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CASE C: RE-TREATMENT PARTIAL PULPECTOMY IN A PREVIOUSLY INITIATED PARTIAL PULPECTOMY
A Partial Pulpectomy was initiated in a 3-year-old child for the deciduous right mandibular second molar (Tooth number 85). However, the
child was not brought in for the subsequent appointment as she had become asymptomatic. The parents returned 18 months later when the tooth
became symptomatic again. It was then taken up for Re-treatment Partial Pulpectomy and restored using Nano-cluster Paste Form composites.
Clinically, the child presented with pain. A Partial Pulpectomy was initiated, and the pulp was subsequently found to be necrotic. A closed
dressing was applied; however, the child did not return for the follow-up visit despite reminder calls.
After another 18 months, the parents brought the child back when tooth number 85 became symptomatic once again—this time, with the
development of an intraoral sinus!

Fig 47: Tooth No. 85: Fig 48: 85 – after 18 months – Recurrent Fig 49: Digital HD Fig 50: 85: Re-treatment Partial Pulpectomy
Occlusal decay – less decay around the temporary restoration. IOPA Reveals: (After 18 initiated under rubber dam.
than 1 mm dentinal Buccal vestibule – Intraoral sinus is evident. months):
barrier – slight - 85 – radiopaque
radiolucent changes restoration – occlusal.
peri-apically. - Radiolucent changes in
- 45 – crown formation the furcal area.
has initiated - 45 – crown formation
has progressed.

Fig 51: Digital HD IOPA reveals: Fig 52: 85 – Buccal View – Healing Intraoral Sinus. Fig 53: 85 – Restored with Nano-cluster Paste Form
- 85: Post re-treatment Partial composites after completing the re-treatment Partial
Pulpectomy. Pulpectomy.
- Radiopaque sealer in the canals.

DISCUSSION association and underlying mechanisms remain unclear. Conversely,
Clinically, failures in pulp therapy for deciduous teeth have always a 2016 review indicated that systemic metabolic disorders can
posed challenges in pediatric dentistry. In most cases, clinicians tend to exacerbate periapical lesions and negatively impact endodontic
opt for extraction of the affected tooth, followed by space maintenance treatment outcomes⁸. Tabassum S. and Khan F.R.⁴ reported that
if accepted by the parents. However, it is widely acknowledged that persistent bacterial presence leads to treatment failures, while effective
the best space maintainer for preserving the Space of Nance is the canal cleaning significantly improves success rates in endodontic
deciduous tooth itself. therapy.
A 2023 review by Ye L. et al.⁵ discussed a possible link between Faghihian et al.⁶ (2022) reported that rotary endodontic
periapical infections and cardiovascular conditions. However, the instruments reduce instrumentation time and increase the percentage

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