Pulpotomy for treating primary teeth with irreversible pulpitis: a call for action

PURPOSE: This narrative review aims to assimilate the current state of evidence for considering pulpotomy as a treatment option to manage vital primary teeth clinically diagnosed with irreversible pulpitis. METHODS: A structured literature search was undertaken on four electronic databases (MEDLINE, Embase, Web of Science, and Cochrane Library) to compile evidence for this narrative review. Eligible studies included clinical investigations and systematic reviews assessing outcomes of pulpotomy for treating primary teeth with clinical signs and symptoms of irreversible pulpitis. RESULTS: Seven clinical studies and two meta-analyses met the inclusion criteria for data synthesis. Across the clinical studies,clinical success of pulpotomy for management of irreversible pulpitis-affected primary teeth ranged from 95-100%, while radiographic success ranged from 90-100% at the 6-month to 1-year post-treatment follow-up. The meta-analyses of these clinical studies concluded that pulpotomy may represent a viable alternative to conventional pulpectomy for the management of irreversible pulpitis in primary teeth. Based on current evidence, new diagnostic considerations and treatment procedural guidelines have been proposed for primary tooth pulpitis. CONCLUSIONS: Accumulating histological and clinical evidence supports pulpotomy as a successful, minimally invasive treatment option for management of primary teeth with clinical symptoms of irreversible pulpitis. The paper calls for revision of international guidelines to incorporate these developments and reduce unnecessary invasive interventions.