Direct Pulp Capping Versus Pulpotomy Using a Calcium Silicate‐Based Putty for Carious Pulp Exposures in Primary Molars: A Split Mouth Randomized Clinical Trial

BACKGROUND: Direct pulp capping with calcium silicate-based materials has gained attention as a minimally invasive treatment for carious pulp exposures in primary molars. AIM: To compare the outcome of direct pulp capping and pulpotomy in primary molars with carious pulp exposure. DESIGN: A split-mouth randomized clinical trial, 100 carious primary molars in children aged 4-9 years were included. After pulp exposure, teeth were randomly assigned to direct pulp capping or pulpotomy; a calcium silicate-based putty (NeoPUTTY) was applied, and teeth were restored with glass ionomer cement and stainless-steel crowns. Preoperative pain and baseline variables were recorded. Clinical and radiographic evaluations were conducted at 3, 6, and 12 months. RESULTS: At 3 months, 96 teeth evaluated, with one failure in the pulpotomy group. At 6 months (96% recall), nine teeth failed (5 pulpotomy, 4 direct pulp capping), with success rates of 89.6% and 91.7%, respectively (p = 0.73). At 12 months (94% recall), seven failures occurred in each group, yielding identical success rates of 85.1% and survival rates of 93.6%. Preoperative factors were not associated with treatment outcomes. CONCLUSION: Direct pulp capping demonstrated comparable short-term outcomes to pulpotomy in cariously exposed primary molars.