Vital pulp therapy (VPT) is a minimally invasive procedure designed to maintain the vitality of the pulp in permanent teeth, particularly in young patients. When diagnosed and performed correctly, adult pulpotomy can preserve the tooth’s natural vitality, allow continued root development, and extend the tooth’s lifespan.
Why Vital Pulp Therapy?
Goal: Preserve healthy pulp tissue, encourage natural healing, and avoid full root canal treatment (RCT).
Indication: Permanent teeth with carious or traumatic pulp exposure but with no signs of irreversible pulpitis or periapical pathology.
Step 1: Proper Diagnosis
A correct diagnosis is critical. Evaluate:
1- Pulp vitality (cold/electric pulp tests).
2- Symptoms: No spontaneous or lingering pain.
Only proceed with VPT when the pulp is healthy or reversibly inflamed.
Step 2: Isolation
Isolation is mandatory to prevent contamination:
Best approach: Place the rubber dam before any procedure.
read this guide about Rubber Dam Isolation in Dentistry
Step 3: Caries Removal
1- Most cases present with a soft dentin layer (lacerated dentin).
2- Use a sharp excavator to remove the soft dentin quickly.
Tip: Stop just before pulp exposure, then apply full-strength NaOCl on cotton to reduce bacterial load.
Step 4: Pulp Chamber Access
1- Use a clean, sterile bur to complete removal of coronal pulp tissue.
2- Alternate between sharp excavators and burs as needed.
Sterility Tip: Wipe the handpiece with alcohol every time you change the bur. Keep contaminated instruments separate and disinfect the bracket table with alcohol.
Step 5: Controlling Bleeding
Controlling bleeding is essential for success:
1- Place a cotton pellet with 2.5% NaOCl in the cavity for 1 minute.
2- Irrigate with saline.
If bleeding persists beyond 8–10 minutes:
Consider partial pulpectomy or complete pulpectomy (root canal treatment).
Step 6: Pulp Capping & Sealing
Once bleeding stops:
1- Dry the cavity.
2- Place MTA (Mineral Trioxide Aggregate) or bioceramic putty (BC putty) over the pulp.
Key Tips for Successful VPT
When to Switch to Endodontic Treatment?
1- Uncontrollable bleeding after 8–10 minutes.
2- Persistent severe pain or signs of irreversible pulpitis.
Vital pulp therapy is a conservative, biological approach to preserving natural tooth vitality, particularly beneficial for young patients with immature roots. Proper case selection, isolation, and careful technique are the keys to long-term success.