Pulpectomy is a dental procedure that involves removing the whole pulp tissue from the crown down to root of the tooth to treat infection and avoid tooth loss. This typically involves the primary teeth of paediatric patients and is considered part of endodontic treatment. Some dentists refer to this procedure as partial root canal therapy.
The pulp, which is located in the center of the tooth, is made up of odontoblasts (cells that produce dentin and connective tissue) and a network of nerves and blood vessels. Aside from being the source of dentin, the pulp is also responsible for supplying nutrients to the surrounding parts and serves as the source of pain perception in cases of trauma, disease, or pressure to the dentin. When the pulp becomes infected or injured, it can cause a great deal of pain and trauma to the patient.
Pulpectomy should not be confused with pulpotomy, which involves the removal of a part of the pulp to stop the spread of dental caries. Pulpectomy is performed when the pulp tissue has been irreversibly damaged or has undergone necrosis (death of tissue) due to extreme dental caries or trauma.
Pulpectomy is typically performed on children diagnosed with pulpitis exhibiting tissue necrosis or death. Pulpitis is the medical term that refers to the inflammation of the pulp due to bacterial infection secondary to tooth decay, or dental caries. This condition is characterised by throbbing pain and extreme sensitivity to cold or hot temperatures. The procedure is particularly indicated for those with periapical abscess formation or when pus is already present.
Damage to the pulp can be caused by several factors including large dental fillings that are unable to provide enough protection against bacteria and injury to the face that damages the pulp.
Pulpectomy on primary teeth has a high success rate in preventing the spread of bacterial infection and necrosis to nearby teeth. Avoidance of tooth loss is achieved, as well as providing immediate pain relief. It is a standard practice for patients to take some pain medication after the procedure to lessen their discomfort. After the initial procedure, patients are scheduled for several follow-up appointments to fill the canals and encourage normal teeth development. Dentists follow strict protocols to make sure that there is enough space held for permanent teeth when they erupt later on.
Several days before pulpectomy is performed, the patient is prescribed with antibiotic medications to address bacterial infection, especially in cases where abscess has already set in.
The procedure starts with the application of topical anaesthesia to reduce patient discomfort. The dentist then drills a hole into the tooth to access and remove the infected pulp using broaches, a type of barbed dental instrument. The nerve inside the pulp is also drilled out using files. The dentist would typically use files of different sizes to make sure that all debris, as well as all infected tissues, is removed before irrigating the canal using sodium hypochlorite solution or a mixture of sodium hypochlorite with surface modifiers. After irrigation, the root canal and pulp chamber are filled with an inert, non-resorbable material. The tooth is then capped with a crown, which can be temporarily bonded to the underlying structure using dental cement.
Pulpectomy is a very straightforward procedure with a low risk of serious complications. However, there are cases that result in the following:
Adverse reactions to the applied anesthesia - The application of local anesthetics may numb the lips, tongue, and other nearby tissue but this typically resolves on its own a few hours after the procedure. However, there are rare instances in which the patient develops adverse reactions to the applied anesthesia. Thus, parents are typically asked if their child is allergic to any substances before the procedure is performed.
The affected tooth may suffer a fracture and break during the procedure, causing further damage that may lead to tooth loss.
Excessive bleeding – This is a possibility especially for patients with pre-existing medical conditions.
Infection of the treatment site – This can also occur and may lead to inflammation and further pain for the patient.
Some irrigating solution may inadvertently affect the surrounding tissue, leading to pain and edema.
Pain - If the dentist fails to remove all necrotic tissue, there is a possibility of pain recurrence and well as the spread of infection to nearby parts.
Tooth discoloration – This is a common result of this procedure and is due to the staining of filling materials and cement used.
M. A. Marciano, R. Ordinola-Zapata, T. V. R. N. Cunha, M. A. H. Duarte, B. C. Cavenago, R. B. Garcia, C. M. Bramante, N. Bernardineli, I. G. Moraes (April 2011). "Analysis of four gutta-percha techniques used to fill mesial root canals of mandibular molars". International Endodontic Journal 44: 321–329.
Hülsmann M, Hahn W (2000). "Complications during root canal irrigation--literature review and case reports". Int Endod J (Review) 33 (3): 186–93. doi:10.1046/j.1365-2591.2000.00303.x. PMID 11307434.