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 82.3% of the time; those without smear layer removal, 88.2%, 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.