
==== Front
J Conserv Dent Endod
J Conserv Dent Endod
JCDE
J Conserv Dent Endod
Journal of Conservative Dentistry and Endodontics
2950-4716
2950-4708
Wolters Kluwer - Medknow India

JCDE-27-673
10.4103/JCDE.JCDE_338_24
Editorial
Vital pulp therapy demystified
Singh Shishir
Mulay Sanjyot 1
Editor in Chief - Journal of Conservative Dentistry and Endodontics, Dean, Professor and Head, Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India
1 Section Editor - Journal of Conservative Dentistry and Endodontics, Professor, Department of Conservative Dentistry and Endodontics, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India
Address for correspondence: Dr. Shishir Singh, Editor in Chief - Journal of Conservative Dentistry and Endodontics, Dean, Professor and Head, Department of Conservative Dentistry and Endodontics, Terna Dental College, Nerul, Navi Mumbai, Maharashtra, India. E-mail: drshishirs@gmail.com
7 2024
08 7 2024
27 7 673674
06 6 2024
06 6 2024
Copyright: © 2024 Journal of Conservative Dentistry and Endodontics
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcTherapeutic strategies for vital teeth with pulp exposure in deeply carious teeth are directed toward the preservation of pulpal vitality. For over a century, these vital pulp treatments of indirect and direct pulp capping procedures have been described.[1]

Enhanced knowledge of pulp biology and immunity coupled with continuous clinical research has led us to a better understanding of vital pulp therapy (VPT) in matured cariously involved teeth indicative of irreversibly inflamed pulp. Pulpal inflammation can be in response to either chemical, thermal, or mechanical irritation; however, the vitality of the tooth is at risk only when the pulp tissue is invaded by microbes.[2] However, as documented by some authors, in irreversible pulpitis cases, most of the pulpal tissue may not be infected or inflamed.[3,4]

With the advent of new materials such as hydraulic calcium silicate cement, more predictable treatment outcomes are possible. These materials possess favorable physicochemical characteristics such as high pH, mineralization of intratubular dentin, prevention of biofilm, decline in pro-inflammatory mediators, and reduction in pain after dental procedures involving pulp.[5,6] These effects of immunomodulation of biomaterials provide much-needed osteogenic as well as bioactive properties.[7,8,9] Hence, the selection of a suitable material should be dependent on available evidence directed toward a patient-centric outcome with respect to the formation of hard tissue along with the preservation of vitality of pulp.

Documented literature suggests that success rates range from 85% to 100% at 1–2 years when permanent teeth with or without symptoms in an irreversibly inflamed pulp are managed with VPT using bioceramic materials.[10,11]

Cushley et al. in 2019 stated that at 12-month patients, recall after complete coronal pulpotomy of permanent teeth affected by irreversible pulpitis due to caries, success rates of 97.4% and 95.4% clinically and radiographically were observed. However, at 36 months, there was a reduction in success rate, i.e. 93.97% clinical and 88.39% radiographic, implying a similar outcome with nonsurgical root canal treatment (NSRCT).[12] A study by Eghbal et al. in 2020 demonstrated comparable postoperative pain relief after NSRCT and full pulpotomy using biomaterials in permanent teeth. The authors reported a considerable decrease in postoperative pain at 24 h in all the study groups. In NSRCT, pain reduced from 56.5% to 13.1%, whereas in the MTA group, the pain lessened from 55.7% to 10.6% and in the CEM group from 56.7% to 12.9%.[13]

The American Association of Endodontists in 2021 published a position statement on VPT wherein they stated that irreversibly inflamed pulp tissue has the capacity to heal if the microorganisms are eliminated, even in mature permanent teeth.[14] Hence, to conclude, VPT may be prescribed as evidence-based treatment in clinical dental practice. For a predictable, consistent, and successful outcome, decision-making is of paramount importance.
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REFERENCES

1 Duncan HF Present status and future directions-vital pulp treatment and pulp preservation strategies Int Endod J 2022 55 Suppl 3 497 511 35080024
2 Möller AJ Fabricius L Dahlén G Ohman AE Heyden G Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys Scand J Dent Res 1981 89 475 84 6951246
3 Lin LM Ricucci D Saoud TM Sigurdsson A Kahler B Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology Aust Endod J 2020 46 154 66 31865629
4 Ricucci D Siqueira JF Jr. Abdelsayed RA Lio SG Rôças IN Bacterial invasion of pulp blood vessels in teeth with symptomatic irreversible pulpitis J Endod 2021 47 1854 64 34597722
5 Asgary S Shahabi S Jafarzadeh T Amini S Kheirieh S The properties of a new endodontic material J Endod 2008 34 990 3 18634932
6 Yoo JS Chang SW Oh SR Perinpanayagam H Lim SM Yoo YJ Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation: A scanning electron microscopy study Int J Oral Sci 2014 6 227 32 25012869
7 Luo Z Li D Kohli MR Yu Q Kim S He WX Effect of biodentine™ on the proliferation, migration and adhesion of human dental pulp stem cells J Dent 2014 42 490 7 24440605
8 Rechenberg DK Galicia JC Peters OA Biological markers for pulpal inflammation: A systematic review PLoS One 2016 11 e0167289. 27898727
9 Wongwatanasanti N Jantarat J Sritanaudomchai H Hargreaves KM Effect of bioceramic materials on proliferation and odontoblast differentiation of human stem cells from the apical papilla J Endod 2018 44 1270 5 29935871
10 Taha NA Khazali MA Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: A randomized clinical trial J Endod 2017 43 1417 21 28673494
11 Asgary S Eghbal MJ Bagheban AA Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: A multi-center randomized controlled trial Am J Dent 2017 30 151 5 29178761
12 Cushley S Duncan HF Lappin MJ Tomson PL Lundy FT Cooper P Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review J Dent 2019 88 103158. 31229496
13 Eghbal MJ Haeri A Shahravan A Kazemi A Moazami F Mozayeni MA Postendodontic pain after pulpotomy or root canal treatment in mature teeth with carious pulp exposure: A multicenter randomized controlled trial Pain Res Manag 2020 2020 5853412. 32676136
14 AAE position statement on vital pulp therapy J Endod 2021 47 1340 4 34352305
