Pulpotomy Notes Template for UK Dentists
Nosht
Published by Nosht Limited
Pulpotomy is having a renaissance — BES 2022 and ESE S3 2023 now support vital pulp therapy on permanent teeth with irreversible pulpitis as a valid alternative to RCT. Below is a template for UK clinicians to paste into their PMS, BES-aligned.
Why this pulpotomy template wins
- Rubber dam recorded as MANDATORY per BES 2022 — a frequent gap in pulp therapy records.
- Time to haemostasis recorded — <5min = good prognosis; >5min indicates irreversible pulpitis below and need to convert to RCT.
- Bioceramic / MTA lot number captured — MDR + medicine traceability requirement.
- BES 2022-aligned indications including irreversible pulpitis on permanent (no periapical lesion) — the modern evidence base.
- Review schedule built into the note — vitality re-check at 6 weeks + 6 months + 1 year is the standard.
The template (paste into your PMS notes field)
Paste the pulpotomy template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.
TOOTH: [FDI] DENTITION: [Primary / permanent] PROCEDURE: [Partial / full / cervical pulpotomy] INDICATION: [Reversible pulpitis with exposure / irreversible pulpitis on permanent tooth (BES 2022) / mechanical exposure / primary tooth caries] PRE-OP DIAGNOSIS: [Symptoms — pain history if any / vitality test result / percussion / radiograph findings] CONSENT (Montgomery): Risks discussed — possibility of failure requiring RCT or extraction (~10-15% at 2yr for permanent), post-op pain/swelling, sensitivity, need for crown after pulpotomy on permanent tooth. Benefit: preserve pulp vitality, avoid RCT, conservative. Alternative: RCT, extraction. Patient/parent consents. LA: [Agent — volume — technique]. Profound anaesthesia confirmed. ISOLATION: Rubber dam placed — [clamp / tooth isolated]. Dry field throughout. [MANDATORY per BES 2022] CARIES REMOVAL: [Complete — extent / depth] PULP EXPOSURE: [Size in mm / location / character of bleeding: brisk red (vital, expected) / dark/profuse (suggests irreversible)] PULPOTOMY: - Technique: [Partial: 2mm of pulp removed / Full: coronal pulp removed to canal orifices / Cervical (primary only): removed to pulp chamber floor] - Instruments: [Sterile diamond round bur / spoon excavator] - Irrigation: [Saline / NaOCl 1.5-3%] HAEMOSTASIS: - Method: [Cotton pellet + saline pressure 1-2 min / sodium hypochlorite 3% pellet] - Time to haemostasis: [< 5 min = good prognosis / > 5 min = irreversible pulpitis below = convert to RCT] - Achieved: [Y/N — if N, proceeded to pulpectomy] MATERIAL PLACED: - Type: [Bioceramic (Biodentine / BC RRM) / MTA (ProRoot, MTA Angelus) / Ca(OH)2] - Brand: [Specify] - Lot number: [Recorded for traceability] - Thickness: [2-3mm minimum] CORONAL SEAL: [GIC base + composite / SS crown on primary / composite if permanent + crown planned] POST-OP RADIOGRAPH: [Taken to confirm material placement and coronal seal. Quality A/N. Justification: confirm placement.] POST-OP ADVICE: Mild discomfort 24-48h expected — paracetamol / ibuprofen PRN. Return if severe pain, swelling, or sinus tract develops. REVIEW SCHEDULE: - Primary tooth: 6 months - Permanent tooth: 6 weeks + 6 months + 1 year + then annually - Vitality test at each review (permanent) — document
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What good looks like — a worked example
The same pulpotomy template, completed for a realistic case.
TOOTH: UR6 DENTITION: Permanent PROCEDURE: Full pulpotomy INDICATION: Irreversible pulpitis (spontaneous pain, lingering cold response, no periapical pathology). BES 2022 — full pulpotomy now indicated as alternative to RCT for IRP with no periapical lesion. Patient prefers preservation of vitality. PRE-OP DIAGNOSIS: 3-day history spontaneous pain. Cold (Endo-Ice) — lingering, severe. Percussion +. PA today — no periapical lesion, intact lamina dura, deep distal caries to pulp. CONSENT (Montgomery): Risks discussed — possibility of failure requiring RCT or extraction (~10-15% at 2yr per BES 2022 data), post-op pain/swelling, need for crown after pulpotomy to protect tooth. Benefit: preserve pulp vitality, simpler than RCT, single visit. Alternative: full RCT (2 visits, similar long-term outcome but more intervention), extraction. Patient elects full pulpotomy with crown to follow. LA: Articaine 4% w/ adrenaline 1:100,000, 1.7ml buccal infiltration. Supplemental palatal 0.5ml. Profound anaesthesia. ISOLATION: Rubber dam placed — Ivory 9 clamp UR6. Dry field throughout. CARIES REMOVAL: Complete. Distal carious lesion removed to dentine, no residual caries on detector dye. PULP EXPOSURE: Spontaneous on caries removal. ~3mm diameter coronal pulp exposed. Bleeding brisk red, characteristic of vital pulp. PULPOTOMY: - Technique: Full pulpotomy — coronal pulp removed to canal orifices in MB, ML, P canals - Instruments: Sterile diamond round bur (slow speed, copious water) - Irrigation: NaOCl 3% irrigation throughout, copious saline final HAEMOSTASIS: - Method: Sodium hypochlorite 3% pellet, light pressure 2 min - Time to haemostasis: 3 min (good prognosis indicator) - Achieved: Yes — all 3 canal orifices showing clean dentine, no continued bleeding MATERIAL PLACED: - Type: Bioceramic — Biodentine - Brand: Septodont Biodentine - Lot number: [BD-2026-04-1234] - Thickness: 3mm over canal orifices and pulp chamber floor CORONAL SEAL: GIC base over Biodentine + composite (Filtek Supreme Ultra A3) restoring full coronal contour. POST-OP RADIOGRAPH: PA taken — Biodentine clearly visible covering canal orifices, no voids. Coronal seal intact. Quality A. POST-OP ADVICE: Mild discomfort 24-48h expected. Paracetamol / ibuprofen PRN. Avoid heavy chewing on UR6. Crown to be prepared in 4 weeks. Return immediately if severe pain, swelling, or sinus tract develops. REVIEW SCHEDULE: 6 weeks (vitality re-check), 6 months (vitality + PA), 1 year (vitality + PA), annually thereafter.
