Tooth discolouration is addressed as a serious consequence of different traumatic injuries as well as an undesirable outcome of various dental and maxillofacial treatments. In addition, the colour changes of teeth are one of the major concerns and chief complaints of dental patients, specifically when the corresponding injuries and/or treatments occur in the aesthetic zone. Endodontic therapy plays a major role in the formation of discolouration inside and outside the involved teeth since the dehydration of dental structure and the use of different biomaterials in Endodontics and related treatments have shown to result in the creation of colour changes in the involved tooth. Vital pulp therapy (VPT) modalities, as ultraconservative approaches in Endodontics, have demonstrated to simplify endodontic procedures and seem to be able to preserve the dental tissue; however, it has been shown that pulp bleeding and (bio)materials used in VPT could cause different degrees of tooth discolouration mainly due to the residual blood products and components within the formula of the (bio)material, penetrating deep into dentinal tubules while changing the colour of the remaining structure. Consequently, when VPT modalities are considered for the treatment of compromised pulp, their pitfalls should be thoroughly elaborated, especially when the aesthetic zone is involved. Therefore, a thorough understanding of potential factors causing tooth discolouration and possible preventive measures in VPT is mandatory to prevent tooth colour changes, particularly in the anterior teeth or sites where aesthetics is of utmost importance.