Pulpotomy in immature permanent teeth

shutterstock_48486751 stomatologist shows x-ray

Pulpotomy has been recommended by the American Association of Paediatric Dentistry for the management of pulp exposure in immature permanent teeth in order to achieve continued root formation. Mineral trioxide aggregate is now more commonly used than calcium hydroxide although a number of other agents have been tested including, calcium-enriched mixture, platelet-rich fibrin and antibiotic mixtures such as triple antibiotic paste.

The aim of this review was to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth.


Searches were conducted in the Medline/PubMed, Embase, the Cochrane Library (CENTRAL) and the clinicaltrials.gov database. Randomised controlled trials (RCTs) comparing two or more pulp dressing agents in permanent teeth with open apex with a follow up of at least 6 months and published in English were considered. Two reviewers independently selected studies and extracted data with study quality being assessed using the Cochrane risk of bias tool. Clinical and radiographic success rates were expressed as risk ratios (RRs) together with 95% confidence intervals (CI). Meta-analyses were performed where possible.


  • 5 studies were included.
  • Studies were conducted in Egypt, India, Iran and Turkey.
  • All studies were considered to be at high risk of bias as the interventions do not allow the blinding of operators.
  • Mineral trioxide aggregate (MTA) v Calcium hydroxide (CH)
    •  2 studies (99 teeth) contributed to a meta-analysis.
    • There was no statistically significant difference clinical or radiographic success rate between MTA and CH at 6 [ RR= 1.00 (95%CI; 0.94 to 1.06)] or 12 months [ RR= 1.04 (95%CI; 0.96 to 1.13)].
  • 1 study compared MTA and Calcium-enriched mixture (CEM) demonstrating no difference in clinical or radiographic success.
  • 1 study compared MTA versus platelet-rich fibrin (PRF) with no differences at 6 and 12 months.
  • MTA was compared with triple antibiotic paste (TAP) and abscess remedy in one study which suggested increased success rate with MTA.


The authors concluded: –

Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.


The authors have searched a good range of databases for this review although restricting the inclusion to publications in English may exclude some relevant studies.  Only 5 studies were included, and the sample sizes are small as noted by the authors. All the studies were rated as being at high risk of bias because the use of different materials means that it is difficult to blind the operators to the intervention. The authors also highlight variation in the radiographic criteria employed in the individual studies.  So, while the available data suggest the various agents tested had similar success rates these should be interpreted cautiously because of the limited amount of data.  Further high quality well reported studies of appropriate size and duration are needed this should help clarify the most effective and cost-effective approaches.


Primary Paper

Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis. Yuan Chen, Xinlei Chen, Yali Zhang, Fangjie Zhou, Jiaxin Deng, Jing Zou & Yan Wang. BMC Oral Health volume 19, Article number: 227 (2019)

Other references

Dental Elf – 10th Jul 2019

Pulpotomy for permanent teeth



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