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ENDODONTIC MANAGEMENT OF A MANDIBULAR PRIMARY MOLAR WITH PULPAL NECROSIS AND PERIAPICAL ABSCESS: A CASE REPORT
Abstract
Background: Dental caries in children remains a major public health concern due to its high prevalence and propensity to progress to pulp tissue involvement. The thinner enamel and dentin of primary teeth accelerates bacterial penetration to the pulp and periapical tissues. Purpose: This case report describes the endodontic management of pulpal necrosis with periapical abscess in a mandibular primary second molar. Case Report: An 8-year-old boy presented with food impaction in tooth 85 without accompanying pain. Clinical and radiographic examination confirmed pulpal necrosis with a periapical abscess. Case Management: Treatment was initiated with open access, trepanation, and placement of intracanal dressing. Subsequent visits involved root canal preparation using the conventional step-back technique, irrigation with 2.5% NaOCl, and intracanal medication with calcium hydroxide. Obturation was performed using a combination of Ca(OH)₂ and iodoform paste (Metapex), followed by final restoration with a stainless-steel crown. Conclusion: Follow-up evaluation demonstrated complete resolution of clinical symptoms, and radiographic findings confirmed periapical healing. Structured endodontic management of primary teeth with pulpal necrosis and periapical abscess employing conventional techniques and biocompatible materials is effective in controlling infection, promoting healing, and preserving tooth function until natural exfoliation.
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Yirsaw AN, Bogale EK, Tefera M, et al. Prevalence of dental caries and associated factors among primary school children in Ethiopia: systematic review and meta-analysis. BMC Oral Health. 2024;24(1):1–10. doi:10.1186/s12903-024-04555-5
Hasan F, Yuliana LT, Budi HS, et al. Prevalence of dental caries among children in Indonesia: a systematic review and meta-analysis of observational studies. Heliyon. 2024;10(11). doi:10.1016/j.heliyon.2024.e31440
Tiwari S, Dubey A, Singh B, Avinash A. Clinical consequences of untreated dental caries evaluated with the pulpal involvement-roots-sepsis index in the primary dentition of school children from the Raipur and Durg Districts, Chhattisgarh State, India. Med Princ Pract. 2015;24(2):184–188. doi:10.1159/000369067
Reis PPG, Jorge RC, Marañón-Vásquez GA, Fidalgo TKDS, Maia LC, Soviero VM. Impact of clinical consequences of pulp involvement due to caries on oral health-related quality of life in children and adolescents: a systematic review and meta-analysis. Caries Res. 2025;59(1):71–84. doi:10.1159/000541027
Paramasivam K, Manjunathappa TH, Kumar BS, Vaishnavi G. Association of pulp involvement, ulceration, fistula, abscess and body mass index among primary school children: a case-control study. Int J Clin Pediatr Dent. 2025;18(8):930–939. doi:10.5005/jp-journals-10005-3190
Ramzan M. Root canal treatment in primary teeth: review article. EC Dent Sci. 2020;19:142–150.
Wibisono L, Dharsono HDA. Root canal treatment of mandibular right first molar with symptomatic irreversible pulpitis. J Kedokt Gigi Univ Padjadjaran. 2021;32(3):127. doi:10.24198/jkg.v32i3.29523
Cahyani RD. Multi-visit root canal treatment with the step-back technique in a lateral incisor: a case report. JIKG. 2022;5(2):1–6.
Yu B, Zhao S. Evaluation of effective rate and pain intensity of root canal treatment in primary teeth: a retrospective study. J Clin Pediatr Dent. 2024;48(2):88–92. doi:10.22514/jocpd.2024.037
Lee SM, Yu YH, Karabucak B. Endodontic treatments on permanent teeth in pediatric patients aged 6–12 years. J Dent Sci. 2023;18(3):1109–1115. doi:10.1016/j.jds.2022.11.003
Şahin TN, Çakir A. Deciphering pediatric root canal practices in Turkey: a comparative study bridging the gap between practice and literature. Med Sci Monit. 2023;29:1–10. doi:10.12659/MSM.940296
Grover S, Mala K, D'Souza JL. Drain and treat: a rubber dam technique for acute periapical abscess. Acta Medica Bulg. 2024;51(S2):143–147. doi:10.2478/AMB-2024-0063
Gazali M, Fauzi A. Management of submandibular abscess extending to the temporal space in a child. Makassar Dent J. 2023;12(3):362–365.
