Pulpectomy Treatment Research Articles

Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial

BackgroundPulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.Methods/designThis clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.DiscussionThis trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.Trial registrationClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

A Comparison of Preparation Times between Manual, Rotary, and Reciprocating Files in Primary Molar Pulpectomy

Abstract Aim: To compare preparation times using manual, rotary, and reciprocating files during pulpectomy treatment of primary molars. Settings and Design: This study was an in vitro, randomised, cross-sectional study. Methods: The study was performed on 60 extracted human primary mandibular second molars. Only mesiobuccal canals were prepared using one of three preparation techniques; each preparation technique group comprised 20 canals. Canal preparations were performed by a single, skilled operator using stainless-steel (ss) K-files (ISO size 20–35), a ProTaper Gold SX file, and a WaveOne Gold Medium file following glide path preparation. Preparation times were recorded in second (s) with a digital stopwatch. Statistical Analysis: Preparation times were compared using analysis of variance and the Kruskal–Wallis analysis of variance, where appropriate. The level of significance was set at P ≤ 0.05. Results: The mean preparation time using the ss K-files was significantly longer (186.4 s) than when using the ProTaper Gold SX (29.6 s) or WaveOne Gold Medium files (30.5 s) (P < 0.001). Similar preparation times were recorded when using the ProTaper Gold SX and WaveOne Gold Medium files (P = 0.939). Conclusion: Preparation times with the ProTaper Gold SX and WaveOne Gold Medium files were significantly faster than when using the ss K-files to prepare primary tooth root canals for pulpectomy. Similar preparation times were noted when using the rotary and reciprocation instrumentation groups (P > 0.05).

The difference distance between the apical foramen and the anatomical apex in primary teeth-An in vitro study.

The apex area in the primary teeth changes continuously due to the physiologic resorption, therefore; the apical foramen (AF) may not correspond to the anatomic apex (AA), which gives a big challenge to achieve successful endodontic treatment. The aim of this research was to study the difference distance (DD) between the position of the AA and AF, besides the difference acceptance (DA) in primary teeth, and the effect of the following variables: root canal curvature, resorption degree, and canal size on DD and DA separately. In this research, 180 root canals from 60 primary teeth were studied. Two lengths of each canal were measured by a K-file from a certain point in the crown; the first length was until the AA and the second was until the AF. Then DD was obtained by calculating the difference between those two lengths. Statistical analysis tests were done. A p value of <.05 was considered significant at a 95% confidence level. The percentage of canals with 0 mm DD was 34.4%, while it was 1.1% with DD of 6 mm. The percentages of acceptable ( ≤ 2 mm) and unacceptable ( > 2 mm) difference were 84.4% and 15.6%, respectively. There was a significant difference in the DD value between the three groups of curvature degree and the three groups of canal size. There was a significant difference between the DA in the three groups of canal size. DD has a wide variation value in primary teeth regardless of the degree of root resorption, which has not affected this value or the accepted difference; however, DD and acceptable difference values are somehow affected by the degree of root curvature and canal size. We recommend adding acceptable difference as a criterion when considering pulpectomy treatment in primary teeth.

Effectiveness ZnOE, Ca(OH)2 and Iodoform as Root Canal Filling Materials for Pulpectomy in Primary Teeth

Background: Dental caries is a disease that affects almost half of the world's population. A pulpectomy is an endodontic treatment by removing the entire pulp and filling the root canals of primary teeth using an appropriate root canal filling material. Root canal filling material becomes an indicator of the effectiveness of pulpectomy in primary teeth. Operators must comprehend various types of root canal filling materials available in primary dental pulpectomy treatments. Objective: This scoping review aims to obtain data on the effectiveness of ZnOE, Ca(OH)2, and Iodoform paste as root canal filling materials in pulpectomy treatment of primary teeth. Methods: This research was a scoping review. By using the PRISMA-ScR study, electronic database searches were conducted on PubMed, EBSCOhost, and Google Scholar. Results: A total of 89 articles were identified through a search on PubMed, 137 articles through EBSCOhost, 442 articles through GoogleScholar, and 48 articles through a search using Handsearching. The total number of articles identified through all the databases results in 716 articles. Using the PRISMA-ScR flow diagram to do the selection process, it results in seven articles that are eligible for review. Conclusion: As root canal filling materials in pulpectomy treatment for primary teeth, ZnOE, Ca(OH)2, and Iodoform paste were considered effective. The scoping review results in this study showed that Ca(OH)2 + Iodoform Paste (Metapex®) were better than ZnOE.

