Partial vs. Conventional Pulpotomy in Primary Teeth: A Comprehensive Clinical Guide for Pediatric Dentists

✅ 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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This article provides an evidence-based comparison of both approaches, exploring indications, materials, clinical outcomes, and current recommendations for pediatric dental practice in 2025.

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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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✅ Indications and Case Selection
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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✅ 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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✅ Material Selection and Biocompatibility
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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✅ Discussion and Future Directions
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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✍️ Conclusion
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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Partial pulpotomy vs. Conventional (full) pulpotomy in primary teeth — a comparative, evidence-based review

✅ Abstract
This article compares partial pulpotomy and conventional (full/coronal) pulpotomy in primary teeth, focusing on definitions, technique differences, materials, clinical outcomes, and benefits.

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✅ Introduction
Vital pulp therapy in primary teeth aims to preserve radicular pulp vitality, maintain space, and avoid extraction/pulpectomy where possible. The choice between a partial pulpotomy (limited removal of coronal pulp) and a conventional/full pulpotomy (complete removal of coronal pulp) depends on pulp status, exposure etiology (trauma vs caries), clinical signs, and material availability. Recent guideline updates and meta-analyses have refined indications and shown high overall success rates for pulpotomy procedures under appropriate conditions.

✅ Definitions
• Partial pulpotomy (also called Cvek pulpotomy in many contexts): surgical removal of a limited portion (typically ~1–3 mm) of inflamed coronal pulp beneath an exposure, leaving most coronal pulp intact to preserve vitality and promote repair. It is commonly used after traumatic exposures and selected carious exposures when the remaining pulp appears healthy.
• Conventional (full or coronal) pulpotomy: removal of the entire coronal pulp tissue to the level of the canal orifices, followed by placement of a medicament over radicular pulp stumps and definitive coronal restoration. It is widely used for primary molars with carious exposures when radicular pulp is judged capable of healing.

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✅ Similarities

• Both are forms of vital pulp therapy (VPT) that aim to preserve radicular pulp vitality and avoid pulpectomy or extraction.
• Both require hemostasis, an aseptic technique, and a hermetic coronal seal with a definitive restoration to prevent bacterial leakage.
• Success in both procedures depends on case selection, operator skill, and appropriate post-op follow-up (clinical + radiographic).

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✅ Differences — techniques and clinical steps

➤ Partial pulpotomy
• Indication: small pulp exposures (trauma is classic indication) or carious exposures when the coronal inflammation is limited and the remaining pulp looks healthy.
• Procedure steps (typical):
1. Remove superficial inflamed pulp tissue ~1–3 mm (or until healthy bleeding tissue encountered).
2. Achieve controlled hemostasis (gentle pressure with saline/sterile cotton; should stop in a few minutes).
3. Place a biocompatible pulp dressing (e.g., MTA, Biodentine, calcium hydroxide, or newer calcium silicate cements).
4. Restore with durable coronal seal (glass ionomer + stainless steel crown or appropriate restoration).

➤ Conventional (full/coronal) pulpotomy
• Indication: deeper carious exposures where coronal pulp is judged inflamed but radicular pulp may still be healthy (commonly used in primary molars).
• Procedure steps (typical):
1. Remove entire coronal pulp down to canal orifices.
2. Achieve hemostasis at canal orifices.
3. Place pulp medicament over radicular stumps (historically formocresol, calcium hydroxide; increasingly MTA, Biodentine, or iRoot/Bioceramics are used).
4. Definitive coronal restoration (often stainless steel crown in primary molars).

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✅ Differences — materials (common choices and evidence)

• Calcium hydroxide (CH): traditional agent; can induce reparative dentin but associated with higher internal resorption and lower long-term success in some studies.
• Mineral trioxide aggregate (MTA): strong evidence for higher success and better tissue response than CH in primary molar pulpotomies (less internal resorption, thicker dentinal bridge), though it can cause crown discoloration and is more costly. A randomized trial reported ~94% success for MTA vs ~65% for CH in primary molars (small RCT).
• Biodentine & other calcium-silicate cements: growing evidence suggests comparable outcomes to MTA in many settings and advantages such as improved handling and faster setting in some formulations; recent systematic reviews/meta-analyses have examined these comparisons in primary teeth.

