Success of Three Materials and Influence of Behavior Guidance in Primary Molar Pulpotomies : A Retrospective Study

Purpose: To assess the effectiveness of Biodentine^™ (BD), mineral trioxide aggregate (MTA) and ferric sulfate (FS) as pulpotomy agents in primary molars and evaluate the impact of behavior guidance strategies on pulpotomy success.Methods: In this retrospective cross-sectional study, data from 374 cases (50.5 percent male, aged two to 10 years) undergoing 469 pulpotomies at a university pediatric clinic between April 1, 2016 and January 1, 2020 were analyzed. Clinical and radiographic outcomes were evaluated by two calibrated examiners using validated criteria. Statistical analysis included descriptive statistics, logistic regression (P <0.05), Kaplan-Meier survival curves and Cox proportional hazard models, with inter- and intra-examiner reliability confirmed by Cohen's Kappa. Results: Among the materials, BD and MTA showed the highest clinical (98.5 percent and 97.9 percent, respectively) and radiographic (95.2 percent and 93.6 percent, respectively) success, significantly outperforming FS (88.9 percent and 80.9 percent, respectively). Pulpotomy failures were notably higher with the use of protective stabilization (P =0.002), while treatment under general anesthesia and good patient cooperation were associated with better outcomes. Conclusions: BD and MTA demonstrated superior effectiveness over FS for primary molar pulpotomies. The success of pulpotomy is significantly influenced by behavior guidance techniques, with less restrictive methods correlating with improved outcomes.