Difference between Pulpotomy and Pulpectomy: your full guide

Understanding the key differences between “pulpotomy” and “pulpectomy” is essential for both dental professionals and patients alike.

Pulpotomy involves the removal of the infected pulp in the crown portion of the tooth, while pulpectomy goes a step further by complete removal of the infected pulp from both the crown and root canals.

Pulpotomy is commonly performed to preserve the remaining healthy pulp in primary teeth with reversible pulpitis or shallow decay, hence considered a vital pulp therapy.

Also, evidence has developed enough to support the use of pulpotomy in mature & immature permanent teeth.

In contrast, pulpectomy finds its application in permanent teeth or primary teeth with irreversible pulpitis or extensive decay, or simply when pulpotomy fails.

While pulpotomy is a relatively simpler and faster procedure, pulpectomy is more complex and time-consuming, considering the need to remove the entire pulp tissue.

When to do pulpectomy vs pulpotomy?

When deciding whether to perform a pulpectomy or pulpotomy, your endodontist has to consider many factors.

Pulpectomy is typically recommended when the tooth has irreversible pulpitis, extensive decay, or infection that has spread into the root canals.

It is more commonly performed in permanent teeth.

On the other hand, pulpotomy is often chosen for primary or permanent teeth with reversible pulpitis or shallow decay, where there is a possibility of preserving the remaining healthy pulp.

Additionally, pulpotomy may be preferred when there are limitations in performing a complete pulpectomy due to patient cooperation or anatomical considerations.

The decision between pulpectomy and pulpotomy should be made based on the individual case, as every case has it’s distinct features!

Can pulpectomy be done in primary teeth?

what is the difference between pulpotomy and pulpectomy

The answer is yes!

Pulpectomy can be performed in primary teeth.

Even though pulpectomy is more commonly associated with permanent teeth, if we have primary teeth with irreversible pulpitis or extensive decay, your endodontist/pediatric dentist can choose to do pulpectomy.

The infected pulp can be completely removed from both the crown and root canals of the primary tooth, and the canals are then filled with an appropriate material.

However, our decision to proceed with pulpectomy in primary teeth depends on the severity of the pulp condition, the child’s ability to cooperate during the procedure, and overall pulp health of this patient!

It is crucial to consult your dentist to determine the most suitable treatment approach. 

What is the difference between pulpotomy and pulpectomy for kids?

Kids have primary teeth! And as we mentioned before, we more commonly do pulpotomy more than pulpectomy in these.

However, we have situations where we decide to proceed with pulpectomy despite the fact that the patient is a kid with primary teeth!

And these include that the pulp is severely affected, the kid’s ability to to cooperate with the professionals during the procedure, and the overall oral health of that kid! 

Is Gutta Percha used in pulpectomy?

Before we answer this question, Gutta Percha is a rubbery material derived from the sap of the Malaysian tree, It is widely utilized as a root filling material! 

Gutta percha derived from the sap of a malaysian tree

And Yes, we commonly use Gutta Percha in pulpectomy, but in permanent teeth!

After the infected pulp is completely removed from both the crown and root canals during a pulpectomy, Gutta Percha is often placed into the canals to seal and fill the space.

This helps to prevent the re-entry of bacteria or any further infection. Gutta Percha is favored due to its biocompatibility, ease of use, and long-term stability as a root canal filling material so it is reliable and helps maintain the integrity of the treated tooth!

However, in primary teeth pulpectomy, we have to use another material that is resorbable in the same rate as the primary tooth, and gutta percha is not resorbable.

What are the stages of pulpectomy?

A pulpectomy procedure involves six main stages, each of them is essential to remove the infected pulp, clean the canals, and seal the tooth efficiently!

While these steps may vary depending on the specific patient’s tooth and the endodontist’s preferences, these are commonly used:

1- Local anesthesia

The first stage involves administering local anesthesia to numb the tooth and surrounding tissues, ensuring a pain-free procedure for our patient.

2- Access cavity preparation

The dentist creates an access opening in the tooth, usually using a dental drill, to gain access to the pulp chamber and root canals.

3- Pulp tissue removal

The infected pulp is carefully removed from its chamber and root canals using specialized instruments such as files and irrigating solutions.

4- Cleaning and shaping

The canals are meticulously cleaned and shaped using the same materials mentioned in the last stage, in order to remove any remaining debris, bacteria, or infected tissue, ensuring proper disinfection.

5- Obturation

Once the canals are ready, they’re filled with a biocompatible material, often Gutta Percha, to seal the canals and prevent reinfection.

6- Coronal Restoration

After the pulpectomy procedure, the access opening in the tooth is filled with a suitable restorative material, such as a crown, to restore the tooth’s structure and functionality.

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