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✅ Clinical outcomes & success rates — what the recent evidence shows

• Recent meta-analysis/systematic review data indicate high overall success rates for pulpotomy in primary teeth when performed for appropriate indications: pooled 6- and 12-month success rates reported in some reviews exceed 90% under selected conditions. However, heterogeneity in study design, materials, and follow-up remains.
• MTA shows higher success compared with calcium hydroxide in randomized trials of primary molars (example RCT: MTA ~94% vs CH ~65%).
• Partial pulpotomy (when properly indicated, e.g., traumatic exposures or selective carious exposures) demonstrates excellent success in many reports and is increasingly accepted as the conservative option for appropriately selected primary and permanent teeth. Systematic reviews of traumatic exposures report pooled success rates often in the high 80s–90s%.

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✅ Benefits

➤ Benefits when partial pulpotomy may be preferred
• More conservative: preserves more pulp tissue and potential for continued physiologic function.
• Simpler and quicker: less pulp removal, often easier hemostasis, and preservation of tooth structure.
• High success in traumatic exposures: excellent evidence supports partial pulpotomy after trauma, making it the treatment of choice for many exposed traumatized teeth.
• Lower risk of devitalization-related sequelae: by preserving more vital tissue, risk of certain complications may be reduced if case selection is correct.

➤ Benefits of conventional/full pulpotomy:
• Established for carious exposures in primary molars with extensive coronal pulp involvement when radicular pulp is likely healthy.
• When MTA or modern calcium silicate cements are used, conventional pulpotomy outcomes are excellent and may avoid need for pulpectomy/extraction.

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✅ Practical considerations & clinical decision points

• Etiology matters: Traumatic exposures often favor partial pulpotomy; carious exposures often lead clinicians to full pulpotomy, although selected carious exposures may be amenable to partial pulpotomy with careful assessment.
• Hemostasis test: inability to achieve hemostasis within a few minutes after pulp amputation suggests deeper inflammation and may indicate need to convert to pulpotomy/pulpectomy or extraction.
• Material selection: current guideline and trial evidence favors bioceramic materials (MTA, Biodentine, iRoot) over CH for better outcomes in many settings. Cost, handling, and esthetic considerations (discoloration with some MTA formulations) should be weighed.
• Seal and restoration: a durable coronal seal (often a stainless steel crown in primary molars) is critical for long-term success.

🦷 Clinical Flowchart: Decision Process — Partial vs. Conventional Pulpotomy in Primary Teeth

Clinical Step	Assessment or Finding	Recommended Treatment	Key Notes
1. Initial Diagnosis	No spontaneous pain, normal mobility, no radiolucency	Candidate for vital pulp therapy	Confirm tooth restorable and pulp potentially vital
2. Exposure Etiology	Traumatic pulp exposure with minimal contamination	Partial pulpotomy	Remove 1–3 mm of inflamed tissue; ideal for trauma cases
3. Carious Exposure	Deep caries, small exposure, bleeding easily controlled	Partial pulpotomy or Full pulpotomy	Decision depends on depth of inflammation and hemostasis
4. Hemostasis Evaluation	Bleeding stops within 5 minutes with gentle pressure	Partial pulpotomy	Indicates superficial inflammation and healthy radicular pulp
5. Hemostasis Difficult to Achieve	Bleeding persists beyond 5 minutes or dark blood present	Full pulpotomy	Remove entire coronal pulp to canal orifices
6. Pulp Status After Amputation	Healthy bleeding tissue at orifices	Full pulpotomy	Apply MTA or Biodentine; avoid formocresol
7. Pulp Exposure Size	Small (≤1 mm)	Partial pulpotomy may suffice	Especially if recent exposure and asymptomatic
8. Material Selection	MTA, Biodentine, or bioceramic cement	For both techniques	High biocompatibility, promotes dentin bridge formation
9. Coronal Seal	Immediate restoration with glass ionomer + SSC	Mandatory for both	Ensures long-term success and prevents microleakage
10. Follow-up	Clinical & radiographic check at 6–12 months	Both procedures	Look for absence of symptoms, resorption, or radiolucency

