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This study compared the clinical and radiographic outcomes of EP, Biodentine, and mineral trioxide aggregate (MTA) when used as pulpotomy agents in primary molars. A randomized split-mouth clinical trial was performed on 30 children, each receiving pulpotomy in 3 primary molars assigned to Group I (EP), Group II (Biodentine), and Group III (MTA), with 30 teeth per group. Clinical evaluations were carried out at baseline, 3-, 6-, and 12-month. Cone-beam computed tomography (CBCT) scans were performed immediately postoperatively and at 12- month to evaluate root resorption and radiodensity changes. All groups demonstrated 100% clinical success within 3-month. At 12-month, Group I showed significantly higher rates of spontaneous pain, abnormal mobility, fistula, and internal and external root resorption (\n                    <jats:italic>p<\/jats:italic>\n                    &lt; .05). CBCT analysis revealed significantly lower radiodensity values in Group I compared with Groups II and III. Group III (MTA) exhibited the most favorable radiographic outcomes, followed by Group II (Biodentine). EP achieved acceptable short-term results; however, its long-term performance was inferior to MTA and Biodentine.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Clinical significance<\/jats:italic>\n                    EP represents a low-cost, biocompatible, and environmentally sustainable biomaterial derived from recycled natural waste. Despite its eco-friendly and biomimetic advantages, its long-term clinical and radiographic performance remained inferior to Biodentine and MTA, which continue to be the more reliable pulpotomy materials for primary molars.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Trial registration<\/jats:italic>\n                    NCT05812053, \u201cComparativeEvaluation of Eggshell Powder in Primary Teeth Pulpotomy\u201d,\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/<\/jats:ext-link>\n                    . Registered: 2023\/04\/13.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-61564-w","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:33:07Z","timestamp":1784043187000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Eggshell powder as a biomimetic alternative to biodentine in primary teeth pulpotomy: a comparative clinical and radiographic study"],"prefix":"10.1038","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05812053","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Shaimaa S.","family":"El-Desouky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehab F.","family":"Ghouraba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim A.","family":"Kabbash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy M.","family":"Metwally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"61564_CR1","doi-asserted-by":"publisher","first-page":"832","DOI":"10.4103\/1119-3077.197022","volume":"20","author":"B Ozmen","year":"2017","unstructured":"Ozmen, B. & Bayrak, S. 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