Survival Analysis and Risk Factors of Pulpectomy among Children with Severe Early Childhood Caries Treated under General Anesthesia: A Retrospective Study.

This study aims to retrospectively evaluate the survival rate of pulpectomy performed under dental general anesthesia (DGA) through long-term follow-up and to explore the risk factors associated with treatment failure. The medical records of the children who were diagnosed with S-ECC and received pulpectomy treatment under general anesthesia (GA) from 1 August 2014 to 1 December 2019, in the Stomatological Hospital of Xi'an Jiaotong University, were collected. Two dentistry postgraduates extracted the necessary information and filled in a predesigned excel form. Survival analysis was performed using the Kaplan-Meier method. The shared frailty model was used to explore possible factors affecting the success rate of pulpectomy in primary teeth. A total of 381 children (mean age 3.49 ± 0.90) with S-ECC and 1220 teeth were included in the study, including 590 primary anterior teeth and 630 primary molars. The overall 35-month survival rate was 38.5%, which was 52.9% for anterior teeth and 31.1% for molars. The overall median survival time was 31 months, in which anterior teeth were 35 months and molars were 26 months. The older the children were, the greater the risk of treatment failure (HR 1.56, 95% CI 1.09, 2.24). The risk of pulpectomy failure of primary molars was 1.9 times that of primary anterior teeth (95% CI 1.36, 2.65) and the teeth with abnormal radiological findings before treatment was 1.41 times higher than that of teeth without imaging abnormalities (95% CI 1.74, 3.36). The survival rate of primary tooth pulpectomy is acceptable but decreased gradually with time. The failure rate of pulpectomy in primary molars is higher than that of primary anterior teeth. When the primary caries has extended to the pulp and resulted in a nonvital lesion, pulpectomy could be an option for maximum retention of the primary tooth.

Influence of treatment setting on success of pulpectomy in primary molars: a retrospective analysis up to 4 years.

The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone). Data were retrieved from 92 patients' records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed. The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression. Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia.

Evaluation of quality of obturation in 6-9-year-old children.

The effectiveness of root canal therapy is dependent on the quality of obturation. The objective of the current study was to evaluate the obturation quality in pediatric patients of age 6-9 years reporting for pulpectomy treatment. Among the comprehensive data of patients attending Saveetha Dental College, a retrospective analysis of all the patients referred for pulpectomy was extracted. SPSS software version 19 was used to analyze the data gathered. Data were statistically evaluated using the Chi-square test. RESULTS: In the present study carried out, it was observed that the most frequent quality of obturation was normal (12.36%) and it is higher in the 7-year-old age category. The second frequent quality of obturation was voids (6.55%) and its higher in the 9-year-old age category. The results obtained were positively significant (P < 0.05). The most frequent quality of obturation was normal and it is higher in the 7 years category. The second frequent quality of obturation was voids with higher level in the 9 years category.

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

ObjectivesTo 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 methodsThis 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.ResultsTwo 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).ConclusionsPulpectomized 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.Based on our findings, practitioners could apply these findings and discuss with caregivers about the treatment options, outcomes, and prognosis of pulpectomized teeth.

One year clinical success of pulpectomy in primary molars with iodoform-calcium hydroxide paste.