💬 Discussion
Contemporary evidence (systematic reviews and updated AAPD guidance) supports a broader role of vital pulp therapies in primary teeth than historically believed, with high short- to medium-term success rates when case selection, technique, and materials are appropriate. The AAPD Vital Pulp Therapy guideline (systematic review to July 2022) provides an evidence-based framework for selecting pulpotomy vs other treatments and emphasizes the importance of case selection, asepsis, hemostasis, and a good coronal seal.
While partial pulpotomy is classically favored for traumatic exposures, evidence from meta-analyses indicates it can be an effective conservative option even in some carious exposures — but the clinician must carefully evaluate the extent of inflammation and ability to control bleeding. Conversely, conventional pulpotomy remains a reliable standard for many primary molars with carious exposure, especially when modern bioceramic materials (MTA, Biodentine) are used — these appear to perform better than calcium hydroxide in randomized trials.
Limitations in the evidence base include variability in follow-up duration, outcome definitions, and heterogeneity of materials used across studies. Long-term comparative trials with standardized protocols and longer follow-up would further clarify optimal indications for partial vs full pulpotomy in primary teeth.

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✍️ Conclusion
• Both partial and conventional pulpotomy are valid vital pulp therapies for primary teeth when performed with correct indication, aseptic technique, hemostasis, appropriate medicament (increasing evidence for MTA/bioceramics), and a durable coronal seal.
• Partial pulpotomy is more conservative and shows excellent success in traumatic exposures and selected carious cases when the remaining pulp is healthy and hemostasis is achievable.
• Conventional/full pulpotomy, especially when using MTA or Biodentine, provides high success rates for primary molars and may be preferable when coronal pulp removal is required.
• Clinicians should follow current evidence-based guidelines (e.g., AAPD) and apply individualized judgment for each case.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Vital pulp therapy guideline (Clinical Practice Guideline). Pediatric Dentistry, 46(1). Retrieved from the American Academy of Pediatric Dentistry website.
✔ Lin, G. S. S., Chin, Y. J., Choong, R. S., Wafa, S. W. W. S., Dziaruddin, N., Baharin, F., & Ismail, A. F. (2024). Treatment outcomes of pulpotomy in primary teeth with irreversible pulpitis: A systematic review and meta-analysis. Children, 11, 574. https://doi.org/10.3390/children11050574
✔ Liu, H., Zhou, Q., & Qin, M. (2011). Mineral trioxide aggregate versus calcium hydroxide for pulpotomy in primary molars. Chinese Journal of Dental Research, 14(2), 121–125. (Randomized clinical trial showing higher success with MTA).
✔ Madhumita, S., Chakravarthy, D., Vijayaraja, S., Kumar, A. S., & Kavimalar, D. S. (2022). The outcome of partial pulpotomy in traumatized permanent anterior teeth – a systematic review and meta-analysis. Indian Journal of Dental Research, 33(2), 203–208. DOI:10.4103/ijdr.ijdr_1150_21. (Systematic review supporting high success of partial pulpotomy in traumatic exposures).

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The webinar “Mastering Primary Teeth Pulpotomies: Techniques and Best Practices for Dental Professionals” explores modern strategies in pulp therapy for vital primary teeth.

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Modern pulpotomy techniques emphasize the selection of safe and effective medicaments, accurate diagnosis, and careful execution of the procedure. This approach not only improves treatment outcomes but also promotes long-term oral health in children by managing pulp vitality while minimizing complications.

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✅ Definition of Partial Pulpotomy
Also known as Cvek pulpotomy, partial pulpotomy involves the removal of 1–3 mm of inflamed coronal pulp tissue directly beneath the exposure, preserving the remaining healthy pulp and covering it with a biocompatible material that supports healing and dentin bridge formation.

✅ Differences Between Partial and Conventional Pulpotomy

✅ Biological Rationale
Partial pulpotomy is grounded in the understanding that pulp inflammation is often localized. When only the affected area is removed, the remaining pulp can regenerate and form a dentin bridge. Young permanent teeth, in particular, have a high regenerative capacity, which enhances success rates when proper isolation and materials are used.

