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Background: Currently, the indications for pulpectomy of primary molars performed under dental general anesthesia vary across countries. Therefore, we retrospectively investigated the five-year survival rate of primary molars following pulpectomy performed under dental general anesthesia and the impact of this treatment on permanent successors, assessed the risk factors related to overall survival and clarified the indications for pulpectomy., Methods: The medical records of children receiving pulpectomy of primary molars under dental general anesthesia from August 1, 2013, to November 30, 2023, were reviewed. Potential risk factors, including gender, age, general health, tooth type, tooth location, endodontic diagnosis and quality of root filling, were assessed via univariate and multivariate Cox proportional hazards regression models, and the survival rate was examined via the Kaplan‒Meier technique. Moreover, the rate of resorption of the root canal filling materials, degree of resorption of the overfilled/over-extended root canal filling materials and development of permanent successors were assessed by clinical and radiographic examination., Results: The study included 320 teeth from 161 children (86 boys and 75 girls). The overall five-year survival rate was 38.2%, and the mean overall survival time was 54.2 months. Endodontic diagnosis was considered a significant risk factor (P < 0.05). In the first, second and third years, 57.4%, 81.8%, and 94.8%, respectively, of obturation materials in the root canals were resorbed at a faster rate than the roots. There was an altered eruption direction in 7 permanent teeth, and 4 permanent teeth were diagnosed with enamel hypoplasia., Conclusions: In this study, the 60-month survival rate of primary molars treated by pulpectomy under dental general anesthesia was 38.32%. Operators should have an accurate assessment of the status of the pulp, have a strict grasp of the preoperative indications and select the appropriate treatment method according to the guidelines. Individual cases suggest overfilling, overextension and periapical periodontitis in primary molars have an impact on enamel hypoplasia and altered eruption direction in permanent teeth., (© 2024. The Author(s).)

Objective: The demand for esthetics has increased in today's world and most parents prefer to preserve their children's primary anterior teeth until their natural exfoliation. However, an intracanal post is required to provide retention for reconstruction of severely damaged anterior teeth due to caries or trauma. Various materials and methods may be used for the fabrication of intracanal posts. This study assessed the fracture strength and fracture mode of primary canine teeth reconstructed with prefabricated and customized polyethylene and glass fiber posts., Materials and Methods: This in vitro study evaluated 60 extracted primary canine teeth in four groups (n = 15). After pulpectomy and post space preparation with 4 mm depth, composite resin post, prefabricated glass fiber post (Whitepost), customized glass fiber post (Interlig), or customized polyethylene fiber post (Ribbond) were placed in the root canals to provide retention, and the tooth crown was restored with bulk-fill composite resin. The fracture strength was then measured in a universal testing machine. The fracture mode was also evaluated visually., Results: The mean fracture strength was 22.45 ± 5.06, 33.10 ± 8.5, 30.20 ± 7.33, and 32.61 ± 5.73 N/mm 2 in the composite resin post, Whitepost, Interlig, and Ribbond groups, respectively. The fracture strength was significantly lower in the composite group than in the remaining three groups (p = 0.000). No other significant differences were found (p > 0.05). Also, no significant difference was observed among the study groups in the fracture mode (p = 0.241)., Conclusion: The composite resin post yielded a significantly lower fracture strength than the prefabricated and customized glass and polyethylene fiber posts, but the fracture mode was not significantly different among the four groups., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

The accomplishment of a successful pulpectomy depends on multiple factors that involve targeted removal of the causative irritants and soft and hard tissue debris by mechanical and chemical means. Compare and evaluate the efficacy of canal preparation and volumetric filling using conventional files and two rotary file systems using cone beam computed tomography (CBCT). Thirty freshly extracted human primary second molars were randomly divided into three groups of 10 teeth each. After access opening and working length determination, pre-operative volume analysis was done using CBCT. The canals were then instrumented by either hand K-files, ProTaper rotary files or Kedo-SG Blue rotary files. Post-operative volume analysis was performed using CBCT. All the canals were obturated using Metapex and scanned again using CBCT. Mean values of the pre- and post-operative canal volumes were analyzed using one-way Analysis of Variance (ANOVA). Inter- and intra-group volumetric changes were analyzed statistically using a post hoc test. The mean difference in volume after canal preparation and obturation was the highest in the Kedo-SG Blue group, followed by the ProTaper group and the least in the hand K group ( p = 0.001). Inter-group comparison showed statistically significant differences between the hand K group and ProTaper group ( p = 0.001), the ProTaper group and Kedo-SG Blue group ( p = 0.001), and the hand-K group and Kedo-SG Blue group ( p = 0.02). The volume of preparation and obturation was the highest using Kedo-SG Blue, followed by the ProTaper file systems., Competing Interests: The author declares no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Objective: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children., Methods: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA)., Results: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84., Conclusion: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

Study Design: A randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars., Study Selection: Children between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded., Clinical Procedures and Success Criteria: After computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child's self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes., Results: The mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42-4.20) and 1.4 (95% CI: 0.84-2.11), respectively. While both treatments significantly improved the children's OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46-1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30-4.89), and they reported 93% more odds of 'dental pain with high level' immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83-4.49)., Conclusion: Children treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted., (© 2024. The Author(s).)

