Endodontics
Course Review
Enoch Ng, DDS 2014
Pediatric Endodontics
Indications
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The successful treatment of the pulpally involved tooth is to retain that tooth in a healthy condition so it may
fulfill its role as a useful component of the primary and young permanent dentition
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Sequelae (pathosis) of premature loss
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Loss of arch length
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Insufficient space for erupting permanent teeth
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Ectopic eruption, premolar impaction
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Mesial tipping of molars adjacent to lost primary molars
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Extrusion of opposing permanent teeth
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Midline shift, possible crossbite occlusion
o
Development of abnormal tongue positions
Considerations of Primary Dentition
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Developmental Considerations
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Root length completed 1-4 years after eruption
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Permanent tooth bud apical lingual to primary anterior tooth
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Anatomic Considerations
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Relatively larger pulp chambers
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Mesial pulp horns extend closer to outer surface
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Accessory canals in pulp chamber floor lead directly into furcation
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Ribbon-like canals
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Roots are narrower mesial-distally
o
Root more divergent than in permanent teeth
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Primary Pulp Tissue
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Responds differently that permanent teeth to trauma, infection, irritation, medication
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Loss innervation density – diagnosis is more difficult
o
Larger apical foramina – greater inflammatory response
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Open Apex
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Developing root of immature tooth, root growth retarded in presence of disease
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Closure normally 3years after eruption, resorption of mature apex may be from ortho, healing after
trauma, periradicular inflammation
Pulpal Diagnosis in Kids
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Visual and tactile examination of carious dentin and associated periodontium
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Radiographics of
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Periradicular and furcation areas
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Pulp canals
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Periodontal space
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Developing permanent tooth
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History spontaneous pain
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Pain percussion, mastication
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Mobile
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Palpation surrounding soft tissues
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Size, appearance, and amount of hemorrhage associated with pulp exposure
