Bull Tokyo Dent Coll (2017) 58(2): 77–83

Original Article doi:10.2209/tdcpublication.2016-0006

Clinical and Radiographic Success of Electrosurgical

Pulpectomy in Primary Teeth

Rasoul Sahebalam1), Alireza Sarraf1), Hamid Jafarzadeh2),

Maryam Jouybari-Moghaddam2) and Samane Seyed-Musavi3)
1)
Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical
Sciences,
P. O. Box: 91735-984, Mashhad, Iran
2)
Department of Endodontics, Faculty of Dentistry, Dental Research Center, Mashhad
University of Medical Sciences,
P. O. Box: 91735-984, Mashhad, Iran
3)
Student Research Committee, Mashhad University of Medical Sciences,
P. O. Box: 91735-984, Mashhad, Iran

Received 25 April, 2016/Accepted for publication 27 June, 2016

Abstract
A pulpectomy requires the swift extraction of the inflamed tissue. Moreover, the
speed of treatment is especially important in the case of uncooperative children. Conven-
tional pulpectomies, however, often require an extended treatment period, which can
therefore cause problems with such patients. Electrosurgical methods have been applied
to pulpotomies for a number of years. However, to the best of our knowledge, no studies
to date have assessed its application to pulpectomies. The aim of this study was to com-
pare clinical and radiographic success rates over a 6-month follow-up period between
conventional and electrosurgical pulpectomies. A total of 50 children aged 4 to 8 years
were enrolled in this randomized clinical trial. A pulpectomy of the first and second pri-
mary molar teeth was seen as the optimal treatment plan in all these patients. One group
was treated using the conventional method (C group, 25 teeth) and the other with elec-
trosurgery (ES group, 25 teeth). The patients were evaluated for the presence of pain,
mobility, abscess, sinus tract, erythema, tenderness to percussion, internal and external
root resorption, and radiolucency. Clinical and radiographic success rates and total work-
ing time were assessed. The Fisher’s exact test and Mann-Whitney U-test were used for the
statistical analysis. After 6 months of follow-up, the clinical and radiographic success rates
were 90.5 and 85.7%, respectively, in the ES group, compared with 88.9 and 72.2%,
respectively, in the C group. No statistically significant difference was observed between
the two groups (p>0.05). Working time, however, was significantly shorter in the ES
group (p<0.001). This suggests that pulpectomy with electrosurgery reduces treatment
time, and is therefore quite useful in situations where duration of the treatment course is
of crucial concern.
Key words: Pulpectomy — Electrosurgery — Primary teeth

