Outcomes and risk factors of pulpotomy in mature permanent teeth with complicated crown fractures: A 12-60-month prospective clinical study

Traumatic dental injuries (TDIs), especially complicated crown fractures (CCFs), challenge pulp preservation in mature teeth. This study evaluated outcomes and risk factors in mature permanent teeth treated with pulpotomy using iRoot BP Plus. This prospective single-arm clinical trial included 47 mature permanent anterior teeth with CCFs and pulp exposures within 24 h post-trauma. Partial pulpotomy was performed under magnification, involving removal of 2–3 mm of coronal pulp, with hemostasis achieved within 5 min. The exposed pulp was capped with iRoot BP Plus, followed by immediate coronal restoration. Patients were followed for 12–60 months. Success was defined as asymptomatic status, maintained pulp vitality, functional integrity, absence of pathology, and dentin bridge formation ≥0.3 mm. The cumulative clinical and radiographic success rate was 93.6 % (44/47) over a median follow-up of 12–60 months. Three teeth (6.4 %) developed pulpitis and required root canal treatment. A pre-operative widened apical periodontal ligament (PDL) space was a significant predictor of failure (Hazard Ratio = 17.9; 95 % CI: 2.4–195.8; P = 0.007). Failure occurred in 50 % (2/4) of teeth with widened PDLs versus 2.3 % with normal PDLs ( P = 0.008). Other factors, including patient age, time to treatment, pulp exposure size, depth of pulp removal, and type of restoration, were not significantly associated with outcomes. Pulpotomy with iRoot BP Plus is effective in mature teeth with traumatic CCFs (93.6 % success). Apical periodontal ligament space widening represents a significant risk factor requiring intensive clinical and radiographic monitoring.