Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

ELECTIVE ENDODONTICS
Elective devitalisation is the procedure that involves the purposeful
extirpation of healthy (i.e. non-inflamed, non-infected) pulpal tissue
as a prelude or aid to provision of a restoration. Pulpal tissues com-
prise part of a dentino-pulpal complex and can normally respond
dynamically to stimuli and may play a role in proprioception. As
such, the needless removal of this important tissue should be avoided;
however there are certain situations in which elective devitalisation
may still have a role.
Rationale for devitalisation
In general terms, the basis for elective devitalisation of a tooth may be
due to biological considerations, mechanical considerations or as an
aid to specific treatments.
Biological considerations
A tooth that has an extensive restoration is likely to have had multiple
previous restorations, the placement of each having caused trauma to
the pulpal tissues. These injurious insults to the tooth are thought 
to be cumulative
6
(termed ‘stressed pulp syndrome’) and further
restorations or preparation for an indirect restoration will further
stress the pulpal health. In such a situation the likelihood of sub-
sequent loss of vitality is obviously increased. When the tooth in 
question is to be restored indirectly, the problems of performing 
root canal treatment through the restoration are axiomatic. The 
problems are further compounded if the unit in question forms part 
of a larger restoration, such as a bridge retainer. In addition to the
problems of performing root canal treatment, the indirect restoration
itself is also compromised with lower survival
7
. Given the situation 
of an extensively restored tooth that requires restoration with an indir-
ect restoration and has uncertain or doubtful vitality, it is sometimes
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prudent to perform root canal treatment before provision of the
restoration.
There are also a number of other situations in which elective 
devitalisation may be performed for biological reasons: continued
sensitivity not amenable or not responsive to treatment, evidence of
progressively sclerosing canals, root resorption and treatment for
periodontal disease that involves root amputation or hemisection.