Pulpotomy vs. pulpectomy for equivocal pulp status in primary molars: a retrospective cohort study with propensity...

Background Diagnosing pulp status in primary molars is often challenging when clinical and radiographic findings fall into an equivocal range between reversible and irreversible pulpitis. This uncertainty complicates treatment decisions between pulpotomy and pulpectomy. This study aimed to compare long-term survival outcomes of pulpotomy and pulpectomy in primary molars with diagnostically equivocal pulp status and to identify potential predictors of treatment success.MethodsA retrospective cohort study was conducted on 312 primary molars from children aged 3-8 years treated at Hefei Stomatological Hospital. All teeth exhibited borderline pulp status, such as prolonged bleeding (5-10 min) or inconclusive radiographic signs. Teeth were treated with pulpotomy using iRoot(Innovative BioCeramix Inc.,Vancouver, Canada) BP Plus or pulpectomy with ZOE-iodoform paste, followed by stainless steel crown restoration. Propensity score matching (1:1) was applied to balance baseline variables. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate survival outcomes and predictors of failure.ResultsAfter matching, 156 pairs were analyzed. The 24-month survival rate was significantly higher in the pulpotomy group (86.4%, 95% CI: 81.2-91.6%) compared to the pulpectomy group (67.1%, 95% CI: 60.3-73.9%) (P < 0.001). In asymptomatic teeth, pulpotomy was associated with a significantly lower risk of failure (HR = 0.42, P = 0.002), while no significant difference was found in symptomatic cases (HR = 0.88, P = 0.41). Internal resorption was more common in the pulpotomy group, whereas external resorption and periapical pathology were more frequent after pulpectomy.ConclusionsIn primary molars with equivocal pulp status, pulpotomy demonstrates superior long-term survival, particularly in asymptomatic cases. These findings support a more conservative approach and suggest revisiting current guidelines for managing diagnostically borderline pulp conditions.