Pediatric Dentistry · patient case question
What is the appropriate treatment for these two teeth?
Patient case: Discoloured primary incisors after an old injury
Patient: Female, 4 years old, accompanied by her father
Chief complaint: Father: “Her two front teeth have gone dark and now she says they hurt.”
History: Fell against a coffee table about a year ago. Teeth E and F were bruised but not displaced and were not treated at the time.
Findings: Teeth E and F are grey-brown. Both are tender to percussion. Neither responds to pulp testing. A sinus tract is present buccal to tooth E. Radiographs show periapical radiolucencies on both, with roots not yet resorbing.
Show answer and explanation
Correct answer: B. Pulpectomy with a resorbable filling material and stainless steel crowns
- A. Observation is only acceptable where the tooth is close to exfoliation, unrestorable, or where infection threatens the permanent successor and extraction is indicated instead. Leaving established periapical infection in place risks damaging the developing permanent tooth bud.
- B. CORRECT. A NECROTIC primary tooth with periapical pathology and a sinus tract, where the root is not yet resorbing and the tooth is otherwise restorable, is treated by PULPECTOMY — the whole radicular pulp is removed and the canals filled with a RESORBABLE material such as zinc oxide eugenol or an iodoform paste, so the filling resorbs in step with the root. Full-coverage stainless steel crowns follow, because a pulpectomised primary incisor has lost too much structure to hold an intracoronal restoration.
- C. Indirect pulp capping is for a deep carious lesion with a VITAL, asymptomatic pulp. It has no application to a necrotic tooth with periapical disease.
- D. Pulpotomy removes only the CORONAL pulp and requires the radicular pulp to be VITAL and healthy. This pulp is necrotic throughout, so a pulpotomy would seal infection into the canals.
Note: The main alternative is EXTRACTION with space maintenance, chosen if the tooth is unrestorable, if there is significant root resorption or bone loss, or if the permanent successor's follicle is threatened. Both answers are defensible; the deciding factor is restorability and root status.
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