Pulpotomy: Modern concepts and materials

Abstract

Pulpotomy is one of the most common treatment modalities in pediatric dentistry where amputation of only coronal pulp is done. Radicular pulp remain untouched and treated with long term clinically successful medicaments such as formocresol, glutaraldehyde, ferric sulphate etc. The success of pulpotomy depends on assessment of the pulp and the technique. Due to the availability of newer material nowadays pulp regeneration can also be done.

Full text

International Journal of Oral Health Dentistry 2021;7(4):245–252
Content available at: https://www.ipinnovative.com/open-access-journals
International Journal of Oral Health Dentistry
Journal homepage: www.ijohd.org
Review Article
Pulpotomy: Modern concepts and materials
Puloma Bagchi1, Nilotpol Kashyap1,*, Sanhati Biswas1
1Dept. of Pediatric and Preventive Dentistry, Rungta College of Dental Sciences and Research, Chhattisgarh, India
ARTICLE INFO
Article history:
Received 01-11-2021
Accepted 15-12-2021
Available online 28-12-2021
Keywords:
Pulpotomy
Pulp
Formocresol
MTA
ABSTRACT
Pulpotomy is one of the most common treatment modalities in pediatric dentistry where amputation of only
coronal pulp is done. Radicular pulp remain untouched and treated with long term clinically successful
medicaments such as formocresol, glutaraldehyde, ferric sulphate etc. The success of pulpotomy depends
on assessment of the pulp and the technique. Due to the availability of newer material nowadays pulp
regeneration can also be done.
This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon
the work non-commercially, as long as appropriate credit is given and the new creations are licensed under
the identical terms.
For reprints contact: reprint@ipinnovative.com
1. Introduction
The pulp Therapy has many controvercy than any other
treatment in pediatric dentistry specially pulpotomy.This
review article presented in the context of rationals that have
guided development of new and very divergent treatment
modalities while no reviews presented a framework for the
systemic analysis of past development or future trends.1
According to the AAPD a pulpotomy is performed in a
primary tooth with extensive caries but without evidence of
radicular pathology when caries removal results in a carious
or mechanical pulp exposure. The coronal pulp is amputated
and the remaining vital radicular pulp tissue is treated
with a long term clinically successful medicament such as
Buckley’s solution of formocresol or ferric sulphate.2
According to Finn (1995), pulpotomy is defined as the
complete removal of coronal portion of the dental pulp,
followed by the placement of the suitable dressing or
medicament that will promote healing and preserve the
vitality of the tooth.
* Corresponding author.
E-mail address:nilkash9365@gmail.com (N. Kashyap).
1.1. Indications of pulpotomy
1. Pulp exposure during removal of caries in primary
teeth
2. Pulp exposure due to trauma
3. No history of spontaneous pain
4. Hemorrhage from exposure site is easily controllable
5. Hemorrhage from the exposure site is bright red in
colour
6. No intraradicular bone loss
7. No intraradicular radioleucency
8. Absence of abscess or fistula
9. In young permanent tooth with vital exposed pulp and
incompletely formed root
10. History of spontaneous pain
Pulpotomy can be performed using different techniques
including non pharmacotherapeutic treatments such
as electrosurgey and lasers or pharmacotherapeutic
approaches by dressing pulp tissue with different
medicaments or biological materials such as formocresol,
glutaraldehyde, ferric sulphate, freezed dried bone, bone
morphogenic protein (BMP), osteogenic protein, sodium
hyochloride, calcium enriched mixture (CEM), enriched
collagen solutions and fully synthetic nano crystalline
https://doi.org/10.18231/j.ijohd.2021.049
2395-4914/© 2021 Innovative Publication, All rights reserved. 245

246 Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252
hydroxyappatite paste.
1.2. Classification of pulpotomy
Pulpotomy can be classified according to treatment
objectives (Don M Ranly 1994).1
1.3. Depending on the size of exposure
1. Partial pulpotomy (shallow, low level or Cvek’s
Pulpotomy.
