Can You Use a Bur to Remove Coronal Pulp in a Pulpotomy?
Yes, a bur can be used to remove the coronal pulp during pulpotomy in pediatric patients, and this is explicitly described in FDA-approved protocols for formocresol pulpotomy in primary teeth. 1
Standard Technique for Coronal Pulp Removal
The FDA-approved formocresol protocol specifically states two acceptable methods for removing coronal pulp during pulpotomy in primary teeth:
- Remove the coronal pulp with an excavator or bur, leaving the radicular pulp intact 1
- Both instruments are considered appropriate for achieving the goal of amputating the coronally infected pulp tissue while maintaining vitality of the radicular pulp 2
Critical Technical Considerations
When using a bur for coronal pulp removal during pulpotomy:
- Achieve complete hemostasis after removing the coronal pulp before placing any medicament 1
- The radicular pulp stumps must be left intact and vital, as the goal is to preserve the vitality and function of the remaining radicular pulp 2
- Rubber dam isolation is mandatory before beginning the procedure to prevent contamination 1
Common Pitfalls to Avoid
The most critical error is removing too much tissue and damaging the radicular pulp, which would compromise the entire purpose of pulpotomy as a vital pulp therapy. The distinction between pulpotomy (removing only coronal pulp) and pulpectomy (removing all pulp tissue) must be maintained 3.
Another common mistake is failing to achieve hemostasis before placing the medicament. If bleeding cannot be controlled after removing the coronal pulp, this suggests the inflammation extends into the radicular pulp, and pulpotomy may not be the appropriate treatment 4.
Evidence Quality Note
While the FDA label 1 provides the clearest procedural guidance, multiple high-quality studies confirm that the method of coronal pulp removal (bur versus excavator) is less important than operator experience and final restoration quality. Research shows experienced operators achieve 100% clinical success rates at 2 years regardless of the specific instrument used for pulp removal 2.