The effectiveness of obturation materials on pulpectomy outcomes in primary teeth: a retrospective study

Penmatsa Chaitanya; Gontla Devi Saranya; Peddi Ravigna; Chandrappa Vinay; Kadidal Shamanna Uloopi; Gadisetti Lakshmi Surekha

doi:10.2340/biid.v13.47015

Authors

Penmatsa Chaitanya Department of Pedodontics, Vishnu Dental College, Bhimavaram, India
Gontla Devi Saranya Department of Pedodontics, Vishnu Dental College, Bhimavaram, India
Peddi Ravigna Department of Pedodontics, Vishnu Dental College, Bhimavaram, India
Chandrappa Vinay Department of Pedodontics, Vishnu Dental College, Bhimavaram, India
Kadidal Shamanna Uloopi Department of Pedodontics, Vishnu Dental College, Bhimavaram, India
Gadisetti Lakshmi Surekha Department of Pedodontics, Vishnu Dental College, Bhimavaram, India

DOI:

https://doi.org/10.2340/biid.v13.47015

Keywords:

calcium hydroxide, iodoform, pulpectomy, root canal filling materials, zinc oxide-eugenol cement

Abstract

Objective: Pulpectomy is an essential procedure for preserving primary teeth with irreversible pulpitis. Its success may vary according to lesion etiology, preoperative pulp condition, follow-up duration, obturation materials, restorations, and other clinical factors. This study aimed to evaluate the success of pulpectomy in primary teeth treated with different obturation materials.

Materials and methodology: Records of children aged 4–10 years who underwent pulpectomy were retrospectively retrieved and assessed using clinical and radiographic records. The success rate was determined by considering clinical and radiographic findings together. Resorption of obturation materials was assessed radiographically at 3, 6, 9, and 12 months by comparing the follow-up radiographs with the immediate post-treatment radiographs. Data were analyzed using the chi-square test.

Results: The study evaluated 225 pulpectomised primary teeth using Endoflas (n = 85), Metapex (n = 73), and zinc oxide eugenol (ZOE) (n = 67) as obturating materials. The success rates were comparable among the groups at 3 months. Significant differences were observed at 6 and 9 months (p < 0.05), with ZOE showing the highest success rate, followed by Endoflas and Metapex. At 12 months, a significant difference in success rate was also observed among the groups (p = 0.001) with ZOE still demonstrating the highest success rate (92.5%), followed by Endoflas (80%) and Metapex (42.5%). Rate of resorption differed significantly among the materials (p < 0.001), with Metapex showing the highest resorption rate at 6 months (29.9%), 9 months (43.8%), and 12 months (75.3%), followed by Endoflas and ZOE.

Conclusion: Pulpectomy success rate was found to be highest when ZOE was used as the obturation material, followed by Endoflas and Metapex, at the 6, 9 and 12 months of follow-ups. Metapex exhibited the highest resorption rate among the three materials.

Downloads

Download data is not yet available.

References

Barja-Fidalgo F, Moutinho-Ribeiro M, Oliveira MA, de Oliveira BH. A systematic review of root canal filling materials for deciduous teeth: is there an alternative for zinc oxide-eugenol? ISRN Dent. 2011;2011:367318. DOI: https://doi.org/10.5402/2011/367318

Gupta S, Das G. Clinical and radiographic evaluation of zinc oxide eugenol and metapex in root canal treatment of primary teeth. J Indian Soc Pedod Prev Dent. 2011;29(3):222–8. DOI: https://doi.org/10.4103/0970-4388.85829

American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:487–96.

Brustolin JP, Mariath AAS, Ardenghi TM, Casagrande L. Survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. Braz Dent J. 2017;28(1):121–8. DOI: https://doi.org/10.1590/0103-6440201601009

Rajsheker S, Mallineni SK, Nuvvula S. Obturating materials used for pulpectomy in primary teeth – a review. J Dent Craniofac Res. 2018;3(1):3. DOI: https://doi.org/10.21767/2576-392X.100019

Chen X, Liu X, Zhong J. Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial. Head Face Med. 2017;13(1):12. DOI: https://doi.org/10.1186/s13005-017-0145-1

Nurko C, Ranly DM, García-Godoy F, Lakshmyya KN. Resorption of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth: a case report. Pediatr Dent. 2000;22(6):517–20.