77
78 Sahebalam R et al.
Introduction
Despite all the progress that has been made
in improving technology and methods aimed
at improving prevention of dental caries and
raising levels of awareness concerning the
significance of maintaining normal dentition,
teeth continue to be lost as it is too late to save
them by the time the patient presents10,14). The
removal of a diseased pulp in its entirety,
including the pulp tissue in the roots, is
referred to as a pulpectomy12,13). The primary
aim of this procedure is to save a tooth that
would otherwise have to be extracted to avoid
the disturbance of the permanent dentition
that would result from the subsequent change
in spatial relationships3,17). Basically, it involves
accessing the root canals to remove as much
dead and infected material as possible and
then filling them with a suitable material to
maintain the tooth in a non-infected state7,17).
Removing pulp from the root canals of the
posterior primary teeth using conventional
techniques can be time-consuming. One
problem here, however, is that long endodon-
tic treatment sessions are contraindicated in
young children14,16). Moreover, shaping and
cleaning the canals can also prove problem-
atic, which has led to an extensive search for
more effective instruments, materials, and
techniques for this purpose. All this effort is
aimed at securing a faster and more effective
way of preparing a canal for obturation. While
conventional methods have insisted on using
hand and rotary instruments, more recent
approaches have applied laser technology,
non-instrumentation techniques, and tech-
niques employing ultrasonic or sonic equip-
ment9,14). Moreover, clinicians are now inter-
ested in the biocompatibility offered by alter-
native approaches, as conventional treatment
modalities incur significant disadvantages
such as cytotoxicity, potential mutagenicity,
and undesirable immune sensitization. Even
so, the conventional approaches are still the
most commonly used when undertaking a
pulpotomy of the primary molars9).
Electrosurgery involves using a high-fre-
quency electric current to cut, coagulate,
desiccate, or fulgurate various types of tissue.
Basically, heat is conducted from a probe
heated to glowing temperature using a direct
current, much as with a soldering iron. In the
ambient area of the active electrode, tempera-
tures of 60–70°C lead to the slow boiling of
the intra-cellular fluid through the cell mem-
brane17). Electrosurgical devices are frequently
used to help prevent blood loss in outpatient
treatment procedures or in hospital operat-
ing rooms. Here, the bleeding is stopped by a
kind of “welding” effect.
Electrosurgery can also be safely used to
resect inflamed coronal pulp prior to placing
a lining material, owing to the non-pharmaco-
logical, hemostatic nature of the tech-
nique17,20). One of its benefits is that it allows
precise cuts to be made with only limited
blood loss.
Electrosurgical pulpotomy in the primary
teeth has been described by Anderman as a
time-efficient method that is relatively free
from postoperative complications1). It also
permits enhanced observation and produces
results faster than conventional approaches
such as formocresol pulpotomy2,14,15). Applying
electrosurgery to a pulpectomy would also
afford the aforementioned advantages, ensur-
ing improved visualization and homeostasis
among other things. In addition, electrosur-
gery does not seem to have any undesirable
effect on the succedaneous permanent
teeth14).
The purpose of this study, therefore, was to
compare the results of conventional pulpec-
tomy with those of an electrosurgical approach
in the treatment of the primary teeth by evalu-
ating clinical and radiographic success rates
over a 6-month follow-up period.
Materials and Methods
A total of 50 first or second primary man-
dibular molars obtained from children of
between 4 and 8 years in age attending the
Pedodontics Department of the Mashhad Fac-
ulty of Dentistry were used in this study. All
the teeth selected required a pulpectomy.
 【版面】W：396 pt（片段　192 pt） 　H：588 pt　 【本文】行数不明（手組み） 　10pt　12pt 送り
【図】●図番号・タイトル・説明：11.3Q　12.7H　New Baskerville ITC Std　図タイトルと説明のアキ　9Q　●タイトル折り返
く説明の先頭は字下げ不要）　●図説の幅　片段：片段固定　全段：図幅　　
【表】●番号・タイトル・説明：11.3Q　12.7H　New Baskerville ITC Std　タイトルと表のアキ　10.5Q　●罫線　表はじめの
罫の太さ　1.411mm ●表中：11.3Q　12.7H　New Baskerville ITC Std　●脚注　11.3Q　12.7H　New Baskerville ITC S
斜体は New Success of Electrosurgical
Baskerville Pulpectomy
ITC Std Italic（タグは <l>） 79
　半角ダーシは -（ハイフン）に F50：tohaba の文字スタイルをかけて作成

