Factors Affecting Success and Failure of Pulpectomy in Primary Teeth: A Systematic Review

Abstract

Aims and background: A pulpectomy in primary teeth is considered successful when there are no clinical symptoms or radiographic evidence of pathology. Outcomes vary due to multiple influencing factors, and comprehensive long-term evidence remains limited. This systematic review evaluates pulpectomy success over long-term follow-ups and identifies risk factors for failure. Methods: An electronic database search was conducted in PubMed, EBSCOhost, Scopus, and Cochrane from January, 1990 to December 30, 2024. Different keywords were employed in various combinations during the search process to find all possible articles focused on our subject. The Cochrane risk of bias tool (ROB 2.0) was employed for evaluating randomized controlled trials, whereas observational studies were assessed using the ROBINS-I tool. Results: A total of 360 articles were reviewed, and only 12 satisfied the inclusion requirements. The success rate of pulpectomy ranged between 38.5% and 96.2% over 5 years. The minimum amount of preoperative root resorption and adequate length of root canal filling material are the common factors associated with the success of pulpectomy. Zinc oxide eugenol (ZOE) and Endoflas success rate were 90% and 71% or less for iodoform after 18 months of evaluation. Conclusion: Factors associated with the success of pulpectomy were an absence of preoperative periapical lesions, minimal preoperative root resorption, adequate root canal filling, and the type of postendodontic restoration. The factors associated with pulpectomy failure were the presence of a periapical lesion, preoperative swelling, fistula, pulpectomy performed in trauma cases, and inadequate quality of the root filling. Age, gender, tooth position, treatment modality, and number of appointments did not significantly affect pulpectomy.