Dr Phil Tomson, Past President of the British Endodontic Society (BES), discusses the value of managing irreversible pulpitis with pulpotomy, the factors to consider during case selection, and what its implementation in general dental practice could mean for practitioners and patients alike.
A pulpotomy is a clinical procedure whereby part of the inflamed pulp is removed. Subsequent to its removal, a layer of biocompatible material is applied – a calcium silicate cement, such as Biodentine XP from Septodont – allowing the remaining pulp to heal. Pulpotomy is a far simpler procedure than traditional root canal treatment[i] and could be appropriate for most patients with irreversible pulpitis. Clinicians of any experience level can provide it, including new graduates, with advantages for both dentists and patients.
Factors affecting decision making
Pulpotomy should be considered whenever vital pulp is under threat – when it becomes exposed if the dental decay has entered the pulp or if the pulp is inadvertently compromised during caries treatment even in cases of what is known as irreversible pulpitis.
The rise of vital pulp therapy, and pulpotomy specifically, has been a major advance in managing endodontic disease in the last 5-7 years. Evidence suggests that it can be performed on patients with irreversible pulpitis – those with prolonged, gnawing pulpitic pain. Traditionally in such cases the only option for treatment has been the choice between root canal treatment or extraction – pulpotomy provides clinicians with another option.
Benefits all round
When compared to conventional root canal treatment, pulpotomy is far quicker, simpler, and can be provided by any dentist. So, when patients come in with the classic symptoms of irreversible pulpitis, this can and should be the first port of call. As such, pulpotomy is potentially a definitive treatment that can be provided within an emergency appointment slot in comparison to more complex root canal treatment which in most cases, is unlikely to be achievable in such situations.
Compared to traditional root canal treatment, pulpotomy is also more cost-effective, requiring less chair time to complete the procedure.[ii] Additionally, it preserves the blood supply and pulp – the tooth’s natural defence system – allowing it to respond and protect the tooth going forward. This is a fantastic outcome for patients, especially considering that root filled teeth are more vulnerable to high biting forces, and that rates of bruxism rose during the COVID-19 pandemic and have persisted since then.[iii] This pairing creates a risk of treatment failure that, where at all possible, should be avoided.
Pulpotomy is particularly beneficial for younger patients, especially those between 6 and 11 years of age. This is because their roots are still developing at this age, so a pulpotomy would preserve sufficient pulp to enable this crucial process to complete.
Raising the profile of pulpotomy
The goal of the British Endodontic Society (BES) is to promote and advance endodontics. Pulpotomy for definitive treatment marks the most impactful change in our ability to carry out endodontic treatment since the introduction of NiTi files in the early 1990s. Currently, there are over 49,000 registered dentists, according to the General Dental Council, and only 349 of these are endodontic specialists.[iv] General dental practitioners are the professionals who see most of the disease, so it is important that they know about this transformative procedure and feel confident to provide it to their patients.
Increased provision of pulpotomy procedures will, ultimately, increase tooth retention amongst the population and an estimated 60,000-80,000 fewer conventional root canal treatments will be provided as a consequence within the NHS. Additionally, the pulpotomy procedure provides another treatment modality within the restorative cycle, meaning that should it fail, the option of conventional root canal treatment is still available, as is extraction. Overall, this will help patients to retain as much of their natural dentition as possible for as long as possible.
Expanding the awareness and use of the pulpotomy will bring the conservation of natural tooth tissue, maintain pulp viability, and add an extra treatment modality in the restorative cycle. It is a definitive treatment possibility in an unscheduled appointment, which incurs a lower cost, which is easier for the clinician to perform and is thought to be the patient preference when compared to extraction and root canal treatment. However, this expansion will ultimately only be possible with a change in culture, knowledge, and the education surrounding it.
For more information about the BES, or to join, please visit the website www.britishendodonticsociety.org.uk or call 07762945847
Dr Phil Tomson, Past President of the British Endodontic Society (BES)
[i] European Society of Endodontology (ESE) developed by:; Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019 Jul;52(7):923-934. doi: 10.1111/iej.13080. PMID: 30664240.
[ii] Schwendicke F, Herbst SR. Health economic evaluation of endodontic therapies. Int Endod J. 2023 Mar;56 Suppl 2:207-218. doi: 10.1111/iej.13757. Epub 2022 May 16. PMID: 35488881.
[iii] Shalev-Antsel T, Winocur-Arias O, Friedman-Rubin P, Naim G, Keren L, Eli I, Emodi-Perlman A. The continuous adverse impact of COVID-19 on temporomandibular disorders and bruxism: comparison of pre- during- and post-pandemic time periods. BMC Oral Health. 2023 Oct 4;23(1):716. doi: 10.1186/s12903-023-03447-4. PMID: 37794398; PMCID: PMC10552226.
[iv] General Dental Council. Registration report – September 2026. Accessed September 26: https://www.gdc-uk.org/docs/default-source/registration/registration-reports/registration-report—september-2026-acc.pdf?sfvrsn=ad44d5c1_1