The study was approved by the Statistics and

Methodology and Research Ethics commit-
tees of Mashhad University of Medical Sci-
ences, Iran. To be selected, the primary molar
teeth had to meet the following inclusion cri-
teria: the absence of a dental abscess or any
radiographic lesions; no resorption or necro-
sis; and continued flow of dark blood during
preparation of the access cavity. Exclusion
criteria were as follows: the tooth being non-
restorable or impossible to isolate; and the
patient or their guardian being uncoopera‑
tive.
Informed consent was obtained from the
guardians of all the children participating in
the study. Those selected had no contraindi-
cations to pulpectomy in their medical history
and were willing to submit to periodic exami-
nations of the pulpectomised teeth.
The patients were randomly divided into
two study groups: an electrosurgical (ES) or a
conventional (C) group, both comprising 25
patients. The www.Randomizer.org database,
whereby a number is generated for each
patient, was used to allot each patient to each
group. If an odd number was generated, the
patient was assigned to the C group; if an even
number was generated, they were assigned to
the ES group.
In each patient, first, the mouth was rinsed
with 0.2% chlorhexidine mouthwash (Shah-
daru, Tehran, Iran) followed by application of
inferior alveolar nerve block. Next, rubber
dam isolation was performed and the access
cavity prepared utilizing a #4 diamond bur
(D+z, Kalletal, Germany). The working
length was determined by superimposing an
endodontic instrument over the pre-operative
radiograph and keeping it 1–2 mm short of
the radiographic apex. A range of Hedstrom
files (Dentsply Maillefer, Ballaigues, Switzer-
land) up to #40 were employed to extirpate
the radicular pulp. Irrigation was carried out
using 2.25% sodium hypochlorite. In the C
group, no other procedure was performed
before filling the canal14).
In the ES group, the largest file which could
reach the working length was inserted into
the canal while a dispersive electrode was
Fig.　1　‌‌Method of applying electrode in electrosur-
gery, including insertion of largest file to work-
ing length and attachment of electrode to
metal part of file in coagulate mode
placed against the patient’s back. The electro-
surgical device (PerFect® TCS || Coltene
Whaledent AG, Alstätten, Switzerland) was set
at 5 degrees, placing it in coagulate mode.
The electrode was then attached to the metal
part of the K-file for 1 sec each time (Fig. 1).
This action was performed for the other
canals as well in case there was unstoppable
bleeding. The procedure was executed up to
3 times for each canal. To avoid possible heat
complications after each use of the active elec-
trode, the current was cut off for approxi-
mately 5 seconds. The procedure was contin-
ued by insertion of files up to 3 numbers
larger than the initial file. Irrigation was per-
formed using 2.25% sodium hypochlorite.
Finally, all the canals were dried with sterile
paper points (Ariadent, Tehran, Iran) and
filled with zinc oxide eugenol paste (Gol-
chadent, Tehran, Iran). The teeth were
restored using a stainless steel crown (3M
ESPE, St. Paul, MN, USA). Figure 2 shows a
periapical radiograph obtained at immedi-
ately after treatment.
All the pulpectomy procedures were per-
formed by the principal investigator (RS) to
ensure consistency in both approaches.
The duration of treatment was precisely
measured with a chronometer in both groups,
and encompassed the insertion of the first file
into the canal until drying was completed
with a paper point.
pt（片段　192 pt）　H：588 pt　 【本文】行数不明（手組み） 　10pt　12ptpt
【版面】W：396 送り
（片段　192 pt）　H：588 pt　 【本文】行数不明（手組み） 　10pt　12pt 送り
タイトル・説明：11.3Q　12.7H　New Baskerville ITC 【図】●図番号・タイ
Std　図タイトルと説明のアキ　9Q　●タイ
トル・説明：11.3Q　12.7H　Newトル折り返し：番号の後 （続
Baskerville ITC Std　図タイトルと説明のアキ　9Q　●タイトル折り返し：番
字下げ不要）　●図説の幅　片段：片段固定　全段：図幅　　 く説明の先頭は字下げ不要）　●図説の幅　片段：片段固定　全段：図幅　　
イトル・説明：11.3Q　12.7H　New Baskerville ITC Std　タイ トルと表のアキ　10.5Q　●罫線　表はじめのみ双罫　表中の
【表】●番号・タイ トル・説明：11.3Q　12.7H　New Baskerville ITC Std　タイトルと表のアキ　10.5Q　●罫線　表はじめのみ双
mm ●表中：11.3Q　12.7H　New Baskerville ITC Std　●脚注　11.3Q　12.7H　New Baskerville ITC Std　
罫の太さ　1.411mm ●表中：11.3Q　12.7H　New 字下げなし　
Baskerville ITC Std　●脚注　11.3Q　12.7H　New Baskerville ITC Std　
80（タグは <l>）　半角ダーシは -（ハイフン）に
kerville ITC Std Italic BaskervilleSahebalam
斜体は NewF50：tohaba の文字スタイルをかけて作成
ITC Std Italicet al. <l>）　半角ダーシは -（ハイフン）に F50：tohaba の文字スタイルをかけて作成
R （タグは

‌ inal periapical radiograph showing filling of

Fig.　2　‌F ‌ eriapical radiograph after 6 months follow-up
Fig.　3　‌P
all canals and stainless steel crown showing no pathosis in furcation or periapical
areas

