Vital pulp therapy (VPT) has undergone a remarkable transformation over the past decade.
Once considered a temporary or limited approach reserved for young teeth with reversible pulpitis, VPT is now emerging as a primary treatment option even in mature permanent teeth diagnosed with irreversible pulpitis.
Traditionally, root canal therapy (RCT) was the go-to treatment for deep carious lesions affecting the pulp.
However, recent scientific evidence, biomaterials innovation, and refined clinical protocols have repositioned VPT as a predictable, conservative, and biologically respectful alternative, often yielding outcomes comparable to or better than root canal procedures.
This paradigm shift is driven by:
✔ Advances in diagnostic technologies that better assess pulp vitality.
✔ The development of bioactive materials like calcium silicate cements that promote dentin regeneration.
✔ A stronger understanding of pulpal healing mechanisms and minimally invasive dentistry principles.
As a result, VPT is no longer just an interim measure—it’s a viable long-term solution.
► DENTAL BOOK: Vital Pulp Treatment – A Modern Guide to Pulp Preservation
Key Scientific Advances in VPT (2018–2025)
1. Improved Diagnostic Accuracy
Modern tools such as laser Doppler flowmetry and pulse oximetry provide a more reliable assessment of pulp vitality than traditional cold or electric tests, leading to better case selection for VPT.
✅ These methods improve detection of inflammation status, helping clinicians differentiate between reversible and irreversible pulpitis with higher precision.
2. Clinical Outcomes of VPT Techniques
A 2024 systematic review comparing the four main VPT procedures—indirect pulp capping (IPC), direct pulp capping (DPC), partial pulpotomy (PP), and full pulpotomy (FP)—reported clinical success rates above 91–97% at 24-month follow-up, even in teeth diagnosed with irreversible pulpitis.
📊 No significant differences in success were noted among the four procedures when proper case selection and materials were used.
3. Superior Bioactive Materials
A shift from calcium hydroxide to bioactive calcium silicate cements such as Mineral Trioxide Aggregate (MTA) and Biodentine has drastically improved long-term outcomes:
✔ Enhanced dentin bridge formation
✔ Better sealing ability
✔ Less pulp inflammation
✔ Reduced discoloration with Biodentine
4. Full Pulpotomy in Mature Teeth
Recent studies show that full pulpotomy using MTA or bioceramics in permanent teeth with irreversible pulpitis yields comparable success to root canal therapy, with benefits such as:
✔ Lower postoperative pain
✔ Shorter treatment time
✔ Preservation of pulpal immune defense
🔄 This finding redefines clinical decision-making and offers a minimally invasive alternative for millions of patients.
5. Regenerative Potential and Future Trends
Cutting-edge research is exploring biomimetic scaffolds, growth factors, and pulp tissue engineering, aiming to regenerate not just dentin but the entire pulp–dentin complex in the near future.
Conclusion
The last seven years have redefined vital pulp therapy. From better diagnostic accuracy to biocompatible materials and simplified protocols, VPT now stands as a frontline treatment strategy, rather than a secondary or temporary one.
Its success is grounded in evidence-based clinical practices, biologically driven approaches, and technological innovation—making it an essential tool in modern endodontics.
* As the field continues to evolve, VPT will likely expand its indications and further reduce the reliance on conventional root canal therapy, especially in younger and structurally intact teeth.
📚 Recommended Reading
- “Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta‑Analysis”
Published in 2024, this study compares IPC, DPC, PP, and FP in permanent teeth, demonstrating success rates above 90% using bioactive materials like MTA and Biodentine.
- British Dental Journal volume 238, pages 458–468 (2025). Vital pulp therapies in permanent teeth: what, when, where, who, why and how?
