Clinical Update quiz
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August 2026 Clinical Update
Assessment of Alterations in Permanent Premolars After Endodontic Treatment of Predecessor Primary Molars: A Prospective Study.
de Sousa RL, de Oliveira EV, Soares JP, Alencar N, Barasuol J, Santos PS, Cardoso M, Bolan M. International Journal of Paediatric Dentistry, 2026; 36:33–39.
Compiled by Dr Sarah Chin.
This article was originally published by the International Journal of Paediatric Dentistry, and has been edited for brevity and clarity.
Introduction
Early childhood caries and traumatic dental injuries are the main cause of pulpal damage which affects the permanent successor tooth germ, such as the reduced enamel epithelium or gubernacular canal. This may result in enamel hypomineralisation, hypoplasia, arrested development of the permanent tooth, formation of dentigerous cysts, germ expulsion resembling bone sequestration in osteomyelitis, and alterations in the follicular structure.
Pulp therapy in primary teeth is performed to maintain the tooth until natural exfoliation to maintain space for the permanent successor and development of the dental arch. Pulpectomy is indicated when there are clinical and radiographic signs of irreversible pulpitis or pulp necrosis. Successful endodontic treatment of primary teeth involves eliminating bacteria from the complex root canal curvature which can pose significant challenges to instrumentation. Irregular root resorption also complicates the determination of a precise apical limit for both instrumentation and obturation.
Obturation materials need to be biocompatible with periapical tissues and the developing permanent tooth germ, resorption rate similar to the primary tooth root, antiseptic properties, good adhesion to canal walls, ease of application and removal, radiopacity and absence of tooth discolouration. As no material fulfils these requirements, the most commonly used root canal filling in paediatric dentistry include zinc oxide-eugenol (ZOE) paste, iodoform-based pastes, and calcium hydroxide-based formulations. In some studies, ZOE has a higher clinical success rate while others have shown no superiority over alternative materials. Overfilling with ZOE has been associated with potential alterations in the eruption path of the permanent successor and slower resorption rate than the primary roots.
The primary objective of this study was to assess the developmental and eruptive alterations in permanent premolars after endodontic treatment of their primary molar predecessors. Potential demographic, tooth and treatment related variables were also investigated as possible explanatory factors associated with alterations in successor premolars.
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