Vital Pulp Therapy for Endodontic Treatment of Mature Teeth: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Dental pulp is a type of connective tissue found within the hard tissues (dentine and enamel) of the teeth. When exposed to damage such as caries or tooth fracture, dental pulp is at risk of infection, which can lead to pain, necrosis, and infection of the jaw bone and surrounding tissues. Currently in permanent teeth (secondary dentition), root canal (usually compromised of a pulpectomy [removal of the vital pulp in the tooth], refilling with synthetic material, and sealing), is the most common treatment for infected pulp.Vital pulp therapy (VPT) is a potential alternative to root canal treatment (RC). VPT is a restorative dental procedure that aims to treat teeth with compromised dental pulp without the full removal or excavation of all healthy pulp tissue. It is commonly performed in primary dentition (also known as baby teeth), as primary dentition has not fully developed the apical root, but is less commonly performed in secondary dentition. VPT can include indirect or direct pulp capping (i.e., placement of a protective material over the pulp) and partial or full pulpotomy (i.e., removal of part or all of the coronal pulp). Dressings used in VPT can include resin modified glass ionomers, adhesive resins, calcium hydroxide (CaOH), mineral trioxide aggregate (MTA), and bioceramics.VPT may be of benefit to patients with secondary dentition as it may help prolong survival of the tooth, especially molar teeth. As the forces exerted on teeth during mastication (i.e., chewing) are very high, endodontically-treated teeth with RC can be at risk of structural failure. Teeth treated with RC are also at risk of loss of sensation of environmental changes (potentially leading to more or worse caries), rejection of the foreign material, reinfection, and occurrence of apical periodontitis.,Success of VPT is dependent on a variety of factors, including the amount of infected tissue, an adequate blood supply to the tooth, healthy periodontium, and the opportunity to create an appropriate coronal seal. VPT is of interest to dentists as an alternative to RC, as the ability to restore or salvage vital pulp can be beneficial to patients, despite the generally successful results with RC treatment.The purpose of this report is to evaluate the clinical evidence regarding the clinical effectiveness and safety of vital pulp therapies compared with RC, and to evaluate available cost-effectiveness data to support reimbursement decision making. Additionally, evidence-based recommendations were sought to provide guidance on the use of VPT in secondary dentition.