J Gandhara Med Dent Sci

October - December 2025

shadmanch@gmail.com

How to cite this article

Manan S, Azad A, Ain Q U, Naz S,

Sajid M. Success Rate of Pulpotomy

in Cariously Exposed Mature

Permanent Teeth Using Mineral

Trioxide Aggregate. J Gandhara Med

Dent Sci. 2025;12(4): 39-43.https://doi.

Date Submission: 01-06-2025

Date Revised: 22-08-2025

Date Acceptance: 27-08-2025

Postgraduate Trainee, Operative

Dentistry & Endodontics, Ibn-e-Siena

Hospital & Research Institute Multan

Correspondence

Sheeza Manan, Postgraduate Trainee,

Ibn-e-Siena Hospital and Research

Institute, Multan, Pakistan

+92

300

5876918

SUCCESS RA TE OF PULPOTOMY IN CARIOUSLY EXPOSED MATURE PERMANENT

TEETH USING MINERAL TRIOXIDE AGGREGATE

Sheeza Manan

Ambreen Azad

, Qurat ul Ain

, Sharina Naz

, Mustafa Sajid

ABSTRACT

OBJECTIVES

This study aimed to determine the success rate of pulpotomy in cariously

exposed mature permanent teeth using mineral trioxide aggregate.

METHODOLOGY

A cross-sectional study was conducted at the Department of Operative

Dentistry, Ibn-e-Sina Hospital, Multan, over nine months from July 1, 2023,

to March 31, 2024. A consecutive 114 patients with irreversible Pulpitis were

enrolled after informed consent. Following rubber dam isolation and local

anaesthesia, coronal caries and pulp were removed; hemostasis was achieved

with 5.25% sodium hypochlorite (NaOCl). A 2-4 mm layer of mineral trioxide

aggregate (MTA) was placed over canal orices, followed by temporary

CAVIT restoration. After 24 hours, denitive amalgam restoration was

completed. Immediate and six-month postoperative radiographs were used to

assess the periapical status. SPSS v25 was used for data analysis. Medians

and interquartile ranges are reported for non-normal data, and frequencies

and percentages are reported for categorical variables.

RESULTS

The median patient age was 30.5 years (IQR, 21-36); 55.3% were 30 years or

older, and 50.9% were female. The median symptom duration was 2 days

(IQR, 1-3). Right-sided (50.9%), maxillary (52.6%), and molar teeth (53.5%)

predominated. Overall, MTA pulpotomy succeeded in 88.6% of cases.

Stratied analysis demonstrated higher success in patients <30 years (96.1%

vs. 82.5%, p=0.036), maxillary compared to mandibular teeth (95% vs.

81.5%, p=0.036), and those treated within 48 hours of symptom onset (100%

vs. 68.3%, p <0.01).

CONCLUSION

Pulpotomy with MTA in adults presenting with recent irreversible Pulpitis

yields high mid-term success, particularly in younger patients, maxillary

teeth, and early interventions.

KEYWORDS: Pulpotomy, Mineral Trioxide Aggregate (MTA), Permanent

Teeth, Dental Caries, Pulpitis

INTRODUCTION

Epidemiological studies indicate that dental caries is

highly prevalent worldwide, especially in adults. This

can lead to pulp necrosis, abscess formation, and

ultimately, tooth loss if treatment is not received.

The

radicular pulp does not get inamed, but the coronal

pulp does. Therefore, by resecting just the infected

dental pulp tissue using a vital pulp therapy process, the

cariously exposed pulps can be preserved.

vital pulp

therapy aims to eliminate the tooth's symptoms while

maintaining the tooth's functionality and vitality.

According to a 2019 policy statement from the European

Society of Endodontology, conservative vital pulp

treatment may be benecial for teeth without symptoms

that have deep lesions and carious pulp exposures.

One

of the vital pulp therapies (VPT) is pulpotomy. It entails

the coronal pulp being surgically removed.

The proper

material is applied over the remaining vital radicular

pulp. That substance promotes healing and shields the

radicular pulp from additional harm.

The substance

ought to shield against bacterial invasion and encourage

the growth of dentin tissue. Calcium hydroxide was the

gold standard material in the past. However, research has

shown that diminishing results are unpredictable and

vary over time.

Mineral trioxide aggregate (MTA) is

resistant to dissolution and possesses sucient structural

integrity. Compared to calcium hydroxide, it produces a

dentin bridge that is thicker, more uniform, and

localised.

