SP-30 - Outcome of Vital Pulp Therapy in Permanent Mature Teeth with Pulpitis: Myths and Facts

The purpose of vital pulp therapy (VPT) is to maintain the health of all or part of the pulp in normal or inflamed pulps. This group of treatments includes direct pulp capping, partial and full pulpotomy. For decades, VPT has been recommended and widely accepted as treatment for mechanical or carious pulp exposure of permanent immature teeth, with pre-operative diagnosis of normal pulp or pulpitis, to assure completion of root formation (apexogenesis). Over the past decade, advancements in our understanding of pulp biology coupled with the development of new bioactive materials have expanded the indications for VPT. Recent high-quality scientific evidence encouraged clinicians, and also endodontic associations, to suggest VPT as a predictable approach for treatment of mature permanent teeth with preoperative inflammation, in order to conserve the pulp’s protective mechanisms and great healing capacities. Notably, pulpotomy now offers a viable alternative to traditional root canal treatments for mature permanent teeth with symptomatic irreversible pulpitis.
The success of VPT greatly depends on i) the absence of microorganisms, and ii) the pulpal immunocompetence/level of inflammation. Presently, these conditions cannot be reliably assessed through clinical methods alone. Consequently, it is essential to integrate meticulous pre-operative pulp diagnosis with careful intraoperative assessment of pulp tissue to ensure proper case selection. Furthermore, strict adherence to established operative protocols is crucial to improve treatment outcomes.