Pulpotomy and Stainless Steel Crowns

Steps involved for a pulpotomy and stainless steel crown:

How it's done

Step 1

First, your child is made to feel comfortable in the dental chair, some children are anxious and appropriate behaviour managing techniques are used. 
A technique called Tell-Show-Do is used, where the procedures are explained in steps in language which they can comprehend, the step is shown (usually on their hand) and then the procedure is conducted. 
Another technique – distraction is also used.  This involves constantly talking to your child and involving their imagination in the conversation.  Distraction is also used by your child watching a movie on the ceiling screen.

Step 2

Topical anaesthetic is placed on the gums.  This is a cream that numbs the gums to allow a painless local anaesthetic to be given.  The cream is kept on the gums for 3-5 mins.

Step 3

The local anaesthetic that we use is computer assisted and called “The Wand”.  The major advantages are that it does not look like a fearful syringe, and the flow of the solution is controlled to be expressed drop by drop.  This makes the anaesthetic very comfortable.  Many children do not know they have had an injection.

Step 4

Rubber dam is used.  This is a sheet of rubber with holes punched out so the teeth poke through the holes.  Advantages:  isolates the teeth we are working on, reduces saliva moisture (this is very important to allow white restorations and sealants to stick properly), protects the soft tissues and reduces the risk of anything falling down the airway.  The rubber is held in place by a metal ring around the tooth.

Step 5

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The cavity is cleaned with a highspeed and slowspeed handpiece.  Deep decay is removed, which leads down to the pulp.

Step 6

The pulp is cleaned, this is where the nerve and blood supply are located. 

NB: This procedure is NOT like a root canal for adult teeth.

Step 7

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A medicament is placed into the pulp to stop bleeding.

Step 8

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The tooth built up with a white restoration core.

Step 9

Pulpotomy

The tooth is now trimmed down to specific dimensions to allow for a crown to fit over the tooth.

Step 10

An appropriate crown size is selected and adjusted.

Step 11

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The crown is cemented onto the tooth.  The crown acts like a “crash helmet” to protect the underlying weak tooth.

  • The stainless steel crowns remains on the tooth, until the baby tooth naturally wiggles out. 
  • Occasionally the crown may debond, sometimes if sticky food is chewed.  The surface may wear down, especially if the child grinds his/her teeth.
  • Infection may develop around or in between the roots of the tooth.
  • The crown needs to be checked regularly at the six monthly reviews for any of the above signs.