From Volume 51, Issue 7, July 2024 | Pages 468-473
This article discusses vital pulp therapy in the adult dentition and describes two cases where a different strategy for caries removal has been used followed by dressing with a contemporary material and tooth restoration on the same visit. A simplified guide for best practice is given.
Vital pulp therapy is an important procedure that requires clinical skill and can be undertaken in general practice.
Preserving the vitality of the dental pulp is a key factor for long-term tooth survival. Vital pulp therapy (VPT) is designed to preserve and maintain the vitality of the pulp tissue in a tooth that has been compromised by trauma, caries, or restorative procedures. The objective is to protect and encourage healing of the areas of the pulp that are reversibly inflamed, while stimulating the formation of tertiary dentine to retain the tooth as a functional unit. The procedures of VPT range from conservative treatments including indirect and direct pulp capping, to more invasive treatments including partial pulpotomy and full pulpotomy.1,2
The decision when to perform vital pulp treatment is dependent upon the histology of the pulp in response to insult. Historically, it has been reported that the histological condition of the pulp could not be determined from clinical symptoms.3 However more recent evidence4 indicates that specific symptoms reflect histological findings with good concordance (Table 1). It is worth noting though that pulpitis is not uniform across the entire pulp and histology will show areas of reversible pulpitis and areas of irreversible pulpitis. Therefore, the decision to categorize a pulp as reversibly or irreversibly inflamed does not determine the actual potential for the inflamed tissue to repair.5
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