Background: Pulpectomy 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/design: This 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., Discussion: This 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 Registration: ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024., (© 2024. The Author(s).)

Background: Endodontic therapy in pediatric dentistry is a challenging procedure, especially for special needs, uncooperative, and very young patients. A new conservative approach which is the non-instrumental endodontic treatment (NIET) has been developed to simplify the management of primary teeth requiring pulpectomy. This review aimed to compare the efficiency of NIET and conventional endodontic treatment in primary teeth., Methods: Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed., Results: From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05)., Conclusion: No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended., (© 2024. The Author(s).)

Background: Traditionally, pediatric endodontics lacked access to the full potential of rotary instruments. These instruments, designed for the permanent root canal system, often presented limitations when used in primary teeth. To address this, exclusive pediatric rotary files with regular improvements have been introduced, featuring superior cutting efficiency with a focus on precise alignment. This design offers the advantage of reduced risk of ledges, perforations, instrument separation, and canal transportation. This study aimed to compare and evaluate the effectiveness of Pro AF Baby Gold and Kedo-S rotary files in preparing primary tooth root canals during pulpectomy procedures through a meta-analysis., Methodology: The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review searched electronic databases from 2000 to February 2024 for studies evaluating the efficacy of Pro AF Baby Gold and Kedo-S files in terms of canal instrumentation, transportation, and centering ratio. The Cochrane risk of bias (ROB)-2 tool assessed quality, with analyses conducted using RevMan software version 5.3. The standardized mean difference (SMD) served as the summary with a random effects model (P < 0.05)., Results: Out of the five studies identified through the eligibility criteria, three were deemed suitable for a meta-analysis, while all five were included in a qualitative synthesis. The quality assessment revealed a presence of moderate-to-low ROB. The pooled analysis using SMD did not show any statistically significant differences between the files, except for the centering ratio in the mesiobuccal canal, where the Kedo-S file performed slightly better. In addition, the absence of any significant asymmetry in the funnel plot suggests that there is likely no publication bias present in the data., Conclusion: Pro AF Baby Gold files can be used as an alternative adjunct in pediatric endodontics to Kedo-S files and manual files.Prospero Registration: CRD42023469406., (Copyright © 2024 Copyright: © 2024 Journal of Indian Society of Pedodontics and Preventive Dentistry.)

Background: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments., Aim: The aim of this study was to compare 1 m/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects., Materials and Methods: In this cross-over trial, 15 children aged 6-8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week., Results: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post-treatment., Conclusion: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 m/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children., (Copyright © 2024 Copyright: © 2024 Journal of Indian Society of Pedodontics and Preventive Dentistry.)

Purpose: Pulpectomy can be used for the management of deep dentinal carious lesions in primary teeth which can be restored. Mechanical preparation of root canals can be performed using hand or NiTi rotary files. However, this may cause dentinal stress and consequently dentinal microcracks. Hence, the aim was comparative evaluation of hand and rotary file systems on dentinal microcrack formation during pulpectomy procedure in primary teeth., Methods: 60 extracted primary molar teeth were selected comprising of 80 root canals. Simple random sampling was used to divide root canals into four groups (n = 20): Group A-Hedstrom file, Group B-Pro AF Baby Gold rotary, Group C-ProTaper Next rotary, and Group D-unprepared group. Assessment was conducted on presence or absence of microcracks using Chi square test (p < 0.05)., Results: The total number of microcracks in Group A: one (5%), Group B: four (20%), Group C: nine (45%) and Group D: zero (0%) which was statistically significant (p = 0.002). At cervical third, the number of microcracks seen with Group A: one (5%), Group B: zero (0%), Group C: five (25%) and Group D: zero (0%) (p = 0.005). At the middle third, the number of microcracks seen in Group A: zero (0%), Group B: four (20%), Group C: four (20%) and Group D: zero (0%) (p = 0.029)., Conclusion: The study concluded that dentinal microcracks are formed with both hand and rotary file systems in primary teeth. ProTaper Next showed significantly higher number of microcracks, followed by ProAF Baby Gold and H files., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

Purpose: The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP)., Methods: A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates., Results: The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05)., Conclusion: In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP., Trial Registration Number: Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Background: Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors., Methods: Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months., Results: 39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2)., Conclusions: Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors., Trial Registration: The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022., (© 2024. The Author(s).)

Background: Dental caries is the most common oral disease worldwide, and it is estimated to affect 2.3 billion people, with at least 530 million of them being schoolchildren with decayed primary teeth. This condition can rapidly evolve into irreversible pulp inflammation and pulp necrosis and thus requiring endodontic intervention. Photodynamic therapy (PDT) is a supplementary method to conventional pulpectomy and is used to improve the protocol used for disinfection., Aim: The main objective of this study was to evaluate through a systematic review the efficacy of supplementary PDT on the pulpectomy of primary teeth. This review was registered a priori on the PROSPERO database (CRD42022310581)., Design: Two independent and blinded reviewers carried out a comprehensive search in five databases: PubMed, Cochrane, Scopus, Embase, and Web of Science. Eligible studies were randomized and nonrandomized clinical trials that evaluated in vivo microbiological load or clinical outcomes after using supplementary PDT in infected primary teeth., Results: After the selection process, four studies met the inclusion criteria and were included in this study. Data regarding the sample characteristics and PDT protocols were retrieved. All included trials used phenothiazinium salts as photosensitizer agents. Only one study observed a significant difference in the in vivo microbiological load reduction outcome when performing PDT on primary teeth. The remaining studies all discussed the possible benefits of this intervention; however, none observed a significant difference in this outcome., Conclusion: In this systematic review, moderate-to-low certainty of the available evidence was observed, and thus, no significant conclusions can be drawn from the findings., (© 2023 BSPD, IAPD and John Wiley & Sons Ltd.)