2. Cervical pulpotomy (deep, high level, total or
conventional pulpotomy.
1.4. Classification depending upon the number of visits
1. Single visit pulpotomy
2. Multivisit pulpotomy
2. Formocresol Pulpotomy/ Single Visit Pulpotomy
Pulpotomy using formocresol was first introduced by
Buckley in 19043
Buckley’s formula consisted of
1. Formaldehyde – 19%
2. Cresol – 35%
3. Glycerine – 15%
4. And water
The Ph of Buckley’s solution is 5.1
Currently 1:5 dilution of Buckley’s Formocresol is
commonly used. A diluent consisting of 3 part of glycerine
(90 ml) added to 1 part distilled water (30ml) is prepared.
Later 4 parts of diluent (120 ml) is mixed with 1 part of
buckley’s formocresol (30 ml).
Sweet (1930) proposed the multivisit technique.
Doyle (1962) proposed the two visit pulpotomy.
Spedding (1965) gave a five minute protocol (partial
devitalization).
Redig gave five minutes single visit pulpotomy
Garcia Godoy (1991) advocated 1 min. single visit
pulpotomy.
Current pulpotomy procedure uses 4 minutes of
application time.
2.1. Steps of single visit pulpotomy
1. Anaesthesize the tooth and tissue
2. Isolate the tooth with rubber dam
3. Remove caries with a high speed straight bur without
entering the pulp chamber
4. Remove the roof of pulp chamber with a slow speed
round bur
5. Remove coronal pulp with a large excavator or a large
round bur
6. Apply formocresol with a pledget of cotton and apply
it on the amputated pulp for 4 minutes.
7. Remove formocresol pledget after 4 minutes and
check that hemorrhage stopped
8. Filled the pulp chamber with Zinc Oxide Eugenol
cement
9. Restore the tooth with stainless crown.
2.2. Mechanism of action of formocresol
Formocresol prevents tissue autolysis by binding the peptide
group of side chain of amino acid. It is a reversible process
without changing of basic structure of protein molecules.
2.3. Controversy between 1 minute formocresol
pulpotomy vs 5 minutes formocresol pulpotomy
Zohra et al (2011) used 1 minute formocresol pulpotomy
and reported success rates comparable to techniques that
used the 5 minute diluted or full strength solutions reported
in the literature.
2.4. Histological changes
Massler and Mansukhani (1959) reported that between 7 to
14 days three zones appeared.
1. A broad acidophllic zone (fixation
2. A broad pale – staining zone (atrophy
3. A broad zone of inflammatory cells
After 60 days only strand of eosinophillic fibrous tissue
remained at the exposure site.
2.5. Concerns of formocresol
1. Formocresol is believed to cause mutagenecity,
cytogenecity and carcinogenicity.
2. IARC (June 2004) classified formaldehyde as a
carcinogen that has potency to cause leaukemia and
nasopharyngeal carcinoma. However Ranly calculated
the formocresol concentration following pulpotomy
and reported that 3000 pulpotomies have to be
performed in the same individual to reach toxic level.
3. Systemic distribution – Myers (1978) while using
radioisotope labelled formaldehyde to perform
pulpotomies in animals found its presence in PDL,
dentine, bone and urine.
4. Antigenocity – Thoden Valzen found immunogenic
potential of formaldehyde in rabbits, dogs, and guinea
pigs.
5. Mutagenecity and cytogenecity – According to studies
done formaldehyde dentaures nuclic acids by forming
methylol derivaties that renders genetic machinery
inoperable. It may also affect biosynthesis and cell
reproduction by interacting with DNA and RNA.

Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252 247
Table 1:
Vital pulpotomy
Types Other name Features Examples
Devitalization Mummification
Cauterization
Intended to mummify the vital
tissue
Single sitting
Formocresol
Electrosurgery
LASER
Two sittings
Gysi triopaste
Easlick’s formaldehyde
Paraform devitalizing paste
Preservation Minimum deviatlization, non
inductive
Maintains vital tissue with no
induction of reparative dentine
Zinc oxide eugenol
Glutaraldehyde
Ferric sulphate
Regeneration Inductive, reparative Causes formation of dentin
bridge
Ca(OH)2
Bone morphogenic protein
Mineral trioxide aggregate
Enriched collagen
Freezed dried bone
Osteogenic protein
Non vital pulpotomy
Mortal pulpotomy It is done inn teeth with
nonnegotiable root canals
Beechwood cresol
Formocresol
2.6. Two visit devitalization pulpotomy
2.6.1. Indications
1. Evidence of sluggish or profuse bleeding at the
amputation site
2. Hemorrhage difficult to control
3. Slight purulence in the pulp chamber but not at the
amputation site
4. Thickening of the periodontal ligament
5. A history of spontaneous pain without other
contraindications
2.7. Contraindications
1. Non restorable tooth
2. Soon to be exfoliated tooth
3. Necrotic pulp
It is a two stage procedure involving the use of
paraformaldehyde. The medicament has a devitalizing,
mummifying and bactericidal action.
2.7.1. Technique of two visit pulpotomy
1. First appointment
(a) Same as formocresol pulpotomy but
paraformaldehyde paste in cotton pellet is
placed over the exposure and the tooth is sealed
for 1 to 2 weeks.
(b) Formaldehyde gas liberates from the
paraformaldehyde paste and permeates through
the coronal and radicular pulp fixing the tissues.
2. Second appointment
(a) Pulpotomy is carried out with the help of LA and
pulp chamber is filled with antiseptic paste and
the tooth is restored with stainless steel crown.
2.7.2. Materials used in two visit pulpotomy
1. Gysi triopaste consit of tricresol, cresol, glyserine,
paraformaldehyde, zinc oxide eugenol
2. Easlick’s paraformaldehyde paste consist of
paraformaldehyde, procaine base, powdered asbestos,
petroleum jelly
3. Paraform devitalizing paste consist of
paraformaldehyde, lignocaine, propylene glycol,
carbowax, carmine for colour.
3. Glutaraldehyde Pulpotomy
Glutaraldehyde for pulp fixation was proposed by
Gravenmade (1975), In recent years glutaraldehyde
has been proposed as an alternative to formocresol based
on its superior fixative properties, self limiting penetration,
low antigenecity, low toxicity and elimination of cresol.
Glutaraldehyde has a cross liniking property superior to
that of formocresol.3
3.1. Histology
Narrow zone of eosinophillic stained and compressed fix
tissue isi found beneath the area of application which blends
with underlying normal pulp.
Concentration and application time of glutaraldehyde

248 Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252
Garcia Godoy (1987) found that increase in
concentration and longer time improves fixation and
suggested the use of 4% glutaraldehyde for 4 minutes or
8% glutaraldehyde for 2 minutes.
3.2. Disadvantages
1. It is costly
2. Inadequate fixation that leaves a deficient barrier
susceptible for sub-base irritation resulting in internal
resorption.
4. Ferric Sulphate Pulptomy
It is a non aldehyde chemical which is used as a pulpotomy
material. Ferric sulphate is a coagulative and hemostatic
agent this compound was proposed as a pulpotomy
agent that it prevents the problem in clot formation
thereby minimizing chances of inflammation and internal
resorption.4
4.1. Mechanism of action of ferric sulphate
When ferric sulphate comes in contact with pulp tissue it
forms ferric ion protein complex that mechanically occludes
capillaries in the amputation site forming barrier for irritants
of sub base.
4.2. Advantages
1. Minimizes clot formation at the amputation site
2. Cheap
4.3. Disadvantages
1. Some studies reported fibrosis.
5. Calcium Hydroxide Pulpotomy
Calcium hydroxide was introduced to dentistry in 1938 by
Nygren. In 1930 Herman showed that calcium hydroxide
stimulated the formation of new dentine when placed in
contact with human pulp tissue.5
Calcium hydroxide was used as a medicament for
indirect pulp capping, direct pulp capping and pulpotomy
in permanent and primary teeth because of its bactericidal
effect and ability to form reparative dentine bridge however,
there are a controversies regarding the us e of calcium
hydroxide in primary teeth pulpotomy, because it results
in the development of chronic pulpal inflammation and
internal resorption.
