{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:16:11Z","timestamp":1778768171158,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Full pulpotomy has gained increasing attention as a conservative treatment option for managing complicated crown fractures and pulp exposures in mature permanent teeth. However, little is known about how undergraduate dental students perceive this treatment approach and which factors influence their willingness to adopt it in clinical practice. Objective: This study aimed to evaluate undergraduate dental students\u2019 knowledge, attitudes, and preferences regarding full pulpotomy and to identify factors associated with willingness to use full pulpotomy as a definitive treatment option. Materials and Methods: A cross-sectional questionnaire-based study was conducted among fourth- and fifth-year dental students. The questionnaire evaluated participants\u2019 treatment preferences, perceived procedural difficulties, preferred pulp capping materials, attitudes toward rubber dam use, perceived barriers to full pulpotomy adoption, and willingness to use full pulpotomy as a definitive treatment. Associations between variables were assessed using chi-square tests and multivariable binary logistic regression analysis. Results: In total, 255 undergraduate dental students participated in the study. Spontaneous pain (69.4%), prolonged pain to heat (50.6%), percussion sensitivity (46.7%), and radiographic findings (43.9%) were the most frequently reported diagnostic criteria for symptomatic irreversible pulpitis. In the standardized clinical scenario, a pulpotomy-based approach was the most preferred treatment strategy (45.1%), followed by single-visit pulpectomy with obturation (28.6%) and pulpectomy with calcium hydroxide dressing (24.7%). MTA was the most preferred pulp capping material (57.3%), followed by Biodentin (12.9%) and calcium hydroxide (8.2%). Overall, 55.7% of participants reported willingness to use full pulpotomy as a definitive treatment option. Clinical year, previous exposure to pulpotomy cases, and confidence in bleeding control were independently associated with willingness to use full pulpotomy. Previous performance of pulpotomy procedures and attitude toward mandatory rubber dam use were independently associated with greater willingness to use full pulpotomy, whereas perceived barriers and uncertainty regarding implementation were negatively associated. Conclusions: In this single-center, questionnaire-based study, undergraduate dental students generally showed a positive attitude toward full pulpotomy; however, acceptance was strongly influenced by practical experience, confidence in procedural protocols, and perceived implementation barriers. These findings may help inform future educational strategies aimed at improving confidence and supporting evidence-based adoption of conservative pulp-preserving approaches.<\/jats:p>","DOI":"10.3390\/healthcare14101342","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"1342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Definitive Full Pulpotomy Adoption in Symptomatic Irreversible Pulpitis: A Multivariable Analysis of Dental Trainee Decision-Making"],"prefix":"10.3390","volume":"14","author":[{"given":"Suzan","family":"Cang\u00fcl","sequence":"first","affiliation":[{"name":"Department of Restorative Dentistry, Faculty of Dentistry, Dicle University, Diyarbakir 21280, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zkan","family":"Ad\u0131g\u00fczel","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir 21280, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makbule","family":"Ta\u015fy\u00fcrek","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, Dicle University, Diyarbakir 21280, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatice","family":"Orta\u00e7","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine, Dicle University, Diyarbakir 21280, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","first-page":"433","article-title":"Vital Pulp Therapy in Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review","volume":"22","author":"Bafail","year":"2024","journal-title":"Oral Health Prev. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4103\/jpdtsm.jpdtsm_112_25","article-title":"Vital Pulp Therapy versus Root Canal Treatment in Permanent Teeth with Irreversible Pulpitis\u2014Current Evidence and Clinical Perspectives","volume":"4","author":"Bharadwaj","year":"2025","journal-title":"J. Prev. Diagn. Treat. Strateg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/JCD.JCD_179_19","article-title":"Success of pulpotomy in mature permanent teeth with irreversible pulpitis: A systematic review","volume":"23","author":"Zafar","year":"2020","journal-title":"J. Conserv. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Pohl, S., Akamp, T., Smeda, M., Uderhardt, S., Besold, D., Krastl, G., Galler, K.M., Buchalla, W., and Widbiller, M. (2024). Understanding dental pulp inflammation: From signaling to structure. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1474466"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Shah, D., Lynd, T., Ho, D., Chen, J., Vines, J., Jung, H.D., Kim, J.H., Zhang, P., Wu, H., and Jun, H.W. (2020). Pulp-Dentin Tissue Healing Response: A Discussion of Current Biomedical Approaches. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020434"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"937","DOI":"10.4103\/JCDE.JCDE_468_25","article-title":"Outcome of full pulpotomy versus partial radicular pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis using Biodentine\u2014A randomized controlled trial","volume":"28","author":"Baranwal","year":"2025","journal-title":"J. Conserv. Dent. Endod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00784-024-05814-z","article-title":"Elective full pulpotomy in mature permanent teeth diagnosed with symptomatic irreversible pulpitis: A two years retrospective study","volume":"28","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tosco, V., Monterubbianesi, R., Montagna, P., Orilisi, G., Vitiello, F., Song, H., Putignano, A., De Santis, D., and Orsini, G. (2026). Vital Pulp Therapy: A Three-Year Clinical Case Series on Regenerative Potential and Adhesive Restoration Strategies. Regenesis Repair Rehabil.","DOI":"10.1016\/j.rerere.2026.01.005"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tu\u0161as, P., Camilleri, J., Alksn\u0117, M., \u0160imoli\u016bnas, E., Drukteinis, S., Urbon\u0117, E.M., Bukelskien\u0117, V., Rutk\u016bnas, V., and Pe\u010diulien\u0117, V. (2025). Biocompatibility of Hydraulic Calcium Silicate-Based Cement MTA Flow(TM) on Human Dental Pulp Stem Cells In Vitro. J. Funct. Biomater., 16.","DOI":"10.3390\/jfb16070252"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/j.joen.2021.08.008","article-title":"Prognosis of Vital Pulp Therapy on Permanent Dentition: A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"47","author":"Sabeti","year":"2021","journal-title":"J. Endod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/iej.12629","article-title":"European Society of Endodontology position statement: Revitalization procedures","volume":"49","author":"Galler","year":"2016","journal-title":"Int. Endod. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/s41415-025-8335-x","article-title":"Endodontic S3-level clinical practice guidelines: The European Society of Endodontology process and recommendations","volume":"238","author":"Duncan","year":"2025","journal-title":"Br. Dent. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1038\/s41405-026-00404-5","article-title":"Therapeutic pulpotomy for permanent teeth with irreversible pulpitis: Comparative results from a practice-based quick poll in the USA and UK","volume":"12","author":"Colloc","year":"2026","journal-title":"BDJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yi, J.K., Kim, A.N., and Kwon, K.H. (2023). Evaluation of the reasons for preferring root canal treatment in mature permanent teeth potentially indicated for pulp preservation: A clinical case\/photo-based questionnaire study. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-03750-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1186\/s13063-023-07836-6","article-title":"Effectiveness of full Pulpotomy compared with Root canal treatment in managing teeth with signs and symptOms indicative of irreversible pulpitis: A protocol for prospectiVE meta-analysis of individual participant data of linked randomised clinical trials (PROVE)","volume":"24","author":"Duncan","year":"2023","journal-title":"Trials"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/jehp.jehp_988_20","article-title":"Effectiveness of early clinical exposure in medical education: Settings and scientific theories\u2014Review","volume":"10","author":"Tayade","year":"2021","journal-title":"J. Educ. Health Promot."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"85","DOI":"10.2147\/CCIDE.S501541","article-title":"Evaluating the Impact of Preclinical and Clinical Exposure to the Pediatric Pulpotomy Procedure on Confidence Among Senior Dental Students: An Analytical Survey Study","volume":"17","author":"Alzain","year":"2025","journal-title":"Clin. Cosmet. Investig. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/iej.13974","article-title":"Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline","volume":"56","author":"Duncan","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1136\/bmj.39339.610000.BE","article-title":"The Declaration of Helsinki","volume":"335","author":"Goodyear","year":"2007","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/iej.13688","article-title":"Present status and future directions-Vital pulp treatment and pulp preservation strategies","volume":"55","author":"Duncan","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhu, L., Liu, W., Deng, X., Chen, Z., Chen, J., and Qian, W. (2024). Full pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: A randomized controlled trial. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-05011-0"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"European Society of Endodontology (1994). Consensus report of the European Society of Endodontology on quality guidelines for endodontic treatment. Int. Endod. J., 27, 115\u2013124.","DOI":"10.1111\/j.1365-2591.1994.tb00240.x"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/iej.13080","article-title":"European Society of Endodontology position statement: Management of deep caries and the exposed pulp","volume":"52","author":"Duncan","year":"2019","journal-title":"Int. Endod. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1111\/iej.14275","article-title":"Symptom correlation and spatial distribution of inflammatory mediators in pulpitis-A preliminary study","volume":"58","author":"Loo","year":"2025","journal-title":"Int. Endod. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1016\/j.joen.2014.08.010","article-title":"Correlation between clinical and histologic pulp diagnoses","volume":"40","author":"Ricucci","year":"2014","journal-title":"J. Endod."