Aim: The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL)., Design: A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%)., Results: The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008)., Conclusion: Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

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)., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Objectives: The complex root canal anatomy of primary teeth keeps it very tricky to attain appropriate cleansing by biomechanical instrumentation, so obtaining an obturating material with excellent antimicrobial properties is a challenge in current clinical pulpectomy practice. So, this study aimed to assess the clinical and radiographic performance of zinc oxide-ozonated olive oil as a primary root canal filling material., Materials and Methods: Ninety non-vital primary molars in children ranging from 4 to 8 years were allocated into three groups in which root canals were filled with zinc oxide-ozonated olive oil, zinc oxide-olive oil, and zinc oxide-eugenol (ZOE) according to each group after pulpectomy procedure. Clinical and radiographic evaluations were done at 3-, 6-, and 12-month follow-up periods. Statistical analysis was performed for the collected data., Results: All study groups showed a significant improvement regarding clinical signs and symptoms during follow-up periods. Ozonated-olive oil group revealed a significant increase in furcation radiodensity and a decrease in periodontal ligament space at 3-, 6-, and 12-month follow-up intervals compared to other groups., Conclusion: Zinc oxide-ozonated olive oil and zinc oxide-olive oil paste had shown good clinical and radiographic success for primary teeth pulpectomy., Clinical Relevance: The intricate torturous primary root canal anatomy, in addition to the child's negative behavior, interferes with the complete debridement, so the long-lasting antibacterial effect of the primary root canal filling material aids in the pulpectomy success., (© 2023. The Author(s).)

Aim: To compare the clinical and radiographically mixture of zinc oxide with Aloe vera , Curcumin and neem as an obturating material for pulpectomy., Materials and Methods: The study comprised of age group 4-8 years children requiring endodontic treatment for at least a single primary molar tooth. Sixty primary molar teeth from 43 children were divided equally and randomly into four study groups. The materials used for obturation were zinc oxide powder (ZnO) and Eugenol (ZOE) (group I), ZnO and Aloe vera Gel (group II), ZnO and Curcumin Powder (group III), ZnO and neem extract (group IV). They were evaluated clinically and radiographically at immediate postoperative and then at 1-, 3-, 6-, and 9-month intervals., Results: At the end of 9 months, the Chi-square test revealed 100% success rate for recovery of pain in group I and III, 66.66% in group II and 93.3% in group IV. The success rates for absence of abscess and for periradicular radiolucency in group I, III, and group IV were 100% and 66.6% for group II. The success rate for periapical radiolucency in group I and group III was 100%, in group II 66.6% and in group IV 93.35%. The success rate for all the groups shows 100% success in terms of pathological root resorption., Conclusion: Zinc oxide eugenol has proven to be the best obturating material. ZnO with Aloe vera showed a success rate which is significantly lower than the other medicaments. ZnO with Curcumin and ZnO with neem had shown promising clinical and radiographical results., Clinical Significance: ZnO with Curcumin and ZnO with neem can be used as a root canal filling material in primary teeth with further follow-up studies.

Background: Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis., Aim: To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis., Design: Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months., Results: At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00)., Conclusion: After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis., (© 2023 BSPD, IAPD and John Wiley & Sons Ltd.)

Background: Pulpotomy has been successfully performed in immature and mature permanent teeth with irreversible pulpitis but rarely in primary teeth., Aim: To evaluate the outcomes of iRoot BP Plus pulpotomy and Vitapex pulpectomy in primary molars with irreversible pulpitis., Design: We selected 130 primary molars of 99 patients, aged 3-7 years, diagnosed with irreversible pulpitis with coronal pulp tissue and treated with iRoot BP Plus pulpotomy or Vitapex pulpectomy (median follow-up period: 18 months). They were divided into the pulpotomy (n = 88) and pulpectomy (n = 42) groups according to treatment procedure. The pulpotomy group was further divided into asymptomatic (n = 46) and symptomatic (n = 42) subgroups according to preoperative symptoms. The chi-squared test and Cox regression were performed to analyze the outcomes., Results: Clinical and radiographic success rates were significantly higher in the pulpotomy group (98.9% and 95.5%) than in the pulpectomy group (88.1% and 54.8%) and did not differ significantly between asymptomatic and symptomatic pulpotomy subgroups., Conclusion: Irreversible pulpitis of primary molars with coronal pulp tissue can be successfully treated with iRoot BP Plus pulpotomy. Early intraradicular resorption of materials is the main adverse outcome of Vitapex pulpectomy., (© 2022 BSPD, IAPD and John Wiley & Sons Ltd.)

