Abstract
Objective: The aim of this clinical study was to evaluate the survival rate of a new pulpectomy protocol using2% chlorhexidine digluconate gel and Feapex paste for endodontic treatment in primary teeth. Material andMethods: A total of 105 pulpectomies were performed in anterior and posterior teeth of 48 infants (1-3 yearsold) with high caries experience with irreversible pulpitis or pulp necrosis. All treatments were performed bydental surgeons with no specialization in Pediatric Dentistry, under local anesthesia and rubberdam isolation.Manual files were used in conjunction with 2% chlorherixidine gel for root canal instrumentation, and Feapex®paste was used as a obturation material. The clinical and radiographic outcomes were collected by one trainedindependent evaluator with a follow-up period of 24months. Success was determined by the absence of pain,pathological mobility, pathologic bone rarefaction, pathological root resorption and soft tissue pathology aroundthe affected tooth Survival of the endodontic treatment was evaluated by estimating survival rates throughKaplan-Meier curves. Cox Regression analysis with shared fragility were performed to evaluate the associationbetween the independent variables to endodontic treatment failure (alpha=5%). Results: After 24 months, thetreatment survival was 86% (SE=0.03). Root resorption at baseline was associated with a higher risk of failure(HR=2.81; CI=1.12-7.08; p=0.027). The survival rate of the endodontic treated teeth due to dental traumawas 100%, while teeth with dental caries had lower survival rate (85.05%; p<0.001*). Other variables analyzedincluded gender, age of the child, tooth position (incisor/molar), restoration type, obturation quality, andcaries experience were not associated with treatment failure (p>0.05). Conclusion: The new protocol using2% chlorhexidine digluconate and Feapex® presented a high survival rate and can be considered as a suitableprotocol for pulpectomy in primary teeth.Trial Registration: REBEC (RBR-282s2f).KEYWORDSRoot canal treatment; Primary teeth; Infants; Pulpectomy.
Highlights
In Brazil, irreversible pulpities and pulp necrosis caused by dental caries and trauma to primary teeth is still very common [1,2]
There are two clinical approaches for managing infected or necrotic molars: endodontic treatment and non-conservative treatment [8,9]. Both approaches are used around the world in the primary dentition, and the treatment decision is based on different philosophies and socio-cultural contexts due to the lack of evidence on the best approach to treat these teeth between professionals and countries [10,11]
We investigated the possible association of the independent variables to the endodontic treatment failure, such as age of the child, gender, restoration material used, tooth, pain in the baseline, tooth condition, type of pulp involvement, obturation quality, caries experience, root resorption at the baseline
Summary
In Brazil, irreversible pulpities and pulp necrosis caused by dental caries and trauma to primary teeth is still very common [1,2]. With regard to the treatment of severe dental caries with pulpal involvement, a systematic review concluded that there is insufficient evidence to support the superiority of one type of treatment for primary molars due to the lack of reliable evidence [8]. There are two clinical approaches for managing infected or necrotic molars: endodontic treatment (pulpectomy in primary teeth) and non-conservative treatment (dental extractions) [8,9]. Both approaches are used around the world in the primary dentition, and the treatment decision is based on different philosophies and socio-cultural contexts due to the lack of evidence on the best approach to treat these teeth between professionals and countries [10,11]. Pulpectomy has gained strength since one of the main purposes of Pediatric Dentistry is the maintenance of the deciduous teeth in the arch under anatomical-functional conditions until the time of its physiological exfoliation [13]
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