Endodontic treatment in primary teeth

Abstract

Endodontic treatment in primary teeth, commonly referred to as pulpectomy, is an essential clinical procedure aimed at preserving primary teeth affected by pulp or periradicular infections until their physiological exfoliation. Maintaining primary teeth is crucial for proper mastication, speech development, arch integrity, and guidance of permanent tooth eruption. This comprehensive review summarizes current concepts, materials, and techniques used in the root canal treatment of primary teeth, with a focus on improving clinical outcomes. The complex and dynamic root canal anatomy of primary teeth, particularly the presence of physiological root resorption, presents unique challenges for endodontic procedures. Successful treatment depends on accurate diagnosis, careful case selection, effective chemomechanical preparation, optimal irrigation, and the use of appropriate root canal filling materials. Irrigation plays a critical role in eliminating microorganisms that cannot be removed by mechanical instrumentation alone. Commonly used irrigants include sodium hypochlorite, chlorhexidine, ethylenediaminetetraacetic acid, citric acid, and newer combination solutions, each with specific advantages and limitations regarding antimicrobial activity, tissue dissolution, and biocompatibility. Advances in instrumentation, particularly the use of nickel–titanium rotary systems specifically designed for pediatric patients, have improved cleaning efficiency, reduced treatment time, and enhanced patient cooperation. Determination of working length using electronic apex locators in combination with radiography has further increased procedural accuracy while minimizing radiation exposure. Root canal filling materials for primary teeth must meet specific criteria, including biocompatibility, adequate antimicrobial properties, resorption compatible with physiological root resorption, and safety for the underlying permanent tooth germ. Zinc oxide eugenol, calcium hydroxide–based pastes, iodoform-containing materials, and newer bioceramic-based pastes are commonly used, although no material fully satisfies all ideal requirements. In conclusion, endodontic treatment in primary teeth is a reliable and effective approach when performed with proper technique and material selection. Continuous updates in materials and technologies, along with adherence to evidence-based protocols, are essential for enhancing treatment success and supporting the overall oral health and development of pediatric patients.