Background: Pulpotomy is a widely used conservative treatment approach for managing deep carious lesions and reversible pulpitis in permanent molars. It aims to preserve the vitality of the remaining pulp tissue by removing the coronal pulp while maintaining the functionality of the radicular pulp. Traditionally, mineral trioxide aggregate (MTA) has been the preferred biomaterial for pulpotomy due to its excellent biocompatibility, sealing ability, and ability to induce dentin bridge formation. However, concerns regarding its excessive cost, long setting time, and potential discoloration of teeth have led to the exploration of alternative materials. Biodentine, a newer calcium silicate-based biomaterial, has emerged as a promising alternative to MTA, offering shorter setting time, improved handling properties, and enhanced bioactivity while maintaining similar biocompatibility. While several studies have compared the effectiveness of Biodentine and MTA in primary teeth pulpotomy, limited clinical evidence exists regarding their use in permanent molars. This study aims to compare the clinical and radiographic success rates of Biodentine and MTA in pulpotomy of permanent molars in an Indian tertiary care hospital setting, evaluating postoperative pain, healing response, and long-term treatment success. Objectives: The study aims to evaluate and compare the clinical success rate, radiographic healing response, and post-operative outcomes of Biodentine and MTA in pulpotomy procedures for permanent molars. It further investigates the differences in dentin bridge formation, material handling characteristics, and patient-reported symptoms over a follow-up period of 12 months. The findings will contribute to clinical decision-making by determining whether Biodentine offers a viable alternative to MTA in permanent molar pulpotomy. Methods: This randomized clinical study was conducted at a tertiary care hospital in India, involving 100 patients aged 10–30 years who required pulpotomy in permanent molars due to deep carious lesions with clinical signs of reversible pulpitis. Patients were randomly assigned into two equal groups (n=50 each), with one group receiving Biodentine pulpotomy and the other undergoing MTA pulpotomy. Standard pulpotomy protocols were followed, including aseptic pulp chamber debridement and hemostasis using sterile cotton pellets before applying the assigned biomaterial. The final restoration was completed using resin-modified glass ionomer cement (RMGIC) and composite resin. Clinical evaluations were performed at 1, 3, 6, and 12 months postoperatively, assessing pain, tenderness to percussion, swelling, and other signs of failure. Radiographic assessments were conducted at baseline, 6 months, and 12 months, evaluating periapical healing, dentin bridge formation, and the presence of pathological root resorption or periapical radiolucency. Data were analyzed using Chi-square and Fisher’s exact tests, with Kaplan-Meier survival analysis to compare the long-term success rates between both materials. A p-value of <0.05 was considered statistically significant. Results: At the 12-month follow-up, the overall clinical success rate was 94% in the Biodentine group and 90% in the MTA group. Postoperative pain was reported in 12% of MTA-treated cases within the first week, compared to 8% in the Biodentine group, though this difference was not statistically significant (p>0.05). Radiographic healing at 6 and 12 months showed dentin bridge formation in 82% of Biodentine cases versus 79% in MTA cases, with comparable periapical healing outcomes (p=0.32). Root resorption or treatment failure requiring extraction occurred in 6% of MTA-treated cases and 4% of Biodentine-treated cases, reinforcing their similar long-term efficacy. Biodentine was found to be easier to manipulate, with shorter setting time, whereas MTA exhibited better sealing ability but had occasional cases of discoloration in anterior teeth. Conclusion: Both Biodentine and MTA demonstrated high clinical and radiographic success rates in pulpotomy of permanent molars, making them effective biomaterials for vital pulp therapy. Biodentine offered advantages such as faster setting time, ease of handling, and minimal discoloration, whereas MTA maintained excellent sealing properties and long-term biocompatibility. Given their comparable success rates and clinical outcomes, Biodentine presents a viable and cost-effective alternative to MTA in pulpotomy procedures for permanent molars, particularly in cases where faster treatment completion and esthetic concerns are priorities. Further long-term studies with larger sample sizes are recommended to confirm these findings and establish clear clinical guidelines for material selection in pulpotomy procedures.

Pulpotomy, Biodentine, Mineral Trioxide Aggregate, Vital Pulp Therapy, Permanent Molars, Calcium Silicate-Based Materials, Endodontic Treatment, Pulp Preservation, Dentin Bridge Formation, Pulp Healing.