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PEDIATRIC DENTISTRY SECTION

RE-TREATMENT PULP THERAPY:

AN ALTERNATIVE THERAPY IN

PEDIATRIC DENTISTRY

Rajesh Ahal and Ritu Ahal

INTRODUCTION seal with sealants in a resorbing deciduous root(s) is challenging.
Re-treatment of deciduous (primary) teeth, especially in the 2. Sufficient Time Until Exfoliation: The deciduous tooth should have
context of endodontic procedures, remains a topic with limited more than six months before exfoliation, which can be assessed using
direct research. Pediatric dentists, who aim to conserve the known methods such as the Stage of Succedaneous Tooth Development
Leeway Space of Nance for a child’s optimal future, face the (Nolla Stage) and the remaining bone thickness above a succedaneous
daunting challenge of delivering a non-reinfecting Partial tooth crypt.
Pulpectomy. A non-cooperative child and tortuous root canal
architecture often hinder thorough debridement and complete CASE A – A RADIOLOGICAL EVALUATION OF RE-TREATMENT
sealing of the canals. However, the introduction of Rotary PARTIAL PULPECTOMY OVER 2 YEARS
Endodontics into Pediatric Endodontics has significantly A 5-year-old boy underwent pulp therapy for the right mandibular
improved the success rates⁶. Even if a partial pulpectomy fails, deciduous first molar (Tooth No. 84) at another facility. Unfortunately,
the tooth can still be preserved through timely retreatment⁷. the treatment failed, resulting in a gingival abscess that persisted for
Typically, a deciduous molar post-Pediatric Endodontic two months. Despite being prescribed antibiotics, the condition did not
treatment requires crown placement, entailing longer treatment resolve. Seeking further assistance, the child’s mother consulted another
visits or additional appointments. However, restoring these facility, where additional attempts were made to treat the tooth. However,
endodontically treated or decayed teeth with composites can after two visits, extraction was recommended.
reduce treatment time and possibly eliminate the need for a Determined to avoid extraction, the mother brought the child to our clinic
subsequent visit. Using flowable composites instead of paste- for assessment and evaluation.
form composites allows for better adaptation to the tooth surface Tooth 84 – Occlusal decay with remnants of a temporary restoration and
and restoration completion in two or three incremental layers. cotton was observed, with the gingival abscess still present on the buccal
This article presents three cases: the first involves a Re- aspect.
Treatment Partial Pulpectomy with a two-year radiological
follow-up. The second case, with a four-month follow-up, IOPA HD Digital radiographs:
features a Partial Re-Treatment Pulpectomy and a comparison
of using Nano-cluster composites in paste and flowable forms
for readers to appreciate and apply in their clinical practices. The
third case involves a partially initiated pulpectomy that became
symptomatic 18 months later and was taken up for Re-treatment
Partial Pulpectomy. These cases share various challenging
clinical conditions under which re-treatment pulp therapies and
subsequent restorations were undertaken, indicating the viability
and success of this approach and highlighting a paradigm shift.

CRITERIA FOR SELECTING CASE FOR RE-TREATMENT
PULP THERAPY
Clinicians worldwide often consider radiolucent changes below
the deciduous tooth on a radiograph as critical deciding factors.
Clinically, it has been observed that a tooth can last almost until Fig 1: IOPA HD digital 84 Fig 2: IOPA HD digital radiograph:
its exfoliation time, even with an intraoral sinus. Additionally, radiograph: Pre-treatment. 84 – Post Re-treatment Partial
these radiolucent changes can turn radiopaque once the - Occlusal decay involving the pulp Pulpectomy.
underlying cause has been adequately treated . Therefore, the chamber - Radiopaque sealer obturating the
1-3
mesio-buccal, mesio-lingual & distal
- Radiopaque plug in the occlusal
criteria for selecting a tooth for re-treatment pulp therapy are cavity canals
as follows: - Slight diffuse radiolucent changes - Slight puff in the distal and mesial
1. Minimal or No Root Resorption: Achieving a good-quality in the furcation area canal – indicating good obturation.
- Distal root – slight resorption.
20 Dental Practice I January-February 2025 I Vol 21 No 1