Long-term Outcomes of Primary Tooth Pulpectomy With and Without Smear Layer Removal: A Randomized Split-mouth Clinical Trial

Purpose: The aim of this study was to evaluate, via clinical and radiographic assessment, pulpectomy outcomes performed on primary anterior teeth both with and without a citric acid solution to enhance smear layer removal. Methods: Patients with a matched pair of primary incisors (split-mouth design) with irreversible pulp changes were selected. A total of 36 teeth (18 children) received pulpectomies and were followed for 36 months. Pulpectomies were performed using sodium hypochlorite and saline solution as canal irrigants; during the last irrigation, the tooth was randomly selected to receive (Group 1) or not receive (Group 2) the citric acid solution for smear layer removal. The roots were filled with ZOE paste. Results: Overall pulpectomy success was 90.6%. Cases with smear layer removal were successful 823% of the time; those without smear layer removal, 882%, and there were no statistical differences (P=1.00). Conclusion: Pulpectomy with smear layer removal in primary incisors exhibited, after 36 months, a high success rate; however, comparable results were obtained when the smear layer was not removed. (Pediatr Dent 2011;33:316-20) Received December 2, 2009 vertical bar Last Revision March 9, 2010 vertical bar Accepted April 1, 2010