The Effectiveness of Full Pulpotomy Versus Root Canal Therapy for Mature Teeth With Irreversible Pulpitis: A...

Full pulpotomy preserves the radicular pulp and may reduce the procedural burden of root canal therapy (RCT), but comparative randomized evidence in mature teeth with irreversible pulpitis remains limited. We performed a systematic review and meta-analysis of randomized controlled trials comparing the two procedures. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception through February 2026. Five trials comprising 832 participants were eligible. The primary outcome was pain at seven days after treatment; secondary outcomes were pain at one day, time to pain relief, moderate-to-severe pain at seven days, clinical or radiographic success, and postoperative analgesic use. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool for randomized trials (RoB 2). Pain at seven days did not differ significantly between full pulpotomy and RCT (mean difference (MD) = -0.31, 95% confidence interval (CI): -0.71 to 0.10; p = 0.14), and the likelihood of successful healing was similar ( risk ratio (RR) = 1.00, 95% CI: 0.81 to 1.24; p = 0.99). Pain at one day was lower after pulpotomy (MD = -1.60, 95% CI: -2.99 to -0.21; p = 0.02), although this association lost statistical significance when several individual studies were omitted. The pooled estimate for the variably defined reported time-to-relief outcome favored pulpotomy: RCT required 18.86 hours longer than pulpotomy (MD for RCT minus pulpotomy, 95% CI: 12.58 to 25.14; p < 0.001). Moderate-to-severe pain at seven days and analgesic use were not significantly different. On the basis of the available randomized evidence, full pulpotomy can achieve short-term pain and healing outcomes comparable with RCT in carefully selected mature permanent teeth. RCT remains the established reference treatment, whereas full pulpotomy may be considered a tissue-preserving alternative in appropriate cases. Further large-scale randomized trials using standardized outcome definitions and longer follow-up periods are warranted.