Background <p>Advancements in technology have enabled successful outcomes to be achieved in primary tooth pulpotomy treatments using various materials. This randomized clinical trial aimed to compare the 12-month clinical and radiographic success rates of three calcium silicate-based cements with different physical forms in primary tooth pulpotomy.</p> Methods <p>A total of 112 primary second molars from 70 children were block-randomized into three groups: ProRoot^® MTA (powder–liquid form, <i>n</i> = 38), NeoPutty^® (ready-to-use putty form, <i>n</i> = 36), and TheraCal PT^® (light-cured, resin-modified calcium silicate, <i>n</i> = 38). Teeth underwent pulpotomy followed by stainless steel crown restoration. Clinical and radiographic success rates were evaluated at 1, 3, 6, and 12 months. Statistical analysis was performed at a significance level of 0.05.</p> Results <p>At the 12-month follow-up, the clinical and radiographic success rates were 97.2% and 91.7% for NeoPutty^® MTA, 97.4% and 84.2% for ProRoot^® MTA, and 91.9% and 67.6% for TheraCal PT^®, respectively. Radiographically, TheraCal PT^® demonstrated significantly lower success compared to the other materials (<i>p</i> = 0.026).</p> Conclusion <p>Although the light-cured TheraCal PT^® demonstrated clinical outcomes comparable to those of MTA-based materials, its inferior radiographic performance raises concerns regarding its long-term effectiveness.</p> Trial registration <p>The study was registered retrospectively at ClinicalTrials.gov (<a href="https://clinicaltrials.gov">https://clinicaltrials.gov</a>) with the ID NCT06874062 (2025-03-03).</p>