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1113-5181/10/18.2/153
ODONTOLOGÍA PEDIÁTRICA ODONTOL PEDIÁTR (Madrid)
Copyright © 2010 SEOP Y ARÁN EDICIONES, S. L. Vol. 18. N.º 2, pp. 153-158, 2010
Protocolo de la SEOP
indicación de tratamientos pulpares en lugar de nuevas sobre la pulpa normal. En el caso de los diente tempora-
extracciones. les, sólo se llevará a cabo cuando la pulpa haya sido
—Contraindicaremos tratamientos pulpares comple- accidentalmente expuesta durante el procedimiento ope-
jos y de pronóstico dudoso en dientes que requieran ratorio o en casos de mínimas exposiciones traumáticas.
monitorización, más de una sesión o la posibilidad de El diente debe estar asintomático y la exposición pulpar
retratamientos en niños con familias que no tengan una mínima y libre de contaminación de fluidos orales. No
actitud favorable hacia la salud dental y que no valoren se consideran las exposiciones por lesiones por caries
los tratamientos en su justa medida. ya que fácilmente se produce contaminación e inflama-
Para cualquiera de los tratamientos pulpares se reco- ción pulpar.
mienda la utilización de aislamiento con dique de goma La finalidad del tratamiento es mantener la vitalidad
para minimizar la contaminación bacteriana. del diente sin evidencias clínicas ni radiográficas de
Por último, en todos los tratamientos pulpares debe patología pulpar, pudiéndose apreciar formación de
realizarse un seguimiento clínico y radiológico cuya dentina reparativa. No debe existir lesión en el germen
periodicidad debe ajustarse según el caso. del diente permanente.
BIBLIOGRAFÍA RECOMENDADA for old rationales. Pediatr Dent 1994; 16: 403-9.
6. Cortés O, Boj JR, Canalda C, Carreras M. Pulpal tissue reaction
1. Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ, Nowak to formocresol vs. ferric sulfate in pulpotomized rat teeth. J Clin
AJ. Pediatric Dentistry. Infancy through adolescence. 4th ed. Pediatr Dent 1997; 21: 247-53.
Philadelphia: Mosby; 2005. 7. Fuks A, Holan G, Davis JM, Eidelman E. Ferric sulfate versus
2. McDonald R, Avery DR. Dentistry for the child and the adoles- dilute formocresol in pulpotomized primary molars: long-term
cent. 8th ed. St. Louis, Mo: Mosby Inc.; 2004. follow up. Pediatr Dent 1997; 19: 327-30.
3. Boj JR, Catalá M, García-Ballesta C, Mendoza A. Odontopedia- 8. Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpo-
tría. Barcelona: Masson; 2004. tomy in primary molars using mineral trioxide aggregate or for-
4. American Academy of Pediatric Dentistry. Reference Manual mocresol. Pediatr Dent 2005; 27: 129-36.
2004-2005. Guideline on pulp therapy for primary and young 9. Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp
permanent teeth. Pediatr Dent 2004; 26: 115-9. treatment of primary posterior teeth: a retrospective study.
5. Ranly DM. Pulpotomy therapy for primary teeth: new modalities Pediatr Dent 2003; 25: 29-36.
Vol. 18. N.º 2, 2010 PULP TREATMENT IN THE PRIMARY DENTITION 157
Extraction should be considered in those cases were the The aim is to maintain the vitality of the pulp and in
infection cannot be controlled, and if there is considerable later check-ups no lesions of the permanent tooth bud
loss of the supporting bone and considerable mobility, or should be observed, nor should there be any clinical or
extensive pathologic root resorption, or if the tooth cannot radiographic evidence indicating pathology such as
be restored. pain, sensitivity or inflammation, nor should there be
Nevertheless, in addition to this, a series of factors and any root resorption. The results obtained from studies
considerations should be taken into account that will carried out in primary teeth consider that in particular
influence the final decision on the most suitable treatment situations this is a suitable technique. Emphasis is
for each particular patient, which are the following: placed on the importance of a previous diagnosis show-
—Congenital cardiopathy due to the risk of endocardi- ing an “absence of pulp pathology” and on carrying out
tis, immunodepressed patients and patients not in good of careful cleaning of the cavity, especially of the walls
health, given the risk of infection, favors the decision of of the amelo-dentinal junction, together with achieving
extracting a primary tooth. a proper seal of the cavity. This seal is more important
—Disorders regarding hemorrhaging and coagu- than the type of material applied over the lesion.
