Pulpotomy vs. Pulpectomy

Overview

Learning Objectives

  1. Understand the definitions of each procedure
  2. Understand the indications for each procedure
  3. Understand the general techniques for each procedure

Anatomy Overview

    • Blood vessels and nerves are found throughout the pulp. The coronal portion of the pulp is in the dental crown, and the radicular portion of the pulp extends into the root system of the tooth.

    Pulpotemy vs. Pulpectomy: AAE Definitions

    • Full Pulpotomy

      The removal of the coronal portion of a vital pulp as a means of preserving the vitality of the remaining radicular portion

    • Partial Pulpotomy (Cvek Pulpotomy)

      The removal of a small portion of the vital coronal pulp as a means of preserving the remaining coronal and radicular pulp tissues

    • Pulpectomy

      The complete removal of the dental pulp

    Indications

    Additional Considerations for the Pediatric Patient:

    • In pediatric patients where the apex may not be fully developed, maintaining the vitality of the radicular pulp by performing a pulpotomy or partial pulpotomy serves an important goal of treatment: As long as there is a healthy blood supply to the radicular pulp, root development may continue. This allows for development of a closed apex (apexogenesis), development of an appropriate crown to root ratio, and thickening of the root walls, all of which ensure the best long-term prognosis for the tooth.
    • In pediatric patients, minimizing treatment time and utilizing appropriate behavior guidance including non-pharmacologic and pharmacologic strategies may also be beneficial, particularly for optimizing behavioral outcomes.
    • Following vital pulp therapy, close follow-up will be necessary, and patients and their families should be aware that further intervention may be necessary in the future. 

    Video

    Pulpotomy Procedure Overview

    A
    B

    As the goal is to maintain the pulp’s vitality, remember to use appropriate water coolant when removing diseased tooth structure

    C

    After caries removal, change to clean instruments and burs

    D

    Instrument options: Spoon excavator or slow speed round bur (size #2 or #4)

    E
    • To obtain hemostatic control, apply pressure with a cotton pellet saturated in sodium hypochlorite for 3-5 minutes
    • Carefully suction liquid to prevent it from moving beyond the bounds of the endodontic access
    • If hemostasis cannot be obtained, the pulp may be irreversibly inflamed and further intervention (RCT) may be required
    F
    • If pulpotomy is the current definitive treatment, either bioceramic, tricalcium silicate (e.g. BiodentineTM), or mineral trioxide aggregate (MTA) can be placed (thickness of >4 mm) with definitive coronal seal (e.g. resin composite restoration or stainless steel crown in pediatrics) and frequent follow-up
    • If full root canal therapy is anticipated in the short-term, place a eugenol-saturated cotton pellet in the chamber and temporize with glass ionomer, IRM, or Cavit until the patient’s next appointment

    Pulpectomy Procedure Overview

    A
    B

    As the goal is to maintain the pulp’s vitality, remember to use appropriate water coolant

    C

    After caries removal, change to clean instruments and burs

    D
    E
    •  Disinfection with sodium hypochlorite should be used throughout the procedure
    F
    G
    H
    • At a future visit, these temporary medicaments and space holders will be removed and obturation will take place prior to definitive restorative treatment with a core or post/core, and crown
    • Temporary restorations must be replaced within their lifetime to reduce the risk of coronal leakage and reinfection
    I

    See lessons below for more details on the pulpectomy procedure

    Cleaning and Shaping
    Obturation

    References

    Blicher, Pryles, R. L., & Lin, J. (2019). Endodontics Review. Quintessence Publishing Co.
    Hargreaves, K. M., Cohen, S., & Berman, L. H. (2011). Cohen’s pathways of the pulp (10th ed.). St. Louis, Mo.: Mosby Elsevier.
    Walton, R. E., & Torabinejad, M. (2002). Principles and practice of endodontics. Philadelphia, PA: Saunders.

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