Conservative Management of Mature Permanent Teeth with Carious Pulp Exposure

Vital pulp therapy (VPT) in mature permanent teeth with carious pulp exposure has been a matter of debate, with root canal therapy being the conventional standard of care. Previously reported negative outcomes for VPT in these teeth were based on data from studies that have used calcium hydroxide in direct pulp capping and partial and full pulpotomy. The introduction of hydraulic calcium silicate-based materials with sealing and bioactive potentials have opened a new era in VPT with more favorable results. Understanding the histopathology and histobacteriology of the cariously exposed pulp and the healing potential of the inflamed pulp could guide the decision-making process toward an ultraconservative management of these teeth. However, proper case selection, strict aseptic condition, capping material, and good coronal seal are crucial for long-term success.