Total Pulpotomy With Two Repair Cements in Hypomineralized Teeth

Molar-incisor hypomineralization (MIH) is a developmental enamel defect affecting one or more permanent first molars, frequently associated with affected incisors. The condition is characterized by qualitative defects in enamel mineralization, resulting in increased porosity, post-eruptive enamel breakdown, hypersensitivity, and a higher risk of rapid caries progression. These clinical characteristics often complicate restorative treatment and may lead to early pulpal involvement in affected teeth.

The management of deep carious lesions and pulp inflammation in MIH-affected teeth remains a clinical challenge. Due to structural alterations in enamel and dentin, these teeth may present increased sensitivity, difficulty achieving adequate anesthesia, and a greater likelihood of restorative failure. Consequently, preserving pulpal vitality while controlling symptoms is a priority in pediatric dental care.

In recent years, vital pulp therapy has gained increasing acceptance as a conservative treatment approach for permanent teeth diagnosed with pulp inflammation. Among these procedures, full pulpotomy has demonstrated favorable clinical and radiographic outcomes, even in cases previously considered candidates for conventional root canal treatment. This approach aims to maintain the vitality and function of the remaining radicular pulp tissue, supporting continued tooth preservation and reducing treatment complexity.

Calcium silicate-based biomaterials play a central role in the success of pulpotomy procedures because of their bioactivity, sealing ability, and capacity to stimulate hard tissue formation. Mineral Trioxide Aggregate (MTA) is considered a reference material for vital pulp therapy; however, its cost and handling characteristics may limit widespread use in some clinical settings. CIMMO DTA® is a calcium silicate-based material that has shown promising biological and physicochemical properties and may represent a more accessible alternative. Nevertheless, clinical evidence comparing its performance with established materials in teeth affected by MIH remains limited.

This randomized clinical trial was designed to contribute to the evidence base regarding the management of pulpally involved MIH-affected permanent molars. By evaluating postoperative outcomes following full pulpotomy performed with different calcium silicate-based materials, the study seeks to generate clinically relevant information that may support treatment decision-making and expand access to conservative therapeutic options for children and adolescents.

The results of this study may contribute to improving the management of MIH-related complications, reducing the burden of dental pain, supporting tooth preservation, and strengthening evidence-based approaches in pediatric dentistry and vital pulp therapy.

Inclusion criteria

• Children aged 6 to 16 years.
• Presence of at least one permanent first molar diagnosed with Molar-Incisor
• Hypomineralization (MIH), according to the criteria established by the European Academy of Paediatric Dentistry (EAPD).
• Deep carious lesion involving the inner third of dentin, confirmed clinically and radiographically.
• Diagnosis of symptomatic or asymptomatic irreversible pulpitis based on clinical examination, patient history, and pulp sensibility tests.
• Tooth considered restorable after completion of treatment.
• Presence of vital pulp tissue confirmed by bleeding following coronal pulp removal.
• Child and parent/legal guardian able to understand study procedures and comply with follow-up requirements.
• Written informed consent obtained from the parent or legal guardian and assent obtained from the child when applicable.

Exclusion criteria

• Teeth presenting clinical or radiographic signs of pulp necrosis.
• Presence of spontaneous swelling, abscess, sinus tract, cellulitis, or other signs of acute odontogenic infection.
• Evidence of internal or external root resorption.
• Presence of periapical or furcation radiolucency suggestive of endodontic pathology.
• Teeth with advanced periodontal disease or pathological mobility.
• Teeth with root fractures, crown-root fractures, or extensive structural destruction that precludes definitive restoration.
• Teeth in which hemostasis cannot be achieved within the time established by the study protocol after coronal pulp removal.
• Children with systemic diseases or medical conditions that may affect healing or interfere with study outcomes.
• Current use of medications that may alter pain perception, inflammatory response, or tissue healing.
• Previous endodontic treatment or pulp therapy performed on the study tooth.
• Inability or unwillingness of the participant or parent/legal guardian to attend follow-up visits.