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Figs. 10–14_10-year-old patient. Pulpotomy of upper first and second primary molar. Fig. 10_07.04.1992: Post cavity-preparation: slight bleeding of first molar, moderate bleeding of second molar. Fig. 11_07.04.1992: Post N2-application. Fig. 12_07.04.1992: Ante treatment. Fig. 13_07.04.1992: Post treatment (N2, Amalgam-filling). Fig. 14_15.04.1993: 12 months after vital-amputation. observation in the practice. During the observation period, clinical failure (pain, swelling and fistulas) was registered in 5.7% (n = 28) of the patients. The symptoms of clinical failure occurred within 23 monthsaftertreatmentin78.6%ofpatients(n=22). Inonepatient,thesesymptomsoccurredonlyseveral hours after devitalisation followed by mortal ampu- tation. Of the extractions done, 76.1 per cent (n = 54) occurred 24 months or more post-treatment. Prob- lemswithtootheruptionoforenameldamagetothe permanent teeth were not observed. In summary, we observed that the number of extractionsandfailuresintheobservationperiodwas twice as high in necrotic teeth when comparing vital amputationwithtreatmentofgangrenousteeth(col- umn 1 compared to column 3 to 5 in Table I). _Discussion The number of young patients that did not return to the dental practice after treatment may be attrib- uted to the discomfort of the treatment. However, the DMS III (Third German Oral Health Study) found a social attachment to the dentist (“always the same dentist”) as high as 92.5% in 12-year-old patients in WestGermanyin1997.8 Itispossiblethatasignificant number of those who did not return were clinical failures, prompting the patients’ parents to consult another dentist, but this is rather unlikely. Huber9 analysed 179 N2 vital amputations in 105 patients and documented a failure rate of 9.5%. The age of tooth loss corresponded to the average age of premolar eruption. The N2 pulpotomies had a low failure rate of 4.4% in this study. This was confirmed by Einwag, who gives the clinical success rate of N2 pulpotomies as 90 to 100%.6 Although not documented in detail in this study, pain anamnesis appears to be insignificant in deter- mining the success of a N2 pulpotomy. Acute exacer- bations, as often observed following pulpotomy with Ca(OH)2, almost never occurred after N2 pulpotomy. Against this background, it is incomprehensible that GermanuniversitiescontinuetofavourCa(OH)2pulpo- tomies.TheUKGuidelineisastepaheadinthisrespect.2 It is important for the dental practice that the outcome of the treatment be guaranteed, that both the young patient and the dentist be comfortable with one another, that the treated tooth remains in situ until development of the permanent teeth and that the erupted permanent teeth are not damaged. DentalpractitionerGarry10 aptlyexpressestheuse of N2 in endodontic treatment of primary teeth, whichreflectsmypersonalopinion:“Whenendodon- tic treatment is recommended for primary teeth, the concept ‘careful selection of cases’ is often used to warn the practitioner against treating gangrenous teeth. The technique herein does not require ‘careful selection’ for treatment […]. The goal of endodontic intervention on primary teeth is not to obtain radio- graphic images which meet standards used in treat- ing adult teeth, but to retain deciduous teeth as long as possible as entities and space maintainers.”_ Editorial note: A list of references is available from the publisher. 30 I I research _ primary teeth endo roots3_2010 Dr Robert Teeuwen Berliner Ring 100 52511 Geilenkirchen Germany E-mail: robteeuwen@t-online.de _contact roots Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 10