Paediatric dentistry is a unique specialty dealing with the total and comprehensive oral health care of children. With the passage of time, there has been a definite shift from an ‘extraction-based approach’ of managing the symptomatic teeth to a more conservative approach of maintaining the integrity of the natural oral structures while alleviating the symptom for the child. The advent and progression of various endodontics procedures suited specifically for primary teeth has been at the forefront of this shift. Paediatric endodonticcs has seen a paradigm shift from the conventional aggressive approaches of managing pulpally involved teeth to a biological approach due to the better understanding of the physiology of pulpal tissue and dynamics of caries progression. In this approach, not only is the effect treated but also the cause of the pulpal involvement. This presentation would provide the audience with a brief overview of several contemporary endodontic procedures performed under dental operating microscope in children using appropriate diagnostic aids and adhering to a biologically harmonious approach.