The patients were contacted one day after
the treatment and asked about pain or any
other postoperative complaints. After 6
months, in addition to clinical examination,
radiography was conducted for a second time
and the periapical tissues assessed (Fig. 3). At
this point, the teeth were checked by the same
examiner, who was blind to the study groups.
As shown in the flowchart, 4 patients from the
ES and 7 from the C group were excluded
from the study, as they did not present for
evaluation and follow-up.
At the follow-up visit, both clinical examina-
tion and periapical radiography of the tooth
were conducted. Clinical success was defined
as the absence of pain, abscess, fistula or
excessive mobility, redness and tenderness on
percussion, or palpation. The radiographs
were evaluated by the same examiner, who
was blinded to which group the patient had
been assigned to.
Follow-up radiographs were compared
against primary radiographs, which had been
taken 6 months earlier. The radiographs were
then coded and given to two pedodontists,
who were to grade the success rates of the
treatment. These radiographs were inter-
preted with a set light and magnifier housed
in room set aside for that purpose. In the
event of any disagreement regarding any
given radiograph, the examiners were
instructed to review until they reached a
consensus.
Radiographic success was defined as the
presence of a normal periodontal ligament
space, the absence of pathologic root resorp-
tion or canal calcification, and no periradicu-
lar or furcal radiolucency. The SPSS software
(version 11.5, SPSS Inc., Chicago, IL, USA)
was used for the statistical analysis, applying
the Fisher’s exact test and Mann-Whitney
U-test.
Results
A total of 50 molar teeth were treated in
this study. Clinical and radiographic success
rates were evaluated at the follow-up point
(Table 1).
In the C group, one patient returned at one
day postoperatively with an acute abscess,
which was successfully treated with antibiotics
within 24 hours. Two more patients presented
with percussion sensitivity, as did 2 further
patients in the ES group.
In the C group, radiography revealed furcal
radiolucency in 1 tooth and periapical radio-
lucency in 4.
In the ES group, radiography revealed fur-
cal radiolucency in 1 tooth and periapical
radiolucency in 2.
Working time was significantly shorter in
the ES group (p<0.001). After 6 months of
follow-up, no statistically significant differ-
ence was observed in the success rates between
the two study groups (p>0.05).
【版面】W：396 pt（片段　192 pt）　H：588 pt　【本文】行数不明（手組み） 　10pt　12pt 送り
【図】●図番号・タイトル・説明：11.3Q　12.7H　New Baskerville ITC Std　図タイトルと説明のアキ　9Q　●タイトル折り返し：番号の後（続
く説明の先頭は字下げ不要）　●図説の幅　片段：片段固定　全段：図幅　　
【表】●番号・タイトル・説明：11.3Q　12.7H　New Baskerville ITC Std　タイトルと表のアキ　10.5Q　●罫線　表はじめのみ双罫　表中の
罫の太さ　1.411mm ●表中：11.3Q　12.7H　New Baskerville ITC Std　●脚注　11.3Q　12.7H　New Baskerville ITC Std　 字下げなし　
Success
斜体は New Baskerville ITC Std Italic（タグは <l>） of Electrosurgical
　半角ダーシは -（ハイフン）に Pulpectomy
F50：tohaba の文字スタイルをかけて作成 81

Table　1　Clinical and radiographic success rates plus working time in two study groups

Conventional group Electrosurgery group Total p value

Treated patients (n) 25 25 50

6-month follow-up (n) 18 21 39
Clinical success rate 16 (88.9%) 19 (90.5%) 35 (89.7%) 0.323
Radiographic success rate 13 (72.2%) 18 (85.7%) 31 (79.5%) 0.432
Working time (minute) mean±SD 25.50±11.3 13.09±3.9 <0.001

