Ovidental Editorial Team
hola@ovidentalgo.com
The preservation of primary teeth is vital for the proper development of a child's permanent dentition.
When the dental pulp of a primary tooth is compromised due to deep caries or trauma, the clinician must decide between two primary treatment options: pulpectomy or extraction.
Pulpectomy in Primary
Teeth
Pulpectomy involves the complete removal of the inflamed or necrotic pulp tissue from a primary tooth, followed by cleaning, disinfecting, and filling the root canals with a resorbable material.
This procedure aims to maintain the tooth in the oral cavity until its natural exfoliation, thereby preserving its function and space within the dental arch.
According to a systematic review, pulpectomy demonstrated superior patient-centered outcomes, suggesting it is a more favorable choice for treating primary teeth than tooth extraction.
Extraction of Primary Teeth
Extraction is considered when a primary tooth is severely damaged, has an uncontrollable infection, or lacks sufficient structure to support a restoration.
While extraction removes the source of infection or pain, it can lead to space loss in the dental arch, potentially resulting in malocclusion or eruption issues for permanent teeth.
Therefore, careful evaluation of each case is essential, and the use of space maintainers should be considered when necessary.
Comparison Between Pulpectomy and Extraction
The decision between pulpectomy and extraction depends on various factors, including the extent of pulp involvement, the degree of crown destruction, the presence of infection, and patient cooperation.
A randomized clinical trial comparing these treatments found that pulpectomy resulted in improved oral health-related quality of life (OHRQoL) scores after 12 months compared to tooth extraction, suggesting pulpectomy should be considered the treatment of choice for necrotic primary molars.
► Read also: Clinical Guide to Ambulatory Dental Emergencies
Conclusion
Choosing between pulpectomy and extraction for a primary tooth should be based on a thorough clinical and radiographic assessment, considering the specific circumstances of each case and the individual needs of the patient.
When appropriately indicated and performed, pulpectomy offers the advantage of preserving the primary tooth, maintaining its function, and supporting the proper development of the permanent dentition.
However, in cases where tooth preservation is not feasible or may compromise the patient's oral health, extraction followed by appropriate space management is recommended.
References
- The Journal of Clinical Pediatric Dentistry. Volume 44, Number 5/2020. Pulpectomy versus Extraction for the Treatment of Nonvital Primary Second Molars.
- Epub 2024 Nov 29. IMPACT OF PULPECTOMY VERSUS EXTRACTION OF PRIMARY TEETH ON PATIENT-CENTERED OUTCOMES: A SYSTEMATIC REVIEW OF CLINICAL STUDIES.
- Community Dent Oral Epidemiol. 2024;52:13–23. Impact of pulpectomy versus tooth extraction in children's oralhealth-related quality of life: A randomized clinical trial.
