Essence and indications for biological intervention
In dentistry, pulp amputation refers to the removal of its coronal part. Vital amputation belongs to biological treatment methods, as its main goal is to preserve the viability of the radicular neurovascular bundle after removing the infected coronal part.
The main indication for choosing this technique is the treatment of pulpitis in teeth that have not yet completed root formation. Most commonly, this approach is practiced when working with multi-rooted teeth.
For comparison, there is also devital amputation—a method in which, after removing the coronal pulp, the radicular part undergoes mummification using devitalizing agents. Today, the devital method is used extremely rarely and is indicated only for teeth with instrumentally inaccessible root canals. Such treatment always requires multiple visits.
Anesthesia and aseptic rules
Since the radicular pulp remains alive, preparation and all manipulations must be performed under reliable anesthesia. Local anesthesia (conduction or infiltration) is used for this purpose. With proper technique, the patient feels absolutely no pain during hard tissue preparation.
The following are used as anesthetics:
- 2% lidocaine solution;
- 3–4% articaine or mepivacaine solutions.
To increase the duration of the anesthetic's action and reduce the required volume, vasoconstrictors (e.g., epinephrine or norepinephrine) are added to the solution.
The success of vital amputation directly depends on strict adherence to asepsis and antisepsis rules. The dentist must ensure complete isolation of the working area from saliva. All instruments and materials must be sterile, and sterile burs must be regularly replaced during preparation.
Single-visit treatment protocol
The classic technique of vital amputation includes a strict sequence of steps:
- Preparation of the carious cavity. Mechanical and chemical treatment is performed using handpieces and burs. As a result, no caries-affected tissue should remain in the cavity.
- Opening and unroofing of the pulp chamber. Round and fissure burs are used. Rule of thumb: when opening the chamber, the bur is directed toward the pulp cavity, and during unroofing, the movement is directed away from it.
- Removal of the coronal pulp. Performed with a sterile excavator up to the level of the canal orifices.
- Removal of the orifice pulp. The tissue is carefully extracted from the orifice area of the root canals.
- Antiseptic treatment. Throughout the procedure, the cavity is constantly rinsed with antiseptic solutions.
- Hemostasis and drying. Bleeding from the pulp stump is stopped using sterile cotton pellets or a hemostatic sponge. Then the cavity is dried with sterile pellets.
- Filling. A calcium hydroxide-based therapeutic base is placed on the canal orifices or the entire cavity floor. If the paste is non-setting, a base is placed over it. The stage is completed by placing a permanent filling.
Two-visit treatment
In some clinical situations, an alternative approach is used, dividing the treatment into two visits.
In this case, after medical treatment, hemostasis, and placement of the therapeutic base, the tooth is sealed with a temporary filling for a period of 3 to 4 weeks. If the patient experiences no pain during this time, the temporary restoration is removed on the second visit and replaced with a permanent filling.
Briefly: answers to topical questions
What specific preparations are used for antiseptic cavity treatment during vital amputation?
Hydrogen peroxide and chloramine solutions are used for antiseptic treatment of the pulp cavity during vital amputation.
- Hydrogen peroxide — used as a 3% solution.
- Chloramine — used as a 2% solution.
Medical treatment is carried out using cotton pellets from the basic instrument kit until pulp bleeding from the canal orifices completely stops.
What instruments are used to remove the coronal pulp?
Removal of the coronal pulp and widening of the root canal orifices are performed using manual and rotary endodontic instruments. The following are used during amputation:
- Excavator — used sterile to remove pulp down to the canal orifices.
- Burs — round burs, endo burs, and special burs for deep amputation are used.
- Rotary instruments — Gates Glidden and Largo reamers are used.
Dental handpieces and an explorer are also used in the procedure.
What means are used to achieve pulp stump hemostasis?
Sterile pellets, a hemostatic sponge, or other hemostatic agents are used for hemostasis in case of bleeding from the pulp stump. After bleeding stops, the cavity is dried with sterile cotton pellets.
What materials are used for the therapeutic base in vital pulp amputation?
Calcium hydroxide-based materials are used for the therapeutic base in vital pulp amputation. The following types of materials are used:
- Calcium hydroxide cements — combination preparations containing calcium hydroxide in an aqueous or polymeric carrier.
These materials are placed strictly on the root canal orifices or the entire cavity floor. They have a high pH (up to 12.0), exhibit odontotropic action, stimulate the formation of reparative dentin, and provide a prolonged antiseptic effect.
Class and exam questions
What is the main difference between vital and devital amputation?
During vital amputation, the radicular pulp remains viable, allowing the roots to form. During devital amputation, devitalizing agents are applied, and the radicular pulp is mummified.
Which drugs are used for a therapeutic base?
Vital amputation uses calcium hydroxide-based therapeutic pastes.
How to properly use a burs when opening and unroofing the pulp cavity?
When opening the pulp chamber, the bur is directed toward the cavity itself, and during the unroofing stage, the bur's movement should be directed away from it.
What else to study on this topic
- Properties and types of calcium hydroxide-based preparations
- Technique of local anesthesia in dentistry
- Vasoconstrictors: mechanism of action and contraindications
- Devital methods of pulpitis treatment: indications and preparations
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