How to Perform a Full Pulpotomy: Why Hemostasis Decides Whether the Pulp Lives

For decades, a diagnosis of irreversible pulpitis meant one thing: root canal. That rule is bending. In selected mature permanent teeth, a full pulpotomy can now keep the roots alive — but only if you can read the one signal that matters: the bleeding you see chairside outranks the chart.

The Core Idea: Coronal Out, Radicular In

A full pulpotomy removes the entire coronal pulp — the whole chamber, down to the canal orifices — then covers the root stumps with a bioactive dressing and an immediate, well-sealed restoration. The point is not to empty the tooth; it is to remove the inflamed chamber tissue while keeping the radicular pulp inside the roots alive and functioning. That single anatomical line, coronal out and radicular in, defines everything about the procedure.

On the vital pulp therapy ladder — indirect capping, direct capping, partial (Cvek) pulpotomy — full pulpotomy sits at the top: it removes the most pulp while keeping the tooth vital. One step further is a root canal; this is the boundary between saving the pulp and removing it.

Two things bent the old rule: bioactive calcium-silicate cements (MTA-class and Biodentine-type) that seal and support healing, and evidence that a well-sealed pulpotomy can heal when bleeding is controlled. So the real decision happens intra-operatively, not on paper. If the stumps stop bleeding, the radicular pulp is healthy enough to keep; if bleeding cannot be controlled, the inflammation runs deeper than you can see, and proceeding blindly courts failure. The AAE treats hemostasis as the critical intra-operative determinant — the bleeding is your biopsy.

The concept has hard edges too. Clear apical pathology — a sinus tract, swelling, or an apical radiolucency — means the disease is already past the pulp and beyond vital pulp therapy. And because microleakage is a major cause of failure, the procedure is only as good as the definitive seal placed over it in the same visit.

Key takeaways

• Coronal out, radicular in. One anatomical line defines the whole procedure and how success is judged.
• The bleeding is your biopsy. The intra-operative wound, not the pre-op diagnosis, decides whether the pulp stays.
• The seal makes or breaks it. A perfect pulpotomy under a leaky restoration still fails.

Learn the full protocol

The complete walkthrough lives inside Dentalverse: the narrated video lesson, the step-by-step protocol with armamentarium and pitfalls, and the night-before prep sheet. Start with [the reference page](/explore/procedures/full-pulpotomy), then [start free](/signup) to unlock it all.

This article is a study aid for dental students, not medical advice. Always follow your institution's protocols and your supervisor's guidance.