Seventy-ve individuals with curiously

exposed adult permanent teeth, aged 15 to 26 years, were

examined in a study by Sha N et al. Ninety-two per

cent of cases achieved success at the 6-month mark, and

69 of those cases showed no periapical radiolucency on

the periapical radiograph.

The clinical suitability of

several MTA materials as partial pulpotomy materials in

ORIGINAL ARTICLE

Postgraduate Trainee, Operative

Dentistry & Endodontics, Ibn-e-Siena

Hospital & Research Institute Multan

Professor, Operative Dentistry &

Endodontics,Ibn-e-Siena Hospital

& Research Institute Multan

org//10.37762//jgmds.12-4.737

Professor, Operative Dentistry &

Endodontics,Ibn-e-Siena Hospital

& Research Institute Multan

Operative Dentistry and Endodontics,

J Gandhara Med Dent Sci

October - December 2025

permanent teeth (104 permanent teeth) was compared by

Kang C et al. Up to a year after the procedure, partial

pulpotomy maintained a higher success rate, with no

discernible variations in results between the three MTA

materials: Prorok MTA (96.0%), OrthoMTA (92.8%),

and RetroMTA (96.0%).

Region-specic studies are

scarce in low-resource settings evaluating pulpotomy as

a viable, cost-effective alternative. The current study

aimed to determine the success rate of pulpotomy using

MTA in patients with cariously exposed mature

permanent teeth (irreversible Pulpitis), presenting in our

local setting. This study aims to address the gap in local

clinical data that supports the use of MTA pulpotomy as

a conservative, tooth-preserving alternative to root canal

treatment. Ultimately, the study results would promote

the procedure of pulpotomy using MTA with condence

in the future. The preservation of teeth would improve

the quality of life in the aected patients. The study

results will oer a less invasive and more aordable

treatment option compared to root canal therapy,

especially benecial in resource-constrained

populations. This will also encourage early intervention

and awareness among adults to preserve their natural

teeth.

METHODOLOGY

This prospective observational study was conducted at

the Department of Operative Dentistry, Ibn-e-Siena

Hospital, Multan, following approval from the

institutional ethics review committee (ERC# C-60-1010-

01, dated June 13, 2023) over a period of nine months

from July 1, 2023, to March 31, 2024. A total of 114

patients, 18-65 years of age, either male or female

gender, with irreversible Pulpitis of ≤ 7-days, American

Society of Anesthesiologists (ASA) physical status I/II

and able to understand Visual Analogue Scale (VAS)

pain scoring were consecutively enrolled in the study

after written informed consent (as per Declaration of

Helsinki) for pulpotomy using mineral trioxide

aggregate. Patients with known allergy or

contraindication to the study drug were excluded.

Irreversible Pulpitis was diagnosed in the presence of

tooth sensitivity to percussion, a pain score of ≥ 4 on

VAS, and an intraoral periapical X -ray showing

discontinuity in the lamina dura and apical radiolucency.

Age, gender, side of the face, jaw location, and type of

affected tooth (premolar/molar) were recorded. The

affected tooth was isolated using a rubber dam after

administration of local anaesthesia. A slow-speed, large

round bur was used to remove the caries. Coronal pulp

up to the pulp chamber oor and orices was removed

using a high-speed round diamond bur. Haemorrhage

control was achieved using cotton pellets damped in

5.25% NaOCl. A 2-4 mm thick lm of mineral trioxide

aggregate (MTA) was laid down on root canal orices

and condensed with moistened cotton pellets. A

temporary lling was achieved using zinc oxide cement

(CAVIT, 3M, USA). After 24 hours, lling was

removed, and the tooth restoration was done with

amalgam. A reference radiograph was obtained

immediately postoperatively. Patients were then called

for follow-up six months later. The absence of periapical

radiolucency on a radiograph obtained six months

postoperatively was used to indicate the success of the

procedure. A minimum sample size of 114 was

calculated using the WHO sample size calculator, based

on the one-proportion formula, with the following

assumptions: a success rate of 92%, a 95% condence

level, and a 5% margin of error.

SPSS version 25 was

used for data analysis. Normality of numerical data was

assessed through the Shapiro-Wilk test. Age and

symptom, being non-normally distributed, are presented

as median and interquartile range. Categorical data is

presented as frequency and percentages. Confound and

effect modication are controlled through stratication

by patient characteristics, and stratied groups are

compared using a chi-square test at a 5% signicance

level.

RESULTS

The median age of the patients was 30.5 (21-36) years,

and 55.3% (n = 63) were 30 years of age or older. There

were 50.9% (n = 58) female patients in the study.

