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Pediatric Dentistry

Pulpotomy vs Pulpectomy in Primary Teeth (Simple OSCE Guide)

A simple OSCE guide to choosing between pulpotomy and pulpectomy in primary teeth.

Quick Answers

What is pulpotomy?

Removal of the coronal pulp only, keeping the radicular pulp vital and protected with a medicament.

What is pulpectomy?

Complete removal of coronal and radicular pulp, cleaning canals and filling them with a resorbable material.

When do you choose pulpotomy?

Vital pulp with normal/reversible pulpitis and no signs of radicular infection.

When do you choose pulpectomy?

Non-vital pulp or irreversible pulpitis with infection signs but the tooth is still restorable.

1. Why this topic is always tested

In OSCE and viva stations, examiners want to see that you can:

  • diagnose pulp status correctly,
  • choose the right procedure,
  • justify the choice using guidelines.

Most failures happen because students treat based on radiographs alone.

2. The simplest way to decide

Think like this:

Decision Rule

Vital radicular pulp → Pulpotomy
Non-vital / infected radicular pulp → Pulpectomy

3. Indications for pulpotomy (primary teeth)

AAPD guidelines support pulpotomy when the pulp is still vital.

  • Carious or traumatic exposure in a restorable tooth
  • Normal pulp or reversible pulpitis
  • No swelling, sinus tract, or pathological mobility
  • No radiographic furcation/periapical lesion
  • Hemostasis is achievable after coronal pulp removal

4. Indications for pulpectomy (primary teeth)

Pulpectomy is for infected or necrotic radicular pulp in a tooth worth saving.

  • Irreversible pulpitis or pulp necrosis
  • Spontaneous pain or night pain history
  • Sinus tract / swelling or tenderness to percussion
  • Radiolucency at furcation or apex
  • Tooth is restorable and root resorption is not excessive

5. Key clinical clues examiners expect you to mention

  • Pulpotomy clue: bright red bleeding that stops within a few minutes
  • Pulpectomy clue: little/no bleeding or dark, purulent bleeding

Bleeding quality tells you the radicular pulp status more than any radiograph.

6. Materials commonly used

Pulpotomy Medicaments

  • MTA / Biodentine (high success, biocompatible)
  • Ferric sulfate
  • Formocresol (still taught but less favored now)

Pulpectomy Fillings

  • Resorbable paste (iodoform-based)
  • ZOE-based materials

Recent evidence supports pulpotomy using modern calcium-silicate materials as a strong option in many vital cases.

7. OSCE-style model answer

Example Viva / OSCE Answer

“This primary molar is restorable and shows vital pulp signs with no radiographic furcation lesion. I would perform a pulpotomy. My justification is: symptoms suggest reversible pulpitis, bleeding should be controllable, and AAPD guidelines recommend pulpotomy for vital primary teeth with carious exposure.”

8. Common student mistakes

  • Doing pulpotomy despite furcation radiolucency
  • Ignoring clinical signs because the radiograph looks “light”
  • Skipping hemostasis check
  • Choosing pulpectomy for a non-restorable tooth

9. How DentAIstudy helps

DentAIstudy converts pediatric cases into:

  • OSCE flow answers
  • Viva-ready justification scripts
  • Flashcards on indications & materials
  • High-yield pediatric notes

Try Study Builder →

References

  • American Academy of Pediatric Dentistry (AAPD). Vital Pulp Therapies in Primary Teeth, 2024.
  • AAPD. Use of Non-Vital Pulp Therapies in Primary Teeth.
  • Maldupa I, et al. Guideline comparison for pulpectomy indications. BDJ Open, 2024.
  • Philip N, et al. Pulpotomy vs pulpectomy outcomes in vital primary molars. BMC Oral Health, 2024.
  • Coll JA, et al. Evidence-based decision tree for VPT in primary teeth. 2024.