What do you referred with LA?

In which treatment do you use it?

Pulpectomy

In the question, you write: "It is most abused material in pediatric endodontics, a substitute to LA." Sorry, I don´t know what is "LA", Is the acronym of some material?

thanks

Local anesthesia

Thanks for your quick answer

Sorry, but I don`t know nothing about local anesthesic in pulpectomy. Only I have read about local anesthesia used to permeabilize root canal previously the measure with apex locator.

I don´t know if this answer reply your question. Sorry if there is no useful.

Firstly, pulpectomy is indicated in teeth with a root more than 4mm and without pulp floor resorption.

I think that since instrumentation and irrigation with an inert solution alone cannot adequately reduce the microbial population in a root canal system. For assuring optimal bacterial decontamination of the canals, you can disinfect with irrigants such as 1% sodium hypochlorite (because it is a potent tissue irritant, sodium hypochlorite must not be extruded beyond the apex) and/or chlorhexidine, cetrimide...OPW(oxidative potential water) and NSS (normal saline solution) was investigated. Then you can dried the canals.

What do you think about the removal of the smear layer in the outcome of the pulpectomy? I have read about the two positions:

The pulpectomy outcome was improved by smear layer removal (The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation. Barcelos R, Tannure PN, Gleiser R, Luiz RR, Primo LG; Int J Paediatr Dent. 2012 Sep;22(5):369-81.) and the smear layer removal or not, wasn´t statistical differences (Long-term outcomes of primary tooth pulpectomy with and without smear layer removal: a randomized split-mouth clinical trial. Tannure PN, Azevedo CP, Barcelos R, Gleiser R, Primo LG; Pediatr Dent. 2011 Jul-Aug;33(4):316-20.).

Do you know more articles?

Thanks.

thank you,Dr Cristina Benavides

you have really taken lot of trouble of understand the question and give your inputs.

I regret that my question was not clearly described,

The place i come from, Given a local anesthesia [LA] to child is consider a challenge. It may be due to inadequate training and their beliefs, many fear to administer LA in children. therefore they abuse pulp devitalizing agent .

It is place over small pulp exposure [ most of them iatrogenic], in first appointment and next visit doing a pulpectomy.

If its about pulp devitalisation why not go for formocresol,gluteraldehyde,ferric sulfate and many more are thr.

Dr sabina Khan

is there any scientific literature or in vivo study of use of pulp devitalizing agents in children, esp most of these materials were arsenicals untill recently.

I prefer to do the obturation with eugenolate paste and six month later after the apex is closed I will remove all the eugenolate paste and replace the eugenolate paste the obturation by gutta .

Mr Tony,

Thejo is referring to primary teeth-- i feel apex closure doesnt occur and gutta is not indicated. It is for permanent the best can be MTA.

As far as I know, so-called devitalizing agents are definitely out of date, as being dangerous (leaking my cause vast zones of osteonecrosis), and their use could lead to legal procedures...at least in Europe and probably in the USA.

Dr Van Ende is 100% correct : intraosseous (or intradiploic = inside the spongy bone) anesthesia is particularly indicated in pediatric dentistry) because it has an ultra short onset (you can beguin the procedure as soon as you have finished the anesthesia), it is highly efficient, of relatively short duration, with no soft tissue anesthesia, and very well accepted by children.

Please see on that subject, two papers by the French team of the University of Rennes :

1. Sixou JL, Barbosa-Rogier ME. Efficacy of intraosseous injections of anesthetic in children and adolescents.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106 [2]:173-8.

2. Sixou JL, Marie-Cousin A, Huet A, Hingant B, Robert JC. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system [QuickSleeper].lnt J Paediatr Dent. 2009; 19 [5]:360-6.