Pulpectomy method : step by step :
1. Although local anaesthesia is usually not required, as the pulp is non-vital, there may be remnants of vital, inflamed tissue in the apical 1-3mm of the canal which may be sensitive. Furthermore, the tooth may be tender because of apical inflammation.
2. Rubber dam is required.
3. A recent periapical or bite-wing radiograph showing the root apices of the tooth is required.
4. Remove all the caries with a high-speed or slow-speed round burr. Once access has been gained into the pulp chamber, complete the endodontic access with a large round bur.
5. Debride the pulp chamber and instrument only 75% of the estimated length of the canals. Irrigate the canals with normal saline or Milton’s solution and file to three sizes up from the initial file. Flush the canals with saline and dry with paper points. It is almost impossible to fully instrument the canals of primary molar teeth, but they should be debrided as much as possible.
6. Once dry, the canals should be filled with zinc-oxide eugenol (non-reinforced) or calcium hydroxide. These may be instrumented down the canals or spiralled, with care, using a spiral-filler. It may be useful to reduce the length of the spiral-filler.
7. The pulp chamber is filled with a reinforced IRM and the tooth restored, usually with a stainless-steel crown.
If the pulpectomy fails, as shown by a persistence of swelling, increased bone loss and/or resorption, then the tooth should be extracted.