Objectives: 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)., Method and Materials: 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., Results: 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., Conclusion: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia.

Objectives: 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., Methods: 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., Results: 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)., Conclusion: 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.

Aim: The aim of this non-inferiority randomized clinical trial was to compare the efficacy of an iodoform-based paste (Guedes-Pinto -(GP)) as a filling material in pulpectomies of primary teeth, and a standard material composed by calcium hydroxide and iodoform (CaOH/Iodof paste; Vitapex ® )., Design: A total of 104 teeth from 61 children (3-8 years old) were randomly allocated to two groups according to filling materials. Children were followed up for 24 months. The primary endpoint was the treatment success rate evaluated through clinical and radiographic examinations at follow-up, and the secondary outcome was the analysis of the canal filling quality. Differences in the proportion of treatment success was calculated based on 95% confidence intervals (95% CI) and with the Miettinen and Nurminen method in the intention-to-treat population, considering a -20% of the non-inferiority limit., Results: From 104 randomized teeth, 102 were followed up after 24 months (attrition rate of 1.9%). The success rate of teeth treated with the GP paste was 86.8% (95% CI: 69.9-94.9) and 78.4% (95% CI: 61.8-89.1) with the CaOH/Iodof paste. Consequently, a non-inferiority of the GP paste was observed when compared to the CaOH/Iodof paste (P < .001)., Conclusion: The GP paste has a non-inferior success rate than the CaOH/Iodof paste used as filling material for pulpectomy in primary teeth., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Aims: The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment., Methods: Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded., Results: As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18 th month period., Conclusion: The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA., Competing Interests: None

Objectives: To evaluate the success rates of dental procedures, the recurrence rates of caries and changes in oral health-related quality of life (OHRQoL) in children following treatment for early childhood caries (ECC) under dental general anaesthesia (DGA) in Chongqing, China., Design: A single-centre prospective cohort study conducted from December 2016 to June 2017., Setting: A tertiary stomatological hospital in Chongqing, China., Participants: A total of 159 children aged 2-5 years who received treatment for ECC under DGA were included., Main Outcome Measures: The primary outcomes were the success rates of dental procedures (the number of successful procedures divided by the total number of procedures) and the recurrence rates of caries. The success and recurrence rates were evaluated by a specialised examiner. The secondary outcome was the change in children's OHRQoL after DGA treatment, which was measured with the Early Childhood Oral Health Impact Scale (ECOHIS)., Results: Overall, 117 children (73.6%) and 101 children (63.5%) participated in 6-month and 12-month clinical examinations, respectively, and 151 children (95.0%) completed OHRQoL surveys pretreatment and at 1, 3, 6 and 12 months post-treatment. The resin composite, stainless steel crown, indirect pulp capping, pulpectomy, space maintenance and dental sealant success rates were 89.6%, 96.3%, 96.0%, 94.4%, 76.9% and 92.9%, respectively, at 6 months and 78.8%, 95.1%, 92.2%, 88.9%, 63.6% and 89.3%, respectively, at 12 months. 10 (8.5%) and 19 children (18.8%) developed recurrent caries within 6 and 12 months, respectively. Within 1 year of treatment, the total ECOHIS scores at each post-treatment time point were still significantly lower than those at pretreatment, although they had increased slowly over time., Conclusions: Overall, high success rates were obtained for the dental procedures, and the children's OHRQoL significantly improved after treatment. However, there was a tendency towards caries relapse, and the children's OHRQoL deteriorated over time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study was to compare the anesthetic efficacy of two volumes of articaine in conventional inferior alveolar nerve block (IANB) of mandibular molars with irreversible pulpitis, and in cases of anesthetic failure, its complementation with periodontal ligament injection (PDL)., Methods: Ninety patients with irreversible pulpitis in mandibular molars received conventional IANB with 1.8 mL or 3.6 mL of 4% articaine with 1:100,000 epinephrine. In cases of IANB failure, the same volumes were administered in the PDL. Presence of pulpal anesthesia and absence/presence of pain during pulpectomy were evaluated by electric pulp stimulation and verbal analogue scale, respectively. Relative risks (RR) with corresponding 95% confidence intervals (95% CI) were calculated for each outcome., Results: 27% and 42% of the patients achieved pulpal anesthesia following IANB with 1.8 mL and 3.6 mL, respectively (RR = 0.63, CI 95% 0.35 to 1.14, p = 0.12). Analgesia during pulpectomy was present in 64% and 73% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.87, CI 95% 0.66 to 1.16, p = 0.36). In cases of IANB failure, 75% and 42% of the patients that received 1.8 mL and 3.6 mL of PDL injection, respectively, achieved pulpal anesthesia (RR = 1.80, CI 95% 0.87 to 3.72, p = 0.11). During a new attempt at the pulpectomy procedure, analgesia was present in 69% and 75% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.91, CI 95% 0.57 to 1.45, p = 0.71)., Conclusion: Increasing the volume from 1.8 mL to 3.6 mL of the 4% articaine with 1:100,000 epinephrine in the IANB and in the PDL, did not significantly increase the success rate of pulpal anesthesia and clinical analgesia during the pulpectomy procedure. Therefore, both volumes presented a similar efficacy, though neither resulted in effective pain control during irreversible pulpitis treatment., Trial Registration: ClinicalTrials.gov NCT02422823., Competing Interests: The authors have declared that no competing interests exist.

