Pulpotomy/Pulpectomy - New York, NY

Treating Infected Pulp 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 treatment that aims to preserve and maintain compromised 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.

If you need a Pulpotomy/Pulpectomy, reach out to Advanced Endodontics of New York, we can help.

At Advanced Endodontics of New York, our skilled endodontists combine advanced technology with a compassionate touch to deliver tooth-saving pulp capping, pulpectomy and pulpotomy in New York, NY. For both pediatric and adult patients, we offer sedation in addition to local anesthesia.

Young Woman Endodontic patient smiling at coffee shop

Dental Pulp is Essential to a Healthy Smile

Tooth enamel covers softer, bulky material called dentin. Inside dentin is pulp—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, while radicular pulp refers to pulp in the tooth roots. Preservation of pulp is important because vital pulp has several key functions. Pulp plays a role in 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 is 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.

What is a Pulpotomy?

Pulpotomy techniques for primary (baby) teeth have been standard practice in pediatric endodontics for decades. The procedure is sometimes referred to as a “baby root canal.” The goal of a pulpotomy is to preserve the pulp, prevent pain and swelling and ultimately prevent tooth extraction. In a partial pulpotomy in New York, NY, 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 and then the tooth is sealed with a composite restoration. 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.

  • 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
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 (tooth root end). 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 1990s as a sealing agent and has achieved similar success rates.

In mature permanent teeth with irreversible pulp inflammation, root canal is typically the treatment of choice. Yet studies confirm that pulpotomy is a safe and predictable alternative treatment option for permanent teeth with irreversible pulpitis. 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.

A pulpectomy is performed when both the pulp in the crown and roots is impacted and no vital pulp remains. A pulpectomy in New York, NY is often the treatment of choice for severely infected primary teeth. 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 temporary stainless steel crown is used prior to the final zirconia or porcelain crown.
Both procedures are used to treat pulp issues, mainly in primary teeth and immature permanent teeth, but sometimes also in adults. 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.

In some cases, healthy (non-infected) pulp tissue is exposed or nearly exposed, even when decay hasn’t penetrated all the way into the pulp chamber. Pulp capping is considered prior to removing decay in deep cavities. Direct and indirect pulp capping has been used for many years to preserve the health and vitality of pulp and enhance its ability to form new dentin.

Indirect pulp capping: When decay is close to the pulp, this procedure preserves dentin in vital, otherwise healthy teeth to prevent pulp exposure. 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 installed and the final restoration is placed two months later. Recent studies show survival rates of greater than 90% for permanent teeth after indirect pulp capping, without adverse clinical symptoms or issues on X-rays. A 2020 study determined that stepwise pulp capping was a safer technique in permanent teeth in children.

Direct pulp capping:  This method is reserved for permanent teeth with exposed pulp. The AAPD recommends using direct pulp capping on primary teeth only when exposure results from mechanical trauma. 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.

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. During this procedure, we replace damaged pulp tissue with viable tissue to restore normal function of the pulp-dentin structure. Stem cells derived from your pulp or bone marrow are combined with nanofiber-based material to create scaffolding upon which the tooth can regenerate.

The hidden part of teeth deserve as much TLC as pearly whites!

Schedule a consultation at Advanced Endodontics of New York in New York, NY today to alleviate pulp inflammation.

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