Vital pulp therapies in permanent teeth: what, when, where, who, why and how?

The dentine-pulp complex is a unique organ that provides nourishment to the dentine and supports the tooth's innervation and defence system. Preserving its health is a key aspect of minimally invasive dentistry. Vital pulp therapies (VPTs), as defined by the European Society of Endodontology, are 'treatment strategies aimed at maintaining the health of all or part of the pulp'. These therapies are particularly useful when pulp inflammation, caused by caries or trauma, threatens pulp vitality and may otherwise lead to necrosis and the need for invasive treatment. VPTs offer several advantages, including the retention of the pulp's immunological functions, maintenance of the structural integrity of the tooth, reduced patient pain and simplified treatment protocols. Additionally, these therapies lower the costs and inconvenience associated with more invasive treatments, benefiting both patients and society. A range of protocols and key factors promoting successful outcomes have been described to guide dental practitioners in adopting VPTs where appropriate. Future considerations for pragmatic research and implementation in primary care are essential to create a sustainable use of VPTs, thus promoting better oral health.