Vital pulp therapy for permanent teeth with diagnosis of irreversible pulpitis: biological basis and outcome

Abstract

Root canal treatment (RCT) has been considered the conventional standard for the management of teeth with carious pulp exposure, particularly in mature teeth presenting with symptoms. Following a better understanding of the histopathology of deep carious lesions, the histology of the cariously exposed pulp and the healing potential of the inflamed pulp, vital pulp therapy (VPT) is increasingly adopted around the world for the management of permanent teeth with clinical signs and symptoms indicative of irreversible pulpitis. Furthermore, VPT became a recognized treatment modality by the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) by virtue of its high success rates reported in outcome studies using contemporary hydraulic calcium silicate‐based cements. However, proper case selection, strict asepsis, capping materials and good coronal seal are mandatory for success. The aim of this paper is to review the biological basis for VPT in symptomatic teeth with carious pulp exposure and to report on the outcome of pulpotomy in teeth with clinical diagnosis of irreversible pulpitis.

Managing failed vital pulp therapies in mature permanent teeth in a retrospective cohort study, with success and survival rates of managing protocols

“…Although the occurrence of pulp canal calcification (PCC) after VPT is recognized as a potential complication 21 , significant calcifications are not expected to occur within a short observation period. While some researchers/clinicians suggest that retreatment of a failed pulpotomy may be perceived as an easier procedure than managing a tooth with filled root canal treatments 22 , the current evidence on the incidence, magnitude, and influential factors of PCC in VPT-treated teeth remains insufficient 21 . Importantly, even if calcification occurs in root canals after VPT, it tends to manifest as canal narrowing rather than complete obliteration, making it generally manageable considering the advancements in endodontic techniques 22 .…”

Effectiveness of TheraCal LC versus MTA in Vital Pulp Therapy of Cariously-Exposed Young Permanent Molars: Five-Year Follow up of a Randomised Clinical Trial

“…Accurate diagnosis of pulp inflammatory status before treatment could affect the results of pulpotomy. However, several studies have reported the successful outcome of VPT for irreversible pulpitis [14,25,26], and this would exclude misdiagnosis of pulp inflammation from the causes of pulpotomy failure.…”

Understanding the Dynamics of Inflammatory Cytokines in Endodontic Diagnosis: A Systematic Review

“…There is still general doubt on classifying pulpitis (irreversible, partial irreversible, reversible) when the histological findings do not meet the symptoms or signs that the patient presents with. [23,24].…”