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Pulpotomy

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Dental Glossary Dental Procedures

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Pulpotomy

Pulpotomy is a dental procedure in which the inflamed or infected coronal pulp tissue is surgically removed from the pulp chamber while the vital radicular pulp within the root canals is preserved. It is most commonly performed on primary (deciduous) teeth affected by deep dental caries that have encroached upon or exposed the pulp.

Why It Matters

Pulpotomy serves as a conservative alternative to full pulpectomy or premature tooth extraction. In pediatric dentistry, preserving primary teeth is essential — these teeth guide the eruption of permanent successors, maintain arch space, and support normal chewing and speech development. By removing only the diseased coronal pulp and medicating the remaining tissue, a pulpotomy can extend the functional life of the tooth until natural exfoliation occurs.

The procedure is also indicated for young permanent teeth with immature root development and open apices, where maintaining pulp vitality supports continued root formation — a process known as apexogenesis.

How the Procedure Works

A pulpotomy follows a structured clinical sequence:

  • Local anesthesia is administered and the tooth is isolated with a rubber dam.
  • Carious tooth structure and overlying dentin are removed to access the pulp chamber.
  • The coronal pulp is excised using a round bur or sharp spoon excavator.
  • Hemostasis is achieved to assess the health of the remaining radicular pulp tissue.
  • A pulp-capping medicament — commonly mineral trioxide aggregate (MTA), ferric sulfate, or formocresol — is placed over the radicular pulp stumps.
  • The tooth is sealed and restored, typically with a stainless steel crown or composite buildup.

Case Selection and Contraindications

Accurate diagnosis is the cornerstone of pulpotomy success: the radicular pulp must be free of irreversible inflammation or necrosis. Spontaneous pain, pathologic mobility, or radiographic evidence of furcation involvement, periapical pathology, or internal root resorption are contraindications — these findings indicate that pulpectomy or extraction is more appropriate. When case selection criteria are met, pulpotomy offers a predictable, well-documented outcome that avoids more invasive intervention and preserves the natural tooth structure for as long as clinically necessary.