Reviving vs Replacing the Pulp – Clinical Insights into Vital Pulp Therapy and Root Canal Treatment for Irreversible Pulpitis

Root canal treatment (RCT) has traditionally been considered the benchmark for treating teeth diagnosed with irreversible pulpitis or pulpal necrosis. Yet, with advancements in biomaterials and a deeper understanding of pulp biology, there has been a renewed focus on vital pulp therapy (VPT) as a biologically oriented alternative designed to maintain pulp vitality. The introduction of modern calcium silicate–based bioceramics, including mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM) cement, has enhanced the clinical success of VPT due to their superior sealing capacity, excellent biocompatibility, and regenerative potential, surpassing conventional options such as calcium hydroxide. Current randomized clinical trials and observational research indicate that, in carefully selected cases, VPT can deliver outcomes comparable to RCT, with added benefits such as conservation of tooth structure, shorter treatment duration, and lower cost. This review consolidates evidence on the biological rationale, biomaterials, procedural techniques, clinical indications, success rates, and inherent limitations of VPT versus RCT. It also emphasizes patient-centered aspects such as pain management and economic feasibility, while exploring future directions including regenerative endodontics and tissue engineering. Overall, the review underscores that with appropriate case selection and the use of contemporary bioactive materials, VPT stands as a minimally invasive and promising alternative to conventional RCT in specific clinical scenarios.