Treatment effectiveness of pulpotomy compared to pulpectomy for management of carious pulp-exposed primary teeth: A systematic review and meta-analysis

Introduction: Pulpotomy and pulpectomy are standard treatments for carious pulp-exposed primary teeth. Determining the correct procedure is challenging, especially in children where clinical and radiographic findings are less reliable. This systematic review evaluates the comparative success of pulpotomy versus pulpectomy. Methods: A comprehensive search of PubMed, Scopus, Embase, and Web of Science databases was conducted up to February 2025. Randomized controlled trials and cohort studies comparing pulpotomy and pulpectomy in primary teeth were included. Data extraction followed the PRISMA guidelines, and meta-analysis was planned for homogeneous data. Results: From 3347 screened studies, 13 full-texts were included for detailed evaluation. Pulpotomy procedures demonstrated high success even in symptomatic teeth. Subgroup and sensitivity analyses were conducted to assess heterogeneity. Conclusions: Evidence indicates a paradigm shift in pulp therapy, with bio-ceramic materials and modern pulp biology supporting pulpotomy as a conservative, efficient, and predictable alternative to pulpectomy.