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He SY, Li JY, Dai SS, Yang YH, Wen YF, Guo QY, Liu F. Survival Analysis and Risk Factors of Pulpectomy among Children with Severe Early Childhood Caries Treated under General Anesthesia: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1191. [PMID: 36673947 PMCID: PMC9859510 DOI: 10.3390/ijerph20021191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aims to retrospectively evaluate the survival rate of pulpectomy performed under dental general anesthesia (DGA) through long-term follow-up and to explore the risk factors associated with treatment failure. METHODS The medical records of the children who were diagnosed with S-ECC and received pulpectomy treatment under general anesthesia (GA) from 1 August 2014 to 1 December 2019, in the Stomatological Hospital of Xi'an Jiaotong University, were collected. Two dentistry postgraduates extracted the necessary information and filled in a predesigned excel form. Survival analysis was performed using the Kaplan-Meier method. The shared frailty model was used to explore possible factors affecting the success rate of pulpectomy in primary teeth. RESULTS A total of 381 children (mean age 3.49 ± 0.90) with S-ECC and 1220 teeth were included in the study, including 590 primary anterior teeth and 630 primary molars. The overall 35-month survival rate was 38.5%, which was 52.9% for anterior teeth and 31.1% for molars. The overall median survival time was 31 months, in which anterior teeth were 35 months and molars were 26 months. The older the children were, the greater the risk of treatment failure (HR 1.56, 95% CI 1.09, 2.24). The risk of pulpectomy failure of primary molars was 1.9 times that of primary anterior teeth (95% CI 1.36, 2.65) and the teeth with abnormal radiological findings before treatment was 1.41 times higher than that of teeth without imaging abnormalities (95% CI 1.74, 3.36). CONCLUSION The survival rate of primary tooth pulpectomy is acceptable but decreased gradually with time. The failure rate of pulpectomy in primary molars is higher than that of primary anterior teeth. When the primary caries has extended to the pulp and resulted in a nonvital lesion, pulpectomy could be an option for maximum retention of the primary tooth.
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Affiliation(s)
- Shu-yang He
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jin-yi Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Department of Pediatric Dentistry, Affiliated Stomatology Hospital of Xi’an Jiaotong University, Xi Wu Road No. 98, Xi’an 710041, China
| | - Shan-shan Dai
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Department of Pediatric Dentistry, Affiliated Stomatology Hospital of Xi’an Jiaotong University, Xi Wu Road No. 98, Xi’an 710041, China
| | - Yu-hui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yi-feng Wen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Department of Endodontics, Affiliated Stomatology Hospital of Xi’an Jiaotong University, Xi’an 710004, China
| | - Qing-yu Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Department of Pediatric Dentistry, Affiliated Stomatology Hospital of Xi’an Jiaotong University, Xi Wu Road No. 98, Xi’an 710041, China
| | - Fei Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medical Research, College of Stomatology, Xi’an Jiaotong University, Xi’an 710004, China
- Department of Pediatric Dentistry, Affiliated Stomatology Hospital of Xi’an Jiaotong University, Xi Wu Road No. 98, Xi’an 710041, China
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Hanafi L. An approach of preserving a mandibular primary second molar by a hemisection procedure: A case report with 36-month follow up. Heliyon 2022; 8:e10655. [PMID: 36158099 PMCID: PMC9489956 DOI: 10.1016/j.heliyon.2022.e10655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/02/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
Primary teeth play a crucial role in functional, aesthetic and speech tasks. They are also responsible for maintaining the jaw space for successor permanent teeth. Thus, dentists should understand that extraction might be the easiest decision but not always the correct one, especially, in the case of multiple loss of primary molars. On the other hand, endodontic treatments should be accurately diagnosed - necrotic and irreversibly inflamed teeth - and performed with suitable dental tools and materials. Then it is important to provide a good sealing with a suitable final restoration. This case report discusses an approach for preserving a mandibular primary second molar which had a radiographic lesion in the mesial root and the furcation area with multiple loss of primary molars (before eruption of first permanent molar). This treatment was done by performing a root canal treatment (pulpectomy) just for the distal root and a hemisection procedure by extracting the mesial root, followed by applying SSC crown and space maintainer (band and loop). To conclude, this type of treatment should be temporary until the eruption of the first permanent molar and then changed to be a lingual arch appliance. Moreover, hemisection was a suitable alternative approach to extraction over 36 months of following up.
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Affiliation(s)
- Louay Hanafi
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
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