Outcome Following Complete and Partial Pulpotomy in Managing Cariously Exposed Mature Permanent Molars With Symptomatic Irreversible Pulpitis: A 5-Year Follow-Up of a Randomised Clinical Trial
02 September 2025 https://doi.org/10.1111/iej.70028
A review by Dr Richard S Kahan
This paper sets out to answer a big, important question about whether complete pulpotomy and partial pulpotomy can genuinely act as long-term treatments for symptomatic irreversible pulpitis. The introduction states The European Society of Endodontology and the American Association of Endodontists emphasised the need for long-term evidence before establishing pulpotomy as a definitive treatment, and here was the answer…… except by the time we reach the 5-year mark, a third of the patients have disappeared, the sample size is too small to prove very much, and we’re essentially told, “Well… nothing looks too different, so let’s just say they’re the same.” The teeth treated with complete pulpotomy belonged to slightly older patients and had more fractured restorations, which already muddies the water, yet the authors still manage to turn this fairly murky dataset into a gentle suggestion that partial pulpotomy “may be preferred.” It’s a bit like running a 5k with your shoelaces tied together, not falling over, and concluding that this is the optimal way to run.
The secondary outcomes—hard tissue barrier formation, pulp canal obliteration and pulp sensibility tests—don’t lend much more clarity. Everything is assessed on two-dimensional radiographs with only partial blinding, so we’re already relying on wishful thinking before any statistics appear. More pulp canal obliteration shows up in the complete pulpotomy group, more cold test responses in the partial pulpotomy group, and from this we are nudged toward preferring the latter, despite no real evidence that any of these factors make life better for patients or dentists. The only finding that truly lands—that secondary caries destroys long-term success—is presented with considerable statistical ceremony, even though it’s the dental equivalent of discovering that rain makes you wet.
In the end, the study does show that both procedures can hold up reasonably well over 5 years, which is reassuring. But if this is supposed to be the grand, definitive long-term proof to settle the pulpotomy debate, it feels more like being promised a gourmet meal and receiving a perfectly pleasant, but very modest, snack.
