Outcomes of vital pulp therapy in permanent molars treated under general anesthesia: a systematic review and meta-analysis

Vital Pulp Therapy (VPT) offers a conservative alternative to Root Canal Treatment (RCT) by preserving pulpal vitality in teeth exhibiting varying degrees of inflammation. Although VPT under local anesthesia has been extensively studied, evidence regarding its clinical performance under General Anesthesia (GA) remains limited. Therefore, this study systematically reviewed and analyzed the clinical and radiographic outcomes of VPT performed on permanent molars under GA. This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251048359). Electronic searches were conducted across PubMed, Scopus, EBSCO/CINAHL and Embase databases up to August 2026. Studies reporting clinical and radiographic outcomes of VPT in permanent molars treated under GA were included. Risk-of-bias was assessed using the Newcastle–Ottawa Scale (NOS), and the certainty of evidence was evaluated using the GRADE approach. A random effect proportion meta-analysis was conducted to estimate pooled success rates with 95% confidence intervals (CIs). Additionally, an exploratory subgroup meta-analysis was conducted across type of pulp capping material used and time to achieve hemostasis. Four studies published between 2014 and 2025 met the inclusion criteria. The pooled success rate of VPT under GA was 96% (95% CI: 0.93–0.98) with low heterogeneity overall (I² = 5.3%). Moderate to substantial heterogeneity was reported in the subgroup analysis across pulp capping materials, and hemostasis duration. Results from four observational studies indicate that VPT in permanent molars performed under GA can yield high success rates in the short- to medium-term, positioning it as a potentially promising and biologically conservative approach. Nonetheless, the very low certainty of the available evidence substantially limits confidence in these findings and precludes definitive clinical recommendations. Well-designed, randomized controlled trials are therefore warranted to provide higher-certainty evidence and establish more robust clinical guidance.