In order to retain primary molars, eg with irreversible pulpitis or pulp necrosis, pulpectomy can be an alternative to extraction. However, reports on the success of pulpectomies in primary teeth vary widely in the literature. Thus, the objective of this study was not only to analyze the success rate of primary tooth pulpectomy 12 months posttreatment in the setting of a specialized clinic, but also to identify and analyze various factors that modify the outcome. Between 2012 and 2018, a total of 76 dental records of the Department of Preventive and Pediatric Dentistry at the University of Greifswald fulfilled the inclusion criteria, resulting in a 1-year analysis of 62 primary molars with an idoform-calcium hydroxide paste as root canal filling material almost exclusively covered by a stainless steel crown as restoration. The pulpectomy treatment was successful after 1 year in 93.5%, with a significantly higher survival for mandibular primary molars (100.0% vs 83.3%; chi-square test P = .01). Apart from the very few cases in the mixed dentition, no other factors related to the patient (sex, caries level, general health conditions, distance to clinic), tooth (first or second primary molar, pulpal and periapical condition before treatment), or treatment (indication, academic qualification of the operator, number of visits) proved to be of significance for the treatment outcome due to the overall high success rate. Pulpectomies for pulpally involved or even necrotic primary molars followed by stainless steel crowns as restoration should be considered as a treatment option, especially in the mandible. (Quintessence Int 2021;52:528-537; doi: 10.3290/j.qi.b1244443).

Effect of Adaptive, Rotary, and Manual Root Canal Instrumentation in Primary Molars: A Triple-Armed, Randomized Controlled Clinical Trial.

Simple SummaryUntimely loss of primary molars may lead to undesirable consequences; hence, pulpectomy is considered a rational treatment approach to avoid it. Advances in root canal instrumentation by means of motorized files while treating primary teeth have reduced the chair-side time and have also exhibited better quality of obturation. This helps reduce the patient’s anxiety about pulpectomy procedures. However, root canals in primary teeth exhibit a larger perimeter and are irregular in shape, posing a challenge to currently used motorized endodontic files. Instrumenting root canals in three dimensions is the need of the hour and is vastly explored in the literature, albeit for adult dentition. The application of adaptive root canal instrumentation for pulpectomies in primary teeth is yet to be reported in the literature.This clinical trial focused on collating the instrumentation time and quality of root canal obturation in primary molars treated with three instrumentation techniques: adaptive, rotary, and manual. A triple-armed, randomized controlled clinical trial was performed on 75 primary molars requiring pulpectomy treatment, divided into three groups (n = 25 per group). The teeth in Group 1 were instrumented with an adaptive technique (XP-endo Shaper, FKG Dentaire, La Chaux-de-Fonds, Switzerland), Group 2 with pediatric rotary files (Kedo-S; D1 and E1), and Group 3 with a manual technique (hand K-files). The apical size of the final instrumentation was maintained at #30 for all groups. Instrumentation time and the grade of the root canal obturation were evaluated. Instrumentation duration was recorded, employing a digital stopwatch from the insertion of the first file until the completion of final irrigation. Obturation quality was assessed using radiographs. The criteria taken as a reference for obturation were: optimal (1 mm short of the apex), underfilled (2 mm short of the apex), or overfilled (beyond the apex). The use of an adaptive technique was associated with the lowest instrumentation time (p < 0.0001) when used for instrumenting primary molars and with the highest root canal filling quality of the three groups. The application of the new concept of adaptive instrumentation for pulpectomy of primary molars was a favorable technique, considering the significant reduction in instrumentation time and better obturation.

Obturation Techniques in Primary Teeth

Dental caries is a global concern affecting children and adults. A pulpectomy is considered to be the treatment of choice to preserve the pulpally involved primary teeth. Among the various factors determining the clinical success of pulpectomy, proper obturation of the root canals plays an important role. Different obturation materials are being used for the obturation of the primary teeth root canal, which includes zinc oxide eugenol, calcium hydroxide, calcium hydroxide iodoform paste and combinations. These materials are available in different forms such as powder, powder and liquid, paste forms. Various techniques are available to introduce the obturation materials into the root canal systems. These techniques have been tried to create a three-dimensional fluid-tight seal of the root canals. This review article aims to highlight the different techniques that are being used for the obturation of primary teeth. Each technique has its advantages and disadvantages. Creation of voids within the obturation, underfilling or overfilling are the common problems that can be encountered during root canal obturation. These factors can compromise the clinical and radiographic success of pulpectomy treatment. With the current evidence, no definitive conclusions can be made to decide which is the best obturation technique in terms of clinical and radiographic success. The choice of technique selection depends on the clinician’s preference, cost-effectiveness, time consumption, ease of handling.