Navit S, Jaiswal N, Khan SA, Malhotra S, Sharma A, Mukesh, et al. Antimicrobial efficacy of contemporary obturating materials used in primary teeth – an in-vitro study. J Clin Diagn Res. 2016;10(9): ZC09–12. DOI: https://doi.org/10.7860/JCDR/2016/21883.8426

Elicherla SR, Bandi S, Venkata Saikiran K, Nunna M, Sai Sahiti P, Nuvvula S. The clinical and radiographic success of Endoflas compared with other root canal obturating materials in primary teeth: a systematic review. Dent Res J. 2022;19:72. DOI: https://doi.org/10.4103/1735-3327.356805

Barcelos R, Santos MP, Primo LG, Luiz RR, Maia LC. ZOE paste pulpectomies outcome in primary teeth: a systematic review. J Clin Pediatr Dent. 2011;35(3):241–8. DOI: https://doi.org/10.17796/jcpd.35.3.y777187463255n34

Sadrian R, Coll JA. A long-term followup on the retention rate of zinc oxide eugenol filler after primary tooth pulpectomy. Pediatr Dent. 1993;15(4):249–53.

Ou-Yang LW, Chang PC, Chuang LC, Yu HT, Tsai AI. Treatment outcomes of pulpectomy in primary maxillary incisors filled with ZOE and Metapex: a two-year retrospective study. J Clin Pediatr Dent. 2021;45(2):83–9. DOI: https://doi.org/10.17796/1053-4625-45.2.3

Fuks AB, Eidelman E, Pauker N. Root fillings with Endoflas in primary teeth: a retrospective study. J Clin Pediatr Dent. 2002;27(1):41–5. DOI: https://doi.org/10.17796/jcpd.27.1.pp237453707386m1

Kumar KS, Asokan S, Geethapriya PR, Sivakumar K, Yamunadevi A. Survival function of clinical and radiographic success of three obturating materials in primary teeth at 3, 6 and 9 months periodic intervals – a randomized controlled clinical trial. J Pharm Bioallied Sci. 2023;15(Suppl. 1):S747–51. DOI: https://doi.org/10.4103/jpbs.jpbs_579_22

Payne RG, Kenny DJ, Johnston DH, Judd PL. Two-year outcome study of zinc oxide-eugenol root canal treatment for vital primary teeth. J Can Dent Assoc. 1993;59(6):528–30, 533–6.

Ozalp N, Saroğlu I, Sönmez H. Evaluation of various root canal filling materials in primary molar pulpectomies: an in vivo study. Am J Dent. 2005;18(6):347–50.

Trairatvorakul C, Chunlasikaiwan S. Success of pulpectomy with zinc oxide-eugenol vs calcium hydroxide/iodoform paste in primary molars: a clinical study. Pediatr Dent. 2008;30(4):303–8.

Kargül B, Tanboga I, Altinok B. Conventional endodontic treatment of primary molars using metronidazole as an intra-canal medicament: a pilot study. Eur Arch Paediatr Dent. 2010;11(4):196–200. DOI: https://doi.org/10.1007/BF03262744

Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex as treatment options for pulpally involved primary molars. Int J Paediatr Dent. 2010;20:214–21. DOI: https://doi.org/10.1111/j.1365-263X.2010.01044.x

Barr ES, Flatiz CM, Hicks MJ. A retrospective radiographic evaluation of primary molar pulpectomies. Pediatr Dent. 1991;13(1):4–9.

Nadkarni U, Damle SG. Comparative evaluation of calcium hydroxide and zinc oxide eugenol as root canal filling materials for primary molars: a clinical and radiographic study. J Indian Soc Pedod Prev Dent. 2000;19:1–11.

Primosch RE, Ahmadi A, Setzer B, Guelmann M. A retrospective assessment of zinc oxide-eugenol pulpectomies in vital maxillary primary incisors successfully restored with composite resin crowns. Pediatr Dent. 2005;27(6):470–7.

Rewal N, Thakur AS, Sachdev V, Mahajan N. Comparison of Endoflas and zinc oxide eugenol as root canal filling materials in primary dentition. J Indian Soc Pedod Prev Dent. 2014;32(4):317–21. DOI: https://doi.org/10.4103/0970-4388.140958

Brar GS, Bajaj N, Bhola M, Brar JK. Clinical evaluation of root resorption and its correlation with obturation quality in pulpectomized deciduous teeth with different obturating materials: an in vivo study. Contemp Clin Dent. 2019;10(2):243–8. DOI: https://doi.org/10.4103/ccd.ccd_448_18

Subramaniam P, Gilhotra K. Endoflas, zinc oxide eugenol and metapex as root canal filling materials in primary molars – a comparative clinical study. J Clin Pediatr Dent. 2011;35(4):365–9. DOI: https://doi.org/10.17796/jcpd.35.4.1377v06621143233

Holan G, Fuks AB, Ketlz N. Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalga. Pediatr Dent. 2002;24(3):212–16.

Hutcheson C, Seale NS, McWhorter A, Kerins C, Wright J. Multi-surface composite vs stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial. Pediatr Dent. 2012;34(7):460–7.