Pediatric endodontics plays a vital role in preserving primary and immature permanent teeth, ensuring proper arch integrity and long-term oral health.
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✅ Introduction
Endodontic treatment in children has evolved beyond the traditional “pulpectomy vs. pulpotomy” debate. Modern approaches focus on biological preservation, functional maintenance, and predictable long-term outcomes (Govindaraju et al., 2017). With advances in diagnostics, imaging, and biomaterials, pediatric root canal therapy has become more predictable and evidence-based.
✅ Diagnosis and Treatment Planning
Accurate diagnosis is critical in pediatric endodontics. Clinical evaluation should include:
° History of pain (spontaneous, provoked, nocturnal).
° Pulp vitality tests (though less reliable in primary teeth).
° Radiographic assessment using periapical or bitewing radiographs, sometimes complemented with CBCT in complex cases.
Treatment planning must consider the child’s age, cooperation, root resorption stage, and restorability of the tooth (Parisay et al., 2015).
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Emergency management typically addresses:
° Acute pulpitis: pulpotomy or pulpectomy.
° Acute apical abscess: drainage, antibiotics when systemic involvement exists.
° Dental trauma: apexogenesis or apexification procedures in immature permanent teeth.
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Video 🔽 What is the difference between apexogenesis and apexification? ... The apex opening is usually very large in an immature tooth, and the canal walls are very thin, so appropriate treatment must be performed.✅ Root Canal System Morphology in Primary Teeth
Primary teeth present unique challenges due to thin dentinal walls, ribbon-shaped canals, and frequent accessory canals (Moskovitz & Holan, 2019). These anatomical complexities require conservative shaping to prevent perforations and maintain structural integrity.
✅ Instrumentation and Basic Materials
° Hand files (K-files, H-files): traditionally preferred for tactile control.
° Rotary NiTi systems: increasing use in pediatric cases due to reduced chair time and improved shaping (Rao et al., 2014).
° Irrigants: sodium hypochlorite (1–2.5%), chlorhexidine, saline.
° Materials: calcium hydroxide, iodoform-based pastes, and bioceramic sealers.
📊 Tabla comparativa: Access Cavity Design in Primary Teeth
| Tooth | Access Design | Considerations |
|---|---|---|
| Primary Anterior Teeth | Lingual cingulum approach | Preserve labial enamel for esthetics |
| Primary Molars | Occlusal central fossa approach | Extend to expose all canals, avoid perforation |
| Canines | Lingual approach | Maintain cusp integrity |
| Second Molars | Triangular or trapezoidal access | Adapt shape to number of canals |
Minimal invasive preparation is emphasized to preserve dentinal walls. Step-back and crown-down techniques may be used. Pediatric rotary systems (e.g., Kedo-S) allow efficient shaping with minimal taper (Subramaniam et al., 2019).
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The goal is a resorbable, biocompatible material that resorbs at a rate similar to the primary tooth root. Commonly used materials include:
° Zinc oxide-eugenol (ZOE): traditional, antibacterial, but resorbs slower than roots.
° Calcium hydroxide pastes: faster resorption, antimicrobial.
° Iodoform pastes (Vitapex, Metapex): excellent resorbability, widely accepted.
Discussion
Modern pediatric endodontics balances the biological principles of pulp preservation with advances in materials and instrumentation. While rotary systems and bioceramic sealers show promise, their long-term outcomes in children require more clinical trials. Treatment should always be individualized, guided by patient cooperation, anatomy, and prognosis of the tooth.
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Video 🔽 Pulpotomy and pulpectomy procedures. Indications and Differences ... Clinical and radiological evaluation are necessary to determine appropriate treatment. Pulpectomy is recommended when it is necessary to completely remove the affected dental pulp, and pulpotomy partially removes the dental pulp.Conclusion
Endodontic treatment in pediatric patients is essential for maintaining arch integrity, preventing premature tooth loss, and ensuring normal development. Mastery of diagnosis, access, instrumentation, and materials is critical for successful outcomes. Advances in rotary systems and bioceramic materials represent the future of pediatric endodontics.
References
✔ Govindaraju, L., Jeevanandan, G., & Subramanian, E. M. G. (2017). Clinical evaluation of instrumentation of primary molars using manual and rotary techniques: A randomized controlled trial. Journal of Clinical and Diagnostic Research, 11(9), ZC55–ZC58. https://doi.org/10.7860/JCDR/2017/29268.10622
✔ Moskovitz, M., & Holan, G. (2019). The treatment of severely decayed primary teeth using resin-modified glass ionomer cement: A long-term follow-up study. Pediatric Dentistry, 41(1), 30–35.
✔ Parisay, I., Ghoddusi, J., & Forghani, M. (2015). A review on vital pulp therapy in primary teeth. Iranian Endodontic Journal, 10(1), 6–15. https://doi.org/10.7508/iej.2015.01.002
✔ Rao, A., Malhotra, N., & Acharya, S. (2014). Rotary endodontics in pediatric dentistry: A review. International Journal of Clinical Pediatric Dentistry, 7(1), 35–39. https://doi.org/10.5005/jp-journals-10005-1229
✔ Subramaniam, P., Konde, S., Mandanna, D. K., & Naik, S. (2019). Comparative evaluation of cleaning efficacy and instrumentation time between manual and rotary techniques in primary teeth: An in vitro study. International Journal of Clinical Pediatric Dentistry, 12(2), 123–127. https://doi.org/10.5005/jp-journals-10005-1603
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