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doddares · Oct 6, 2009, 01:45 PM

Pulpotomy,

If I don't have formocresol and only have CaoH... what are the steps for pulpotomy for a primary tooth and is t contra-indicated to use CaOH rather then formocresol.

I plan to place caoh and the stumps followed a cotton pellet and fuji on top.

Can I stop the bleeding from the pulp with cotton pellet and hydrogen peroxide.

Any help appreciated

Amir1981 · Oct 6, 2009, 02:38 PM

Well you can use Ferric sulfate... remove the coronal pulp, stop bleeding with ferric sulfate... the place CaOH and IRM (ZOE) that's the way I've done it anyway

doddares · Oct 7, 2009, 07:02 AM

Hey Amir,

Thanks for the advice... whats the theory behind using ZOE or were u just taught that ? Do u know if I can use GIC fuji instead on top of the CaOH ?

Cheers

flossie · Oct 7, 2009, 08:08 AM

doddares, are you a dentist? If so, where do you practise?

doddares · Oct 7, 2009, 11:29 AM

Practice in the UK

flossie · Oct 7, 2009, 11:58 AM

How many years have you been in practice? I'm just curious why you'd need to know what is used for pulpotomies. IRM(ZOE) has been used here in Canada for pulpotomies for at least 30 yrs.

doddares · Oct 7, 2009, 12:18 PM

I know what is used in pulpotomies but I don't know why certain medication is used and not other.
I wanted to know if caoh was an advisable alternative to formocresol.
Also why zoe is placed as the irm. Could for example fuji gic be used instead.
In my opinion there is no need to keep questioning your knowledge and improving ones theory.
By the way I've been practicing for a month.

I hope I've answered your queries

Amir1981 · Oct 7, 2009, 12:58 PM

Well the idea of the ferric sulfate is to stop bleeding... the CaOH will disinfect the area and stimulate a dentinal bridge (by the remaining radicular pulp).. finally, the ZOE is a pulpal sedative (has eugenol in it) so it will prevent inflammation in the remaining pulp. Plus it's a filler to fill up the cavity so you can prep/place a stainless steel crown (which every pulpotomied posterior tooth should have) I just checked the endo book PATHWAYS OF THE PULP (GREAT book!). It says you don't even need CaOH, just ZOE but that's the way I was taught. Formocresol has fallen out of favor (due to toxicity concerns)

Amir1981 · Oct 7, 2009, 12:59 PM

You could use GIC but id imagine that might seal the area up and prevent the ZOE from providing its therapeutic benefit...

doddares · Oct 7, 2009, 01:08 PM

Cheers amir... great help... I guess ill look up that book.

PedDentRes11 · Jan 17, 2010, 09:12 AM

From what I was taught in dentistry school, CaOH is far inferior to ZOE / IRM in primary teeth due to a higher rate of internal resorption associated with this material postoperatively. Also something regarding failure of material to resorb properly with primary tooth exfoliation. As for hemostatic agents, there are toxicity concerns being placed with formocresol, but they are of minimal to no significance. Ferric sulfate is the new trend in pulpotomy procedures at this point in time, and a lot of pediatric and general dentists are transitioning to this due to the decreased amount of time to obtain hemostasis (15 seconds vs. 5 minutes w/ formo), but research also shows ferric sulfate has a higher rate of internal resorption postoperatively as well. New success in the field has been shown w/ MTA (mineral trioxide aggregate). While it is fairly expensive to purchase from dental suppliers, it is highly effective and is being incorporated more and more every day in the routine care of patients receiving pulp therapy. Hope this is helpful as well for you. I am currently a pediatric dental resident, and am doing my research in this area.

PedDentRes11 · Jan 17, 2010, 09:16 AM

Oh yea, and if you want to place Fuji inside the prep after placing a small layer of ZOE or MTA in the root orificies, I believe that would work well prior to placement of your SSC. Not sure how much research has been done in this area though. I will have to find out.