Nonvital Pulp Therapy in Primary Teeth Using Mineral Trioxide Aggregate Obturation: A Retrospective Case Series

Nonvital pulp therapy is a treatment option that can preserve pathologically affected primary teeth and contribute to space maintenance. This retrospective case series examined the healing effects in infected primary teeth after pulpectomy (PE) using mineral trioxide aggregate (MTA) obturation and eruption characteristics of the succedaneous teeth. Twenty-one teeth in 17 patients (mean age: 7 years 1 month) were selected for PE using MTA and diagnosed with pulp necrosis, periapical/furcation radiolucencies (67%, n = 14), resorptive defects (62%, n = 13), failing previous PEs (33%, n = 7), pulpotomies (29%, n = 6), or histories of trauma. All accessible canals were obturated with MTA and restored teeth monitored up until the time of natural exfoliation or planned extraction. Teeth with and without pretreatment root resorptive defects were evaluated over a 6-year period for MTA extrusion, posttreatment healing, preservation periods, residual MTA retention, radiographic connection between the tooth lesion and follicle, succedaneous tooth eruption times, and enamel defects. Posttreatment evaluations revealed healing or stabilization of supporting tissues without signs of recurrent infection in all cases. All primary teeth exfoliated or were extracted successfully and replaced by unaffected permanent teeth. Residual MTA cement was not detected in supporting bone after exfoliation. In cases where residual MTA was detected in soft tissues after exfoliation, the cement was shed during permanent tooth eruption in all cases. In five cases, MTA was curetted and removed along with partially resorbed roots at the time of extraction or after exfoliation (23.8%, n = 5). The average preservation period was 2 year 3 months (SD 1 year 3 months). The replacement period for contralateral primary teeth was not significantly different (paired t-test p value = 0.49). This retrospective case series suggests that MTA obturation/extrusion can promote healing and prolonged retention of infected primary teeth without affecting normal successor tooth eruption or newly formed enamel.