Pulpectomy in
Primary Teeth
OUTLINE
• Introduction
• Establishing an access
-- Access cavity preparation
-- Pulp extirpation
-- Establishment of working length
• Debridement and enlargement of root canal
• Obturation of root canal
• Case description
-- Case I
-- Case II
-- Case III
INTRODUCTION
The radical mode of endodontic therapy in primary
teeth is indicated when coronal and radicular pulps are
irreversibly inflamed or necrosed. The treatment objec-
tive is to amputate the pulp in toto or completely remove
its fragments to eliminate the purulent focus. This is
achieved by pulpectomy, enlargement and cleansing
of the root canal system. Pulpectomy implies complete
removal of pulp tissue, to the clinically possible extent.
Removing pulp tissue from the lateral canal is not pos-
sible. Pulpectomy is followed by root canal filling with
suitable materials and post-endodontic restoration.
The radicular mode of endodontic therapy in pri-
mary teeth is different from that of permanent teeth
due to the anatomic variations in primary teeth. While
the technique is discussed in detail later in this chapter,
the significant variations in anatomy and the corre-
sponding modifications in the technique are as follows:
1. Primary molar roots are flared out and diverging. It
demands a wider access cavity preparation than that
in permanent tooth to obtain a straight-line access to
the root canals.
2. The roots are mesiodistally flattened. This requires
precision during initial endodontic instrumentation
to avoid breakage of instruments in the canal.
3. The root canals are slender and tortuous and make
extirpation of pulp in toto relatively difficult. This
demands meticulous endodontic instrumentation.
4. The apical foramen is relatively larger in diameter
when compared to permanent teeth. The length
of instrumentation is fixed at 1 mm short of the
radiographic apex as compared to 0.5 mm in
permanent teeth. This is to prevent instrumentation
beyond the apex and expulsion of root canal filling
material across the apex.
5. The number of lateral canals ismore in the apical one-
third in the permanent tooth. They are more at the
furcation area in the primary tooth. So, dentoalveolar
abscess and early periodontal bone rarefaction are
observed at the furcation (inter-radicular region) in
primary molars rather than at the root apices.
RATIONALE
A tooth suggested for pulpectomy
must have at least two-third of its root length intact.
Pulpectomy is indicated in the following cases:
1. Chronic or acute irreversible pulpitis
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