Pulpotec® is a radiopaque, non‑resorbable medicament widely used for pulpotomy/pulpitis treatment in vital primary and immature permanent molars, as well as for emergency root canal dressings.
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This in-depth article reviews its composition, clinical indications, advantages, disadvantages, and a standardized application protocol. Information is supported by recent clinical evidence.
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1. Composition
Pulpotec® is a two-part resinous paste comprising:
➤ Powder: polyoxymethylene, iodoform, and zinc oxide.
➤ Liquid: dexamethasone acetate, formaldehyde, phenol, guaiacol, and excipients.
These components combine to yield antimicrobial, anti-inflammatory, hemostatic, and soothing effects.
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2. Indications
Pulpotec® demonstrates broad clinical applications:
➤ Primary molars: vital or mildly infected, including cases with abscess when pulpotomy is indicated.
➤ Immature permanent molars: to facilitate continued root development.
➤ Permanent molars in adults: pulpitis treatment or as a prep for abutments in prosthetics.
It is also effective in emergency intracanal dressings to relieve pain and swelling across multiple appointments.
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3. Advantages
Clinical studies support Pulpotec® due to its:
➤ High success rates: Clinical success of 93–100% and radiographic success of 83–100% in pulpotomies; compared favorably with MTA and formocresol.
➤ Rapid symptom relief: 80–100% of patients report immediate pain reduction; flare-ups post-op are rare (~1%).
➤ Ease of use and efficiency: Simplifies emergency endodontic treatment and supports long-term pulp health.
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4. Disadvantages
Potential drawbacks include:
➤ Non‑resorbability: This may complicate exfoliation in primary molars.
➤ Formaldehyde content: Concerns over toxicity and rare allergic reactions.
➤ Limited histological regeneration: It promotes sclerosis rather than dentin bridge formation.
➤ Need for coronal seal: Success depends on proper restoration to prevent microleakage.
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5. Step-by-Step Clinical Use Protocol
Step 1. Diagnose pulpitis suitable for vital pulp therapy.
Step 2. Anesthetize and isolate the tooth (rubber dam recommended).
Step 3. Access and remove coronal pulp to canal orifice level.
Step 4. Irrigate with 5% NaOCl; dry chamber.
Step 5. Prepare a salin-damped sterile cotton pellet; confirm bleeding control.
Step 6. Insert Pulpotec® paste into chamber (or canal up to ~5 mm from apex in root-filled cases) using a file.
Step 7. Place a dry cotton pellet and temporary restorative material (e.g., IRM/Cavit).
Step 8. Schedule recall after 7 days; proceed to definitive restoration—ideally stainless steel crown or adhesive restoration.
Step 9. Evaluate post-op pain at intervals (8 h, 24 h, 48 h, 3 d, 1 wk).
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6. Clinical Evidence
➤ Prospective RCT (860 teeth): Pulpotec® intracanal dressing reduced incidence of inter-appointment flare-up to 1.16% at 24 h and 0.69% at 48 h, with complete pain relief by 7 days.
➤ Comparative pediatric studies:
° Pulpotec® and MTA showed 100% clinical success at 3–9 months; radiographic success favored Pulpotec® (100%) over MTA (92.9%) and formocresol (78.6%).
° At 24 months, radiographic success was 94.3% for Pulpotec®, 91.2% for MTA, 83.3% for formocresolile cotton pellet; confirm bleeding control.
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Conclusion
Pulpotec® is an effective and efficient pulpotomy and intracanal medicament providing high clinical and radiographic success, rapid pain relief, and broad indications. However, formaldehyde content and non-resorbability in primary teeth demand careful case selection and precise restoration. Clinicians should weigh its benefits and limitations against alternatives such as MTA or Biodentine.
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References
✔ Al-Dahan, Z. A. A., Zwain, A. M., & Haidar, A. (2013). Clinical and radiographical evaluation of pulpotomy in primary molars treated with Pulpotec®, Formocresol, and Mineral Trioxide Aggregate (MTA). Journal of Bagh College Dentistry, 25(4), 164–170.
✔ Faraj, B. M. (2013). Four years of clinical experience with the efficacy of Pulpotec® as a root canal dressing for the management and control of odontogenic pain: A prospective randomized clinical trial. Open Access Emergency Medicine, 12(4), 280–283.
✔ Karrem, M. A. (2012). Clinical and histopathological evaluation of different pulpotomy agents in primary teeth. Iraqi Academic Scientific Journal.
✔ Maslak, E. E., et al. (2020). Pulpotomy efficiency in primary molars: Outcomes of 24‑month randomized clinical trial. Tanta Dental Journal, 17(1), 9–14.
✔ Pulpotec®. (n.d.). Scientific data about Pulpotec® – Swiss solution for pulpotomy. Retrieved from pd-pulpotec.com
✔ Sandhu, S. S., & Nanda, S. (2013). Dental pulp response to collagen and Pulpotec cement. Journal of Conservative Dentistry, PMC3778626.
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