Factors Affecting Pulpectomy Success Rates in Primary Maxillary Incisors

Christine Hwang, DDS; Donna Kritz-Silverstein, PhD; Daniela R. Silva, DDS, MS

Section of Pediatric Dentistry, University of California School of Dentistry, Los Angeles, CA
Success/Failure and Lesion depth by Age at time of treatment.

Prevalence of ECC on children 3-5 years old participating in US Head Start Programs is very high, >90%. i ECC most commonly affects the primary maxillary incisors and primary molars. ii Treatment options for those affected teeth usually are extraction or pulpectomy with restoration Maxillary primary incisors are important for: iii The development of arch form Esthetics Function Normal eruption time of permanent teeth Mastication Pulpectomies can prevent early loss of teeth from dental caries and trauma Past studies shown >70% success rate of maxillary incisor pulpectomies. Primosch et. al: no statistical significance in success depending on age. iii The purpose of this study was to assess the success rates of pulpectomy in primary maxillary incisors based on age and other variables.

A total of 27 patients with 43 pulpectomized teeth were included; 15 (55.6%) female and 12 (44.4%) male. All teeth were treated due to caries. Of the treated teeth, 41 received a composite strip crown as a final restoration, while 2 were restored with a lingual composite to cover pulp access. The average follow up was 25 months. Failures were defined as any tooth that required early extraction: 51.2% were successes while 48.8% were failures.

Success

Failure

<2

Table 1 Success and failure by patients age, dmft, and follow-up time Age (months) dmft Months F/U All (avg) 32.8 9.7 25 Success 34 9.8 23.9 Failure 31.6 9.5 26.3 t 0.99 0.26 -0.66 p 0.16 0.40 0.26

The overall reasons for failure included trauma (5 teeth), abscess of an adjacent tooth, loss of restorations, severe bruxism leading to loss of restoration, and fused #D and E, which made pulp therapy challenging due to the abnormal shape of the pulp chamber. In addition, the average dmft score was high in this study, demonstrating the high caries risk of the patient population. The limitations of this study included: a small sample size, limited chart notes and documentation, and inadequate post-operative radiographs. More research is necessary to discern what variables affect pulpectomy success rates in primary maxillary incisors.

Retrospective chart review at UCLA Childrens Dental Center Patients received pulpectomies on primary maxillary incisors from 2002 through 2010. Inclusion criteria: Treatment under general anesthesia (IV or OR) Healthy ASA I or ASA II Fill Material (Vitapex) Restored with full coverage restoration Had preoperative radiographs that demonstrated caries lesion depth Pulpectomies completed by second year pediatric dental residents Data collected: Figure 1. Lesion Depth distance Incisor type from DEJ to pulp Age at treatment 1: 1/3 into dentin Gender 2: into dentin 3: or into dentin Type of restoration dmft score 1 2 Reason for treatment (caries vs. trauma) 2 3 Presence of symptoms Lesion depth (Figure 1) Fill level At follow up (minimum of one to four recall visits), tooth was determined clinically and/or radiographically as an overall success or failure. Teeth with failed pulpectomies were later extracted

Table 2 Success and failure by tooth type and lesion depth Success (%) Tooth Type: Central Lateral Lesion Depth: 2 3 51.9 50 80.0 35.7 Failure (%) 48.1 50 20.0 64.3 6.00 0.006 X 0.04 p 0.92

Within the limitations of the present study, the following conclusion were drawn: No significant difference in success rates were found when considering age at time of treatment. Deeper carious lesions are more likely to fail than lesions that are less close to the pulp. Older aged patients have higher mean dmft scores than younger patients

Table 3 Age at time of treatment by dmft All (avg) dmft Months to Failure 9.7 26.2 30 Months 7.1 21.0 >30 Months 10.9 28.9 t -4.40 -1.35 p <.0001 0.10
i. Tinanoff, N. and D.M. OSullivan. (1997). Early childhood caries: overview and recent findings. American Academy of Pediatric Dentistry, (19) 12-15. ii. Hallett KB and ORourke PK. Pattern and severity of early childhood caries. Community Dent Oral Epidemiol 2006; 34:25-35. iii. Primosch, R.E. et al. A Retrospective Assessment of Zinc Oxide-Eugenol Pulpectomies in Vital Maxillary Primary Incisors Successfully Restored With Composite Resin Crowns. Pediatric Dentistry 2005; 27: 470-476.