Clinical Management of Intra-Pulp Canal Broken Endodontic Files in Primary Teeth: Literature Review

Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption.

Pulpectomy in Maxillary First Molars With Distal Caries

Dental caries is having the most prevalence of the chronic disease in pediatric patients. It is considered as the most unmet health care for society with the lowest socioeconomic status. If dental caries is not treated with proper treatment, it may develop more complicated consequences in various aspects such as dental, medical, social, and life quality. The aim of this present study was to evaluate the pulpectomy procedure in maxillary first primary molars with distal caries in the Chennai population visiting the Outpatient Department of Saveetha Dental College and Hospital, Chennai based on their gender and age. A total of 199 patients details aged between 4 and 11 years old obtained from patients records to assess pulpectomy treatment done with distal caries involved, with their gender and age. Data analysis was done with the Statistical Package for Social Sciences (SPSS) for Windows (version 20). Chi-square test was used to determine the association of occurrence pulpectomy with distal caries involvement in a maxillary first primary molar, gender, and age. In this present study, the prevalence of male patients was 56.8% and for females was 43.2% with p&gt;0.05 (statistically insignificant). Males patients more prevalent for pulpectomy due to distal caries. Patients in the age group between 4 and 5 years old have a higher prevalence (55.7%) with p&gt;0.05. The most prominent teeth number affected by distal caries was left maxillary first primary molar-64, with 52.8% prevalence. Within this limit of this study, this study showed that the prevalence of pulpectomy in maxillary first primary molars due to distal caries was more in males than females, and higher incidence for age between 4 and 5 years old, with the most affected tooth was left side, 64.

In vivo evaluation of zinc oxide-propolis mixture as root canal filling material in the primary molars: A 24-month follow-up randomized controlled trial.

Pulpectomy is a routine practice in children with pulpal and periapical infections, the success of which depends on the elimination of bacteria from the root canals. Propolis, a natural product with proven antibacterial and anti-inflammatory properties when mixed with zinc oxide powder as root canal filling material, it could provide good success in endodontic therapy of primary teeth. The aim was to evaluate and compare the clinical effectiveness of zinc oxide-propolis mixture with zinc oxide eugenol (ZOE) as root canal filling material in nonvital primary molars. This was a 2-arm, parallel group randomized controlled trial with blinded outcome assessment. Forty primary molars from children aged 4-8 years requiring pulpectomy treatment were randomly allocated into two groups according to the obturating material used: zinc oxide-propolis mixture (test group) and ZOE (control group). All the pulpectomy treated teeth were finally restored with stainless steel crowns, and the children were recalled at 6, 12, and 24 months for postoperative clinical and radiographic evaluation. Chi-square test was used to analyze the data. The overall success rate of pulpectomy with zinc oxide-propolis mixture and ZOE was found to be 95% and 70%, respectively, and the difference was statistically significant (P = 0.037). Zinc oxide-propolis mixture has shown a success rate of 100% at 6 months and 95% at 12 and 24 months follow-up, whereas ZOE has shown 80% success rate at 6 and 12 months, and it declined to 70% at 24-month follow-up. Zinc oxide-propolis mixture demonstrated good clinical and radiographic success at the end of 24 months, and hence, it can be considered as an alternate root canal filling material in the primary teeth.

Clinical and radiographical evaluation of single- versus multiple-visit pulpectomy treatment in primary teeth with apical periodontitis

