Pulpotomy without anesthetic - Laser Dentistry Forum

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April 15, 2003 at 6:11 am #3448 Reply

Glenn van As
Spectator

Here is a weird case on a little 9 year old girl.

I originally diagnosed some decay in November of 2002 and the patient showed up finally today (probably the tooth was sore).

I only have preop radiograph not a photograph because I wasnt going to save it until I hit the pulp.

THe decay was big, used the same technique for her with 1 minute at 30 Hz and 160 mj (it doesnt pop so loud at this setting and then 1 min at 25Hz and 240 mj .

Then I went in and the decay was right into the pulp. Bled lots and finally got hemostasis using astringident as I didnt want to rely on Argon .

Etch bond started bleeding again……..back to astringident and then GI used (Fuji 2 ) for the base then used composite over top.

THe whole thing was done with NO anesthetic. I used Marks defocussed technique for 2 minutes and never had pain but she isnt the easiet to treat so I was pleased I got it done.

Hope you like it………I thought it was cool. She rated the pain 3 out of 10.

Glenn

April 15, 2003 at 6:13 am #11413 Reply

Glenn van As
Spectator

Will try to get a BW radiograph next time…….told the staff to do it today but they forgot.

Cya

Glenn

April 15, 2003 at 2:46 pm #11407 Reply

Anonymous
Guest

Glenn,

Anything(caoh or other) between the Fuji 2 and the pulp?
Why/why not?

Cool case- I thought these always waited til a weekend to call with pain
😉

April 16, 2003 at 4:02 am #11414 Reply

Glenn van As
Spectator

Hi Ron………..great question. My question is why use anything?

CaOh is contraindicated in children from everything I have read.

Formacresol was used for clotting and for sterilization but is it needed with the laser.

IRM was used for the eugenol .

I dont like it with comps but that is arguable.

I just wanted something that would set without etch hence the GI

Then I placed the comp overtop.

LEts see what happens.

Kid wasnt very easy………

Glenn

April 16, 2003 at 6:44 am #11412 Reply

ASI
Spectator

Hi Glenn & Ron,

In direct pulp cap, as long as pulp is not bleedy, I have been using bleach to decontaminate, then acid etch except over exposed pulpal tissue, and dentin adhesive bonding agent, followed by fluoride flowable resin and closing over with composite or other restorative lmaterials. Advise patient of possible endo. Most of the time, the results are favorable.

Andrew

April 16, 2003 at 1:20 pm #11415 Reply

Glenn van As
Spectator

That is fine in the adults Andrew, but the laser sterilizes in a similar fashion to bleach so alot of those using a laser will choose to use that to sterilize the pulp.

This one wasnt bleeding after the astringident and Argon

Cya

Glenn

April 16, 2003 at 11:58 pm #11408 Reply

Anonymous
Guest

Glenn,
Have you been folowing this one?

http://www.dentaltown.com/idealbb/view.asp?mode=viewtopic&topicID=15275&num=50&sessionID={6F955206-28AA-46A6-BF85-FA55B8B7FD0E}&pageNo=1

Its what sparked my curiosity about what you may have placed .

April 17, 2003 at 2:18 am #11411 Reply

2thlaser
Spectator

Interesting thread Ron, thanks.
Mark

April 17, 2003 at 2:42 am #11417 Reply

Glenn van As
Spectator

OK Ron so my question is what would people have done on this very large hemorrhagic pulp exposure that was carious and wouldnt stop bleeding and in addition was on a pediatric tooth.

Glenn

April 17, 2003 at 12:28 pm #11409 Reply

Anonymous
Guest

FWIW,

In my neck of the woods I think you’d see-

35% caoh and amalgam

45% direct bond w/ composite

15% GI and composite

5% no exposure, seal decay with GI and then place composite.

Anyone else with some estimates of how they’d see percentages in their area?

April 17, 2003 at 1:56 pm #11416 Reply

Glenn van As
Spectator

Ok we agree to disagree, I still believe that in pediatric teeth Caoh is not effective.

If there is an exposure that takes a long time to control , a pulpotomy is the right answer. This carious exposure was huge, I could have got it with a spoon it was so big

I wish I had a preop photo but there was tons of decay in the tooth.

Lets see if it becomes necrotic…….it might.

Its not that I dont trust you but very very few of my pulp caps in kids have ever worked and when they go necrotic its time to exo them and space maintainer. You only have one chance and thats when it is vital.

Glenn

April 17, 2003 at 3:27 pm #11410 Reply

Anonymous
Guest

Glenn,

I’m not disagreeing with your treatment at all. I was just trying to see what it was you used and why. From the thread on DT you can see there are lots of opinions, some appear to have some reasonable thought, some do not. I respect your opinion, that’s why I asked.

I think the GI was a very good choice to seal things off.

As far as the % I posted ,that was just a rough guesstimate as to what I would see the dentists around here do. It wasn’t that my choice would agree with the majority.

Anyway, I think the tooth will make it for you, and from the looks of those pictures, the patient will probably give you lots of other challenges too.
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