Partial Pulpotomy in Pediatric Dentistry: Technique, Benefits, and Key Differences

Modern pediatric dentistry emphasizes minimally invasive procedures that preserve pulp vitality and tooth structure.

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Partial pulpotomy offers a biologically favorable approach in cases of limited pulp inflammation, especially in traumatic pulp exposures or shallow carious lesions, promoting healing and long-term tooth survival.

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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."

Youtube / Dr Teeth

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Youtube / Top Doctors UK

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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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Pulpectomy, everything you need to know: Diagnosis, indications, and filling materials

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Source: Youtube/ Toothism