Context: This study highlights success rate as well as advantages and disadvantages of single- versus multiple-visit pulpectomy in children. Aims: This study was aimed to compare the success rate of single- and multiple-visit pulpectomy in primary teeth with apical periodontitis. Settings and Design: It was a randomized, double-blind study. The study was conducted in children with one or more restorable sixty primary molars with deep carious lesions and requiring pulpectomy in the age group of 4–8 years. Subjects and Methods: Selected teeth were divided into two groups of thirty each and treated either in single visit or multiple visits. Follow-up was done at the period of 1 month, 3 months, and 6 months and evaluated using Gutmann criteria. Statistical Analysis Used: The normality of data was checked by Shapiro–Wilk test. Intragroup comparison was made by using Friedman test and post hoc-Wilcoxon test. Mann–Whitney U-test was used for inter group comparison. Results: Clinical and radiographical success for both group showed statistically significant (P 0.05) was obtained when clinical outcome was compared between two groups. Although radiographical success for multiple-visit group is slightly more than the single-visit group at all time intervals, statistically it was not significant (P > 0.05). Conclusions: Single-visit can be considered a viable alternative to multiple-visit pulpectomy considering its various advantages, especially in children.

Quantitative Analysis of Lactobacillus and Enterococcus faecalis between Irreversible Pulpitis and Pulp Necrosis in Primary Teeth

Introduction: Root canal infection is a common consequence of dental caries which can cause premature loss in primary dentition. The exposure of pulp tissue to the oral environment allow oral microorganisms to access into the pulp chamber and lead to pulp necrosis without treatment. To identify bacteria associated with root canal infection would be beneficial and lead to providing more effective treatment. Aims: To quantify Lactobacilli and Enterococcus faecalis levels in infectious root canal of primary teeth between irreversible pulpitis and pulp necrosis groups, and to analyze the association between these bacteria and clinical signs and symptoms. Materials and methods: Total subjects were 170 Thai children aged 2-10 years old. All subjects were selected from patients who came to the pediatric dental clinic, Pediatric Department, Faculty of Dentistry, Mahidol University, Thailand and needed a pulpectomy treatment. DNA extraction and quantitative real-time PCR was performed. Results: Mean age of the children was 5 ± 1.3 years old. One hundred and ten samples were diagnosed with irreversible pulpitis and 60 with pulp necrosis. One hundred and seven subjects (63%) had a history of pain. One hundred and twenty subjects (71%) had clinical signs and symptoms. One hundred and thirty-four radiographs (79%) showed radiographic pathology. The detection of total bacteria, Lactobacillus and E. faecalis was 100%, 100% and 84% (142/170), respectively. The ratio of Lactobacillus and E. faecalis to total bacteria levels was 20% and 9%, respectively. When compared between irreversible pulpitis and pulp necrosis groups, the quantities of total bacteria (p=0.000), Lactobacillus (p=0.000) and E. faecalis (p=0.001) in pulp necrosis group were higher than those of the irreversible pulpitis group. The ratio of Lactobacillus to total bacteria in the pulp necrosis group was higher than in the irreversible pulpitis group (p=0.004), whereas the ratio of E. faecalis to total bacteria was not different between the two groups. Only Lactobacillus was associated with a history of pain (p=0.013). Gingival swelling was correlated with Lactobacillus quantities (p=0.01). When analyzed within each group, E. faecalis quantity was correlated with clinical pain (p=0.01) in pulp necrosis group. In the irreversible pulpitis group, the data showed pathologic finding of lamina dura (p=0.000) and furcation involvement (p=0.016) which correlated with E. faecalis quantities. Conclusion: The bacterial levels of total bacteria, Lactobacillus and E. faecalis in pulp necrosis group were higher than the irreversible pulpitis group. Levels of Lactobacillus and E. faecalis were associated with a history of pain, pathologic finding of lamina dura and furcation involvement. Gingival swelling was correlated with Lactobacillus quantities.

Clinical and Radiographic Characteristics of the Primary Teeth Indicated For Pulpectomy: A Cross-Sectional Analysis

Introduction- Although difficult to achieve but an accurate diagnosis of pulp status is important for the success of pulp therapy in primary teeth. Clinical signs and symptoms, as well as radiographic characteristics, are important in this regard. Material and methods- This cross-sectional analysis evaluated the clinical and radiographic characteristics in 60 decayed primary mandibular second molars from children aged 4-8 years indicated for single visit pulpectomy treatment based on their history, clinical examination and radiographic examination. Results- Pain was present in 60% of cases followed by tenderness on percussion (1.7%) and sinus tract (1.7%). Evaluation of duration of onset of pulpal involvement revealed 86.7% cases had chronic involvement whereas 13.3% cases showed an acute exacerbation of chronic involvement. Irreversible pulpitis was present in 68.3% cases followed by pulp necrosis in 28.3%. Only 7 out of 60 cases indicated for pulpectomy showed radiographic involvement in periapical or furcation areas. Conclusion- Pain was the most common symptom. Majority of cases had chronic involvement and irreversible pulpitis was the most common indication for pulpectomy followed by pulp necrosis. Only a few cases indicated for pulpectomy in the present study had radiographic involvement present.

