What is a pulpotomy and why is it important?

Pulpotomy is a dental procedure that removes inflamed coronal pulp in primary teeth while preserving healthy radicular pulp tissue. This is essential to maintain tooth vitality and structural integrity. This process is vital for proper chewing, speech development, and maintaining space for permanent teeth. Failing to do pulpotomy can lead to tooth loss and potential issues with the development of permanent teeth.

Why was Formocresol (FC) used, and why are alternative treatments like Ferric Sulfate (FS) being considered?

Formocresol (FC) was traditionally preferred for pulpotomies due to its ease of use and high success rates. However, because of concerns about its potential to cause cancer and mutations, there's been a shift towards finding safer alternatives for pulpotomies. This is why materials like Ferric Sulfate (FS) are being explored, to ensure patient safety while maintaining effective dental treatment.

How does Ferric Sulfate (FS) work as a pulpotomy agent?

Ferric Sulfate (FS), chemically known as Fe2(SO4)3, is used as a 15.5% solution. It works as a coagulative and hemostatic agent, meaning it helps to stop bleeding. When FS interacts with blood, it forms a ferric ion-protein complex that seals damaged blood vessels, creating a physical barrier to prevent further blood clot formation. This action is important because it supports the preservation of the remaining pulp tissue in a pulpotomy procedure, which is key to the success of the treatment.

What are the conclusions regarding the use of Ferric Sulfate (FS) in primary molars?

Based on the current evidence in the English literature, there isn't strong support for the widespread use of Ferric Sulfate (FS) as a pulpotomy medicament in primary molars. The existing research reveals mixed results, with some studies showing promise while others indicate lower success rates. The limited number of high-quality studies suggests that more rigorous research is needed before FS can be definitively recommended for general use in pediatric dentistry.

Ferric Sulfate Pulpotomy in Pediatric Dentistry

Ferric Sulfate in Pediatric Dentistry: Is It the Right Choice for Pulpotomies?

Q: How was the effectiveness of Ferric Sulfate (FS) evaluated?

A systematic review was conducted, including PubMed, Ovid®, EBSCOhost, Cochrane Library, and ProQuest databases to assess the efficacy of Ferric Sulfate (FS) compared to other pulpotomy medicaments in primary molars. The review assessed the quality of studies based on established criteria. The review, which initially identified 1371 studies, narrowed down to 20 studies that met the inclusion criteria for final analysis.

Jordan Keane in Health & Wellness December 2025 • 4 min read.

"Navigating the evidence-based landscape of pulpotomy medicaments to determine the efficacy of ferric sulfate in primary molars."

Pulpotomy is a vital dental procedure involving the removal of inflamed coronal pulp while preserving the healthy radicular pulp tissue in primary teeth. This intervention aims to maintain tooth vitality and structural integrity, which is crucial for proper chewing, speech development, and maintaining space for permanent teeth.

The ideal material for pulpotomy should preserve radicular pulp vitality within an odontoblast-lined dentine chamber. For decades, formocresol (FC) was favored for its ease of use and high success rates. However, concerns about its potential carcinogenicity and mutagenicity have prompted the search for safer alternatives. This has led to the exploration of materials like calcium hydroxide, calcium-enriched mixture (CEM) cement, electro-surgery, and, increasingly, ferric sulfate (FS).

Ferric sulfate has gained traction as a pulpotomy medicament. This article examines the evidence-based efficacy of FS compared to other pulpotomy treatments in primary molars. By evaluating existing research, we aim to provide clarity on whether FS stands as a reliable option in pediatric dentistry.

Ferric Sulfate: How Effective Is It?

Ferric Sulfate Pulpotomy in Pediatric Dentistry

Ferric sulfate (FS), known chemically as Fe2(SO4)3, typically used as a 15.5% solution, functions as a coagulative and hemostatic agent. When FS comes into contact with blood, it forms a ferric ion-protein complex, effectively sealing damaged blood vessels and creating hemostasis. This complex acts as a physical barrier, preventing further blood clot formation. Unlike some alternatives, FS is believed to have minimal devitalizing effects on pulp tissue.

While FS’s mechanism seems promising, a comprehensive review of available literature reveals a mixed picture regarding its efficacy in pulpotomies. A systematic review was conducted involving an extensive search across five major databases to evaluate the evidence on ferric sulfate (FS) as compared to other pulpotomy medicaments in primary molars. The review assessed the quality of studies based on established criteria, grading them from A (highest) to C (lowest).

Comprehensive Search: Included PubMed, Ovid®, EBSCOhost, Cochrane Library, and ProQuest databases.
Quality Assessment: Studies were graded based on pre-defined criteria by two independent researchers, ensuring reliability.
Data Analysis: Kappa statistics were used to measure inter-examiner reliability.

The review, which initially identified 1371 studies, narrowed down to 20 studies that met the inclusion criteria for final analysis. Interestingly, none of these 20 studies achieved the highest grade (A). Most studies were graded as B or C, indicating limitations in their methodological rigor. Only four prospective randomised clinical trials reported high success rates with FS compared to other materials, while the remaining studies indicated lower success rates.

The Verdict: Is Ferric Sulfate Ready for Prime Time?

Based on the findings, current evidence does not strongly support the widespread application of FS as a pulpotomy medicament in primary molars within the existing English literature. The limited number of high-quality studies suggests that while FS shows promise, more rigorous research is needed.

To solidify FS’s position as an effective alternative, future studies should prioritize: Randomised clinical trials with larger sample sizes, Long-term follow-up periods to assess sustained success and Standardised assessment criteria for clinical and radiographic outcomes.

In conclusion, while ferric sulfate presents a potential option for pulpotomies in primary molars, dental professionals should remain cautious. High-quality research is crucial to fully understand its efficacy and long-term outcomes compared to traditional and newer medicaments. Until more robust evidence emerges, a balanced approach considering both the potential benefits and limitations of FS is warranted.