Vital Pulp Therapy versus Root Canal Treatment in Permanent Teeth with Irreversible Pulpitis – Current Evidence and Clinical Perspectives

Abstract Root canal treatment (RCT) has long been regarded as the gold standard for managing teeth diagnosed with irreversible pulpitis or pulpal necrosis. However, advances in biomaterials and the biological understanding of pulp healing have revived interest in vital pulp therapy (VPT), a biologically driven approach aimed at preserving pulp vitality. Modern calcium silicate-based bioceramic materials such as mineral trioxide aggregate, biodentine, and calcium-enriched mixture cement have demonstrated superior sealing ability, biocompatibility, and regenerative potential compared with traditional materials such as calcium hydroxide. Recent randomized clinical trials and observational studies suggest that in selected cases, VPT may achieve clinical outcomes comparable to RCT while offering advantages such as tooth structure preservation, reduced chairside time, and lower treatment costs. This review synthesizes the biological basis, materials, techniques, clinical scenarios, outcomes, and limitations of VPT compared to RCT, highlighting evidence from contemporary literature. Patient-centered considerations, including pain management and cost-effectiveness, are explored, and future directions such as regenerative endodontics and tissue engineering are discussed. The review concludes that VPT, when performed under proper case selection and with modern bioactive materials, represents a promising minimally invasive alternative to RCT in certain clinical scenarios.