Manual versus rotary instrumentation for primary molar pulpectomies- A 24 months randomized clinical trial

ObjectiveThe study compared manual and rotary canal instrumentation differences in primary molars receiving pulpectomy and their effect on clinical success after two years. Materials and methodsSixty pulpally involved primary mandibular second molars requiring pulpectomy treatment were randomly assigned for manual or rotary instrumentation in children aged 4–7 years. The endodontic procedural steps were similar except the method of root canal instrumentation i.e. manual group (Stainless steel files 2% taper) and rotary group (Hyflex CM NiTi rotary files 4% taper). ResultsThe mean instrumentation time for the manual and rotary groups were 25.71 ± 3.84 and 19.37 ± 4.94 min respectively with a statistically significant difference (p < 0.001) between the groups. The differences between the groups' obturation time, quality of obturation, and complications during instrumentation were not statistically significant (p > 0.05). At 24 months, the clinical success was 92.3% and 85.2% (p = 0.52) whereas the radiographic success was 65.4% and 66.7% (p = 0.78) comparing the manual and rotary groups respectively. ConclusionRotary instrumentation takes significantly less time than manual. There was no difference in obturation time, quality of obturation, or success rates after 24 months.

Non instrumented endodontic technique using CTZ paste

Dental treatments in children are very complex to carry out and depend on different factors to obtain a clinical success, mainly depending in: selection of materials, clinical abilities and patient ́s cooperation.&#x0D; Objective: To know the biological properties of the CZT paste, as well as its advan-tages and disadvantages compared with other materials currently used in pulpar therapy in children.&#x0D; Method: A pulpectomy treatment was carried out by NIET (non-instrumented endodontic technique in the Pediatric Dentistry Clinic of the Postgraduate School, School of Dentistry, UNAM. All patients presented pulpar necrosis.&#x0D; Results: Recent studies have shown that the components of the CZT paste are more effective in pulpectomy treatment than other materials, finding asymptomatic patients after two weeks of treatment with this paste. Radiographic examination after 2, 4 and 6 months revealed a reduction or stabilization of the periapical lesion.&#x0D; Conclusions: The CZT paste has shown excellent results and reduces the bacteria concentration to minimal level. The characteristics of this paste allow the clinician to carry out pulpar treatment in less time and to obtain superior results comparing with conventional techniques.

Awareness and Attitude of Patients’ Parents Toward Pulp Therapy of the Primary Teeth: A Cross-Sectional Survey

Aim: To assess the awareness of patient’s parent attitude toward pulp therapy of teeth. Materials and methods: A set of questions with multiplechoice answers were formulated. Questionnaires in local language (Hindi) were personally distributed for data collection. The demographic details were collected from the parents. The questionnaire assessed the parental knowledge and awareness about primary teeth, attitude toward treatment of decayed or infected primary teeth, and their willingness to comply with the treatment options. The respondents were asked to indicate the most appropriate answer from the given list of options. The collected data were tabulated and subjected for statistical analysis. Results: In our study, the number of urban patients (24) seeking treatment was less as compared with rural patients (26). Pain and associated features were the most common reasons for visiting the dental clinic. There was 32% urban and 30% rural parents that know about pulpectomy treatment in primary teeth; 16% of urban and 22% of rural parents did not know about pulpectomy treatment. A major percentage of both urban (30%) and rural (24%) populations thought that there is a need for primary teeth treatment. Conclusion: We, as professionals, need to create more awareness among the populace of our country about the significance of maintaining a healthy primary dentition and attendant sequelae of not doing so.