Vital pulp treatments (VPT) are performed to preserve 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 Endodontology (ESE)
has published a position paper on VPT in teeth with deep carious
lesions, which partly s to national guidelines in Nordic countries.
There are unsolved difficulties in assessing the pulpal status in teeth
with deep carious lesions. If the carious lesion has not reached the
pulp, treatments performed to avoid pulp exposure, such as stepwi-
se 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 pro-
bably due to the lack of evidence favoring one treatment over the
other, and due to difficulties in assessing, which exposed pulps are
irreversibly damaged. Minimally invasive management strategies
with recently developed hydraulic calcium silicate cements show
promising results for VPTs aimed at avoiding root canal treatment.
VPTs will be further developed and changes to clinical recommen-
dations are anticipated.