Vital pulp therapy for the mature tooth – can it work?

The dental pulp can be exposed by accidental trauma to a tooth, or by the dentist preparing a tooth for a restoration. When the exposure occurs during cavity preparation, it can be diagnosed as mechanical or carious. The pulp typically is inflamed in either instance, because a mechanical exposure rarely occurs except during removal of a deep restoration or through overzealous excavation of deep caries. Pulpectomy and root canal therapy represent the optimal treatment for carious or mechanically exposed pulps in mature teeth. However, financial considerations or low dental IQ result in some patients refusing the optimal treatment. In our opinion, extraction is not the correct alternative treatment plan for these patients. This paper describes the indications, clinical techniques, and prognosis for three types of vital pulp therapy in the mature tooth – direct pulp capping, partial pulpotomy, and full pulpotomy.