DISCUSSION
pulpitis, bleeding, toxicity, radiolucency, pain, fistula, tooth
PULPITIS, BLEEDING, IRREVERSIBLE PULPITIS, PROLIFERATION, COMPLICATIONS
Irreversible pulpitis of primary teeth are usually treated with pulpectomy its inflamed and healthy pulp, as this procedure is considered invasive, nonbiological, and results in a loss in the repair and regenerative properties that characterize the vital pulp therapy (Wolters et al., The pulpectomy procedurerequires more time and effort in children and the experience of the dentist compared to pulpotomy treatment, these reasons may lead to a decision to extract the primary tooth, which leads to a loss in the function of the tooth (McDOUGAL et al., Therefore, vital pulp treatment techniques have been proposed to treat cases of irreversible pulpitis where this technique is characterized by preserving the immune and vital functions of the pulp, as well as this procedure is simple and avoids complications resulting from the complex anatomy of the root canal anatomy, and less pain‐related treatment compared to root canal treatment (Simon et al., The effectiveness of vital pulpotomy has been proven in the treatment of teeth affected by symptoms and signs of irreversible pulpitis, whether in permanent or primary teeth. Taha et al found a 100% success rate after a year of follow‐up and a 92% success rate after three years, where pulpotomy was performed by MTA in permanent molars affected by irreversible pulpitis (Taha & Khazali, Cushley et al also evaluated, in a systematic review, the success of pulpotomy in teeth affected by irreversible pulpitis, where they found a clinical success rate of 97.4% and a radiological success rate of 95.4% after a follow‐up period of 12 months (Cushley et al., Memarpour et al. (The study sample consisted of 40 s primary mandibular molars to avoid differences resulting from the type of teeth, and molars with irreversible pulpitis (based on the symptoms reported by the patient of spontaneous and continuous pain that requires an analgesic to be given to the child) were included.The time required for hemostasis to occur was between 5 and 10 min after removing the coronal pulp; the case in which the time exceeded 10 min was excluded and shifted to a complete pulpectomy, wherein bleeding that exceeded 10 min was considered to be indicative of severe pulpitis that requires pulpectomy, depending on the classification of World Wolters (Wolters et al., Sodium hypochlorite was used as a disinfection solution with a concentration of 2.5% after removing the coronal pulp, based on the recommendations of the American Association of Endodontists, according to which sodium hypochlorite solution with a concentration ranging from 0.5% to 5.25% should be used when treating vital pulp (Bogen et al., Disinfection with sodium hypochlorite is considered safe without causing damage or toxicity to pulp cells or their proliferation and differentiation and it did not show any negative effect on dentin bridge formation; a concentration of 2.5% was chosen as the median value in this study (Duncan et al., In this study, MTA was used, which is considered the gold standard in the context of vital pulp therapy due to its high biocompatibility and high success rate (Hussain & Bashar, Stainless‐steel crowns were used for final restoration due to their high sealing capacity and durability. The quality of the final restoration plays an important role in improving the treatment prognosis (Demarco et al., Some studies have shown that coronal sealing is possibly to be more important than the biocompatibility materials used in the context of vital pulp therapy (Qudeimat et al., The success rate of Bioceramic putty, clinically and radiologically after a 1‐year follow‐up, was 100%, while the success rate of MTA was 95%. The clinical success depended on the absence of spontaneous pain on percussion and the absence of a fistula.The radiographic success depended on the absence of internal or external absorption and the absence of periodontal ligament widening, in addition to an assessment of radiolucency in the root furcation area, where this area was adopted in the evaluation due to the presence of lateral canals in the junction area (Smaïl‐Faugeron et al., No study has compared MTA with Bioceramic putty in primary molar pulpotomy diagnosed with irreversible pulpitis, but the results of this study are in agreement with the results of the Memarpour et al study, with a difference in the material used in a pulpotomy; they used CEM, and reported a success rate of 92% after a year of follow‐up (Memarpour et al., Asgary et al also evaluated CEM in primary molar pulpotomy with irreversible pulpitis; a success rate of 100% was found after a 34‐month observation period, and they also achieved a success rate of 100% in permanent molar pulpotomy (Asgary et al., 