Vital pulp treatments in teeth with deep carious
lesions
Helena Fransson, Lina Stangvaltaite-Mouhat,
Katri Croft, Athanasia Bletsa and Lars Bjørndal
Tandläkartidningen 2023; 115 (2): 56–62
Vital pulp treatments (VPT) are performed to pre-
serve the defense functions of the pulp, and thus
to avoid pulpectomy and root filling, which can be
technically demanding and do not always result in
the desired outcome. The European Society of En-
dodontology (ESE) has published a position paper on
VPT in teeth with deep carious lesions, which part-
ly adheres to national guidelines in Nordic countri-
es. There are unsolved difficulties in assessing the
pulpal status in teeth with deep carious lesions. If
the carious lesion has not reached the pulp, treat-
ments performed to avoid pulp exposure, such as
stepwise excavation, are recommended. On the
other hand, when the pulp is exposed due to caries,
the recommendations vary between the ESE and
the national Nordic countries guidelines. This is
most probably due to the lack of evidence favoring
one treatment over the other, and due to difficult-
ies in assessing, which exposed pulps are irrever-
sibly damaged. Minimally invasive management
strategies with recently developed hydraulic cal-
cium silicate cements show promising results for
VPTs aimed at avoiding root canal treatment. VPTs
will be further developed and changes to clinical
recommendations are anticipated.