Paste based on paraformaldehyde (Toxavit, Depulpin, Caustinerf) is applied to the pulp through the trepanation hole. After 10-14 days, in a second visit, the coronary part of the devitalized pulp is removed by turbine drill with water cooling until the entrance to the root canals. All this is done without the access of saliva (without rinsing).
The remaining part of the radicular pulp is mumifified on a paraformaldehyde or iodoform base (Caustinerf Pedodontiqe, Crisphea, Maisto paste). Instead of these preparations we can use a paste based on eugenol zinc oxide. Through such protected radical pulp, the base and the definitive filling are placed. If we are not sure about the outcome or asepticity of working conditions during amputation, after the amputation of the coronary pulp at 7 to 14 days, we can put an antiseptic insert on the basis of phenolcamphora or paraclorophenolcamphora (Chlumsky, Cresophene) in a cavum with sterile cotton wool, and then perform the previously described procedure of the final supply of teeth with filling.
This method is relatively fast, simple and effective. The disadvantages are the use of aggressive preparations which puts the method into non-biological procedures and the need for more visits during the treatment of one tooth.
Mortal pulpotomy is a therapeutic procedure that is indicated for necrosis or gangrene pulp of the baby teeth. Given the indication and the therapeutic procedure, this method is not used in some countries. This primarily applies to the US and Scandinavian countries, while most European countries use this method. An alternative to this procedure is pulpectomy and endodontic surgery in its entirety, by processing and filling the root canal or tooth extraction with the afterward makin of the site holder. The clinical procedure for mortal amputation is performed as follows.
After opening the cavum, the necrotic content is removed from it, entrances in the root canals are displayed and the caries is completely removed, after this the tooth is rinsed (cavum pulp) and disinfected (Na-hypochlorite). Then an antiseptic insert based on phenolcamphora or paraklorfenolcamphora (Chlumsky, Chresophene salt) is placed in the cavum pulp, and the tooth is closed with a temporary filling for 7-14 days. If the tooth remains „calm“, that is without objective and subjective disturbances, the process of final reconstruction of the teeth is performed, as with devitalization amputation.
The procedure assumes full co-operability of a patient, anesthesia, X-ray record due to the position of root canals, cofferdam and multiple visits, which largely limits the indications for this procedure. A special feature that distinguishes this procedure from endodoncy in permanent dentition is the filling of the root canal that must be made by material that can be resorbed (ZOE paste, Ca-hydroxide or some of the iodoform paste, Crystalline).