Analysis of survival and factors associated with failure of primary tooth pulpectomies performed under general anaesthesia in children from South China

Abstract

Background Pulpectomy is a technique recommended for treatment of irreversible pulp inflammation or necrosis. Treatment‐related variables and patient factors may affect the prognosis of pulpectomy. Aim To investigate the survival and related predictors associated with failure of pulpectomies performed under general anaesthesia for early childhood caries. Design Dental records of 124 patients, who underwent pulpectomy as part of comprehensive dental treatment under general anaesthesia, were reviewed and assessed. Relapse of pulpitis and periodontal periodontitis were evaluated by clinical examination and periapical film assessment at each follow‐up appointment after original treatment. Results A total of 389 teeth of 124 children were evaluated. By the end of the fourth year, 45% of teeth with pulpitis and 46% of teeth with periapical periodontitis were estimated to relapse; the median (interquartile range) number of years to relapse was 3.5 (3.4‐3.8) and 3.0 (1.8‐3.0) years, respectively. The follow‐up frequency, number of teeth extracted, plaque index, tooth position, type of restoration, pulp status, and quality of root canal filling were observed to have independent effects on relapse. Conclusion Recurrence came earlier in teeth diagnosed with periapical periodontitis than those with pulpitis. Both treatment‐related variables and patient factors could affect the prognosis of pulpectomy.

Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study

“…The management of proximal caries under general anesthesia has been a topic of interest to pediatric dentists across the world [ 9 , 13 , 14 , 16 ]. Traditionally, the SSC has been viewed as an aggressive form of treating dental caries in primary molars [ 12 , 16 ]. This meant that the SSC, especially when performed under GA, has been combined with a pulpotomy or pulpectomy [ 8 , 12 ].…”

“…Traditionally, the SSC has been viewed as an aggressive form of treating dental caries in primary molars [ 12 , 16 ]. This meant that the SSC, especially when performed under GA, has been combined with a pulpotomy or pulpectomy [ 8 , 12 ]. However, with advent of the Hall technique, there has been an increased recognition of the SSC as a form of minimal intervention dentistry [ 11 ].…”

“…While there is consensus that the restoration of choice for a primary tooth with multiple carious surfaces is a stainless-steel crown, there is no consensus on pulp therapy for proximal caries that does not reach the pulp on a radiograph [ 11 ]. While some authors have recommended that all teeth with a marginal ridge destroyed by dental caries should be pulp-treated [ 12 ], others have suggested that covering teeth with a stainless-steel crown without a pulpotomy would be just as effective [ 8 , 10 , 11 ]. Investigators have cited the success of the use of the “Hall Technique” to support the concept of minimal intervention [ 10 ].…”

“…The treatment of children under general anesthesia raises certain concerns since a failure of the treatment often means that the retreatment would need to be carried out under general anesthesia as well [ 8 , 12 , 13 ]. Pulpotomies performed under general anesthesia have been shown to have a failure rate of 1.1% to 3% [ 14 , 15 ].…”

“…Pulpotomies performed under general anesthesia have been shown to have a failure rate of 1.1% to 3% [ 14 , 15 ]. While the failure of SSCs placed under GA has been reported to be as high 5.6%, it has been suggested that the failure of the SSC is often caused due to the failure of the pulp therapy [ 12 , 15 ]. Despite being the restoration for deep caries and after pulp treatment, there is little data on the success or failure of proximal carious lesions restored under general anesthesia without pulp therapy.…”