Pulpectomy versus Extraction for the Treatment of Nonvital Primary Second Molars: A Retrospective Chart Review

The current investigation evaluated parameters leading to the utilization of pulpectomy versus extraction for treatment of nonvital primary second molars. Study design: This retrospective chart review identified patients up to 8-years of age with primary second molars treated by pulpectomy or extraction. Patients in the extraction group were age and gender-matched to the pulpectomy group. Demographic, clinical, radiographic and behavioral data were extracted for comparison. Chi-square, Fisher and T-test were performed for statistical analysis. Results: There were 23 patients in each group, with a mean age of 5 years (ranging 3-8 years, ±1.5 for pulpectomy and ±1.3 for extraction). Significantly more pulpectomies were performed in the mandible (p=0.002), specifically on the left side (p=0.0035). Internal and external root resorption were significantly higher in the extraction group (p=0.033 and p=0.007 respectively). Restorability was significantly lower in the extraction group (p<0.0001). Pre-procedural pain was reported by 76.5 percent of all patients, but pharmacologically treated in 15.2 percent. Nitrous oxide was administered to 73.9 percent of patients for behavior guidance. Conclusion: Pathologic root resorption and nonrestorability were significantly higher in the extraction group. Behavior and pathologic bone resorption did not influence treatment choice. A higher proportion of children reported pre-treatment pain and needed adjunctive behavior guidance than children who did not have pre-treatment pain or did not need adjunctive behavior guidance.

Pulpectomy, extraction, primary teeth, children

1. Ngan P, Alkire RG, Fields H. Management of space problems in the primary and mixed dentitions. J Am Dent Assoc. 1999;130(9):1330-1339. doi: S0002-8177(14)65850-5 [pii].

2. Dean JA. McDonald and avery’s dentistry for the child and adolescent. Tenth ed. St. Louis, Missouri: Elsevier; 2016:221-242.

3. Hargreaves KM. Cohen’s pathways of the pulp. Eleventh ed. St. Louis, Missouri: Elsevier; 2016:e1-e44.

4. Guideline on pulp therapy for primary and immature permanent teeth. Pediatr Dent;38(6):280-288. 2016

5. Burrus D, Barbeau L, Hodgson B. Treatment of abscessed primary molars utilizing lesion sterilization and tissue repair: Literature review and report of three cases. Pediatr Dent;36(3):240-244. 2014.

6. Dunston B, Coll JA. A survey of primary tooth pulp therapy as taught in US dental schools and practiced by diplomates of the american board of pediatric dentistry. Pediatr Dent; 30(1):42-48. 2008.

7. Boonchoo K, Leelataweewud P, Yanpiset K, Jirarattanasopha V. Simplify pulpectomy in primary molars with a single-file reciprocating system: A randomized controlled clinical trial. Clin Oral Investig. 2019. doi: 10.1007/ s00784-019-03130-5 [doi].

8. George S, Anandaraj S, Issac JS, John SA, Harris A. Rotary endodontics in primary teeth–A review. Saudi Dent J. 2016;28(1):12-17. doi: 10.1016/j. sdentj.2015.08.004 [doi].

9. Priyadarshini P, Jeevanandan G, Govindaraju L, Subramanian EMG. Clinical evaluation of instrumentation time and quality of obturation using paediatric hand and rotary file systems with conventional hand K-files for pulpectomy in primary mandibular molars: A double-blinded randomized controlled trial. Eur Arch Paediatr Dent. 2020. doi: 10.1007/s40368-020- 00518-w [doi].

10. Mortazavi M, Abbasi A, Khodadadi E. Comparison of the success rate and cleaning time of pulpectomy in necrotic primary molar teeth using manual and rotary instruments. Journal of Dentistry. 2005;6(1,2):111-119. http:// dentjods.sums.ac.ir/article_41502.html.

11. Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatr Dent;18(1):57-63. 1996.

12. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status–historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-379. doi: 10.1111/anae.14569 [doi].

13. Nusstein JM, Reader A, Drum M. Local anesthesia strategies for the patient with a “hot” tooth. Dent Clin North Am. 2010;54(2):237-247. doi: 10.1016/j.cden.2009.12.003 [doi].

14. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). Core elements of antibiotic stewardship. https://www.cdc.gov/. Updated 2019. Accessed April 13, 2020.

15. Use of antibiotic therapy for pediatric dental patients. Pediatr Dent. 2018;40(6):383-385.

16. Hargreaves KM. Cohen’s pathways of the pulp. Eleventh ed. St. Louis, Missouri: Elsevier; 2016:660-683.

17. Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog. 2007;54(1):9-18. doi: 0003-3006-54-1-9 [pii].

18. Chompu-Inwai P, Simprasert S, Chuveera P, Nirunsittirat A, Sastraruji T, Srisuwan T. Effect of nitrous oxide on pulpal anesthesia: A preliminary study. Anesth Prog. 2018;65(3):156-161. doi: 10.2344/anpr-65-02-08 [doi].