Endodontists’ perspectives on pulpotomy as an alternative to root canal treatment in mature permanent teeth: A cross-sectional survey in Saudi Arabia

Introduction: New biocompatible materials have made pulpotomy a potential alternative to root canal treatment in mature teeth, as shown by recent studies, even for mature permanent teeth with irreversible pulpitis. The aim of this study was to investigate the knowledge, practice patterns, and decision-making factors among endodontists in Saudi Arabia concerning the use of pulpotomy in mature permanent teeth as an alternative to root canal treatment. Materials and Methods: A cross-sectional, questionnaire-based survey was distributed electronically to licensed Saudi endodontists. The survey included sections on demographics, clinical decision-making regarding partial and complete pulpotomy, and factors influencing material selection and follow-up protocols. Descriptive statistics, Chi-square tests, and regression analysis were used to evaluate associations between demographic variables and responses. Results: Of 244 respondents, 238 were included in the final analysis. Most participants were male (67.2%) and under 40 years of age. While the majority reported sometimes (45.4%) or rarely (22.7%) considering pulpotomy, only 15.1% indicated always using the procedure. Complete pulpotomy was generally preferred over partial pulpotomy. The most common indications included traumatic pulp exposure, immature permanent teeth, and symptomatic irreversible pulpitis. Younger and less experienced practitioners were significantly more likely to adopt pulpotomy ( P < 0.05). Mineral trioxide aggregate and other calcium silicate-based materials were the most frequently used. Long-term success rate and biocompatibility were the primary factors influencing material choice. Short-term follow-up intervals were favored by early-career clinicians. Postoperative failure rates were perceived to be higher among less experienced respondents. Conclusion: Younger clinicians demonstrated greater openness to adopting vital pulp therapy than older clinicians, reflecting evolving trends in evidence-based endodontics. Targeted training and updated guidelines may help bridge the gap between awareness and consistent clinical implementation.