Pulpotomy is one of the most common pediatric dentistry procedures, especially when treating cariously exposed primary teeth. It involves removing the coronal pulp tissue located in the crown of the tooth while preserving the radicular pulp in the roots. When performed correctly, pulpotomy maintains the vitality of the remaining pulp and helps retain the tooth in function until natural exfoliation.

In this article, we’ll break down the pulpotomy procedure step by step, highlighting important clinical tips to make the process smoother for beginner dentists.

read our guide about pulpectomy

What is a Pulpotomy?

A pulpotomy is a vital pulp therapy procedure indicated when the coronal pulp is irreversibly inflamed due to caries, but the radicular pulp remains healthy. Unlike pulpectomy, which removes all pulp tissue, pulpotomy only targets the coronal portion.

Step-by-Step Pulpotomy Procedure

pulpotomy diagnosis and treatment planning

pulpotomy diagnosis and treatment planning

1. Caries Removal and Pulp Exposure

isolation for pulpotomy

• Start by carefully removing caries.
• In most primary teeth, especially for beginners, pulp exposure is common and should not be alarming.
• Controlled bleeding is actually desired, as it confirms pulp vitality.

2. Access Opening and Deroofing

access cavity for pulpotomy

• Create an access cavity to expose the pulp chamber.
• Extend the opening until complete deroofing is achieved. This means removing the entire roof of the pulp chamber.
• Use a probe to check for “catches” along the walls—any irregularity indicates remnants of the roof that must be removed.
• A smooth glide of the probe along the walls confirms complete deroofing.

3. Removal of Coronal Pulp

• Excavate coronal pulp tissue using a sharp excavator (preferably a medium or small size, since the pulp chamber in primary teeth is small).
• Avoid dull excavators, as they tend to tear tissue rather than cut it cleanly, leading to prolonged bleeding and inefficient removal.

4. Controlling Bleeding

• Apply moist, squeezed cotton pellets with gentle pressure directly over the pulp stumps.
• Avoid dry cotton, as its fibers may irritate the pulp and delay hemostasis.
• Bleeding should stop within a few minutes if the radicular pulp is healthy.

5. Evaluation of Pulp Health

• A healthy pulp will present with bleeding controlled at each canal orifice, not spread across the entire pulp chamber floor.
• Once hemostasis is achieved and orifices are clearly visible, the tooth is ready for medicament placement (e.g., MTA, ferric sulfate, or formocresol depending on the protocol used).

mta application for pulpotomy tooth restoration after pulpotomy

Clinical Tips for Successful Pulpotomy

• Always ensure complete deroofing for proper access and visualization.
• Use sharp instruments to cleanly separate coronal from radicular pulp.
• Hemostasis is the key indicator of pulp health—persistent uncontrolled bleeding may indicate the need for pulpectomy.
• Cotton pellets must be moist and applied with steady pressure.

Pulpotomy in primary teeth is a fundamental procedure in pediatric dentistry, especially for general dentists starting clinical practice. By following the steps of caries removal, access opening, complete deroofing, careful pulp removal, and proper bleeding control, you can perform pulpotomy effectively and with confidence.

Mastering this technique not only helps preserve primary teeth until exfoliation but also relieves pain, restores function, and maintains space for the permanent dentition.