Compliance: the medico-legal angle
- BES Guide to Good Endodontic Practice 2022 — rubber dam mandatory, bioceramic/MTA preferred, vitality testing at review.
- ESE S3 Clinical Practice Guideline 2023 (IEJ DOI:10.1111/iej.13974) — vital pulp therapy on permanent teeth with irreversible pulpitis without periapical lesion is evidence-based first-line alternative to RCT.
- GDC Principle 4 — operative record sufficient for another clinician to continue or troubleshoot.
- IR(ME)R 2017 — post-op radiograph justified to confirm material placement and coronal seal.
Common documentation mistakes
- NO rubber dam recorded — a serious record gap. If a child swallows or aspirates instrument, indefensible.
- No time-to-haemostasis recorded — leaves the prognostic decision (continue vs convert to RCT) undocumented.
- No lot number for bioceramic / MTA — traceability requirement.
- No post-op vitality review scheduled — pulpotomy success is judged by maintained vitality, which requires testing.
- Pulpotomy on a permanent tooth with periapical lesion — wrong indication, should be RCT.
Sources
- GDC Standards for the Dental Team, Principle 4: Maintain and protect patients’ information (accessed 18 October 2026)
- The Ionising Radiation (Medical Exposure) Regulations 2017 (SI 2017/1322) (accessed 18 October 2026)
- Montgomery v Lanarkshire Health Board (UK Supreme Court, 2015, UKSC 11) (accessed 18 October 2026)
- British Endodontic Society: A Guide to Good Endodontic Practice (1st edition, September 2022) (accessed 18 October 2026)
- Duncan HF, et al. Treatment of pulpal and apical disease: the ESE S3-level clinical practice guideline. Int Endod J 2023 (accessed 18 October 2026)
Frequently asked questions
Can I do pulpotomy on an adult permanent tooth with irreversible pulpitis?
Yes — BES 2022 and ESE S3 2023 both now support full pulpotomy as a valid alternative to RCT for permanent teeth with irreversible pulpitis WHERE THERE IS NO PERIAPICAL LESION. Success rate ~85-90% at 2 years. Bioceramic material (Biodentine, BC RRM, MTA) is preferred. Crown follow-up required.
Why is haemostasis time so important?
It's the clinical prognostic indicator. <5min haemostasis suggests reversible inflammation in the remaining pulp — good prognosis. >5min suggests irreversible inflammation extending into root pulp — pulpotomy likely to fail; convert to pulpectomy/RCT. Document the time.
Why is rubber dam mandatory?
BES Quality Guidelines: isolation prevents bacterial contamination of the exposed pulp (the entire point of pulpotomy fails without isolation) AND prevents instrument aspiration. Without a recorded rubber dam, an endodontic claim is much harder to defend.
Biodentine, MTA, or calcium hydroxide?
Bioceramics (Biodentine, BC RRM) and MTA outperform Ca(OH)2 for pulp capping/pulpotomy in randomised trials. ESE S3: bioceramics or MTA first-line. Ca(OH)2 still acceptable for primary teeth in some protocols. Record what you used and the lot number.
Primary or permanent — same procedure?
Same principle, different technique. Primary teeth: usually cervical pulpotomy (remove all pulp tissue to floor of pulp chamber) using ferric sulfate or MTA, then SS crown (Hall technique variant). Permanent teeth: partial or full pulpotomy using bioceramic/MTA, then composite + future crown.
When does pulpotomy fail and what next?
Failure presents as return of spontaneous pain, swelling, sinus tract, or loss of vitality at review. ~10-15% over 2 years for permanent teeth. Convert to RCT (re-enter, remove all canal pulp, instrument, obturate, restore). Earlier intervention = better outcome.
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Nosht
Published by Nosht Limited
Nosht Limited makes structured clinical note templates for UK dental professionals. Articles refer to guidance from the GDC, CGDent, BSP, SDCEP and NICE. Check the current version of a source before relying on it.