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

Objectives: 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].