The effectiveness of pulpotomy in mature permanent posterior teeth with irreversible pulpitis: a systematic review and meta-analysis

Pulpotomy is increasingly considered an alternative to root canal treatment for preserving pulp vitality. This systematic review compared full pulpotomy (FP) and partial pulpotomy (PP) in mature permanent posterior teeth with irreversible pulpitis and explored prognostic factors (patient age and bleeding time). PubMed, Cochrane Library, and Scopus, supplemented by Google Scholar, were searched up to December 2025 for randomized clinical trials. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE; single-arm proportions were pooled by random-effects meta-analysis within follow-up periods (12, 18–24, and > 24 months). Twenty-three studies were included. At the primary 12-month timepoint, pooled success was 0.92 (95% CI 0.89–0.95) for FP and 0.89 (0.81–0.95) for PP. Estimates were lower and less certain beyond 12 months. In two-arm comparisons using intention-to-treat analysis, FP showed higher success than PP (OR 1.85, 95% CI 1.16–2.94) and fewer pain-related failures (OR 0.22, 95% CI 0.07–0.64). FP success was not clearly associated with patient age or bleeding time. Both techniques achieved favorable short-term outcomes, but FP provided more consistent 12-month success and pain control. Given the low-to-very-low certainty of evidence, these findings warrant caution, and adequately powered trials with longer follow-up are needed.