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✅ Step-by-Step Technique

➤ Clinical and radiographic evaluation
° Indicated for recent pulp exposures (less than 24 hours for trauma)
° No signs of irreversible pulpitis or periapical pathology

➤ Anesthesia and isolation
° Use local anesthesia and rubber dam isolation to ensure an aseptic field.

➤ Partial pulp removal
° Excise 1–3 mm of inflamed pulp using a sterile diamond bur with water coolant.
° Rinse with sterile saline.

➤ Hemostasis
° Apply a moist cotton pellet for 2–5 minutes.
° Successful hemostasis confirms healthy pulp status.

➤ Placement of pulp capping material
° Apply a biocompatible material (e.g., MTA, Biodentine) directly onto the pulp.
° Cover with resin-modified glass ionomer or temporary cement.

➤ Final restoration
° Restore with composite resin or stainless steel crown depending on the tooth's condition and location.

Recommended Materials
° MTA (Mineral Trioxide Aggregate) – ProRoot® MTA (Dentsply Sirona), MTA Angelus®
° Biodentine™ (Septodont) – Bioactive dentin substitute with excellent sealing and biocompatibility
° TheraCal LC® (Bisco) – Light-cured resin-modified calcium silicate
° Vitrebond™ (3M) – Resin-modified glass ionomer for base/sealing

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💬 Discussion
Scientific literature strongly supports partial pulpotomy for managing pulp exposures in both primary and permanent teeth. It is especially effective when performed soon after trauma or in controlled carious exposures. Studies report success rates above 90% with bioceramic materials like MTA and Biodentine. Case selection, operator technique, and proper sealing are critical to achieving optimal outcomes.
Partial pulpotomy aligns with the minimally invasive dentistry philosophy, reducing the need for more extensive endodontic procedures and maintaining tooth vitality for longer periods.

💡 Conclusion
Partial pulpotomy is a reliable and conservative vital pulp therapy that supports biological healing and long-term function. When performed correctly and with appropriate materials, it offers a high success rate and preserves natural pulp defenses. It is recommended as a first-line treatment for immature permanent teeth and select primary teeth with localized inflammation.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. https://www.aapd.org

✔ Aguilar, P., & Linsuwanont, P. (2019). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 45(5), 511–517. https://doi.org/10.1016/j.joen.2019.01.021

✔ Bogen, G., Kim, J. S., & Bakland, L. K. (2008). Direct pulp capping with mineral trioxide aggregate: An observational study. Journal of the American Dental Association, 139(3), 305–315. https://doi.org/10.14219/jada.archive.2008.0177

✔ Nowicka, A., Wilk, G., Lipski, M., Kołecki, J., & Buczkowska-Radlińska, J. (2015). Tomographic evaluation of reparative dentin formation after direct pulp capping with Ca(OH)₂, MTA, Biodentine, and dentin bonding system in human teeth. Journal of Endodontics, 41(8), 1234–1240. https://doi.org/10.1016/j.joen.2015.03.017

✔ Chisini, L. A., Collares, K., Cademartori, M. G., et al. (2022). Vital pulp therapy for primary teeth: A systematic review and meta-analysis. Clinical Oral Investigations, 26(1), 91–106. https://doi.org/10.1007/s00784-021-04076-9

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Mineral Trioxide Aggregate (MTA) in Pediatric Dentistry: Uses, Benefits, and Clinical Evidence

Preserving primary teeth until their natural exfoliation is a key goal in pediatric dentistry. Advances in bioactive materials have made this more predictable.

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Among them, Mineral Trioxide Aggregate (MTA) has emerged as a gold standard for pulp therapy, especially for its regenerative properties and sealing capability.

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✅ Physical and Chemical Characteristics of MTA

° Main components: Tricalcium silicate, tricalcium aluminate, calcium oxide, silica, and bismuth oxide for radiopacity.
° Initial pH: Around 10.2, rising to 12.5 after setting—contributing to its antimicrobial action.
° Setting time: Between 2 to 4 hours, depending on formulation and moisture.
° Biocompatibility: Well-tolerated by periapical tissues and does not provoke significant inflammation.