Median duration of symptoms was 2 (1-3) days. In

50.9% (n=58) of patients, the right side of the face, in

52.6% (n=60) of patients, the upper jaw, and in 53.5%

(n=61) of patients, the molars were aected by

irreversible Pulpitis [Table 1]. Pulpotomy using mineral

trioxide aggregate was successful in 88.6% of the

patients aected by irreversible Pulpitis due to caries

[Fig. 1]. Success rate of pulpotomy was signicantly

higher in < 30-year-olds (96.1% vs. 82.5%, p-value =

0.036), upper jaw aected teeth (95% vs. 81.5%, p-value

= 0.036), and in patients undergoing treatment within 48

hours of symptom onset (100% vs. 68.3%, p < 0.01)

[Table 2].

Table 1: Characteristics of Patients Presenting With Irreversible

pulpitis (N=114)

Age (years)

Median (IQR)

30.5 (21 - 36)

Age groups

< 30 years

51 (44.7)

≥ 30-years

63 (55.3)

Gender

Male

56 (49.1)

Female

58 (50.9)

Symptoms duration (days)

– Median (IQR)

2.0 (1 -

Laterality of

face

Right

58 (50.9)

Left

56 (49.1)

Jaw Position

Upper

60 (52.6)

Lower

54 (47.4)

Tooth type

Premolars

53 (46.5)

Molars

61 (53.5)

Success Rate of Pulpotomy in Curiously Exposed Mature

J Gandhara Med Dent Sci

October - December 2025

Figure 1: Success rate of pulpotomy in cariously exposed mature

permanent teeth using mineral trioxide aggregate (N=114)

Table 2: Factors aecting the Success rate of pulpotomy in patients

presenting irreversible pulpitis due to cariously exposed mature

permanent teeth (N=114)

Associated Factors

Success of Pulpotomy

P-Value

Yes No

Age Groups

< 30-years 49 (96.1) 02 (3.9)

0.036

≥ 30-years 52 (82.5) 11 (17.5)

Gender Male 49 (87.5) 07 (12.5) 0.717

Female 52 (89.7) 06 (10.3)

Facial

laterality

Right 48 (82.8) 10 (17.2) 0.075

Left 53 (94.6) 03 (5.4)

Jaw

Position

Upper 57 (95) 03 (5) 0.036

Lower 44 (81.5) 10 (18.5)

Tooth type Premolar 46 (86.8) 07 (13.2) 0.572

Molar 55 (90.2) 06 (9.8)

Symptoms

duration

≤ 48-hours 73 (100) 0 (00) < 0.001

> 48

hours

28 (68.3) 013 (31.7)

chi-

square test (Fischer’s exact test where cell count < 5)

DISCUSSION

The preservation of pulpal health must be the primary

objective when treating deep carious lesions, according

to a 2015 collaboration meeting held in Leuven,

Belgium.

In adults, the most frequent reason for pulp

invasive procedures like root canal therapy is deep

carious lesions. Traditionally, deep caries has been

addressed with either total excision of the caries or, in

cases of pulp exposure, with Root Canal Treatment

(RCT).

Compared to pulpotomy, RCT is technically

more involved and invasive, and it can have

unfavourable eects such as tooth breakage,

discolouration, and infection-causing vestigial periapical

inflammation.

According to data from epidemiological

studies, failure rates of poorly executed RCTS ranged

from 24% to 66%. RCT thereby shortens the lifespan of

teeth that have had endodontic treatment, particularly

molars.

Preserving the vital pulp and providing a

physiologically grounded concept that sustains the pulp's

development, proprioception, and defensive capabilities

is the primary goal of operatory dentistry. Additionally,

by teaching less aggressive dentistry, overtreatment can

be decreased and the "restoration cycle" shortened. This

keeps the tooth structure intact and makes treatment

more aordable.

Preserving the tooth's vitality and

integrity is the primary goal of the pulpotomy. To

preserve the vitality of the radicular pulp before it

becomes non-vital and necessitates extraction and root

canal treatment, pulpotomy is performed.

MTA was

used in the current investigation to perform a pulpotomy

on a mature permanent tooth. Mineral trioxide aggregate

(MTA) pulpotomy was successful in 88.6% of patients

with caries-induced permanent Pulpitis. This result is

consistent with an increasing amount of data that shows

pulpotomy to be a good substitute for conventional RCT

in these situations. Li et al. conducted a comprehensive

study and meta-analysis to assess the eectiveness of

pulpotomy in treating irreversible Pulpitis in adult

permanent teeth. According to the survey, pulpotomy

can be a successful treatment option in contrast to non-

surgical root canal therapy (NSRCT), with a pooled

clinical success rate of 92.9% and a radiographic success

rate of 78.5%.

