Pulpotomy is a widely accepted vital pulp therapy for primary molars affected by carious exposure or traumatic injury, aiming to preserve the radicular pulp and maintain tooth function until natural exfoliation.
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Video 🔽 Video: Pulpotomy of Deciduous Molar - Step by step ... This article provides a comprehensive, step-by-step overview of the pulpotomy procedure in deciduous molars, a vital technique in pediatric dentistry aimed at preserving pulp vitality after carious exposure.The selection of an appropriate pulpotomy material is critical, as it directly influences clinical success, pulpal healing, and long-term prognosis. Among the materials most frequently studied, calcium hydroxide (CH) and mineral trioxide aggregate (MTA) have received significant attention due to their biological properties and historical relevance.
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This article provides an updated and evidence-based comparison of these two materials, emphasizing their performance in primary molar pulpotomy from a contemporary pediatric dentistry perspective.
✅ Biological Rationale of Pulpotomy Materials
Calcium Hydroxide
Calcium hydroxide has been traditionally used in vital pulp therapy due to its high alkalinity, antibacterial effect, and ability to stimulate reparative dentin formation. However, its application in primary teeth has shown limitations, including internal resorption and incomplete dentinal bridge formation, which may compromise treatment outcomes.
Mineral Trioxide Aggregate (MTA)
MTA is a bioactive calcium silicate-based material known for its excellent biocompatibility, sealing ability, and capacity to induce hard tissue formation. In primary molars, MTA promotes favorable pulpal responses, including reduced inflammation and consistent dentin bridge formation, contributing to higher long-term success rates.
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Dental Article 🔽 Calcium Hydroxide in Pediatric Dentistry: Benefits and Limitations ... In pediatric dentistry, calcium hydroxide is used primarily for vital pulp therapy procedures such as direct pulp capping, pulpotomy, and apexogenesis.✅ Clinical and Radiographic Outcomes
Multiple randomized clinical trials and systematic reviews have demonstrated that MTA exhibits superior clinical and radiographic success compared to calcium hydroxide in primary molar pulpotomy. While CH may provide acceptable short-term outcomes, MTA consistently shows lower rates of pathological root resorption, pulp necrosis, and treatment failure during follow-up periods extending beyond 12 months.
💬 Discussion
The declining use of calcium hydroxide in primary molar pulpotomy is supported by growing evidence highlighting its biological instability in primary pulp tissue. In contrast, MTA has emerged as the reference material due to its predictable healing response and long-term effectiveness. Despite its higher cost and handling complexity, MTA’s advantages outweigh these limitations, particularly in pediatric patients where preservation of primary teeth is essential for occlusal development and space maintenance.
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Dental Article 🔽 Why Formocresol Is No Longer Recommended in Pediatric Pulp Therapy: Evidence-Based Risks and Modern Alternatives ... For decades, formocresol was considered the gold standard for pulpotomy in primary teeth. Its fixative and antimicrobial properties led to widespread use in pediatric dentistry.✍️ Conclusion
Based on current scientific evidence, mineral trioxide aggregate demonstrates superior clinical performance compared to calcium hydroxide in pulpotomy of primary molars. Its enhanced biocompatibility, sealing properties, and reduced risk of internal resorption make MTA the preferred material for vital pulp therapy in primary dentition.
🎯 Clinical Recommendations
▪️ MTA should be considered the material of choice for pulpotomy in primary molars when available.
▪️ Calcium hydroxide should be used with caution due to its association with internal resorption and lower long-term success.
▪️ Proper case selection, hemorrhage control, and coronal sealing remain critical regardless of the material used.
▪️ Long-term clinical and radiographic follow-up is essential to evaluate pulpal response and tooth integrity.
📊 Comparative Table: Calcium Hydroxide vs. MTA in Primary Molar Pulpotomy
| Clinical Parameter | Calcium Hydroxide | Mineral Trioxide Aggregate (MTA) |
|---|---|---|
| Biocompatibility | Moderate; may induce chronic inflammation | Excellent; promotes favorable pulpal healing |
| Dentin bridge formation | Inconsistent and porous | Homogeneous and well-organized |
| Risk of internal resorption | High incidence reported | Minimal to none |
| Long-term clinical success | Lower success rates over time | High success rates in long-term follow-up |
✔ American Academy of Pediatric Dentistry. (2023). Pulp therapy for primary and immature permanent teeth. Pediatric Dentistry, 45(6), 403–412.
✔ Agamy, H. A., Bakry, N. S., Mounir, M. M., & Avery, D. R. (2004). Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatric Dentistry, 26(4), 302–309.
✔ Holan, G., Eidelman, E., & Fuks, A. B. (2005). Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatric Dentistry, 27(2), 129–136.
✔ Peng, L., Ye, L., Guo, X., Tan, H., Zhou, X., Wang, C., & Li, R. (2007). Evaluation of formocresol versus mineral trioxide aggregate primary molar pulpotomy: A meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 104(6), e40–e44.
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