Direct Pulp Capping Matches Pulpotomy In Primary Molars, New Trial Finds

A new trial on direct pulp capping vs. pulpotomy reports identical results. Both reached 85.1 percent success at 12 months in carious-exposed primary molars treated with NeoPUTTY. The finding strengthens the case for less invasive pulp therapy in children. It does not change current guidelines yet.

TL;DR

• The split-mouth trial treated 100 primary molars in children aged 4 to 9.

• Direct pulp capping and pulpotomy both reached 85.1 percent success at 12 months.

• AAPD guidance still favors pulpotomy, and 12 months covers a fraction of a primary molar's lifespan.

What Did The New Direct Pulp Capping Vs. Pulpotomy Trial Find?

An October 2026 randomized trial found identical 85.1 percent success for both treatments at 12 months. Taha and colleagues reported the results in the International Journal of Paediatric Dentistry. Each child received both treatments on opposite sides of the mouth.

Success and survival measure different things. Success means no clinical or radiographic signs of pulp failure. Survival means the tooth stayed in the mouth, even if it needed further treatment.

The numbers are tighter than they look. With 94 percent recall, each arm had about 47 teeth at 12 months. That makes 85.1 percent equal to 40 successes in each group. At 6 months, the groups differed by a single tooth.

How Do Direct Pulp Capping And Pulpotomy Differ?

Direct pulp capping places a bioactive material straight onto the exposure and leaves the pulp intact. Pulpotomy removes the coronal pulp, controls bleeding at the canal orifices, and caps the stumps. Both aim to keep the remaining pulp alive until the tooth exfoliates. The trade-off is information. Pulpotomy lets the clinician inspect the radicular pulp. Capping relies on judgment at a pinpoint exposure.

Why Did Both Treatments Achieve Similar Success Rates?

The trial was not designed to explain why, but three factors stand out. The first is material. Calcium silicates release calcium and hydroxide ions and seal well, which encourages a dentin bridge. The Biodentine guide covers how this class works.

The second is case selection. The trial's registry entry excluded teeth that did not stop bleeding within 6 minutes. That filter removes most inflamed pulps before treatment begins.

The third, and probably the largest, is the stainless steel crown. A full-coverage seal stops the bacterial leakage that ends most capped pulps. The Hall technique trial shows how much crowns alone can achieve in primary molars.

How Do The Findings Compare With Current Pediatric Dentistry Guidelines?

The AAPD's 2024 guideline favors indirect pulp treatment or calcium silicate pulpotomy over direct capping. That conclusion rests on 24-month pooled data with moderate certainty. MTA and Biodentine pulpotomies reached 94 and 90 percent success. Direct capping reached 86 percent.

The new trial does not overturn that. One 12-month trial cannot outweigh a 24-month meta-analysis. However, the AAPD listed capping versus pulpotomy with newer calcium silicates as a research need. This trial answers part of that question.

A May 2026 trial from Thailand points the same way. Partial pulpotomy was not superior to direct capping, with 93.8 percent survival for capping. Its authors linked several capping failures to proximal caries and material placed on axial walls.

What Do The Results Mean For Pediatric Dentists?

Direct capping deserves a place for small, clean exposures on occlusal surfaces that stop bleeding quickly. Rubber dental dam isolation is not optional for it. A stainless steel crown at the same visit is the safer default.

One argument for capping rarely gets attention. A failed cap still leaves pulpotomy or pulpectomy as options. A failed pulpotomy leaves fewer. Capping first spends less of the tooth's reserve.

The counterargument matters too. A 4-year-old's first primary molar may need to function for another six years. Twelve months of data covers only a fraction of that. Routine practice should not shift on one short trial.

Clinicians adopting capping should log exposure size, location, and bleeding time in the dental treatment plan. Those three details make audits and recall decisions meaningful.

What Are The Study's Limitations?

The sample was modest, and follow-up stopped at 12 months. Only one material was tested, so results may not transfer to MTA powders or resin-modified products. Every tooth received a stainless steel crown, which limits relevance for composite restorations. The findings also say nothing about mature permanent teeth, covered in the pulpotomy vs. root canal research.

Bottom Line

Direct pulp capping matched pulpotomy at 85.1 percent success after 12 months in primary molars. The result supports capping for carefully selected exposures with fast bleeding control and full-coverage crowns. AAPD guidance still favors pulpotomy, and longer data are needed before that changes. For now, capping is a reasonable option in selected cases. It should not become the new default.