I think  it works just for some time, and finally root canal therapy must be performed as a more predictable treatment choice. Hence if endo therapy must be done anyway, so it should done later on possible complication of pulpotomy?  kindly Dr. Ranjder could you attach some links about what has been stated by the American Association of Endodontic and the  American Board of Endodontic if that available with you.

May i suggest you to read this interesting paper ? 

It is not considered as a final treatment and only for some time.

It is not a final treatment, usually preferred for apexogenesis n after that Rct is recommended 

pulpotomy using MTA could be a good alternative for RCT for managing symptomatic mature permanent teeth with carious exposure.

As concluded by the following paper..

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662039/

In my opinion, successful pulpotomy should be the final treatment. Leaving vital tissue in the root of permanent teeth is preferrable towards rootfilling material. As long as we can observe radiologically signs of bridging and the tooth ist without simptoms I would leave it as it is!

In countries with good dental health insurances, where RCT is paid, pulpotomy mostly is regarded as a non-permanent measure. However, there are some promising studies on pulpotomy from Switzerland, India, and a recent paper, from which I dot´t actually know its origin, where pulpotomy, when performed respecting some certain precautionary measures, was as successful as customary root canal treatment. So, if the patient can not afford or stand root canal treatment, pulpotomy may be a promising alternative.

This is a great question. I am a proponent of saving the pulp. If I ever do a pulpotomy in a mature tooth, I would certainly follow up the patient and not re-enter until patient comes back with shmptoms or shows radiographic signs of infection. I believe the pulp has a great potential to heal despite it's little size. If we can tip the balance towards healing, the pulp could take care of itself thereafter. But this is all theoretical and anecdotal experiences. I would 

Pulpotomy had certain indication and specifically in permanent tooth it could be done for apexogenisis cases otherwise root canal therapy is a definitive treatment in my opinion.

I agree with Mohammed, Ina, Johannes and Shoib. Pulpotomy is successful if respected in terms of indication and clinical procedures.

Why to be invasive when cured vital pulp is there in canals....of course follow up is needed and patient is told for that. In ages of revascularization, why to remove healed and vital pulp. 

Yes!!! Under an Ideal vital Pulp; pulpotomy for permanent dentition can be considered as a final treatment,  MTA is a reliable biomaterial with vital pulp therapies in permanent teeth. Also  is a suitable dressing agent for parital pulpotomy in cariously exposed young permanent first molars. The human dental pulp responses to CH are unpredictable.

It depends of what you call "final treatment".

Pulpotomy is a vital pulp therapy very useful for permanent teeth with immature apex, aiming for the completion of the root. Pulpectomy in these cases is very challenging and in some cases impossible. If you are talking about an situation like the one stated before, you can say its a final treatment , but only until it gets symptomatic or shows radiographic signs of infection, if it will ever be (its very likely for these teeth to get symptomatic because, at some point, the sealing ability of the materials start to give in, since there is no other seal like the one you get from the original enamel). And that is why you have to do a periodic control on these teeth.

For permanent teeth with complete rooth formation the pulpotomy is kinda pointless, since most of the fractures happen in the crown and not in the rooth, so maintaining the root vitality will not be of great interest and you'll probably end up doing the pulpectomy later on...

Pulpotomy Can be done

we can do with biodentine

In epidemiological and root canal quality studies pulpotomy shows lower success rates over the years and thats why it is not recommended as final treatment - I suggest to read this article "A 24-year follow-up of root filled teeth and periapical health amongst middle aged and elderly women in Göteborg, Sweden"  F. Frisk & M. Hakeberg (International Endodontic Journal, 38, 246–254, 2005). 

Despite of that, recent years with bioceramic materials on the market and science - it might be possible to get better success rate for pulpotomy with those newer materials - there are many informative article about the matter for example: J Conserv Dent. 2015 Jan-Feb;18(1):73-8. doi: 10.4103/0972-0707.148901.

Biodentine pulpotomy several days after pulp exposure: Four case reports. Borkar SA1, Ataide I1.

There is no clear cutoff point between what is called reversible and irreversible pulpitis based on poor correlation between symptoms and histological status of the pulp. This formulates the bases for vital pulp therapy in mature teeth, Linswanont et al reported high success rate for vital pulp therapy regardless of the pulpal diagnosis, Caliskan et al 1995 reported high success rate for pulpotomy in teeth even with periapical pathosis.

So what does long term mean? what are you looking at? Most studies utilizing current techniques are short term 1-3 years follow up, but its an area which is highly investigated currently. So I expect few studies to come up in the near future.

1. yes, no and maybe

a. caries exposures in general give lower rates of success with pulpotomy vs mechanical exposures.

b. that said, a CVEK modified pulpotomy (partial pulpotomy) would be a good idea if there is enough good healthy pulp tissue for the paritial pulpotomy. We did it all the time in my residency in the 1970's with then, CaOH. I agree.. better to use MTA or Biodentine.

c.if inmature roots - i would say yes all 100% of the time. Got nothing to lose and conservative. I would rather do an endo on a perm tooth with closed apices than open. the pulpotomy will help in this regard.

Lance Kisby DMD, FASDC, FAAPD, MAGD

Prog. Dir. Pedo residency AI DuPont hosp for children

Adjunct Clinical Instr. Tufts Dental

Assoc. Clinincal Prof. Temple Dental

When crown is fractured and pulpotomy performed

What is the value of vital root completely closed

Now the crown non vital and liable to fracture and failure is susceptible

So rct is preferred to avoid complications of touch between materials and vital nerve

The only advantage will be easy procedures