Abstract
Pulpectomy in primary teeth is a widely accepted endodontic procedure aimed at preserving arch integrity and function until natural exfoliation, and its success largely depends on the biological and physicochemical properties of the root canal filling material, which must combine antimicrobial efficacy, biocompatibility, and a resorption pattern compatible with physiological root resorption. This systematic review aimed to evaluate and compare the clinical and radiographic outcomes of different obturation materials used in pulpectomy of primary teeth. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library. Clinical studies evaluating pulpectomy outcomes in primary teeth were included, while in vitro studies, animal studies, case reports, and narrative or systematic reviews were excluded. The methodological quality of the included studies was assessed using established risk-of-bias tools, and eligible studies were synthesized through a qualitative analysis. Five clinical studies met the inclusion criteria and were included in the qualitative synthesis. All investigated materials demonstrated acceptable clinical success rates. Calcium hydroxide iodoform pastes showed favorable short- to medium-term outcomes but exhibited a tendency toward faster intracanal resorption, whereas zinc oxide–eugenol–based materials were associated with delayed resorption and lower biological compatibility. Emerging clinical evidence suggests that bioceramic calcium silicate–based materials may offer high clinical and radiographic success rates, although long-term data remain limited. Within the limitations of the available evidence, both calcium hydroxide– iodoform pastes and bioceramic materials appear to be effective for pulpectomy in primary teeth; however, the limited number of eligible clinical studies and the heterogeneity of study designs and followup periods restrict the strength of definitive conclusions, highlighting the need for further well-designed, long-term randomized clinical trials to clarify resorption dynamics and potential effects on permanent tooth eruption. This systematic review was conducted in accordance with the PRISMA 2020 guidelines and was registered in the PROSPERO database (CRD1283772); no external funding was received.
Keywords: Pulpectomy; primary teeth; calcium hydroxide; iodoform paste; bioceramic materials; root canal filling