Pulpectomy phase of non-surgical root canal therapy.PDF

PULPECTOMY – Treatment Considerations Anesthesia It is essential to eliminate any sensation from the tooth being treated prior to endodontic therapy. While it is true that some necrotic teeth can be treated without anesthesia, placement of rubber dam clamps and instrumentation beyond the apex (patency filing) normally make the use of local anesthetic desirable. This is typically achieved through simple infiltration for maxillary teeth or regional blocks for mandibular teeth. However, when a patient presents with an acutely symptomatic tooth, profound anesthesia is often complicated and cannot be achieved by simple means. This may be due to a localized decrease in tissue pH, making the anesthetic less effective (2). Other factors that can make the attainment of profound anesthesia difficult include accessory nerve innervation, sodium-resistant (TTX) nerve channels, and anxious patients (3,4). When these situations are encountered, consideration should be given to supplemental anesthetic techniques. Wider regional blocks, such as the Gow-Gates, Akinosi, Posterior Superior Alveolar, high tuberosity and Division II blocks, are available. Intraosseous techniques, such as the Stabident, X-tip and PDL injection offer other methods of producing anesthesia, and have been proven to greatly enhance anesthesia when other techniques have been deficient (5). As a last resort, intrapulpal injection will allow the practitioner to proceed with treatment. This should be performed through a small opening into the pulp. As such, anesthesia is achieved via pressure. Because the effect of the intrapulpal injection is relatively brief, removal of the majority of the pulp should then be rapid.