Despite the dental profession's emphasis on prevention, threats to pulp survival, such as caries, restorative dental treatment, and traumatic injuries, have not been eliminated. As a consequence, children continue to lose teeth prematurely, and procedures aimed at preventing and treating pulp disease in the primary and immature permanent dentitions remain an integral part of contemporary dental practice. Some may question why efforts to preserve pulpally involved primary teeth are important. These practitioners maintain that such efforts may present a risk to developing permanent successors and, in any case, the primary teeth will be lost before long. Preservation of arch space is one of the principal objectives of pediatric dentistry. Premature loss of primary teeth may cause aberration of the arch length, resulting in mesial drift of the permanent teeth and consequent malocclusion. Whenever possible, the tooth with pulp involvement should be maintained within the dental arch in a functional and disease-free condition. Other objectives of preserving the primary teeth are to safeguard aesthetics and mastication, prevent aberrant tongue habits, aid in speech, and prevent the psychological effects that may be associated with tooth loss. Premature loss of the maxillary incisors before 3 years of age has been shown to cause speech impairment that may persist in later years.
It is equally undesirable for children to suffer the unplanned loss of permanent teeth, and it should be noted that the prognosis for lifelong retention of an immature tooth with a short root and fragile dentinal walls is far worse than for a mature permanent tooth. Special treatments for the immature permanent tooth, therefore, focus on preserving vital pulp functions, at least until dental development is complete