Clinical Approaches to Endodontic Therapy in Primary Teeth Lacking Permanent Successors: A Case Series Analysis

A common dental anomaly, hypodontia, refers to the congenital absence of one or more primary or permanent teeth, excluding the third molars. It is the most prevalent dental abnormality and it is estimated that 2-10 percent of the global population has it. Hypodontia in other instances can be linked with other general disorders or genetic syndromes e.g. ectodermal dysplasia.1 Two treatment options are available: either extract the primary molar to create space for the first permanent teeth to erupt and close the gap or retain the primary second molar until growth is complete.2,3 Endodontic treatment is generally showed when pulp is compromised, with the goal of preserving the tooth to maintain function and space for the eruption of permanent successors. But where there are no permanent successors to primary teeth, the decision to perform endodontic treatment is more complicated. Such cases are frequently seen in patients having congenital defects, developmental disorders or early deficiency of permanent teeth.4 During a standard pulpectomy of a deciduous tooth with pulp involvement, and no permanent replacement, one would fill the root canals with gutta-percha and then rebuild the crown. Nevertheless, there are difficulties because of the limitations of creating the curved and delicate roots of primary molars to accept the master apical file. This renders it awkward to get good obturation.5,6 The purpose of the case series is to explore clinical strategies in endodontic treatment in primary teeth that do not have permanent successors with a special focus on the issues of treatment planning, treatment protocols, and long-term prognosis. The goal of the article is to contribute to the currently existing body of knowledge on the management of primary teeth with no permanent successor by conducting a thorough case analysis of a number of cases and emphasizing the role of the patient-specific treatment plan and follow-up.