Pulpotomy in Hypominerlized Permanent Molars.

Molar-incisor hypomineralization (MIH) is a developmental enamel defect affecting permanent first molars and incisors. Affected molars are more vulnerable to post-eruptive enamel breakdown, dental caries progression, and subsequent pulpal inflammation. When caries progresses to involve the pulp, preserving pulp vitality through vital pulp therapy (VPT) may provide an alternative to root canal treatment, particularly in young patients.

Although partial and full pulpotomy have shown favorable outcomes in young permanent teeth with deep caries and pulp exposure, limited evidence is available regarding their effectiveness in teeth affected by MIH. MIH-affected teeth may have altered pulpal characteristics, including increased vascularity, inflammatory response, and sensitivity, which may influence the response to vital pulp therapy.

This prospective clinical study aims to evaluate the clinical and radiographic outcomes of a stepwise pulpotomy approach in young permanent first molars affected by MIH with deep caries and pulp exposure. Eligible teeth will initially receive partial pulpotomy. If adequate hemostasis cannot be achieved following partial pulpotomy, treatment will be converted to full pulpotomy. A calcium silicate-based material will be used for pulp capping, followed by definitive restoration.

Clinical and patient-reported outcomes will be assessed, including postoperative pain, the need for emergency intervention, and signs or symptoms of treatment failure. Radiographic evaluation will be performed at 6 and 12 months using periapical radiographs, with additional imaging when indicated, to assess the presence of periapical or furcal pathology, root changes, and overall treatment success.

The study will also investigate potential factors associated with treatment outcomes, including patient and tooth characteristics, MIH severity, pulpotomy type performed (partial or full pulpotomy), and pulpal inflammatory markers such as matrix metalloproteinase-9 (MMP-9). The findings will contribute to understanding the effectiveness and predictability of vital pulp therapy for MIH-affected permanent molars with carious pulp exposure.

Inclusion criteria

• • The patient age <14 years old

• Non -contributory medical history
• Molar tooth affected with MIH as per EAPD diagnostic criteria (17).
• Deep caries extending>= 2/3 of dentine or exposing the pulp on the radiograph
• The tooth should give positive response to cold sensibility testing
• Clinical diagnosis of reversible/irreversible pulpitis based on the symptoms and results of cold testing.
• The tooth is restorable, probing pocket depth and mobility are within normal limits
• No signs of pulpal necrosis including sinus tract or swelling

Exclusion criteria

• • Medically compromised patient.

• Non-restorable tooth.
• Signs of pulpal necrosis including sinus tract or swelling.
• Uncooperative children who could not be treated under local anesthesia.
• No enough bleeding after the pulpotomy procedure.
• Inability to achieve hemostasis within 8 min after the pulpotomy.