✅ Abstract
Partial pulpotomy and conventional pulpotomy are essential vital pulp therapy techniques for preserving the function and vitality of primary molars affected by deep carious lesions or traumatic exposures.
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✅ Introduction
Pulpotomy in primary teeth is indicated when the radicular pulp remains vital despite coronal pulp inflammation due to caries or trauma. The objective is to maintain the tooth until natural exfoliation, avoiding more invasive treatments such as pulpectomy or extraction.
Two main techniques are used:
▪️ Conventional pulpotomy, which removes all coronal pulp tissue and applies a medicament to the remaining radicular pulp.
▪️ Partial pulpotomy, which removes only 1–3 mm of inflamed pulp beneath the exposure site, preserving more healthy tissue and promoting dentin bridge formation.
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Both partial and conventional pulpotomy are suitable for primary teeth with:
▪️ Reversible pulpitis
▪️ No spontaneous pain or mobility
▪️ No radiographic signs of periapical pathology
▪️ Restorable coronal structure
Partial pulpotomy is preferred when pulp exposure is small (less than 1 mm) and bleeding is controlled within 5 minutes, as it maximizes pulp vitality and long-term success.
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PDF 🔽 Manual of diagnosis and pulp treatment in non-vital primary teeth ... Non-vital teeth are those whose nerves lack vitality and there is no blood flow inside. This may be due to deep caries or dental trauma that irreversibly affects the dental pulp.✅ Clinical Techniques
➤ Conventional Pulpotomy Procedure
▪️ Local anesthesia and rubber dam isolation
▪️ Caries removal and coronal access
▪️ Complete amputation of coronal pulp
▪️ Hemostasis with moist cotton pellet (3–5 minutes)
▪️ Application of formocresol, MTA, or ferric sulfate
▪️ Final restoration with stainless steel crown (SSC)
➤ Partial Pulpotomy Procedure
▪️ Isolation and caries removal
▪️ Removal of 1–3 mm of coronal pulp tissue
▪️ Hemostasis achieved in less than 5 minutes
▪️ Application of calcium silicate–based material (e.g., Biodentine, MTA)
▪️ Immediate restoration with composite or SSC
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The choice of biomaterial is critical to pulpotomy success. Mineral Trioxide Aggregate (MTA) and Biodentine are considered gold standards due to their biocompatibility, sealing ability, and promotion of hard tissue regeneration.
Formocresol, although historically used, is now discouraged due to cytotoxic and mutagenic concerns. Calcium silicate–based materials are currently recommended by the American Academy of Pediatric Dentistry (AAPD, 2024) as the most effective agents for vital pulp therapy in primary teeth.
📊 Comparative Table: Materials Used in Pulpotomy Procedures
| Material | Advantages | Limitations |
|---|---|---|
| Mineral Trioxide Aggregate (MTA) | Excellent biocompatibility; induces hard tissue barrier; high success rate (>94%) | Long setting time (2–4 hours); tooth discoloration; high cost |
| Biodentine | Fast setting (12 minutes); no discoloration; good sealing ability | Lower long-term data in primary teeth; cost higher than traditional agents |
| Ferric Sulfate (15.5%) | Effective hemostasis; shorter procedure time; cost-effective | No dentin bridge formation; potential for internal resorption |
| Formocresol | Historical gold standard; antibacterial; predictable outcomes | Potential mutagenicity; systemic distribution concerns; declining use |
| Calcium Hydroxide | Stimulates dentin bridge; low cost; antibacterial | High failure rate (30–40%); internal resorption risk |
| Sodium Hypochlorite (NaOCl) | Hemostatic agent; tissue solvent; enhances disinfection | Limited evidence as primary medicament; potential pulp irritation |
✅ Clinical Outcomes and Evidence
Recent systematic reviews confirm the superior performance of partial pulpotomy:
▪️ Partial pulpotomy: 94–98% success at 24 months (Coll et al., 2023)
▪️ Conventional pulpotomy: 85–92% with MTA, 70–80% with formocresol (Smaïl-Faugeron et al., 2024)
▪️ Lower incidence of internal resorption and postoperative sensitivity with partial pulpotomy
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Advances in bioactive materials, such as bioceramic sealers and calcium-enriched cements, are transforming the management of pulp exposures. Future research should compare histologic outcomes of partial pulpotomy in primary vs. permanent teeth and explore stem cell–based regenerative therapies to further improve pulpal healing and preservation.
