Diagnosis dilemmas in vital pulp therapy: treatment for the toothache is changing, especially in young, immature teeth.

The literature is almost devoid of scientific studies of diagnosis of pulpal pathology in primary and permanent teeth with open apices. Most reports are empirical or retrospective studies without adequate prior knowledge of preexisting conditions or histologic findings leading to the necessity of pulpal procedures. Appropriate diagnostic tests and their effectiveness are documented for both groups. This article reviews the available literature and current techniques of indirect pulp therapy, pulp capping, and pulpotomy for primary teeth and permanent teeth with open apex. The apical barrier with mineral trioxide aggregate followed by root strengthening with bonded composite is reviewed.