Short answer: A pulpotomy (known in Turkish as "amputasyon") is a treatment in which, in a tooth affected by deep decay or trauma, the nerve tissue (pulp) in the crown is removed and the healthy nerve in the root canals is preserved. The difference from a root canal is that the root nerve is left alive. It is most often performed on baby molars and on young permanent teeth whose roots are not yet fully formed; after the procedure, the tooth is usually protected with a crown or a filling.
When deep decay is found in your child's baby molar, the dentist may recommend a pulpotomy instead of a "root canal." This method aims to preserve the living tissue in the root by removing only the affected part of the tooth's nerve, not all of it. That way, the baby tooth can keep doing its job in the mouth until the permanent tooth that will replace it comes in. In this article we explain what a pulpotomy is, how it differs from a root canal, which teeth it is used on, the treatment process and what to watch for afterward.
What is pulpotomy treatment?
Pulpotomy is the removal of the nerve and blood vessel tissue called the pulp from the crown portion of the tooth, while the pulp in the root canals is left alive. In Turkish dentistry the same procedure is also called "amputasyon." When deep decay or a tooth fracture causes inflammation in the upper part of the pulp, this method may be suitable if the inflammation has not yet spread to the root.
The main goal of treatment is to preserve the vitality and natural function of the tooth as much as possible. In baby teeth, this keeps the tooth in the mouth until it is due to fall out and preserves the space needed for the permanent tooth to erupt. In young permanent teeth whose roots have not yet finished developing, it allows root development to continue. This approach belongs to the group of conservative treatments known in dentistry as "vital pulp therapies."
The pulp contains the blood vessels that nourish the tooth and the nerves that give it sensation. As decay passes through the enamel and dentin layers and approaches the pulp, bacteria and their by-products cause inflammation in this tissue. At first, the inflammation is usually limited to the crown; if not treated in time, it can progress toward the root canals, and eventually the pulp can lose its vitality entirely. A pulpotomy is an intervention aimed at stopping this progression at an early stage; that is why not delaying treatment of deep decay directly affects which options remain available.
How is a pulpotomy different from a root canal?
The main difference between a pulpotomy and a root canal is whether the nerve tissue in the root canals is preserved. In a pulpotomy, only the pulp in the crown is removed and the living tissue in the root is left in place. In a root canal (also called a pulpectomy in baby teeth), all of the pulp in the root canals is removed, and the canals are cleaned, shaped and filled with a suitable filling material.
This difference has several important consequences:
- Tooth vitality: After a pulpotomy, the root portion of the tooth stays alive; after a root canal, the tooth loses its vitality.
- Treatment time: A pulpotomy usually takes less time and is mostly completed in a single session; this is an advantage for cooperation, especially in children.
- Root development: In young permanent teeth, a pulpotomy allows the root tip to keep closing and the root walls to keep thickening.
- Suitability: If inflammation has spread to the root pulp or the tooth aches on its own, a pulpotomy may not be enough; in that case, a root canal or extraction is considered.
Which teeth is a pulpotomy used on?
A pulpotomy is most often performed on baby molars and on young permanent teeth with incompletely formed roots; in suitable cases, it may also be chosen for adults' permanent teeth.
In baby teeth
Baby molars in which deep decay has reached the pulp but the inflammation is limited to the crown are the most common use for pulpotomy. If the baby tooth still has a long time before it falls out, saving it prevents loss of space and supports the child's ability to chew.
In young permanent teeth
The roots of permanent teeth that erupt in childhood and early adolescence finish developing within a few years after eruption. If the pulp is exposed during this period because of deep decay or a trauma-related fracture of a front tooth, a partial or full pulpotomy can allow root development to continue.
In adult permanent teeth
With the development of new biocompatible materials, a pulpotomy can also be performed in selected situations in some adult cases. However, this decision is made after a detailed assessment of the tooth's condition and the clinical findings.
