Indiana University-Purdue University Indianapolis (IUPUI) / Pulpotomy procedures for the treatment of pulp exposure or disease
have traditionally used an approach from the occlusal surface in primary
molars, with a rotating bur or a spoon excavator being used to
excise the pulp under clean conditions and with a medicament being
applied to the amputation site.
The purpose of this study was: (1) to determine the feasibility of
performing a sterile scalpel excision of coronal pulpal tissue and (2)
to evaluate wound healing after a shield has been placed to prevent all
substances from touching the blood clot at the amputation site.
Using sterile operating room procedures, four of five teeth in five
dogs were rendered free of cultivable bacteria after antimicrobial
treatments were applied. These findings replicated a preliminary in
vivo experiment of 45 teeth which demonstrated that antimicrobial
agents applied to tooth enamel in dogs were effective beyond the 0.001
level of significance, as compared to a control group. Furthermore, in
the main study, negative cultures were obtained during 72 percent of
the trials following each of the five major steps in the pulpotomy
procedure. This included 80 percent negative cultures for bacteria
after pulpal excision and blood clot formation, and 100 percent freedom
from cultivable bacteria after a resin diaphragm was cemented to place.
In eight experimental teeth (three from the preliminary study and
all five from the main study) the buccal dentin over the coronal portion
of the pulp was removed by use of a tissue-protecting device
without grossly macerating the pulpal tissue. In seven of these eight
teeth, the coronal portion of the pulp tissue was amputated with a
scalpel severance and pulpal biopsies were removed through the buccal
preparation. In all eight teeth, the cavity preparation was accomplished
without applying medicaments to the blood clot at the amputation
site. A resin-stainless steel diaphragm was constructed under
sterile conditions and secured in a buccal preparation without touching
the pulpal amputation for a convalescence of 14-21 days, and this
shield provided a buccal wall for closure with an amalgam restoration.
In one animal which had not received a previous autotransfusion for
medical research, histologic sections of the pulp tissue in two root
canals demonstrated satisfactory wound healing (a moderate and a mild
inflammatory infiltrate was considered reversible). Three of the five
dogs in the main study exhibited pulpal necrosis which was attributed
to an interference in the immune system by previous autotransfusion
research, and histologic evaluation of pulpal wound healing was
therefore inconclusive.
This study demonstrates that the enamel surface can be rendered
free of cultivable bacteria in the dog and the operative site can be
maintained in this condition throughout pulpotomy, with the coronal
portion of the pulp being removed without grossly macerating the pulp.
Under these conditions there appears to be a potential for satisfactory
wound healing, with possible implications for the clinical situation.
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/4376 |
| Date | January 1983 |
| Creators | Roche, James R., 1924- |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
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