Alshammari M, Alzoubi F. Endodontic management of unusual extraoral cutaneous sinus tract. Saudi Endod J. 2023;13(1):108–115. doi:10.4103/sej.sej_94_22
Shareghi A, Ahmadpoor E, Lorigooini Z, Ahmadi F, Tohidkhah S. Efficacy of calcium hydroxide/saline versus calcium hydroxide/Artemisia persica essential oil as intracanal medicament to improve radiographic visualization of periapical lesions in necrotic teeth: a randomized clinical trial. Int J Dent. 2023;2023. doi:10.1155/2023/6364881
Pekpinarli B, Kaval ME, Cogulu D, et al. The effect of calcium hydroxide and double antibiotic paste on radiographic outcomes and periapical MMP-8 levels in regenerative endodontic procedures: a randomized clinical trial. J Appl Oral Sci. 2024;32:1–13. doi:10.1590/1678-7757-2024-0122
Arikatla SK, Chalasani U, Mandava J, Yelisela RK. Interfacial adaptation and penetration depth of bioceramic endodontic sealers. J Conserv Dent. 2018;21(4):373–377. doi:10.4103/JCD.JCD
Khan MI, Arif K, Khare A, Mishra P. Periapical pathologies treated with conservative approach. Traumaxilla. 2023;5(1-3):64–67. doi:10.1177/26323273231222571
Giovanni A, Nahzi MYI, Adhani R. Comparative effectiveness of conventional and crown-down root canal preparation techniques on apical debris extrusion. Dentin. 2022;6(2):71–75. doi:10.20527/dentin.v6i2.6389
Rajendra Reddy E, Raju SS, Sandipamu T, Kiranmayi M, Mudusu SP, Saraswati SD. Modified conventional root canal shaping technique in primary teeth: an in vivo study. Int J Clin Pediatr Dent. 2022;15(S1):S8–S11. doi:10.5005/jp-journals-10005-2121
Xu H, Ye Z, Zhang A, Lin F, Fu J, Fok ASL. Effects of concentration of sodium hypochlorite as an endodontic irrigant on the mechanical and structural properties of root dentine: a laboratory study. Int Endod J. 2022;55(10):1091–1102. doi:10.1111/iej.13800
Izzati AF, Fatriadi F. Indirect pulp capping with calcium hydroxide in permanent molars. J Ris Kesehat Poltekkes Depkes Bandung. 2023;15(2):541–547. doi:10.34011/juriskesbdg.v15i2.2312
Duarte ML, Siqueira M, Cassol DV, Scarparo A, Primo LG, Barcelos R. Pulpectomies with iodoform versus calcium hydroxide-based paste: a preliminary randomised controlled clinical trial. Pesqui Bras Odontopediatria Clin Integr. 2023;23:1–11. doi:10.1590/pboci.2023.058
Ridawanty R, Pratidina NB, Primarti RS. Effectiveness of ZnOE, Ca(OH)₂, and iodoform as root canal filling materials for pulpectomy in primary teeth. Denta. 2023;17(2):57–66. doi:10.30649/denta.v17i2.3
Rahaswanti LWA. Evaluasi keberhasilan pengisian saluran akar dengan sediaan zinc oxide eugenol dan campuran calcium hydroxide dengan pasta iodoform [Evaluation of root canal filling success with zinc oxide eugenol and calcium hydroxide-iodoform paste]. Intisari Sains Medis. 2017;8(1):1–7. doi:10.1556/ism.v8i1.1
Kartinawanti AT, Asy'ari AK. Pulp disease and single-visit root canal treatment: a literature review. J Ilmu Kedokt Gigi. 2021;4(2):64–72.
Bintang QA, Fatmawati DWA, Rakhmadian RD, Lestari S. Success rate of root canal treatment in non-vital teeth at the RSGM Universitas Jember in 2016. Arteri J Ilmu Kesehat. 2022;3(3):95–102. doi:10.37148/arteri.v3i3.224
DOI: http://dx.doi.org/10.20527/dentino.v11i2.26507
DOI (PDF): http://dx.doi.org/10.20527/dentino.v11i2.26507.g12538
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