❶ the pulp pulling needle is usually used. There is one "0", two "0" and three "0" points for the pulp pulling needle. When the root canal is thick, select a "0" pulling needle. If the root canal is thin, select three "0" pulling needles. According to our clinical experience, when choosing the pulp pulling needle, it should be one size thin, that is, if the diameter of root canal should use two "0" pulling needles, in fact, three "0" needle should be used. This method can prevent the needle from breaking in the root canal. Especially, the bending root canal should be paid more attention to prevent needle breakage.

❷ the pulp should be removed by local anesthesia or by the method of pulp deactivation. In order to avoid the inequity of pulp extraction, we should take the film before operation, understand the structure of root canal and try to use new pulling needle as much as possible. The basic procedure of pulp pulling is as follows: the pith pulling needle is inserted into about two thirds of the root canal depth, and the root pulp is rotated gently to make the root pulp around the pith pulling needle, and then pulled out. The color and structure of pulp are different due to the degree of lesion. The normal pulp is pulled out in a strip like shape, with toughness and pink color; The pulp color is pale white or red brown with congestion; If it is a corrupt bacterial infection, it has a bad smell.
For chronic inflammation of pulp, the tissue is fragile, and it is difficult to pull out completely. The unpulping pulp can be inserted into the root canal with pullout pin or 10 K shape. It is gently vibrated. Then it is washed alternately with 3% hydrogen peroxide and normal saline to make the corrupt substance burst out of the root canal with the foam formed by the newborn oxygen.
❹ under normal conditions, for the anterior teeth exposed by trauma or accidentally penetrating the pulp, the pith pulling needle can be inserted below two thirds of the root, and the pulp can be pulled out 180 degrees by rotating as close as possible to the root tip hole. For the anterior teeth with a very thick root canal, double needle can be considered for pulp extraction.
Double needle technique
The opening and the root canal mouth were sterilized with 75% alcohol. According to the actual length of the root, first, the smooth pith needle was used, along the far and middle root canal side wall, and slowly inserted into the 1/3 part of the root tip, and slightly shaked, so that the pulp and the root canal wall were slightly separated, and a path was made for the barb pith needle. The same method is used to make the pathway in the near middle, and then insert two barb pith needles into the 1/3 root tip along the path in the near and middle. If there is resistance in the middle, it is not allowed to be forced to penetrate. The handle of the two needles is rotated 180 at the same time °， Hook the root pulp and pull it out. Avoid rough action during operation, avoid breaking in root canal and not easy to take out.
Double needle technique can fix pulp tissue better in clinical practice, and the success rate of complete extraction of pulp tissue is higher, so it is a good method to be popularized to avoid the pulp tissue tearing and causing incomplete pulp extraction.
It is difficult to completely remove the pulp by using the pulp pulling needle only in the root canal after the extraction of the pulp. Especially, the posterior teeth are in the late stage of pulpitis, and the pulp tissue is decayed. After the pulp is pulled, the pulp tissue at the tip of the root tip is often easily left. This can cause postoperative pain and affect the efficacy. The specific treatment method is: use small scale to fall (15 to 20, it is recommended not to exceed 25), slightly strengthen, repeatedly pull (note that it is Tira). If the root canal is not very curved (less than 30 degrees), it can reach the root tip generally. Then, 2 0 or 3 0 pulling needles can be inserted into the place where it cannot be penetrated, and then it can be rotated gently and pulled out. It is usually seen that there is a small and small pulp tissue at the tip of the pulp pulling needle.
If there is pulp residue in the root canal, the dry pulp liquid (ethanol saturated liquid of hydroquinone) can be twisted in the root canal for 5-7 days (root inactivation method), and then the next step is taken.
❼ before pulling the pulp, a little EDTA was added into the root canal, which could be used to lubricate the pulp, and make it easier to pull the pulp out of the root canal. This is a particularly effective method that should be used throughout all complex pulping operations. Lubrication is only one of the functions of EDTA, and EDTA has many other functions:
(1) Cao can soften the hard tissue inside the root canal, which can dissolve dentin, save the time of mechanical preparation, and help to expand the narrow and blocked root canal. It has the cleaning effect and the best efficiency time is 15 minutes;
(2) It has obvious anti microbial performance;
(3) It is not toxic to soft tissue, and can also be used as root canal flushing;
(4) No corrosion to the device;
(5) The opening of the tubules and the penetration of drugs to dentin were increased.
EDTA has a wide range of functions, and it is a kind of oral medicine which is highly praised in recent years.
If the root canal pain caused by the pulp is inevitable in the clinical follow-up, the blue blue hemp should be injected into the pulp cavity, and then the pulp should be removed thoroughly.
Finally, it is difficult to clean the pulp pulling needle after the pulp pulling needle is removed. There is a very quick method. Maybe everyone will. The specific operation is as follows:
Take a toothbrush with your right hand, take the pulp needle on your left hand, brush it from the tip of the needle to the handle with the toothbrush. At the same time, wash it with water. You can wash it up to two times. If not, left hand will take the needle clockwise rotation two times, will not be damaged to the pulp pulling needle!