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✅ Mechanism of Action
MTA promotes dentin bridge formation by stimulating mesenchymal stem cells to differentiate into odontoblast-like cells. Its high pH provides an antimicrobial environment while enhancing mineralization, aiding in pulp healing and hard tissue regeneration.

✅ Clinical Benefits of MTA in Pediatric Dentistry

° Excellent biocompatibility, making it safe for use in primary and immature permanent teeth.
° Superior sealing ability, preventing bacterial microleakage.
° Stimulates pulp regeneration and dentin formation.
° High pH provides antimicrobial effects without the cytotoxicity of other materials.
° Versatile applications in both vital and non-vital pulp therapy.

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✅ Clinical Uses of MTA in Pediatric Dentistry

✅ Commercial Brands of MTA

° ProRoot® MTA (Dentsply Sirona, USA)
° MTA Angelus® (Angelus, Brazil)
° NeoMTA Plus® (Avalon Biomed, USA)
° EndoCem MTA® (Maruchi, South Korea)

Each brand offers variations in setting time, delivery method (powder/liquid or premixed), and handling characteristics. Newer formulations like NeoMTA Plus provide shorter setting times and better clinical handling.

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💬 Discussion
Recent studies and systematic reviews confirm that MTA outperforms traditional materials such as formocresol and calcium hydroxide in pulp therapy of primary teeth. Although its cost and long setting time have been noted as limitations, newer versions address these issues. MTA offers higher long-term success rates, reduced pathologic root resorption, and superior tissue integration.
In U.S. pediatric dental practice, MTA has become the material of choice for many pulp procedures, especially when long-term tooth preservation is the goal.

💡 Conclusion
MTA is a clinically proven, biologically superior material for managing pulp tissues in pediatric patients. Its biocompatibility, sealing properties, and regenerative potential make it ideal for pulpotomies, apexification, and other endodontic procedures. Although cost may be a consideration, the high clinical success justifies its use as a standard of care in pediatric endodontics.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. https://www.aapd.org

✔ Parirokh, M., & Torabinejad, M. (2019). Mineral trioxide aggregate: A comprehensive literature review—Part III: Clinical applications, drawbacks, and mechanism of action. Journal of Endodontics, 45(1), 103–121. https://doi.org/10.1016/j.joen.2018.10.014

✔ Aguilar, P., & Linsuwanont, P. (2019). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 45(5), 511–517. https://doi.org/10.1016/j.joen.2019.01.021

✔ Nosrat, A., Seifi, A., & Asgary, S. (2021). Apexogenesis and Pulpotomy in Immature Teeth Using MTA: A Systematic Review and Meta-analysis. International Endodontic Journal, 54(4), 556–569. https://doi.org/10.1111/iej.13437

✔ Tran, X. V., Gorin, C., Willig, C., Baroukh, B., Pellat, B., Decup, F., & Chaussain, C. (2021). Effect of a calcium-silicate-based restorative cement on pulp repair. Journal of Dental Research, 100(2), 177–185. https://doi.org/10.1177/0022034520952904

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Pulpotec® in Pulpotomy: Composition, Indications, Protocol & Clinical Pros and Cons

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.

✅ 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.

✅ 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.

💡 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.

📚 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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Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names

Pulpotomy is a conservative dental procedure aimed at preserving the vitality of the radicular pulp after removing the affected coronal pulp. This treatment is common in primary teeth and young permanent teeth.

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Selecting the right medication is crucial for clinical success. Below is an overview of the most commonly used pulpotomy agents, their properties, drawbacks, and commercial names.

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✅ 1. Formocresol

➤ Brand Name: Buckley’s Formocresol
➤ Composition: 19% formaldehyde, 35% cresol, 15% glycerin, 21% water
➤ Properties:
° Bactericidal and tissue-fixative agent
° Mummifies remaining pulp tissue
° Easy to handle and low cost
➤ Drawbacks:
° Potentially carcinogenic and mutagenic
° Cytotoxic and allergenic
° Does not promote pulp tissue regeneration
➤ Clinical Notes:
° Although historically effective, its use has declined due to toxicity concerns.