This study indented to assess the clinical and radiographic assessment of Allium sativum extract as an intracanal irrigant for pulpectomy of primary molars. Ninety children with 110 teeth submitted were categorized into two groups. Clinical and radiographic success rates were checked at 3, 6, and 12 months. Qui-square test at a level of significance was ˂0.05. There was no statistically significant difference ( p  ˂ .05) between the two groups that has not been detected clinically or radiographically. Clinical and radiographic success rates of garlic extract at 3 months were (80% and 72.7%), which declined at 6 and 12 months to be 76.4% 6 and 74.5% respectively. For NaOCl group, clinical and radiographic success rates were 87.3% and 85.5% at 3 months, 87.3% and 87.3% at 6 months and 89.1% and 87.3% at 12 months. A. sativum extract can be used efficiently as an irrigant for pulpectomy of primary molar root canals., Competing Interests: None declared.

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH) 2 /iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH) 2 /iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH) 2/ iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta-analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta-analyses. At 6- and 12-month follow-up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH) 2 /iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18-month follow-up. On the basis of the findings of this systematic review, we recommend that Ca(OH) 2 /iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long-term follow-up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH) 2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high-quality randomized control clinical trials with a long-term follow-up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563)., Competing Interests: All authors declare no conflict of interest.

This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Background: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014., Objectives: To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults., Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 February 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 26 February 2018), MEDLINE Ovid (1946 to 26 February 2018), Embase Ovid (1980 to 26 February 2018), and CINAHL EBSCO (1937 to 26 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. A grey literature search was conducted using OpenGrey (to 26 February 2018) and ZETOC Conference Proceedings (1993 to 26 February 2018). No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics., Data Collection and Analysis: Two authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data. A fixed-effect model was used in the meta-analysis as there were fewer than four studies. We contacted study authors to obtain missing information., Main Results: We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo when provided in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. The patients included in these trials had no signs of spreading infection or systemic involvement (fever, malaise). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables reported in both studies were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects, as reported in one study, were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). Neither study reported quality of life measurements.Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscessTwo studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth when provided in conjunction with a surgical intervention. Participants in one study all underwent a total pulpectomy of the affected tooth, while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality.Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscessWe found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults., Authors' Conclusions: There is very low-quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.

Background: Complete pulpectomy and elimination of wide range of microorganisms from infected primary root canals is not possible through conventional endodontic procedures. Thus, lesion sterilization and tissue repair (LSTR) therapy employing 3Mix tri-antibiotic paste have been used as an alternative endodontic modality for infected primary teeth., Aim: This study aims to evaluate the root resorption rate of endodontically treated mandibular primary molars with conventional endodontic treatment or LSTR therapy and to compare it with their healthy contralateral teeth., Materials and Methods: Fifty carious first and second primary mandibular molars from 25 healthy children aged 7-10 years were treated with two different endodontic procedures using LSTR Therapy and conventional endodontic treatment. The resorption rate of these teeth with healthy contralateral teeth was compared clinically and radiographically at 3, 6, 12 and 36 months using Chi-square test., Results: At 12 months, clinically, there was no difference in the outcomes of both groups but radiographically, statistically significant difference (P < 0.001) in root resorption between treated teeth and their controls in both the groups was observed. At 36 months, interradicular bone resorption around the crown of succedaneous teeth and their delayed eruption was noted in LSTR group., Conclusions: LSTR therapy could be a viable treatment modality for infected/nonvital primary molars with poor prognosis and intended to be maintained for shorter duration in the oral cavity as natural space maintainers., Competing Interests: There are no conflicts of interest

