Abstract

Traditional management of irreversible pulpitis in mature permanent teeth has centered on root canal therapy. Full pulpotomy using bioactive cement has been proposed as a pulp-preserving alternative for pain control and tooth retention. In this systematic review and meta-analysis, parallel-group randomized controlled trials assessing full, total, or coronal pulpotomy compared to non-surgical root canal treatment (ROCT) in mature permanent molar teeth with irreversible pulpitis were included. Searches were performed in six databases and trial registries without restrictions. Pain outcomes within 7 days and clinical/radiographic success at ≥6 months were synthesized using random-effects models, RoB 2.0, and GRADE. Nine trials were considered for inclusion, out of which four trials contributed to combined clinical and radiographic success at 12-24 months; the pooled risk ratio for success was 0.99 (95% CI 0.96-1.03; I² = 0%), indicating no clinically important difference between treatments. Qualitative synthesis indicated that pulpotomy generally achieved rapid pain reduction, often comparable to or faster than root canal therapy, with frequent reports of reduced analgesic use and shorter procedure times. Based on the randomized evidence available, in mature permanent teeth presenting with irreversible pulpitis, full pulpotomy demonstrated clinical and radiographic success rates comparable to those of ROCT for up to medium-term observation. At least early pain relief was also comparable, making full pulpotomy a potential definitive treatment option in cases appropriately selected.

Key words: Irreversible pulpitis, vital pulp therapy, pulpotomy, root canal treatment, dental pain, randomized controlled trial, systematic review, meta-analysis