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Abdelkhader, S., Koller, G., Kang, J., and Mannocci, F. (2025). Partial pulpotomy for carious pulp exposure in adult mature permanent teeth: A systematic review and meta-analysis. BMC Oral Health, 26.","DOI":"10.1186\/s12903-025-07408-x"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/iej.12605","article-title":"Assessment of Mineral Trioxide Aggregate pulpotomy in mature permanent teeth with carious exposures","volume":"50","author":"Taha","year":"2017","journal-title":"Int. Endod. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.joen.2017.03.033","article-title":"Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial","volume":"43","author":"Taha","year":"2017","journal-title":"J. Endod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1111\/iej.13628","article-title":"How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care?","volume":"54","author":"Edwards","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1038\/s41415-020-1419-8","article-title":"Investigating acute management of irreversible pulpitis: A survey of general dental practitioners in North East England","volume":"228","author":"Gemmell","year":"2020","journal-title":"Br. Dent. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1177\/0300060519843406","article-title":"Dentist-related factors influencing the use of vital pulp therapy: A survey among dental practitioners in China","volume":"47","author":"Li","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/iej.14149","article-title":"The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis","volume":"58","author":"Louzada","year":"2025","journal-title":"Int. Endod. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/eje.12751","article-title":"Clinical decision-making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study","volume":"26","author":"Liew","year":"2022","journal-title":"Eur. J. Dent. Educ."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ozden, I., Gokyar, M., Ozden, M.E., and Ovecoglu, H.S. (2025). Evaluation of confidence levels of undergraduate dental students in various stages of root canal treatment. BMC Med. Educ., 25.","DOI":"10.1186\/s12909-025-07174-y"},{"key":"ref_35","first-page":"ZC01","article-title":"Prevalence of Rubber Dam Usage during Endodontic Procedure: A Questionnaire Survey","volume":"8","author":"Shashirekha","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_36","first-page":"e58329","article-title":"Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study","volume":"16","author":"Bokhari","year":"2024","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"19664","DOI":"10.1038\/s41598-022-20918-w","article-title":"Outcome of pulpotomy in permanent teeth with irreversible pulpitis: A systematic review and meta-analysis","volume":"12","author":"Ather","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/s41368-024-00333-9","article-title":"Expert consensus on pulpotomy in the management of mature permanent teeth with pulpitis","volume":"17","author":"Zhang","year":"2025","journal-title":"Int. J. Oral Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1038\/s41598-024-52654-8","article-title":"Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years","volume":"14","author":"Asgary","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"368504251346677","DOI":"10.1177\/00368504251346677","article-title":"Pulpotomy for irreversible pulpitis in mature permanent teeth: An overview of systematic reviews of randomized controlled trials","volume":"108","author":"Chhabra","year":"2025","journal-title":"Sci. Prog."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/iej.12793","article-title":"Minimally invasive endodontics: A new diagnostic system for assessing pulpitis and subsequent treatment needs","volume":"50","author":"Wolters","year":"2017","journal-title":"Int. Endod. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"639","DOI":"10.5005\/jp-journals-10005-2636","article-title":"A Correlation between Clinical Classification of Dental Pulp and Periapical Diseases with its Patho Physiology and Pain Pathway","volume":"16","author":"Samir","year":"2023","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3246911","DOI":"10.1155\/ijod\/3246911","article-title":"Dental Students\u2019 Perception and Preference to Pediatric Dentistry Training","volume":"2026","author":"Almaeeni","year":"2026","journal-title":"Int. J. Dent."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Wille, E., Opheim, H.M.S., Princeton, D.M., Kisa, S., and Hjerpaasen, K.J. (2025). Building Resilience and Competence in Bachelor Nursing Students: A Narrative Review Based on Social Cognitive Theory. Nurs. Rep., 15.","DOI":"10.20944\/preprints202506.2171.v1"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hagbaghery, M.A., Salsali, M., and Ahmadi, F. (2004). The factors facilitating and inhibiting effective clinical decision-making in nursing: A qualitative study. BMC Nurs., 3.","DOI":"10.1186\/1472-6955-3-2"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:38:34Z","timestamp":1778765914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/14\/10\/1342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":45,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["healthcare14101342"],"URL":"https:\/\/doi.org\/10.3390\/healthcare14101342","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}