Background: In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate.This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique., Objectives: To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth., Search Methods: Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). OpenGrey was searched for grey literature. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth., Data Collection and Analysis: Two review authors independently extracted data and assessed 'Risk of bias'. We contacted authors of RCTs for additional information when necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. We assessed statistical heterogeneity by using I² coefficients., Main Results: We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. All were small, single-centre trials (median number of randomised teeth = 68). All trials were assessed at unclear or high risk of bias.The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for pulpectomy; four comparisons of pulpotomy and pulpectomy; and 21 comparisons of different medicaments for direct pulp capping.The proportion of clinical failures and radiological failures was low in all trials. In many trials, there were either no clinical failures or no radiographic failures in either study arm.For pulpotomy, we assessed three comparisons as providing moderate-quality evidence. Compared with formocresol, MTA reduced both clinical and radiological failures, with a statistically significant difference at 12 months for clinical failure and at six, 12 and 24 months for radiological failure (12 trials, 740 participants). Compared with calcium hydroxide, MTA reduced both clinical and radiological failures, with statistically significant differences for clinical failure at 12 and 24 months. MTA also appeared to reduce radiological failure at six, 12 and 24 months (four trials, 150 participants) (low-quality evidence). When comparing calcium hydroxide with formocresol, there was a statistically significant difference in favour of formocresol for clinical failure at six and 12 months and radiological failure at six, 12 and 24 months (six trials (one with no failures), 332 participants).Regarding pulpectomy, we found moderate-quality evidence for two comparisons. The comparison between Metapex and zinc oxide and eugenol (ZOE) paste was inconclusive, with no clear evidence of a difference between the interventions for failure at 6 or 12 months (two trials, 62 participants). Similarly inconclusive, there was no clear evidence of a difference in failure between Endoflas and ZOE (outcomes measured at 6 months; two trials, 80 participants). There was low-quality evidence of a difference in failure at 12 months that suggested ZOE paste may be better than Vitapex (calcium hydroxide/iodoform) paste (two trials, 161 participants).Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. We assessed the quality of the evidence as low or very low for all comparisons. One trial appeared to favour formocresol over calcium hydroxide; however, there are safety concerns about formocresol., Authors' Conclusions: Pulp treatment for extensive decay in primary teeth is generally successful. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Any future trials in this area would require a very large sample size and follow up of a minimum of one year.The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptable second choices, and whether, where none of these treatments can be used, application of sodium hypochlorite is the safest option. Formocresol, though effective, has known concerns about toxicity.Regarding pulpectomy, there is no conclusive evidence that one medicament or technique is superior to another, and so the choice of medicament remains at the clinician's discretion. Research could be undertaken to confirm if ZOE paste is more effective than Vitapex and to evaluate other alternatives.Regarding direct pulp capping, the small number of studies and low quality of the evidence limited interpretation. Formocresol may be more successful than calcium hydroxide; however, given its toxicity, any future research should focus on alternatives.

Context: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration., Aims: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE)., Materials and Methods: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test., Results: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05)., Conclusions: Endoflas could be a potential alternative to ZOE for preserving infected primary molars., Competing Interests: There are no conflicts of interest

Aim: To evaluate three emergency procedures for their ability to alleviate clinical symptoms associated with symptomatic teeth having signs of (at least) partial irreversible pulpitis., Methodology: Sixty-six maxillary and mandibular molars were randomly assigned to a total pulpectomy group (TP; n = 22), partial pulpectomy group (PP; n = 22) or pulpotomy group (P; n = 22). Procedure durations were recorded. Patients answered a questionnaire on daily analgesic requirements and about clinical symptoms (pain intensity, chewing sensitivity and thermal sensitivity) after the anaesthetic effect had disappeared (Day 0) and on Days 1, 3 and 7 post-treatment., Results: The total pulpectomy group was associated with the longest procedures (median, 24 min), followed by the partial pulpectomy and pulpotomy groups (P < 0.001 for all). In all three groups, pain intensity, thermal sensitivity and chewing sensitivity decreased significantly from the preoperative time-point to Day 7 (P < 0.001 for all). The total pulpectomy group reported greater reductions in pain intensity than the pulpotomy group between Days 0 and 7, Days 1 and 3, and Days 1 and 7 (P < 0.001 for all). No other intergroup differences were noted regarding reductions in pain intensity, and none were observed with respect to changes in prevalence of thermal sensitivity and chewing sensitivity. There were also no significant intergroup differences regarding the analgesic requirements throughout the 7 days., Conclusion: As emergency treatments for teeth having signs of irreversible pulpitis, pulpotomy, partial pulpectomy and total pulpectomy were comparable with respect to relieving clinical symptoms. Pulpotomy may be preferred because it requires significantly less time and is a simple technique that relieves symptoms quickly and effectively., (© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Aim: The aim of the present study was to assess the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition among pediatric dentists., Methods: A cross-sectional, observational survey was conducted using a closed-ended, multiple-choice questionnaire evaluating the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition, which was formulated and sent to 360 pediatric dentists across India. Descriptive statistics were done, followed by χ 2 -test to test the association between years of experience and the questionnaire items., Results: A total of 3.5% of pediatric dentists performed their treatment using a rubber dam in all cases; 30% preferred to use local anesthesia prior to indirect pulp therapy (IPT). Traditional indirect pulp capping was preferred to IPT, and only 48% of them believed in not removing it completely. Pulpotomy was preferred over IPT (70%) when there was a probability of pulp exposure following complete caries excavation. Calcium hydroxide, along with iodoform, was the material of choice for the obturation of primary teeth (73.5%). A stainless steel crown was placed after pulp therapy in the primary tooth (86.3%). Most dentists believed requested immediate and 3-month follow up., Conclusion: The survey helps in assessing whether our views or approaches are in line with recent trends., (© 2017 John Wiley & Sons Australia, Ltd.)

Background: To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide-eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars., Methods: One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed., Results: At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure., Conclusions: The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement., Trial Registration: ChiCTR-TRC-14004938 . Registered 13 July 2014.

