The instruments needed are:
| Mirror | Base material and instruments |
| Explorer | Temporary cement (IRM, Zinroc) |
| College Plier | Glass ionomer line (vitrebond) |
| Plastic Instrument | |
| Spoon Excavators | |
| Cement Spatula |
Burs:
330 for primary teeth
245 for permanent teeth
Local anesthesia set-up
Rubber dam set-up
1. Seat the patient. Explain the procedure to the patient.
2. A plaque index and home care reinforcement instructions are given to the patient and parent.
3. Local anesthesia is administered after topical has been applied for one minute.
4. Rubber dam is placed. (Floss is attached to the clamp).
5. Ideal depth for a conservative amalgam preparation of the tooth is established using the bur in a high speed handpiece. Ideal outline form is achieved at optimal depth.
6. Removal of caries with spoon excavators and/or a round bur in a low speed handpiece is performed until all infected dentin is removed or a pulp exposure is anticipated.
7. The tooth is evaluated to rule out a pulp exposure. If none exists, a layer of Dycal is placed over the remaining dentin. An appropriate temporary restoration is placed.
If all carious dentin cannot be removed the entire procedure may be repeated and then a permanent restoration placed after the 6 week reevaluation.
PULPOTOMY FOR A PRIMARY TOOTH
Instruments and materials needed:
| Exam Kit | Glass Ionomer Cement |
| Operative Kit | Formocresol |
| Sterile Cotton Pellets | |
| Local anesthesia set-up | Burs: 4,6, 8 round burs |
| Rubber dam set-up | 330, 245 |
1. Local anesthesia is administered.2. The rubber dam is applied. Remember to tie dental floss to the lingual aspect of the clamp.
3. If the tooth requires a stainless steel crown in the future, the mesial-distal dimension is measured now and noted in the chart for future reference.
4. Proper depth for an ideal amalgam restoration is established first. The appropriate outline form for the carious lesion is created.
5. The remaining caries is completely excavated with a slow speed round bur or a large spoon excavator. Begin excavation peripherally so that caries nearest the pulp is removed last.
6. The prep is deepened to the roof of the chamber and extended to include the full extent of the chamber bucco-lingually and mesio-distally. Before entering the pulp chamber disinfect the bur or replace it with a sterile bur. The roof of the pulp chamber is removed with a slow speed round bur. The bur is placed into the chamber and pulled to remove any ledges. The pulp chamber should be fully visible without any overhangs.
7. The coronal pulp is removed with a sterile large sharp spoon excavator. (Do not use the same instrument used to remove caries.)
8. Hemostasis is achieved with cotton pellets placed on the remaining pulp with moderate pressure for one minute. This procedure may be repeated once. If hemostasis has not been achieved, check for pulpal remnants along the walls of the chamber.
9. After hemostasis is achieved, a cotton pellet that has been wet with Buckley's formocresol and blotted on a cotton roll is placed over each root canal orifice. Moderate pressure is applied by packing dry pellets over the formocresol pellets. Leave in place for five minutes. Formocresol
10. The cotton pellet is removed. The pulp stumps should have a brown appearance. If bleeding is observed, check for pulp remnants and repeat steps 10 and 11. No bleeding should be evident before proceeding to step 11.
11. The tooth is then restored to contour with glass ionomer cement. The permanent restoration (stainless steel crown) is ideally placed at the same visit.
12. The rubber dam is removed and the occlusion is checked and adjusted.
13. Home care instructions are given to the patient and the parent.
*Rubber stops should be placed on the lentulo spirals 1 mm short of working length to avoid over filling.