In case of deciduous teeth even before the actual
time for exfoliation there is an inherent predelliction for
the formation of odontoclasts. The preexisting propencity
for transformation could be influenced and hastened by
placement of calcium hydroxide, probly through its high
alkaline ph. It is very likely that high alkaline ph of
calcium hydroxide could trigger existing pre- odontoclasts
(stromal undifferentiated mesenchymal cells) to transform
into odontoclasts which causes internal resorption. Hence,
calcium hydroxide is not recommended as a pulpotomy
agent in case of primary teeth.
6. Newer Concepts in Pulpotomy
6.1. MTA pulpotomy
As a member of hydroxycilic calcium silicate cement MTA
was introduced by Lee et al and patented by Torabinejad and
White in 1995.6
MTA consist of tricalcium silicate, bismuth oxide,
tetracalcium alumina, ferrite, calcium sulphate dehydrate.
6.2. Mechanism of action
When MTA is mixed with water a colloidal gel with a ph
12.5 similar to that of calcium hydroxide is formed. MTA in
contact with pulp tissue promotes dentin bridge formation.
6.3. Advantages
1. Biocompatibility
2. Bactericidal
3. Induction of cementogenesis, osteogeensis,
dentogenesis
4. Good sealing ability
5. Is duperior to formocreo; which is considered the gold
standard in pulpotomy
6.4. Disadvantages
1. Expensive
2. Fast Setting time
7. Calcium Enriched Mixture Cement (CEM)
CEM cement was introduced as a endodontic filling
material. The major componenets of the cement are calcium
oxide, sulphur trioxide, phosphorus peroxide and silver
dioxide.7
7.1. Advantages
1. Biocompatible
2. The physical properties of the cement such as flow,
film thickness and setting in aquous environment are
favorable.
3. Has antibacterial activity
4. Induces hydroxyappatite formation
8. Electrosurgery
It is a non – pharmacological hemostatic technique which
has been suggested for the pulpotomy procedure.8

Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252 249
8.1. Mechanism of action
Electrosurgery involves cutting and coagulating soft tissues
by means of high frequency electric current passing through
the cells. These technique carbonizes and heat denatures the
pulp and bacterial contamination.
8.2. Advantages
1. The self limiting pulp penetration is only a few cell
layers deep.
2. Good visualization
3. Hemostasis without chemical coagulation
4. Less chair time
9. Laser Pulpotomy
Lasers have been introduced to medicine and dentistry
since the early 1960s. Different lasers are used in
pediatric dentistry. These lasers include diagnosis of caries
development (diode 655 mm), argon lasers for composite
curing, Co2 lasers with wavelength of 10600 nm for soft
tissue surgeries, Nd: YAG lasers with wavelength of 1064
nm as well as diode laser with wavelength of 810-980 nm
for soft tissue cutting, the Erbium laser family including
Er: YAG (2940 nm) and Er; Cr: YSGG (2780 nm) which
were used in hard tissues, cavity preparation and in soft
tissue surgery and also low power lasers which are used in
stimulatory and inhibitory biologic process. Several studies
have revealed that laser have proper effects in pulpotomy
of primary teeth with results similar or even better than
formocresol pulpotomy. The advantages of laser compared
to conventional pulpotomy, are hemostasis, preservation of
vital tissues near the tooth apex, absence of vibration and
odor.9
Hz, Co2 laser and 632/980 nm diode lasers can be used
for pulpotomy of primary teeth. Liu et al. in a clinical study
compared the effects of Nd: YAG laser pulpotomy with FC
on human primary teeth. They concluded that the success
rates of the Nd: YAG laser was significantly higher than the
FC pulpotomy.
