Ep. 661 - From Liner to Pulpectomy: Pulpal Therapy Options for Primary Teeth

When a young patient presents with a deep carious lesion in a primary tooth, how do you decide between an indirect pulp cap, direct pulp cap, or pulpotomy? Which materials offer the highest success rates, and what restoration techniques will keep these teeth functional until natural exfoliation?Dr. Carla Cohn is a general dentist who graduated from the University of Manitoba in 1991 and completed a post-graduate internship in Paediatric Dentistry. She owns a private practice in Winnipeg, Canada, devoted solely to dentistry for children and serves as a part-time clinical instructor in Paediatric Dentistry at the University of Manitoba. Dr. Cohn is a partner at a private surgical clinic and a member of numerous professional organizations including the Canadian Dental Association, American Academy of Paediatric Dentistry, and serves on the Dean's Advisory Board. She lectures internationally on prevention and pediatric dentistry for the general dentist and is a regular contributor to VivaLearning.com.This episode provides a comprehensive guide to vital pulp therapy in primary teeth, covering the evidence-based progression from conservative to more aggressive treatments. Dr. Cohn explains how materials science has revolutionized pediatric pulpal therapy, moving away from formocresol and ferric sulfate toward calcium silicate-based materials that promote healing. The discussion emphasizes the critical importance of preserving primary teeth, which serve children for 6-12 years and are essential for proper function, speech development, and space maintenance.Episode Highlights:Indirect pulp therapy shows the highest success rates among vital pulp therapies, with selective caries removal and calcium silicate materials like resin-modified calcium silicate providing predictable outcomes. Silver diamine fluoride application followed by restoration represents another effective indirect approach that arrests caries progression.Modern pulpotomy protocols utilize calcium silicate-based materials like dual-cure formulations specifically designed for pulpal therapy, achieving very high success rates compared to traditional formocresol or ferric sulfate approaches which are no longer recommended.Full coverage restorations including stainless steel crowns or prefabricated aesthetic crowns increase pulpotomy success rates by approximately 20% due to superior sealing properties. Recent evidence suggests bulk-fill bioactive materials may provide adequate sealing for intracoronal restorations.Primary tooth pulpectomies remain uncommon in North America due to technical complexity and require resorbable filling materials containing iodoform compounds. Most practitioners opt for extraction when pulpotomy is contraindicated rather than attempting pulpectomy.Diagnostic challenges in pediatric patients include unreliable symptom history from children ages 2-4 and parents who may not recognize abnormal conditions. Visual examination, radiographic assessment, tooth mobility, and color changes provide more reliable diagnostic information than traditional pulp testing methods.Perfect for: General dentists treating pediatric patients, dental residents learning vital pulp therapy techniques, and practitioners seeking evidence-based approaches to primary tooth preservation using current calcium silicate materials.Discover how modern materials and minimally invasive techniques can transform your approach to pediatric pulpal therapy and improve long-term outcomes for your youngest patients.