Objectives: The aim of this study was to evaluate the clinical and radiographic success of zinc oxide-ozonated oil (ZnO-OO), modified 3Mix antibiotic paste, and Vitapex in treatment of primary molars requiring pulpectomy., Methods: Sixty-four primary molars of forty three children aged between 4 and 8 years with pulpally involved primary molars requiring root canal procedures were treated with ZnO-OO, modified 3Mix-MP paste, and Vitapex. The subjects were followed up clinically at 1, 6, and 12 months whereas radiographically at 6 and 12 months, respectively., Results: The results showed that the clinical and radiographic success rates of ZnO-OO and Vitapex over 12 months period of observation were 100% whereas, for modified 3Mix-MP paste, the results were 95.8% and 79.2%, respectively., Conclusion: On the basis of the overall success rates of all the three medicaments, following order of performance can be inferred clinical success and radiographical success:- ZnO-OO = Vitapex > modified 3MIX-MP paste.

Aim: The aim of this study is to describe the protocol used in the treatment of pulpally necrosed primary molars and to evaluate the effectiveness of ultrasonic instrumentation technique in primary dentition., Materials and Methods: A total of 50 primary molars in 40 children, ranging from 8 to 10 years of age, were endodonti-cally treated using standard protocols and ultrasonic instrumentation. The follow-up was done for each case ranging from 1 to 2/4 years., Results: Clinical and radiographic controls showed a success rate of 97.5%, considering an evaluation time of 19 ± 9.02 months., Conclusion: The use of ultrasonic instrumentation in primary molars with pulpal necrosis succeeded in reducing appointment time and showed a high success rate., Clinical Significance: Ultrasonic instrumentation should be used as a standard protocol in instrumentation of endodontic treatment of primary molars so as to increase the success rate of primary teeth pulpectomies.

Objectives: This study was carried out to investigate whether the changes in hematologic characteristic and color of pulpal bleeding is associated with clinical and histologic status of the pulp in primary teeth., Materials and Methods: A total of 211 primary molars in 103 patients, 3-6 years old, were treated. One hundred eight teeth had pulpectomy, 57 teeth had pulpotomy after pulp exposure during caries excavation, and 46 teeth had pulpotomy after accidental pulp exposure in sound dentin. After pulpal exposure, pulpal blood was collected in capillary tubes for blood color and hematologic assessment. Coronal and radicular pulp tissues were amputated for histologic assessment., Results: Blood color was significantly darker in pulpectomy cases and samples with severe inflammation. The differences were clinically perceptible by the human eye. A significant negative correlation was detected between white blood cell (WBC) count and blood color. The counts of neutrophils and lymphocytes were significantly different between treatment groups. In addition, WBC, eosinophil, monocyte, neutrophil, and basophils counts were significantly different between degrees of inflammation in coronal pulp. Moreover, severe inflammation was higher in pulpectomy group versus pulpotomy groups. Pulp tissue calcification was also significantly higher in the pulpectomy cases., Conclusions: Considering the significant difference in pulpal blood color between the pulpectomy and pulpotomy cases, and between the different levels of pulpal inflammation; blood color can be a valid clinical diagnostic criterion of pulpal status and can be used for the selection of appropriate pulp treatment strategy., Clinical Relevance: This study shows that pulp bleeding color can be used for selection of an appropriate pulp treatment method in primary teeth.

Background: In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection., Case Report: The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills." In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to compare outcomes and survival of ferric sulfate with mineral trioxide aggregate (FS+MTA) pulpotomy and root canal therapy (RCT) in carious vital primary maxillary incisors., Methods: In this parallel group noninferiority trial, asymptomatic carious vital primary incisors with pulp exposure in healthy 18- to 46-month-olds were allocated randomly to receive FS+MTA pulpotomy or RCT between September 2010 and September 2012. Each incisor was classified into one of the following radiographic outcomes: N (incisor without pathologic change); Po (pathologic change present, follow-up recommended); Px (pathologic change present, extract.) Clinical findings and incisor survival were secondary outcomes., Results: Seventy subjects were enrolled with a total of 172 incisors. Twelve- and 18-month radiographic outcomes demonstrated no statistical difference between FS+MTA pulpotomy and RCT incisors for Px outcomes (P=0.38; odds ratio equals 0.60; 95 percent confidence interval equals 0.19 to 1.89; chi-square test). There was no statistical differences in clinical outcomes for FS+MTA pulpotomy and RCT at 12 and 18 months (P=0.51; Fisher's exact test) or survival for FS+MTA pulpotomy and RCT incisors (P=0.11; log-rank test)., Conclusions: Ferric Sulfate with Mineral Trioxide Aggregate (FS+MTA) is an alternative to RCT for vital primary incisors.

A pulpectomy requires the swift extraction of the inflamed tissue. Moreover, the speed of treatment is especially important in the case of uncooperative children. Conventional pulpectomies, however, often require an extended treatment period, which can therefore cause problems with such patients. Electrosurgical methods have been applied to pulpotomies for a number of years. However, to the best of our knowledge, no studies to date have assessed its application to pulpectomies. The aim of this study was to compare clinical and radiographic success rates over a 6-month follow-up period between conventional and electrosurgical pulpectomies. A total of 50 children aged 4 to 8 years were enrolled in this randomized clinical trial. A pulpectomy of the first and second primary molar teeth was seen as the optimal treatment plan in all these patients. One group was treated using the conventional method (C group, 25 teeth) and the other with electrosurgery (ES group, 25 teeth). The patients were evaluated for the presence of pain, mobility, abscess, sinus tract, erythema, tenderness to percussion, internal and external root resorption, and radiolucency. Clinical and radiographic success rates and total working time were assessed. The Fisher's exact test and Mann-Whitney U-test were used for the statistical analysis. After 6 months of follow-up, the clinical and radiographic success rates were 90.5 and 85.7%, respectively, in the ES group, compared with 88.9 and 72.2%, respectively, in the C group. No statistically significant difference was observed between the two groups (p>0.05). Working time, however, was significantly shorter in the ES group (p<0.001). This suggests that pulpectomy with electrosurgery reduces treatment time, and is therefore quite useful in situations where duration of the treatment course is of crucial concern.

