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Vital pulp therapy (VPT) aims to preserve pulpal sensation. Historically VPT was considered a treatment option for deciduous teeth or young immature permanent teeth. Carious pulp exposure in permanent mature teeth was considered a contraindication for VPT and warranted root canal treatment (RCT). Recently, VPT has been used for management of carious pulp exposures in mature permanent teeth, with good outcomes, even in the presence of clinical signs and symptoms suggestive of irreversible pulpitis. VPT is a simple and conservative alternative to root canal treatment in a few clinical situations. It is imperative that dentists understand its indications and techniques.
CPD/Clinical Relevance: The reader should understand the evidence-based changes in approach to VPT and the future direction of this treatment modality.
Article
Conventionally, when a mature permanent tooth has been compromised by caries, and pulp exposure is inevitable, traditional treatment would be in the form of pulp extirpation and root canal treatment (RCT) before restoring the tooth to function and aesthetics.1 This approach is underpinned by the acceptance that the cariously exposed pulp is irreversibly damaged even after removal of the noxious stimulus.2 However, RCT can be challenging and requires both clinical training and the use of dedicated equipment, particularly in the case of multi-rooted teeth. Heavily restored molar teeth, complex anatomy, curved and narrow canals, long and thin roots and difficult access to posterior teeth may make conventional root canal treatment challenging.3 Cross-sectional studies have demonstrated suboptimal outcomes for root canal treatment provided by general dental practitioners (GDPs).4–6 Therefore, a treatment option to successfully manage deep caries and carious pulp exposure that is conservative, appropriate for primary care and demonstrates a favourable outcome would be welcomed.
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