Pulpotomy
What Is Pulpotomy?
Pulpotomy is a conservative pulp treatment used in selected vital teeth when infection or deep decay affects only the crown pulp. The coronal pulp is removed, while the root pulp is kept vital where possible and sealed with a biocompatible material.
It differs fundamentally from pulpectomy, where the root canals are enlarged and filled. The aim, especially in primary teeth, is to keep the tooth in the mouth until its natural shedding time.
Indications and Limits
It may be considered in vital teeth that respond to cold testing and where bleeding can be controlled. Limited pulp exposure after trauma or deep caries may be suitable; necrosis, apical swelling, spontaneous pain or uncontrolled bleeding usually changes the plan to pulpectomy or extraction.
Physiological root resorption is normal in primary teeth. In young permanent teeth with an immature apex and vital pulp, pulpotomy may be assessed; apexification is a separate protocol for necrotic immature permanent teeth and should not be confused with vital pulpotomy.
Pulpotomy Steps
After rubber-dam isolation and local anaesthesia, carious dentine is removed and the coronal pulp is taken away. Controlled bleeding is expected at the root-pulp entrance; if haemostasis cannot be achieved, the plan may change.
Current evidence favours calcium-silicate materials such as MTA in vital pulpotomy of primary teeth. Material selection follows the clinical protocol and current guidance.
Difference from Pulpectomy
In pulpectomy all pulp tissue is removed and the canal system is shaped and filled. In pulpotomy, only the coronal pulp is removed; root canals are not shaped and filled in the same way, and root-pulp vitality is preserved where possible.
If pulpotomy fails, root-canal treatment or extraction may become necessary. The two procedures are not shortened versions of each other.
Follow-up and Prognosis
Radiographic review checks for periapical pathology and internal resorption. Progressive internal resorption, unfavourable treatment response, night pain, swelling or fistula requires clinical and radiographic reassessment.
Success depends on case selection and technical hygiene; no absolute guarantee can be given. Restoration may be completed with a stainless-steel crown, composite or compomer depending on cavity size.
Session planning may be adjusted according to the child’s cooperation level; sedation is assessed under a separate protocol. The restoration is completed with a stainless-steel crown, composite or compomer; in large cavities, a crown may be preferred.