10. Naocl Pulpotomy
Sodium hypochlorite has been used as an irrigant in
dentistry for decades. Hafez and others demonstrated that
the application of sodium hypochlorite selectively dissolves
the superficiall necrotic pulp tissue while leaving the deeper
healthy pulp tissue unharmed.10
10.1. Advantages
1. It is biocompatible
2. It is non irritating to the pulp tissue
3. It is an effective hemostatic agent
Various studies have shown good success rate of sodium
hypochlorite pulpotomy.
11. BMP (Bone Morhogenic Protein)
BMP is thought to induce reparative dentin with
recombinant dentinogenic proteins similar to the native
proteins of the body. This was based on two classic
observations.11
1. Huggins reported urinary tract epithelia implanted into
the abdominal wall of dogs evoked bone formation
2. Urist also noted that demineralized bone matrix
stimulated new bone formation when implanted in
ectopic sites such as muscles. Urist concluded that
bone matrix contains a factor capable of autoinduction
and named it BMP.
The proteins most studied in pulp tissue have been BMP- 2,
BMP-4 and BMP- 7 (OP-1).
Studies on BMP-7 has been done by Rutherford, Jepson
and sin. Whereis studies on BMP 2 and 4 has been done by
Nakashima and Ren.
11.1. Mechanism of action of BMP
Cells similar to fibroblasts migrate from the lower pulp
tissue to the amputation zone (free from contamination)
where they proliferate following this, there is formation
of inactive matrix or utilization of the scaffolds itself, for
the stem and undifferentiated mesenchymal cells to adhere
tooth.
BMP – 2, 4 and 7 induce the differentiation of the
adhered cells into odontoblasts that, inturn take part in the
production and mineralization of the dentin matrix.
In a study done by Bengtsone et al (2008) they found
the success rate of BMP-2 on human deciduous teeth to be
100%.
These suggests that rh BMP -2 is a material with
inductive properties that should be further investigated for
use as an alternative to pulpotomy treatment.
12. Enamel Matrix Derivative (EMD)
Enamel matrix derivative (emdogain) is an extract derived
from porcine foetal tooth material and mainly consists
of amelogenins, a class of protein known to induce the
proliferation of periodontal ligamental cells.12
The ability of EMD to facilitate the regenerative
process is well established. This process mimics
normal odontogenesis and it is believed that reciprocates
ectodermal signaling controls and patterns.
Currently emdogain gel (Straumann, Switzerland) has
been successfully employed for pulpotomy procedures.
EMD by means of amelogenin and ameline rich fraction
has the potential to induce a process that seems to immitate

250 Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252
normal dentinogenesis. It influences the odontoblsts and
endothelial cells of the pulpal capillary vessels to create a
calcified barrier over the pulp amputation site.
12.1. Mechanism of action of EMD
It has been reported that enamel matrix proteins participates
in the differentiation and maturation of odontoblastic cells
and when the pulp exposed to EMB, a substantial amount
of reparative dentin like tissue is formed in a process
much resembling classic wound healing which subsequent
neogenesis of normal pulp tissue. These formation of new
dentin starts from within the pulp at some distance from the
exposure site.
Jumana and Ahmed reported the clinical success of 93%
using emdogain for pulpectomy.
13. Propolis
Propolis is a wax cum resin substance that is produced by
bees.13
1. It is shown to have antibacterial property
2. Antiviral property
3. Antifungal property
4. Hypotensive property
5. Cytostatic activity due to the presence of lavonoids (2
phenyl 1,4 – benzopyrine, aromatic acids and esters)
Histological studies has shown that the inflammatory
response when propolis was applied to the amputated pulp
was less severe, the area of pulp necrosis was smaller and
there was more frequent formation of calcific barrier.
14. Ankaferd Blood Stopper (ABS)
It is a herbal extract obtained from 5 different plants14
1. Thymus vulgaris
2. 2 Glycyrrhiza glubra
3. Vitis vinifera
4. Alpinia officenarum
5. Urtica diocia
All of these plants has some effect on the endothelium,
blood cells, angiogenesis cellular proliferation vascular
dynamics and also as cell mediator.