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✅ 2. Ferric Sulfate

➤ Brand Name: Astringedent®
➤ Composition: 15.5% aqueous solution of ferric sulfate (pH 1.0)
➤ Properties:
° Effective hemostatic agent
° Forms a protein barrier sealing blood vessels
° Affordable and easy to apply
➤ Drawbacks:
° Does not promote pulp regeneration
° May cause radicular inflammation and resorption
➤ Clinical Notes:
° A less toxic alternative to formocresol, but with variable long-term success.

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✅ 3. Calcium Hydroxide (Ca(OH)₂)

➤ Brand Name: Dycal®
➤ Properties:
° Stimulates reparative dentin formation
° Highly alkaline with bactericidal effect
° Biocompatible
➤ Drawbacks:
° May cause superficial pulp necrosis
° Lower success rate in primary teeth
° Tends to dissolve over time
➤ Clinical Notes:
° More suitable for young permanent teeth; limited use in primary dentition.

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✅ 4. Mineral Trioxide Aggregate (MTA)

➤ Brand Name: ProRoot® MTA
➤ Composition: Tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide
➤ Properties:
Highly biocompatible
Stimulates dentin formation
Excellent sealing and antimicrobial properties
➤ Drawbacks:
High cost
Difficult manipulation and long setting time
➤ Clinical Notes:
Studies report a 97.9% clinical success rate in pediatric pulpotomies, outperforming other agents.

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✅ 5. Biodentine

➤ Brand Name: Biodentine®
➤ Composition: Tricalcium silicate, dicalcium silicate, calcium oxide, calcium chloride, zirconium oxide
➤ Properties:
° Bioactive dentin substitute
° Mechanical properties similar to natural dentin
° Fast setting time and good radiopacity
➤ Drawbacks:
° High cost
° Limited long-term clinical evidence compared to MTA
➤ Clinical Notes:
° A promising MTA alternative with easier handling and shorter setting time.

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✅ 6. Zinc Oxide Eugenol (ZOE)

➤ Brand Name: IRM® (Intermediate Restorative Material)
➤ Properties:
° Soothing effect on dental pulp
° Antimicrobial and anti-inflammatory properties
° Easy to handle and inexpensive
➤ Drawbacks:
° Does not induce reparative dentin formation
° May dissolve over time
➤ Clinical Notes:
° Commonly used as a base or sealing material in pulpotomies.

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✅ 7. Pulpotec® Paste

➤ Brand Name: Pulpotec®
➤ Composition:
° Powder: Polyoxymethylene, iodoform
° Liquid: Dexamethasone, formaldehyde, phenol, guaiacol
➤ Properties:
° Induces healing of the pulp stump
° Aseptic and quick treatment
° Effective in both primary and permanent teeth
➤ Drawbacks:
° Contains formaldehyde, which has cytotoxic potential
° Not resorbable
➤ Clinical Notes:
° Long-term success reported in studies, though formaldehyde content limits its use in some cases.

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💡 Conclusion
The choice of pulpotomy medication must be based on a careful evaluation of its properties, disadvantages, and available clinical evidence. While formocresol has been widely used, toxicity concerns have led to the rise of safer and more effective alternatives like MTA and Biodentine. The ideal agent depends on factors such as the patient's age, tooth condition, and specific clinical considerations.

📚 References

✔ Holguin Garcia, S. G. (2019). Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática. Revista de Odontopediatría Latinoamericana, 11(1). https://doi.org/10.47990/alop.v11i1.228

✔ Wikipedia. (2025). Pulpotomía. Retrieved from https://es.wikipedia.org/wiki/Pulpotom%C3%ADa

✔ Apuntes De Odontología. (2015). Pulpotomía. Retrieved from https://apuntes-de-odontologia.blogspot.com/2015/04/pulpotomia.html

✔ Studocu. (2018). Terapia Pulpar I – Dra. Andrea Cárdenas Antonieta Montero. Retrieved from https://www.studocu.com/cl/document/universidad-finis-terrae/odontopediatria/terapia-pulpar-i/4935194

✔ Revista Odontopediatría. (2014). Tratamiento Endodóntico no Instrumentado en dientes deciduos. Retrieved from https://backup.revistaodontopediatria.org/ediciones/2014/1/art-6/

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Pulpotomy and pulpectomy procedures. Indications and Differences

Pulpotomy and pulpectomy are treatments performed on primary teeth that are affected by deep caries and that compromise the dental pulp.