✅ Advantages and Limitations
1. Partial Pulpotomy Advantages
▪️ Preserves pulp vitality and natural immune defense mechanisms.
▪️ Stimulates dentin bridge formation and faster tissue healing.
▪️ Minimally invasive procedure with reduced chair time.
▪️ Demonstrates higher clinical success rates (94–98%) compared to conventional pulpotomy.
➤ Limitations
▪️ Requires precise diagnosis and excellent hemostasis control (less than 5 minutes).
▪️ Not suitable for large exposures (>2 mm) or irreversible pulpitis.
▪️ Technique-sensitive, demanding operator skill and magnification tools.
2. Conventional Pulpotomy Advantages
▪️ Simple and widely used procedure with well-established clinical protocols.
▪️ Effective for larger coronal exposures, especially when partial techniques are not feasible.
▪️ Can be performed with affordable materials and basic instruments.
▪️ Still achieves high success rates (85–92%) when MTA or Biodentine are used.
➤ Conventional Pulpotomy Limitations
▪️ Greater loss of healthy pulp tissue compared to partial technique.
▪️ Higher risk of internal resorption or calcific metamorphosis.
▪️ Formocresol-based protocols are no longer recommended due to toxicity concerns.
▪️ Slightly lower long-term success and pulp vitality preservation rates.
📊 Comparative Table: Partial vs. Conventional Pulpotomy in Primary Teeth
| Aspect | Advantages | Limitations |
|---|---|---|
| Partial Pulpotomy | Preserves pulp vitality; promotes dentin bridge; success rate 94–98% | Limited to small exposures; requires strict hemostasis and skill |
| Conventional Pulpotomy | Effective for larger exposures; simple, standardized protocol | Higher resorption risk; lower success with non–calcium silicate materials |
✅ Clinical Recommendations
▪️ Prefer partial pulpotomy for small exposures (less than 1 mm) in vital primary teeth.
▪️ Use MTA or Biodentine instead of formocresol.
▪️ Maintain rubber dam isolation during all procedures.
▪️ Always restore with stainless steel crowns for long-term sealing.
▪️ Schedule 6-month follow-ups with clinical and radiographic assessments.
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Partial pulpotomy stands out as the first-line treatment for vital primary molars with limited pulp exposure, offering higher success rates, lower complication risk, and better tissue preservation. Although conventional pulpotomy remains effective, current evidence strongly supports partial techniques combined with bioactive calcium silicate materials for optimal outcomes.
📚 References
✔ American Academy of Pediatric Dentistry (AAPD). (2024). Guideline on Vital Pulp Therapies for Primary and Immature Permanent Teeth. Pediatric Dentistry, 46(3), 221–235. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/vital-pulp-therapies/
✔ Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., & American Academy of Pediatric Dentistry. (2023). Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry, 45(5), 349–371. https://www.aapd.org/media/Policies_Guidelines/E_VPT.pdf
✔ Smaïl-Faugeron, V., Glenny, A. M., Courson, F., Durieux, P., Muller-Bolla, M., & Fron Chabouis, H. (2024). Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews, 2024(3), CD003220. https://doi.org/10.1002/14651858.CD003220.pub3
✔ Cushley, S., Duncan, H. F., Lappin, M. J., Chua, P., Elamin, A. D., Clarke, M., & El-Karim, I. A. (2023). Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: A systematic review and meta-analysis. International Endodontic Journal, 56(2), 120–145. https://doi.org/10.1111/iej.13847
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