14.1. Mechanism of action of ABS
Following application of ABS, it forms an encapsulated
protein network that provides focal points for vital
erythrocytes aggregation. ABS induce protein network
formation with blood cells particularly erythrocytes
covering the primary and secondary hemostatic system
without disturbing individual coagulation factors.
It is suggested that ABS may be used to control
pulpal hemorrhage following the mechanical exposure of
the pulp. The levels of coagulation factors II, V, VIII,
IX, X, XI and XII were not affected by ABS, therefore
ABS can be used in patients with primary or /and
secondary hemostasis including patients with disseminated
intravascular coagulation.
Studies show the success rate of ABS in pulpotomy
between the range of 89 -100%.
14.2. Bioactive Glass (BAG)
Bioactive glass has been studied for more than 30 years
as a bone substitute. They react with aquous solutions and
produce a carbonated apatite layer. BAG is biocompatible
and has osteogenic potential. Many researchers claim that
it has odontogenic potential and can formed reparative
dentin.15 Animal studies by Salako et al reported that BAG
showed localized area of inflammation in the pulp and four
week all samples showed comparatively better result where
the inflammation was resolved and an odontogenic layer
was evident.
15. Nanohydroxy Apatite (NHA)
Hydroxyapatite has already been used in bone grafts
in orthopedic and in dental applications due to its
structural similarity with bone and teeth. Despite
each biocompatibility, one of the problems related to
hydroxyapatite is the release of crystals or agglomeres
that could impair cell activity and hinder the regeneration
process. As natural bone has nanoscale features, it is
believed that nanostructured hydroxyapatite could improve
the properties of synthetic bone.16
Recently a fully synthetic nanocrystallanize
hydroxyapatite (NHA) paste containing approximately
65% water and 35% apatite particle was introduced.
The advantages of this material are
1. Its close contact with surrounding tissue
2. Its rapid resorption capacities
3. High number of molecules on its surface
The biocompatibility of NHA combined with its structural
similarity to teeth allows NHA to stimulate odontoblasts
thus promoting the formation of dentine bridges.
Shayegan (2010) in his study found NHA to be
biocompatible and observed that it provoked mild
inflammatory reaction in pulp tissue after pulpotomy.
16. Platelet Rich Plasma (PRP)
It was first introduced by Marx in 1998 for reconstruction of
mandibular defects. PRP gel is an autologous modification
of fibrin glue obtained from autologus blood used to deliver
growth factors in high concentrations. It is an autologous
concentration of human platelets in a small volume of
plasma. It mimics the coagulation cascade leading to

Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252 251
formation of fibrin clot which consolidates an adheres to
application site.17
It is biocompatible, biodegradable and promotes healing.
PRP has been found to work in 3 ways
1. Increase in cell division
2. Inhibition of excess inflammation by decreasing early
macrophase proliferation and
3. Degranulation of the granules in platelets, which
contain the synthesized and prepackaged growth
factors
Studies have reported could clinical success rates of
pulpotomy using PRP
17. PULPOTEC
Pulpotec is a radio-opaque, non resorbable paste that is used
in pulpotomy. Its powder consists of polyoxymethelene,
iodoform and liquid consist of dexamethasone acetate,
formaldehyde, phenol and guaiacol.18
17.1. Mechanism of action
The mode of action is by cycatrization of the pulp stump
at the chamber – canal interface, while maijtaining the
structure of the underlying pulp.
Histological studies have shown no signs of
inflammation but there was a discontinuity in the
odontoblastic layer lining along the dentin walls.
17.2. Nigella Sativa Oil (NS)
Nigella sativa oil is extracted from the seeds of black
cumin. It is shown to have bronchodilator, immunogenic
potentiating, hypotensive, analgesic, antibacterial and anti-
inflammatory activity.