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Clinical and radiological evaluation are necessary to determine appropriate treatment. Pulpectomy is recommended when it is necessary to completely remove the affected dental pulp, and pulpotomy partially removes the dental pulp.

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We share the similarities, differences, indications, contraindications and step-by-step procedures of pulpotomy and pulpectomy.

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📌 Watch video 1 "PULPOTOMY AND PULPECTOMY. DEFINITION.INDICATIONS.CONTRAINDICATIONS."

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📌 Watch video 2 "WHAT IS THE DIFFERENCE BETWEEN A PULPECTOMY AND PULPOTOMY?"

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What is the best pulp dressing for pulpotomies in primary teeth? - Review

Caries is an infectious process that affects the dental structure and compromises the pulp, putting the vitality and permanence of the tooth at risk. Pulpal therapies in primary dentition have as main objective to maintain the tooth until its natural exfoliation.

Pulpotomy removes the pulp from the pulp chamber and places a dressing to stop bleeding and mummify the entrance to the radicular pulp. This procedure maintains the vitality of the primary tooth.

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Different pulp dressings have been used in pulpotomies, each with different characteristics and properties. The article we share compares all pulp dressings to determine which is the most effective.

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Pulpotomy Medicaments used in Deciduous Dentition: An Update

👇 READ AND DOWNLOAD THE ARTICLE "What is the best pulp dressing for pulpotomies in primary teeth? - Review" IN PDF 👇


Bossù, M., Iaculli, F., Di Giorgio, G., Salucci, A., Polimeni, A., & Di Carlo, S. (2020). Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature. Journal of clinical medicine, 9(3), 838. https://doi.org/10.3390/jcm9030838

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Pulpotomy: Diagnosis, types and procedure

Pulpotomy is a dental procedure that is performed on a primary tooth that is observed through an X-ray that the caries is close to the dental pulp. This treatment can be performed on primary dentition as well as permanent dentition.

During the procedure, the caries and the dental pulp are partially removed, thus maintaining the vitality and permanence of the primary tooth in the mouth.

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We share a video that offers us details of the pulpotomy: diagnosis, indications, contraindications, procedure and types of pulpotomy.

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Pulpotomy of Deciduous Molar - Step by step

Pulpotomy is the dental treatment that is responsible for partially removing the dental pulp affected by caries or dental trauma. Unlike the pulpectomy that completely removes the dental pulp.

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To carry out this treatment, a clinical and radiographic evaluation must be carried out to know what the level of involvement of dental caries is. Once this treatment is finished, the restoration of the tooth must be carried out.

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We share an interesting video that shows us how to perform a pulpotomy step by step, indicating the materials and the steps that we must follow.

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Source: Youtube/ QMUL Institute of Dentistry

Pulpotomy Medicaments used in Deciduous Dentition: An Update

The aim of this paper was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies.

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The review showed that pulpotomy of primary teeth has been treated with many different techniques and medicaments, that some of these approaches are controversial and that their results have presented variables of success rates in term of clinical, radiographic and histologic observation.

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It is important that all clinicians, particularly for pediatric dentists, be up to date with the recent trends in this area of dental treatment for children. Vital pulpotomy is the clinical treatment of choice for primary teeth with exposed pulp. Pulpotomy can be defined as the surgical removal or amputation of the coronal pulp of the vital tooth.

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This step is generally followed by the placement of a particular medicament over the intact stump to fix, mummify or stimulate repair of the remaining radicular pulp.



Souce / Author: Al-Dlaigan YH. Pulpotomy Medicaments used in Deciduous Dentition: An Update. J Contemp Dent Pract 2015;16(6):486-503.

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