pulpotomy will be done I primary molars with occlusal or proximal decay and level of cytokines will be measured as an indicator for pulp inflammation levels
Children with provoked pain.
Caries in proximal surface to the dentine full thickness.
Caries in occlusal surface to the dentine full thickness.
Radicular pulp health is verified by achieving hemostasis within eight minutes of compression using a cotton pellet with 5% sodium hypochlorite.
Unrestorable primary molars.
Primary molars with spontaneous pain.
Medically compromised patients who have systemic disease.
Uncooperative children who refuse treatment.
Parallel
Pulpotomy
Procedure/Surgery* Local anesthesia will be administered, and the tooth will be isolated with a rubber dam. * To minimize further bacterial contamination, carious tissues will be removed progressively, starting from the cavity periphery and then over the pulp chamber roof. * Before managing the pulpal hemorrhage, a sterile cotton pellet will be placed over the pulp tissue for 30-45 s. * A fresh sterile bur will be used to remove all coronal pulp tissue down to the root canal orifices, with copious water irrigation * MTA will be used as medicament of choice for pulpotomy. * The pulpotomy-treated tooth will be prepared to receive a full-coverage stainless steel crown (SSC) after the procedure.
Measuring Cytokines level
Other interventionmeasuring cytokines level as an indicator for pulp inflammation
Post operative Pain
The Visual Analogue Scale (VAS) measures pain intensity. The VAS consists of a 10cm line, with two end points representing 0 ('no pain') and 10 ('pain as bad as it could possibly be'). Ask the patient to rate their current level of pain by placing a mark on the line. Use a ruler to measure the distance in centimetres from the 'no pain marker' (or zero) to the current pain mark. This provides a pain intensity score out of 10; for example, 6 out of 10 (or 6/10).
Preapical lesion
by Clinical examination: presence of Swelling, sinus tract, or fistula: ,(binary outcome: present or absent )
Pain on percussion
Tapping the tooth with the blunt end of the mirror binary outcome: present or absent
Mobility
using Miller's mobility test :involves holding the tooth firmly between two instruments and assessing its mobility on a scale from 0 to 3. A score of 0 indicates no detectable movement, while scores of 1-3 represent increasing degrees of mobility. it will be measured as present for any score from 1 to 3 (binary: present or absent)
radiographic success
using Digital periapical intraoral radiograph Radiographic Success: • Radiolucency at the furcation or periapical area, internal or external root resorption, will be examined (present or not) through digital periapical radiographs. Criteria for radiographic success * No evidence of extensive pathologic root resorption. * No evidence of pathological interradicular and/or periapical radiolucency. * No evidence of the development of pathologic radiolucency involving the successor tooth germ.
Cytokines level
blood sample will be collected from exposed pulp chamber before removal and IL-8 \& IL-10 levels will be measured using Enzyme-linked immunoassay ( ELISA) kit. unit of measurement: ng/L
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