Milk tooth with deep cavity, multiple facets, and possible pulp approximation and exposure is better treated for pulpotomy procedure and subsequent steel crown restoration The radiograph must reveal no bifurcation radiolucency nor thickening of the apical lamina dura. There should be no history of prolonged/ unprovoked pain.Treatment should be done absolutely under rubber dam. Caries shoudl be removed before entry to the chamber to minimize contamination using an appropriate round bur. Upon entry to the chamber, there should be healthy pulp attested by its intact pulp tissue (if entry to the pulp was done precisely), pulp tissue stops bleeding normally, no hemorrhaging emanating from the canal tissue. Pulp stump should be cut clean.

Apply ferric sulfate-soaked cotton pledget on the pulp stump for a few seconds. Wash with sterile water. Dry. By this time , the pulp stump should be dry. No fresh bleeding. It should look black but with not much blood clot.

The appearance of a treated pulp stump. No new bleeding. No bleeding emanating from the canal,

Mix IRM into a slightly doughy consistency. Apply to the the pulp stump with care, without much pressure. Fill to the brim. For severely broken crown, a reinforced glass ionomer may be useful to serve as body on top of the IRM,

While the IRM is setting reduction may commence. IF crown is the one clamped, one may remove the dam to facilitate reduction,using flame-shaped or bigger round bur for the occlusal, and tapering fissure bur for the proximal careful not to damage the adjacent teeth.CARE should be exercised to minimize gingival margin injury while reducing. Very small reduction is done on both buccal and lingual surfaces.

Trial Fitting. Using 3m-NiChro Stainless Steel crown, try the crown that should fit SNUGLY making sure that the margins of the proximal hug exactly on the tooth(poor or large- sized crown will create a problem for the future eruption of the adjacent tooth because the bottom distal edge of the crown might be caught by the erupting tooth, thus preventing it from coming out!)Bore a small hole near the bottom end of the lingual surface of the crown for the dental floss as a hold in case the crown falls lest the patient swallows it accidentally!

Use Fuji 1 cement and let it flow out of the crown while seating and pressing it down, not forgetting the floss to be slided out while the cement has not yet set. Remove excess cement after it has set. In a week , the gingival margins will completely heal, and the patient can eat well without discomfort to the previously carious tooth.
A fulfilling feeling! Now the second molar is ready to erupt with an eruption guide.
Again we have prevented another malocclusion nightmare in the making!