pulpotomie

Pulpotomy, or pulpotomie in some languages, is a dental procedure that preserves the vitality of the radicular pulp by removing only the coronal portion of the dental pulp. It is most commonly performed in pediatric dentistry on primary teeth, but can be considered in select cases on permanent teeth with vital pulp.

Indications for pulpotomy include carious exposure of the coronal pulp in a tooth with a healthy or minimally inflamed radicular pulp, absence of spontaneous pain or tenderness to percussion, and no radiographic signs of necrosis or extensive periapical pathology. Contraindications include necrotic or irreversibly inflamed pulp, presence of swelling or fistula, non-restorable tooth structure, and radiographic evidence of periapical disease.

The procedure generally involves anesthesia and rubber dam isolation, removal of the coronal pulp tissue to the canal openings, achieving hemostasis, and then placing a medicament over the remaining pulp tissue. A definitive restoration is placed to seal the tooth, often followed by a full-coverage restoration such as a stainless steel crown in primary teeth. The goal is to maintain pulp vitality and tooth integrity until natural exfoliation.

Materials used as pulpotomy medicaments have evolved over time. Historically formocresol was common, but concerns about toxicity have led to alternatives such as ferric sulfate, calcium hydroxide, mineral trioxide aggregate (MTA), and newer bioactive cements. The choice of material and technique can influence success rates, which remain high when case selection and technique are appropriate.

See also: indirect pulp therapy, pulpectomy.