Which finding would most strongly suggest failure after a pulpotomy in a primary tooth?

• A. Absence of spontaneous pain
• B. Maintained periapical health
• C. Persistent gingival recession only
• D. Radiographic evidence of periapical radiolucency or pathology

Answer: (D)

In pulpotomy outcomes for primary teeth, the strongest indication of failure is radiographic evidence of pathology at the periapical area. When a radiograph shows periapical radiolucency or other periapical pathology, it reveals that infection persists or has spread beyond the coronal treatment, meaning the radicular pulp isn’t healing and the procedure has not been successful. Clinical signs like absence of spontaneous pain can be misleading because a tooth can fail without symptoms, and maintaining periapical health on an X-ray is a sign of success. Persistent gingival recession alone doesn’t directly reflect the success of the pulpotomy in the tooth.