Pulpectomy

A pulpectomy is the complete removal of all pulp tissue from the pulp chamber and root canal system of a tooth, performed when the pulp is irreversibly inflamed or necrotic and cannot be preserved through more conservative vital pulp therapy. In permanent teeth, pulpectomy constitutes the tissue removal phase of conventional root canal therapy, after which the cleaned and shaped canals are obturated with a permanent filling material such as gutta-percha. In primary teeth, pulpectomy follows a similar debridement protocol but uses a resorbable filling material, typically zinc oxide eugenol paste, that will resorb along with the primary tooth root as the permanent successor develops and erupts.

The distinction between pulpectomy and pulpotomy is clinically significant. A pulpotomy removes only the coronal pulp tissue within the chamber while preserving the vital radicular pulp in the root canals, and it is indicated when inflammation is confined to the coronal portion. A pulpectomy is indicated when infection or necrosis extends throughout the entire pulp system, including the radicular tissue. Diagnostic criteria for selecting between these procedures include the presence of spontaneous pain, periapical radiolucency on radiographs, purulent drainage, and the extent of pulp bleeding quality observed during treatment. In pediatric dentistry, pulpectomy on primary teeth serves the important function of preserving the tooth as a natural space maintainer, avoiding the need for an appliance and supporting normal development of the permanent dentition.

Billing accuracy for pulpectomy requires careful attention to the CDT code set, which assigns distinct codes for pulpectomy on primary versus permanent teeth and separates the pulpectomy procedure from the subsequent canal obturation in permanent teeth. Submitting a pulpotomy code when a pulpectomy was performed results in significant underpayment, while the reverse constitutes upcoding. Clinical documentation should specify the diagnosis, the extent of pulp involvement, the instrumentation technique, the irrigants used, and the obturation material placed. Insurance plans covering pediatric dental services generally reimburse primary tooth pulpectomies under the preventive or basic benefit tier, though coverage policies vary and should be verified before treatment.