In a study of 20 patients between the

ages of 25 and 50, Hussain MI et al. examined the results

of pulpotomy with MTA in 20 permanent mandibular

third molar teeth with completely formed roots and

identied irreversible Pulpitis. Overall, there was a 95%

success rate at the end of the year, and 100% clinical and

radiographic success was achieved at both three- and six-

month follow-ups.

The eectiveness of pulpotomy in

adult permanent teeth with irreversible Pulpitis was also

assessed in a systematic study performed by Zafar K et

al. The possibility of pulpotomy as an alternative to RCT

was further supported by the study, which comprised six

studies and reported success rates ranging from 68% to

100%.

The use of bioactive materials promotes

odontoblast-like cell development. This promotes

healing and lessens inammation. The pulp cap material

should provide a good marginal seal.

Asgari et al

examined the eects of pulpotomy with MTA and

calcium-enriched mixture (CEM) cement in permanent

molars with irreversible Pulpitis in a randomised clinical

experiment. The study demonstrated excellent treatment

outcomes, with clinical and radiographic success rates of

98% and 95% for MTA, respectively.

Additionally,

Taha and Khazali's study assessed partial pulpotomy in

adult permanent teeth that had clinical symptoms of

irreversible Pulpitis. After a 2-year follow-up, the study

discovered an 85% success rate for MTA, demonstrating

the material's ecacy in these treatments.

Case

selection, operator expertise, and follow-up time are

among the factors that contribute to the minor

dierences in success rates between studies. A study by

Qudeimat et al. highlighted the signicance of

appropriate patient selection and technique, reporting a

100% success rate with MTA pulpotomy in permanent

molar teeth showing signs of irreversible Pulpitis.

Ninety bilateral primary molar teeth from forty-ve

healthy children aged 5 to 8 years were pulpotomized

with Theriacal in one bilateral tooth and MTA in the

other, at random, according to a study by Hassanpour S

Success Rate of Pulpotomy in Curiously Exposed Mature

J Gandhara Med Dent Sci

October - December 2025

et al. They discovered that the overall success rates for

Theriacal and MTA, respectively, were 98.1% and

99.3% among the 82 teeth available at the last follow-up

appointment.

In summary, the results of this study

support the eectiveness of MTA pulpotomy in adult

permanent teeth with irreversible Pulpitis and are in line

with previous research. According to the excellent

success rates documented in multiple studies, pulpotomy

can be a dependable substitute for conventional RCT if it

is carried out with the right case selection and technique.

The strengths of our study included its prospective

observational design, which reduced recall bias and

enhanced the quality of data collection and internal

validity. Pulpotomy was performed according to an

established protocol that included follow-up

radiographic evaluations, haemostatic protocol, and the

use of MTA. Clear inclusion criteria and stratied

analysis helped identify factors associated with better

outcomes (age, tooth location, and early intervention).

LIMITATIONS

Assessing long-term success or failure, such as internal

resorption or late periapical disease, may require a more

extended follow-up period than six months. Because the

study was limited to a single hospital, its ndings cannot

be applied to larger or more diverse populations, and

generalizability may be limited to similar clinical

settings and populations. Contextual comprehension of

efcacy is limited when a reference group (such as root

canal therapy or another pulpotomy material) is not

available. Absence of a control group (e.g., calcium

hydroxide or full pulpectomy) limited the ability to

compare MTA's ecacy against alternative treatments.

CONCLUSIONS

Pulpotomy using MTA in mature permanent teeth with

carious pulp exposure and recent irreversible Pulpitis

demonstrated a high short-term success rate of 88.6%,

especially in younger patients, maxillary teeth, and those

managed within 48 hours of symptom onset. These

results support MTA pulpotomy as a conservative and

effective alternative to RCT in appropriately selected

adult cases.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Sheeza Manan

Concept & Design;

Data Acquisition;

Drafting Manuscript;

Final Approval

Ambreen Azad

Concept & Design; Data Acquisition;

Data Analysis/ Interpretation;

Final Approval

Qurat Ul Ain

Concept & Design; Data Acquisition;

Drafting Manuscript; Critical

Revision;

Final Approval

Sharina Naz

Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision;

Supervision;

Final

Approval

Mustafa Sajid

–

Concept & Design; Data Acquisition;

Data

Analysis/ Interpretation;

Drafting Manuscript;

Critical

Revision; Final Approval

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Success Rate of Pulpotomy in Curiously Exposed Mature