Purpose: The rationale of this in vivo study was to evaluate and compare different obturation techniques for the intracanal conveyance of Endoflas in the primary molars using conventional radiography., Materials and Methods: Thirty-eight children (4-9 years old) with total of 45 pulpally infected primary mandibular molars indicated for pulpectomy were categorized into three groups (i) endodontic pluggers, (ii) lentulospirals, and (iii) NaviTips, respectively, for obturation with Endoflas. The level of obturation and the presence of voids were evaluated radiographically, and the obtained data were statistically analyzed using Chi-square test., Results: The results showed no significant difference between the three techniques to deliver Endoflas. Motor-driven lentulospirals showed better results (64.4% optimal fillings) compared to the pluggers (62.2%), but NaviTips showed poor results (48.9%) for the level of obturation (P > 0.05). Voids were observed in all the techniques used. Pluggers and lentulospirals showed similar results with greater void-free canals, whereas NaviTip system showed more voids which was statistically not significant (P > 0.05)., Conclusion: Motor-driven lentulospiral and pluggers were almost equally efficient to fill Endoflas to an optimal level, devoid of voids, and both were considered better compared to NaviTip system.

Objectives: The objective of the study was to assess the behavioral effects and the changes in the anxiety level of children after intranasal and sublingual midazolam sedation using Venham's clinical anxiety scale and salivary cortisol level., Study Design: Twenty children aged 3 to 7 years were randomly assigned to Group A (n=10) intranasal or Group B (n=10) sublingual midazolam (0.2mg/kg) sedation. The anxiety levels at various time periods were assessed using Venham clinical anxiety scale and corresponding changes in salivary cortisol levels were assessed before and after the drug administration. The anxiety levels were assessed independently by two pediatric dentists from recorded videos. Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis using SPSS version 19.0., Results: There was a significant decrease in anxiety level from baseline to 20 minutes after drug administration in group A (p=0.004) and group B (p=0.003). There was no significant change in salivary cortisol levels before and after the drug administration in group A (p=0.07) and group B (p=0.38)., Conclusions: Both intranasal and sublingual administration of midazolam was equally effective in reducing the child's anxiety. However, there was no significant difference in the salivary cortisol levels in both groups.

Objective: The aim of this systematic review was to determine whether the smear layer (SL) removal procedure influences the outcome of root canal treatment., Study Design: We performed a search on Pubmed, Scopus, ISI Web of Science, Cochrane Library, Lilacs and SIGLE. We included randomized controlled clinical trials (RCT), with clinical and radiographic outcomes, conducted on subjects who had undergone root canal therapy. The protocol differed only in the SL removal or maintenance procedure. We evaluated the papers for risk of bias according to the Cochrane assessment tool., Results: A total of 1,983 articles were found, after removal of duplicates, 892 remained. We included two studies in this review. One study revealed a low risk of bias and a high success rate for the SL removal group compared to the non SL removal group (P = 0.04), while the other study had a high risk of bias and found no difference between the SL removal and non SL removal groups (P = 1.00)., Conclusion: We concluded that the SL removal for root canal treatment of primary teeth with initial clinical signs and symptoms or pulpal necrotic status, could benefit the outcome, although further RCT should be performed to achieve evidence.

Objective: To conduct a systematic review and meta-analysis to assess the findings on the clinical efficacy of intracanal irrigants employed during pulpectomy of primary teeth., Methods: A systematic search was performed in electronic databases and peer-reviewed paediatric dentistry journals to find relevant studies. Titles, abstracts, and full-text papers were located, screened, and assessed independently by two reviewers, and a meta-analysis was performed., Results: The search identified a total of 775 records; 46 were selected and reviewed in full text. After screening, seven studies met the eligibility criteria for inclusion. Three studies compared the 2% chlorhexidine and saline solutions, but no analysis could be performed because of the heterogeneity between these; two of the studies reported non-comparative methodologies and results when compared, and were not analysed. Finally, two studies compared a mixture of tetracycline isomer, an acid, and a detergent (MTDA) or oxidative potential water (OPW) to sodium hypochlorite (NaOCl), without showing significant heterogeneity; therefore, their combined outcomes were included. Both fixed and random mixed models resulted in a non-significant weighted mean difference between treatments, according to a forest plot., Conclusions: More studies are required with adequate quality, as well as a full-result report, including summary measurements of both response variables and effect size, to determine the most effective irrigant agents for use in pulpectomies., (© 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful., Methods: Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis., Results: At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001)., Conclusions: Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.