When a pulpotomy is not suitable
- Severe pain that wakes the child at night or starts on its own
- Swelling or an abscess around the tooth, or a draining fistula in the gum
- Inflammation at the root tip or abnormal root resorption on the X-ray
- Bleeding that cannot be stopped after the crown pulp is removed
- A tooth too broken down to be restored, or a baby tooth that is about to fall out
How is pulpotomy treatment performed?
A pulpotomy is performed under local anesthesia and usually in a single session. The steps are roughly as follows:
- Examination and X-ray: The depth of the decay, the condition of the root and the surrounding tissues are assessed, and the nature of the complaints is discussed.
- Local anesthesia: The tooth and the area around it are numbed. In children, a topical numbing gel may be used before the injection.
- Isolation: The tooth is isolated with a rubber dam, if possible, to protect it from saliva.
- Removing the decay: The decayed tissue is removed and the pulp chamber is reached.
- Removing the crown pulp: The pulp in the crown is carefully removed down to the openings of the root canals.
- Bleeding control: Bleeding at the root openings stopping within a reasonable time indicates that the root pulp is healthy.
- Capping material: A biocompatible material such as MTA or a calcium silicate-based material, or another agent the dentist considers suitable, is placed over the remaining pulp.
- Restoration: The tooth is sealed with a filling that prevents leakage. For baby molars, a prefabricated stainless steel or zirconia crown is usually recommended; this helps prevent the tooth from fracturing and bacteria from leaking in.
In children, keeping the child comfortable and reducing fear during treatment are important. The dentist explains what will be done in language suited to the child's age and, when needed, divides the treatment into short steps.
How is follow-up done after a pulpotomy?
There may be mild sensitivity in the tooth for the first few days after a pulpotomy; this usually eases on its own. Until the anesthesia wears off, make sure the child does not bite their lip, cheek or tongue. Eating is not recommended until the numbness has gone. A pain reliever recommended by the dentist can be used; always consult the dentist or a pharmacist about the choice of medication and the dose.
The success of treatment is monitored with regular checkups. Clinical and radiographic checks are usually done after 6 and 12 months and then once a year. At these checkups, the tooth is checked for pain, swelling or a fistula, and the X-ray is examined for signs of inflammation around the root. In young permanent teeth, whether root development is continuing is also monitored. If a problem develops, additional treatments such as a root canal can be planned.
Keeping the treated tooth healthy for a long time also depends on oral hygiene. Brushing the child's teeth twice a day with fluoride toothpaste, limiting sugary snacks and regular dental checkups help prevent new cavities. For other topics you may be curious about, see our frequently asked questions page.
When should you seek care in Ankara if your child has deep decay?
If your child says a tooth hurts with cold or sweet foods, you notice a dark hole in their teeth or they avoid chewing on one side, have them examined without waiting for the decay to reach the nerve. Cavities treated early can often be fixed with a simple filling; when treatment is delayed, more extensive procedures such as a pulpotomy or root canal come into play. At our clinic in Oran, Çankaya, your child's teeth are assessed and the most suitable treatment option for saving the tooth is decided together with the family.
Frequently asked questions
How long does a baby tooth last after a pulpotomy?
With a successful pulpotomy and a suitable crown, a baby tooth can in most cases stay in the mouth until it naturally falls out. The success of treatment is monitored with regular checkups. If you notice pain, swelling or discharge, see your dentist.
Why treat a baby tooth if it is going to fall out anyway?
Baby teeth are important for chewing, speaking and holding space for the permanent teeth. When they are lost early, neighboring teeth can drift and make it harder for the permanent tooth to come in. In addition, an untreated infection can affect the permanent tooth underneath.
Is pulpotomy treatment painful?
Because the procedure is done under local anesthesia, pain is usually not felt during treatment; there may only be a feeling of pressure. After the anesthesia wears off, mild sensitivity may be felt for a few days. If pain lasts a long time or increases, see your dentist.
Why is a crown placed after a pulpotomy?
Baby molars treated with a pulpotomy have lost a significant amount of tissue to decay and are therefore prone to fracture. A crown wraps around the whole tooth and helps prevent fracture and bacterial leakage. This contributes to the treatment remaining successful for a long time.
