Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth

Abstract

Objectives: To evaluate the survival rates of pulpectomized primary teeth treated under general anesthesia (GA) or local anesthesia (LA), and to determine which factors affected tooth survival following pulpectomy. Materials and methods: This retrospective study collected data from dental records. Patients under 5 years of age received dental treatment under GA or LA during 2007-2016, with at least one anterior or posterior tooth receiving a pulpectomy, were recruited. Pulpectomy was considered a failure if the tooth required extraction or retreatment due to pulp treatment failure. Survival analysis was used to assess the outcome. The cumulative survival probability was analyzed with the Kaplan-Meier estimator. Cox regression analysis was used to evaluate the associations between tooth survival and possible prognosis factors; sex, age, dental arch (upper/lower), tooth type (anterior/posterior), molar type (first/second molar), molar location (upper/lower molar), root filling material type, restoration type, preoperative radiographic findings and presence of pathologic root resorption.Results: Two hundred and twenty-seven primary teeth were included. At the 5-year follow-up, the survival rates of the pulpectomized teeth treated under GA and LA were 81.4% and 87.4%, respectively, which were not significantly different (p ≥ 0.05). A radiolucency on the preoperative radiograph was the only factor associated with tooth extraction or retreatment following pulpectomy, with a hazard ratio of 3.88 (95% CI = 1.29-11.65).Conclusions: Pulpectomized primary teeth treated under GA and LA demonstrated high survival rates. Preoperative radiolucency is a possible associated factor that decreases tooth survival following pulpectomy. Why this paper is important• Pulpectomy treatment under GA and LA provided high 5-year cumulative survival rates, which were not significantly different.• Pulpectomy treatment in teeth with a preoperative radiolucency were 3.9-fold as likely to fail as teeth without pathology.

An approach of preserving a mandibular primary second molar by a hemisection procedure: A case report with 36-month follow up

“…Therefore, decayed teeth might require extraction in some cases, which will lead to early loss of primary teeth. Children, eventually, may suffer from masticatory disorder, non-aesthetic smile among their peers and psychological problems [ 5 ]. Recent studies encourage clinicians to maintain primary teeth in the oral cavity by doing pulpectomy as an alternative treatment to extraction, especially if they are able to restore (good tooth structure) and do not have severe symptoms in the mobility and abscess [ 5 , 14 ].…”

“…Children, eventually, may suffer from masticatory disorder, non-aesthetic smile among their peers and psychological problems [ 5 ]. Recent studies encourage clinicians to maintain primary teeth in the oral cavity by doing pulpectomy as an alternative treatment to extraction, especially if they are able to restore (good tooth structure) and do not have severe symptoms in the mobility and abscess [ 5 , 14 ]. Moreover, a retrospective study done to evaluate the survival rate of pulpectomized primary teeth (227 in total) for patients under 5 years old with a 5 year follow up after the treatment.…”

“…Moreover, a retrospective study done to evaluate the survival rate of pulpectomized primary teeth (227 in total) for patients under 5 years old with a 5 year follow up after the treatment. The results showed that 87% of primary teeth treated by pulpectomy with local anesthesia, had survived [ 5 ]. On the other hand, another study recorded the long-term outcomes of pulpectomy done to preserve primary teeth (592 in total) with pulpitis or pulp necrosis over a two and a half year follow up.…”

“…Providing preventive treatment like fluoride application and removing caries followed by filling restorations are considered common procedures [ 4 ]. However, dentists with advanced S-ECC cases have only two options in the majority of cases, either root canal treatment (pulpectomy) with crown reconstruction, or extraction of the affected primary teeth and to provide a space maintainer to preserve space for the erupting permanent teeth [ 5 ]. The child's behavior and their cooperation also play a crucial role in the dentists' final decision [ 6 ].…”

“…Primary teeth have a variable and complicated canal system; therefore, understanding the morphology of the human dentition is the key to doing an effective root canal treatment. Doing a root canal treatment with insufficient knowledge of root morphology may result in the case failure, especially when inadequate procedures and instruments are used [ 5 , 10 ]. Mandibular primary second molars usually have two root canals, and it is common to find accessory roots in the furcation area.…”