Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. During the caries removal, this  results in a carious or mechanical pulp exposure (bleeding) from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth leaving healthy pulp tissue which is dressed with a long-term clinically-successful medicament that maintains the survival of the pulp and promotes repair.There are various types of medicament placed above the vital pulp such as Buckley’s Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT). There is another term, which is also related to vital pulp therapy, which is apexogenesis. Apexogenesis is a treatment in preserving vital pulp tissue in the apical part of a root canal to allow the completion in formation of the root apex. This clinical procedure is essentially a deep pulpotomy, aimed to preserve the pulp in immature teeth that have deep pulpal inflammation. Examples include teeth with carious exposures and trauma in which treatment of the exposed pulp is delayed and it becomes necessary to extend farther into the canal to reach healthy tissue. After the pulpotomy treatment, the radicular pulp should remain asymptomatic without any adverse clinical signs or symptoms such as sensitivity, pain, or swelling. From the radiographs, there should be absence of postoperative evidence of pathologic root resorption. There should be absence of clinical signs of infection and inflammation and no harm to the succedaneous tooth. However, radiographs play a very important role, to check if pulpotomy can be done on the primary tooth. For example, the aspects we considered are the extension of caries in the primary tooth, and the development of the succedaneous permanent tooth. When the soft tissue in the pulp chamber is infected (has bacteria in it) or affected (is inflamed), it can be removed by a dentist or dental therapist under local anaesthetic. If the soft tissue in the canals is still healthy enough, a special medicated filling can be put into the chamber in an attempt to keep the remaining pulp (in the canals) alive. The process of removing the pulp from the chamber is the actual "pulpotomy", though the word is often used for the entire process including placement of the medication. There are many medicaments that can be used to fill the pulp chamber including zinc-oxide eugenol as well as mineral trioxide aggregate.

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Regards,
Catherine
Journal Co-Ordinator
Journal of Orthodontics and Endo/dontics