Discussion In the current study, no patient complained

The purpose of this study was to compare
the clinical and radiographic success rates of
electrosurgical pulpectomy in primary teeth
with that achieved by the conventional
method. The results revealed no significant
correlations among the quality of the canal-
filling material, success rate, and treatment
method. Working time was significantly
shorter in the ES group.
Although many studies have investigated
the efficacy of electrosurgery in pulpotomy, to
our knowledge, this is the first study to report
the application of this procedure to pulpec-
tomy. Therefore, there is nothing similar in
the literature with which to compare the pres-
ent results.
In this study, the absence of factors such as
pain, mobility, sinus tract, abscess, tenderness
to percussion, palpation sensitivity, and red-
ness were taken into consideration in the
clinical evaluation and compared with those
observed in earlier studies using conventional
methods.
After 6 months, clinical and radiographic
success rates in the ES (90.5 and 85.7%,
respectively) and C groups (88.9 and 72.2%,
respectively) were comparable to those
observed in previous studies, which have
reported clinical success rates of 96 to 100%
and radiographic success rates of 76 to 84%
during 6 to 22.6 months of follow-up6,8,11,18).
Trairatvorakul and Detsomboonrat (2012)
reported clinical and radiographic success
rates to be 94.9 and 54.4%, respectively, at a
6-month follow-up19).
of pain in either of the groups at the 6-month
follow-up session, which contributed to
patient satisfaction in terms of sustained relief
from pain. Gesi et al. (2006) conducted pulp-
ectomies with calcium hydroxide on 244 teeth
and reported one case of pain at 1–3 year fol-
low-ups4). The present findings are fairly con-
sistent with this. Trairatvorakul and Detsom-
boonrat (2012) used triple antibiotic paste in
endodontic treatment of mandibular primary
molars of 60 cases and reported no case of
pain at a 6-month follow-up19). Another study
examined triple antibiotic paste and Vitapex
in 50 molars and observed no case with pain
after 6 months of follow-up4,8,19).
In the present study, no cases of pathologic
mobility were observed. This suggests that
electrosurgery has no adverse effect on peri-
odontal tissue, although this might not apply
if the duration of the procedure were longer
or the power of the device used greater than
that here. This is due to the heat absorption
effect, which might result in tooth mobility.
However, findings are varied when it comes
to pathologic mobility at 6-month follow-up.
Nakornchai et al. (2010) reported no patho-
logic mobility, whereas Trairatvorakul and
Detsomboonrat (2012) noted that 6.6% of
patients showed pathologic mobility8,19). At a
2-year follow-up, Kargul et al. (2010) reported
that 4.6% of patients presented with patho-
logic mobility5).
In the present study, no sinus tract was
observed in either group, and in this respect,
the results are consistent with those of other
studies8,19). Kargul et al. (2010) reported a
82 Sahebalam R et al.
sinus tract at a 2-year follow-up5). Further-
more, signs of acute abscess were reported at
one day after treatment in one patient in the
C group in the present study, but no cases of
abscess in the ES group. Kargul et al. (2010)
also reported no incidence of abscess at long-
term follow-up5).
In the present study, radiolucency in the
furcation area was observed in 2.5% of the
patients in both groups, whereas radiolucency
in the periapical area was found in 10.2% in
the C and 5.1% in the ES group. Gesi et al.
(2006) similarly reported periapical radiolu-
cency in 6.9% of experimental teeth4).
None of the teeth showed external or inter-
nal resorption in the present investigation.
Kargul et al. (2010), on the other hand,
reported an external resorption rate of 4.6%
at a 2-year follow-up5), while Trairatvorakul
and Detsomboonrat (2012) noted an internal
resorption rate of 9.3% at after 24 to 27
months of follow-up19). The variation in these
results might be attributable to differences in
duration of follow-up and methods applied.
In short, based on the findings of the assess-
ment performed here, applying electrosur-
gery to a pulpectomy appears to offer
promise.
This represents possibly the only study so
far on the application of this treatment modal-
ity to a pulpectomy. Further research is rec-
ommended to popularize the deployment of
this method.
Conclusions
After 6 months of follow-up, no significant
difference was observed in the success rate
between the ES and C groups. The results
indicate that the electrosurgical approach to
a pulpectomy not only preserves the high
clinical and radiographic success rates of the
conventional method, but also effectively
reduces treatment working time. Therefore,
we believe that it should be recommended in
cases where working time needs to be kept to
a minimum, such as when treating uncoop-
erative children, applying general anesthesia,
or treating children incapable of tolerating
multiple appointments.
Acknowledgements
The authors would like to express sincere
appreciation to the Director of Mashhad Den-
tal Research Center.
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Correspondence:
Dr. Maryam Jouybari-Moghaddam
Faculty of Dentistry,
Mashhad University of Medical Sciences,
Vakilabad Blvd, Mashhad, Iran,
91735-984
E-mail: Maryam.jooybari@gmail.com