lopathies will mean that we should try to conserve teeth
with a complicated prognosis due to the risk that surgery
supposes. DIRECT PULP CAPPING
—Saving teeth by means of pulp treatment should be
attempted when there may be space problems in the dental Direct pulp capping consists in applying an agent
arc because of a gap, and in cases of agenesis of perma- (calcium hydroxide) directly on the normal pulp. In the
nent teeth when the orthodontic treatment plan indicates case of primary teeth this is only carried out when the
the importance of conserving primary teeth. pulp has been accidentally exposed during the operative
—The existence of children with previous traumatic procedure or in cases of minimal traumatic exposure.
experiences due to previous extractions, supports the indi- The tooth should be asymptomatic and pulp exposure
cation of pulp treatment instead of further extractions minimal and free of contamination of oral fluids. Expo-
—Complex pulp treatment with a dubious prognosis is sure due to carious lesions are not contemplated, as con-
contraindicated in teeth requiring monitoring, or more that tamination and pulp inflammation easily arise.
one session, or the possibility of retreatment when the The aim of the treatment is to maintain the vitality of
child’s family does not have a favorable attitude towards the tooth with no evidence of clinical or radiographical
dental health and when the value of the treatment is not pulp pathology, and with evidence of reparative dentin
appreciated. formation. There should be no damage to the permanent
For all pulp treatment isolation with a rubber dam is rec- tooth germ.
ommended in order to minimize bacterial contamination.
Lastly, after all pulp treatment a clinical and radiologi-
cal follow-up should be carried out and scheduled PULPOTOMY
depending on each case.
In primary teeth pulpotomy is indicated for those
cases with pulp exposure due to deep caries by the pulp
VITAL PULP TMT. IN PRIMARY TEETH WITH or because of trauma, and if the condition of the pulp is
NORMAL PULP OR REVERSIBLE PULPITIS normal or if there is reversible pulpitis.
The treatment consists in the elimination of the affected
INDIRECT PULP CAPPING pulp crown while the remaining root tissue is kept vital
with no clinical or radiological signs of inflammation or
Indirect pulp capping is recommended for teeth with involvement. The remaining root tissue should be treated
deep caries next to the pulp but with no signs or symp- by applying an agent such as formocresol, ferric sulphate
toms of pulp involvement. This procedure consists of or MTA, in order to preserve function and vitality. Then,
the elimination of infected dentine and the placement of the definitive restoration is carried out which will avoid
biocompatible material on the layer of dentin which is marginal filtration that could jeopardize the treatment. For
still demineralized but not infected with the aim of: a molar tooth the most appropriate restoration would be a
—Avoiding pulp exposure. stainless steel crown providing 2/3 of the root length
—Remineralizing the lesion by means of the forma- remains, in order to ensure a reasonable functional life for
tion of reparative dentine. the molar in question.
—Blocking the passage of bacteria and inactivating There are various studies that emphasize the impor-
what little remains. tance of controlling the hemorrhage, once the pulp
The difficulty of the procedure lies in determining crown has been amputated, thus confirming the diagno-
which is the infected area and which is the demineral- sis of “non-involvement” of the remaining root tissue.
ized area. Clinically this will depend on the type of The aim of the pulpotomy is to keep the root pulp
dentin; soft dentin should be eliminated and harder healthy with no clinical or radiological signs of involve-
dentin maintained. The materials that are most used are ment such as: pain, sensitivity, inflammation and the
calcium hydroxide, glass ionomer cements and zinc presence of root resorption. There should not be any
oxide eugenol. The latter has been questioned for hav- damage to the permanent tooth germ.
ing a sedative effect on pulp tissue that may eventually A pulpotomy is contraindicated if there are signs or
conceal any pulp degeneration. symptoms that indicate involvement of the remaining pulp
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