Omar OM et al. in his studies found that pulpotomy
is done with NS showed mild to moderate vasodilation,
continuous odontoblastic layer and a few samples showed
scattered inflammatory cell infiltration.19
17.3. CVEK’S Pulpotomy
It is also known as partial pulpootomy or calcium hydroxide
pulpotomy. It was advocated by mejare and Cvek (1978).
It is a form of vital pulp therapy performed in a immature
permanent tooth with an open apex that consist of the
surgical amputation of 2-3 mm of damaged and inflamed
coronal pulp tissue. After removal of the damaged tissue, a
dressing agent is placed to stimulate healing and maintain
the vitality of the remaining pulp. It has a success rate of
95% in the treatment of complicated crown fractures and
91 – 93% in cariously exposed immature asymptomatic
permanent teeth.20
17.4. Rationale of Cvek pulpotomy
1. To preserve the vitality of the radicular pulp and allow
for normal root closure.
17.5. Indication
In young permanent immature teeth where the pulp has been
exposed due to trauma or caries and the remaining radicular
pulp is deemed to be vital by clinical and radiographic
criteria wherein the root formation is not complete.
Procedure of cvek pulpotomy
1. Tooth is anaesthesize and isolated
2. Caries is removed with a high speed 801 – 016 ML
diamond round bur with copious irrigation
3. Amputation of 2- 3 ml of the damaged coronal pulp is
executed
4. The cavity is rinsed with normal saline
5. Cotton pellet moistened with saline is used with
moderate pressure to attained hemostasis
6. Calcium hydroxide is then apply to the exposed pulp
ensuring no clot formation takes place
7. The cavity is then sealed with temporary restorative
material
8. At the 1 month follow up, the tooth should be
asymptomatic and show radiographic evidence of root
development and maturation
9. Then permanent restoration with amalgam is done
18. Mortal Pulpotomy
It is also known as non vital pulpotomy. Ideally speaking
pulpotomy is done in the vital tooth and pulpectomy is done
in case of nonvital tooth. But in some cases it is not possible
to do a pulpectomy because of nonnegotiable root canals
and lack of cooperation of the patients. In such cases a
mortal pulpotomy is done.21
18.1. Procedure of Mortal Pulpotomy
18.1.1. First appointment
1. In the first appointment the necrotic pulp from the pulp
chamber is removed
2. The pulp chamber is irrigated with normal saline and
dried with a cotton pellet
3. The radicular pulp is then treated with a strong
antiseptic solution
4. The cavity is then sealed with temporary restorative
material
18.1.2. Second appointment
1. In the second appointment if the tooth is asymptomatic
an antiseptic paste is put in the pulp chamber
2. The tooth is then restored with a stainless steel crown

252 Bagchi, Kashyap and Biswas / International Journal of Oral Health Dentistry 2021;7(4):245–252
19. Conclusion
For the maintenance of the dental arch lenth in children,
mastication, speech and esthetics presentation of the
deciduous teeth are necessary until their permanent
successors erupt. Appropriate procedures such as indirect
pulp capping, direct pulp capping and pulpotomy are often
considered for maintaining the vitality of the deciduous
teeth. The most common treatment in case of pulp
exposure in symptom free primary molars is pulpotomy
though deciduous molar pulpotomy has serve adverse
effects like internal root resorption, this is mainly due to
diagnostic errors during pulp testing and technical failure
while performing the procedure. Newer materials that are
available as pulpotomy agents have also made regeneration
of pulp tissue possible thus the only thing required while
performing pulpotomy procedure is accurate diagnosis of
the pulpal status and proper technique.
20. Source of Funding
None.
21. Conflict of Interest
The authors declare no conflict of interest.
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Author biography
Puloma Bagchi, PG 2nd Year
Nilotpol Kashyap, Professor
Sanhati Biswas, PG Student
Cite this article: Bagchi P, Kashyap N, Biswas S. Pulpotomy: Modern
concepts and materials. Int J Oral Health Dent 2021;7(4):245-252.