. Paschos u. a .: Effectiveness of 4 pulpotomy techniques - randomized controlled trial. In: Journal of dental research. Volume 84, Number 12, December 2005, pp. 1144-1148, doi : 10.1177 / 154405910508401210 , PMID 16304444 .
- ↑ Endodontics in deciduous teeth , scientific report from the German Society for Pediatric Dentistry (DGK) and the German Society for Tooth Preservation (DGZ). Retrieved February 26, 2019.
- ^ NS Seale, JA Coll: Vital pulp therapy for the primary dentition. In: General dentistry. Volume 58, Number 3, 2010 May-June, pp. 194-200, PMID 20478799 .
