A pilot study to compare clinical and radiographic success of a non-root instrumentation non-vital pulpotomy and a traditional pulpectomy

Current options for management of necrotic primary molars include pulpectomy or extraction but are not always appropriate for children with limited cooperation. A pulpotomy may be better tolerated but there is little evidence for its effectiveness. \nThis pilot study assessed clinical and radiographic success of a pulpectomy, pulpotomy and pragmatic pulpotomy, and the feasibility of conducting a randomised controlled trial. \n4-9 year olds with non-vital primary molars were recruited and randomly allocated to receive a pulpectomy or a pulpotomy. If they could not tolerate rubber dam, a pulpotomy was provided without isolation (pragmatic group). \n22 molars were enrolled (17.7% recruitment rate). Insufficient cooperation was a common reason for non­inclusion. 13 of 16 teeth (81.3%) returned for follow-up. At 6 months, 2 of 3 pulpectomised teeth, 5 of 7 teeth with a pulpotomy and 2 of 4 teeth with a pragmatic pulpotomy were successful. At 24 months, success rates were 1 of 1 tooth, 2 of 3 teeth and none of 3 teeth respectively. 4 pulpotomised and 1 tooth in the pragmatic group exfoliated early. \nThe small numbers limit the conclusions that can be drawn but the pulpotomy technique appears to warrant further research. A different study design may improve recruitment.