Pulpectomy is a core conservative endodontic intervention in pediatric dentistry. Its primary clinical goal is to treat irreversible pulpitis or pulpal necrosis in primary teeth, eliminating infection while preserving the tooth structure. Unlike adult root canals, pulpectomy utilizes resorbable obturation materials that degrade at the same rate as the primary tooth roots during physiological root resorption. This prevents interference with the erupting permanent successor tooth while maintaining space and function within the dental arch.

Pulpectomy begins with local anesthesia administration and placement of a rubber dam for isolation. The clinician uses a high-speed handpiece to remove decayed enamel and dentin, opening the pulp chamber. Coronal pulp is extirpated, and small endodontic hand files or specialized rotary instruments carefully clean and shape the root canals. Canals are irrigated with dilute sodium hypochlorite or chlorhexidine to eliminate bacteria. After drying with paper points, the root canals are densely filled with a resorbable paste using a paste carrier or syringe. The tooth is sealed with a durable crown restoration, such as a stainless steel crown.

Evidence demonstrates that successful pulpectomy preserves primary molar teeth, maintaining critical arch length and preventing space loss that leads to dental crowding. Retaining the primary tooth prevents ectopic eruption of permanent teeth, preserves normal masticatory function, aids clear speech development, and eliminates deep localized infection without surgical extraction.

Initial recovery occurs within 24 to 48 hours following treatment. Mild soft tissue tenderness or localized pericoronitis around the restored tooth is manageable with over-the-counter pediatric analgesics such as acetaminophen or ibuprofen. Long-term monitoring involves periodic radiographic evaluations every 6 to 12 months until the primary tooth undergoes physiological shedding and the permanent successor erupts normally.

Pulpectomy treats severe pulpal disease in primary teeth where conservative pulpotomy is insufficient. Specific clinical indications include irreversible pulpitis, primary tooth pulpal necrosis, chronic apical periodontitis, inter-radicular bone loss due to pulpal infection, and localized dentoalveolar abscesses in restorable teeth where space maintenance is critical.

Pre-treatment preparation includes clinical examination, diagnostic digital radiographs (periapical or bitewing), and medical history review. Children are evaluated for systemic conditions or immunocompromise. Pre-procedure counseling helps reduce dental anxiety. Local anesthesia allergy screening is performed, and pre-medication antibiotics are prescribed only if systemic infection or specific medical guidelines require them.

Complications include localized post-operative discomfort, accidental root canal perforation, instrument fracture, incomplete canal filling, overextension of obturation paste into soft tissue, soft tissue injury from local anesthesia, and recurrence of periapical infection requiring extraction.

The clinical journey begins with a thorough diagnostic evaluation, including visual inspection, palpation, mobility testing, and peri-apical radiographs. Once indicated, the patient receives local anesthesia and rubber dam isolation. The clinician creates an access cavity, extirpates inflamed or necrotic coronal and radicular pulp, irrigates the canals, and fills them with a biocompatible resorbable material. A full-coverage restoration, such as a stainless steel crown, is placed immediately or in a subsequent visit. Post-operative follow-up includes radiographic and clinical assessments at 6 and 12 months to monitor periapical healing and physiological root resorption.