Many treatment options are reviewed for pulp therapy in primary teeth. It is mainly undertaken by indirect pulp capping, direct pulp capping, formocresol pulpotomy and pulpectomy. 

Difference between primary and permanent pulp therapy are the use of formocresol for root canal medicament and absorbable zinc oxide and eugenol paste for root canal obturation. Pulp therapy is recommended for primary teeth whose pulps have the potential to recover once the irritation has been removed. 

PULP THERAPY FOR VITAL TOOTH

Pulp therapy for vital tooth is defined as the complete removal of coronal portion of pulp followed by placement of a suitable dressing or medicament that will promote healing and preserve vitality of the tooth.

WHERE IT IS USED?

  • Large carious lesion involving more than 1/3 of marginal ridge in a restorable tooth
  • At least 2/3 of root remaining
  • Vital tooth free of radicular pulpitis with pain of short duration,no swelling,mobility,tenderness

WHEN IT IS INADVISABLE?

  • Unrestorable tooth
  • History of spontaneous pain
  • Pus discharge
  • Sinus tract of fistula
  • Hyperaemic pulp
  • Irreversible pulpitis
  • External or internal resorption
  • Pulp calcification

MATERIAL USED FOR PULP THERAPY

  • Formocresol
  • Ferric sulphate
  • Glutaraldehyde 
  • calcium hydroxide
  • sodium hydroxide
  • electrosurgery
  • laser therapy
MTA

The success rate of pulpotomy was 97% for MTA and 83% for formocresol after a follow up period of 74 months .Calcium hydroxide is less penetrating into periapical tissue and higher success rate than formocresol pulpotomy.

PULP THERAPY FOR NONVITAL TOOTH

The complete removal of necrotic pulp from the root canals of primary teeth and filling the them with an inert resorbable material so as to maintain the tooth in dental arch.

WHERE IT IS USED?

  • Tooth with irreversible pulpitis or necrotic pulp tissue
  • Non vital tooth with prolonged history of pain
  • Mobility
  • Persistence bleeding during vital tooth therapy

WHEN IT IS INADVISABLE?

  • Periradicular involvement
  • Pathological resorption of root
  • Excessive internal root resorption
  • Perforation of floor of pulp chamber