Which of the following is a major contraindication for performing a pulpotomy?

A major contraindication for performing a pulpotomy is the presence of pulpal necrosis. A pulpotomy is a common procedure used in pediatric dentistry and involves the removal of the coronal portion of the pulp, usually in a tooth with irreversible pulpitis, to preserve the vitality of the remaining pulp tissue. If the pulp is necrotic, it indicates that the tissue is dead or dying, rendering the procedure ineffective and inappropriate since the health of the tooth cannot be maintained.

In cases of pulpal necrosis, the appropriate treatment is usually a pulpectomy or extraction, depending on the clinical situation. This distinction is crucial because a pulpotomy is intended to treat a tooth with a functioning pulp, while necrosis signifies a failure of the pulp’s ability to function normally.

The presence of primary teeth does not contraindicate a pulpotomy, as this procedure is often performed on primary teeth as a routine treatment. Good oral hygiene is generally a positive factor and does not impede the ability to perform a pulpotomy. The absence of tooth pain can also occur in cases where the pulp is necrotic; however, it does not automatically contraindicate the procedure, as other factors such as clinical findings and diagnostic tests provide better insight