Pulp Therapy in Primary Teeth
Indirect pulp capping:
Involves the removal of all the caries except that which could expose the pulp if removed. A protective lining such as calcium hydroxide may be placed and the tooth is restored. Biodentine is an excellent restorative material over the pulp. A long lasting intact seal is necessary. A pre-formed metal crown is an ideal restorative technique that ensures the desirable intact seal in the long term. The technique will be successful if the pulp of the tooth is vital or with reversible inflammation. It is an acceptable alternative for pre-cooperative children and during stabilisation of the mouth.
Direct pulp capping:
Involves the placement of a protective lining on to an exposed pulp. It is contraindicated for primary teeth as it will usually lead to pulp necrosis or internal resorption.
Involves the partial removal of inflamed but vital pulp tissue with an attempt to maintain the rest vital and functioning. This is followed by the placement of a medicament to stimulate the repair of the vital radicular pulp. The most commonly used medicament is Ferric Sulphate with a success rate of 74-99%. Pulpotomy is indicated when the pulp is minimally and/or reversibly inflamed, where the marginal ridge is lost especially in first primary molars and when, on the radiographs, caries extend more than two thirds into dentine.
Involves the removal of both the coronal and the radicular pulp tissue followed by a placement of a medicament within the root canals; this can be either pure ZincOxide /Eugenol or Calcium Hydroxide & Iodoform Paste (premixed, Vitapex®NEODENTAL INTL). Pulpectomy is indicated when there is evidence of pulp necrosis, abscess or mobility, hyperhaemic pulp, spontaneous pain, radiographic evidence of bifurcation involvement.