Effectiveness of pulpotomy compared with pulpectomy for irreversible pulpitis in primary teeth: A systematic review and meta-analysis

Abstract

Introduction and objective: Pulpotomy is increasingly explored as a minimally invasive alternative to pulpectomy for managing irreversible pulpitis in primary teeth. However, its comparative effectiveness remains unclear. This systematic review aims to compare the clinical and radiographic success of pulpotomy versus pulpectomy in primary teeth with irreversible pulpitis.

Study selection and sources: A detailed search of six electronic databases up to April 2025 identified studies comparing pulpotomy and pulpectomy in primary teeth with symptomatic or asymptomatic irreversible pulpitis, excluding cases with swelling, sinus tract, furcal or periapical radiolucency, or root resorption, and with a minimum follow-up of 12 months. Two studies met the inclusion criteria: one randomized controlled trial (RCT) and one retrospective cohort study. Meta-analyses were done through random-effects model.

Results: For radiographic success, the pooled risk ratio (RR) was 1.35 (95 % CI: 0.67-2.73; p value = 0.40), with no significant difference between the two treatments. However, it showed very high heterogeneity, I² = 96 %. For clinical success, the pooled RR was 1.06 (95 % CI: 0.95-1.18; p value = 0.28), again showing no significant difference, with heterogeneity, I² = 66 %.

Conclusions: The review revealed no statistically significant difference between the two treatment modalities for managing irreversible pulpitis in primary teeth without clinical signs of swelling or radiographic evidence of periapical infection up to 12 months of follow-up. However, certainty of evidence was very low for both the outcomes.

Clinical significance: Pulpotomy appears to be an effective, minimally invasive alternative to pulpectomy in primary teeth with irreversible pulpitis. However, further well-designed, long-term studies are recommended.

Keywords: Deciduous teeth; Dental caries; Endodontic treatment; Minimally invasive; Pulp therapy; Pulpitis.