Objective: To evaluate the effectiveness of mineral trioxide aggregate (MTA) on pulpotomy in primary molars. Methods: Two hundred and sixty-three cases (310 teeth) of children with early pulpitis of primary molars admitted between February 2019 to February 2022 were enrolled, and their clinical data were retrospectively analyzed. Of them, 130 cases with 155 teeth treated with root canal treatment were set as the control group (CG) and 133 cases with 155 teeth receiving MTA pulpotomy were set as the observation group (OG). Clinical data such as efficacy evaluation, inflammatory factor levels, postoperative adverse reactions, and quality of life (QoL) were compared. Results: After surgery, the overall response rate in the OG was statistically higher than that in the CG, while the levels of inflammatory factors in the OG were significantly lower than those in the CG (all P<0.05). Moreover, the total incidence of complications was significantly lower in OG at 3, 6, and 12 months after surgery (P=0.018, P=0.007, P=0.015, respectively). The QoL of the two groups differed insignificantly before surgery; however, after the treatment, the QoL in OG was significantly higher than those in the CG at 3, 6, and 12 months after surgery (P=0.037, P=0.012, P=0.028, respectively). Moreover, the teeth location and treatment method were independent factors of efficacy (P=0.047, P=0.001, respectively). Conclusions: MTA pulpotomy outperformed root canal treatment for superior efficacy in children with early pulpitis of primary molars, with a positive effect on improving QoL, and patient prognosis.