Non-Vital Pulp Therapies in Primary Teeth

Treatment options for primary teeth diagnosed with irreversible pulpitis or necrotic pulp are pulp treatment or extractions. Primary teeth are the best space maintainers for their successors, and pulp therapy aims to ensure normal physiologic exfoliation and eruption of the successor tooth (or long-term survival when required). Pulpectomy is a root canal procedure for primary teeth that is indicated when the radicular pulp exhibits clinical signs of irreversible pulpitis or pulp necrosis while the roots show minimal or no resorption. The procedure includes the removal of the inflamed or necrotic pulp and pulpal debris, cleaning and shaping the root canals and their obturation with a resorbable root filling material. The goal is to create conditions that lead to the healing of the lesion and the periradicular tissues. Pulpectomy in primary teeth is challenging due to the polymicrobial nature of the infection, complex root canal morphology, inherent physiologic root resorption, and the roots’ proximity to the permanent successors. This chapter elaborates on the clinical steps of the technique-sensitive pulpectomy treatment, reviews new concepts and technologies, and describes the materials and instruments that are used. We also discuss considerations for treatment, adjacent antibiotics administration, and contraindications for pulpectomy treatment.