PDF: Pulpotomy - Management of Endodontic Emergencies - AAE

Emergency cases with a diagnosis of SIP due to caries, large restorations, cracked tooth syndrome or trauma are potential candidates for pulpotomies.

The primary reason for electing to do a pulpotomy over complete instrumentation is the lack of sufficient time to clean and shape canal systems.

Additionally, partial pulpectomy of severely inflamed teeth has been strongly discouraged over pulpotomy due to an arbitrary method of axotomizing sensory nerves due to upregulation of genes such as nerve growth factor responsible for peripheral nerve sprouting and therefore greater postoperative pain. 

Prior studies determining pulpotomy protocols suggest that an effective procedure can be accomplished with adequate removal of the inflamed pulp tissue, preferably at the level of the canal orifice/s followed by a well-suited coronal seal.

Prevention of bacterial penetration during the intermediate time until definitive endodontic therapy can be initiated is the primary purpose of an adequate coronal seal.

To this end, many clinicians prefer placement of an antibacterial chamber dressing following a pulpotomy.

It should be noted that there appears to be no difference between various antibacterial chamber dressings compared to a dry cotton pellet with regards to attenuation of pain. 

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