Vital Pulp Therapy Of Mature Permanent Molar With Irreversible Pulpitis

Vital pulp therapy (VPT) has been advocated for its advantages in preserving tooth vitality. In this case, a mature permanent molar diagnosed with irreversible pulpitis and asymptomatic apical periodontitis was treated by VPT. The 6-month posttreatment examination revealed periapical lesion healed. A 13-year-old patient suffered from thermal sensitivity in 36 for several months, which worsened recently with lasting for minutes post-stimulus. Intral and radiographic examination revealed 36 showed deep caries involving pulp and periapical radiolucency. Diagnosis: 36 - irreversible pulpitis with asymptomatic apical periodontitis. Treatment: direct pulp capping with iRoot bp plus and composite resin restoration for 36. At 6- and 24-months recalls, the patient was asymptomatic and radiograph confirmed resolution of periapical radiolucency. Accurate determination of pulp inflammatory status is critical for preserving mature permanent teeth with carious pulp exposure. Preoperative radiograph of 36 revealed deep caries with pulpal involvement and periapical radiolucency, suggesting pulp inflammation or necrosis. However, upon caries removal, microscopic examination demonstrated well-defined pulp architecture and robust vascularity beneath the exposure site, indicating non-inflammatory, histologically healthy residual pulp tissue. High-quality bioactive pulp capping agents could stimulate the differentiation of dental pulp stem cell into odontoblast-like cells and facilitate tertiary dentin matrix formation. VPT plays a critical role in preserving pulp vitality. Even in teeth diagnosed with irreversible pulpitis and demonstrating periapical lesions, VPT remains a viable treatment option. Direct microscopic visualization of pulp tissue enables precise assessment of pulp status, thereby guiding the formulation of optimal treatment strategies.