Traumatic dental injuries (TDIs) of teeth occur frequently in children and adolescents. TDIs that impact the periodontal tissues and alveolar tissue can be classified into concussion, subluxation, extrusive luxation, intrusive luxation, lateral luxation, and avulsion. In these TDIs, management of injured soft tissue, mainly periodontal ligament, and dental pulp, is crucial in maintaining the function and longevity of the injured teeth. Factors that need to be considered for management in laxation injuries include the maturation stage of the traumatic teeth, mobility, direction of displacement, distance of displacement, and whether there are alveolar fractures. In avulsion, the maturation stage of the permanent tooth, the out-socket time, storage media/condition of the avulsed tooth, and management of the PDL should also be considered. Especially, in this review, we have subdivided the immature tooth into the adolescent tooth (Nolla stage 9) and the very young tooth (Nolla stage 8 and below). This consensus paper aimed to discuss the impacts of those factors on the trauma management and prognosis of TDI to provide a streamlined guide for clinicians from clinical evaluation, diagnostic process, management plan decision, follow-up, and orthodontic treatment for tooth luxation and avulsion injuries.

Calcium silicate-based cements are biocompatible materials for vital pulp therapy. However, they discolour the tooth tissue, which is important for the aesthetics of the anterior teeth. The aim of this study was to investigate the effect of calcium silicate-based cements on tooth discolouration. The study included 70 extracted bovine incisors. The crown of the tooth was cut off from the root, 2 mm below the cement-enamel junction. The pulp tissue was removed via a cervical cut with a barbed broach. The teeth were randomly divided into five experimental, one positive, and one negative control groups. The evaluated materials included Biodentine, Ortho MTA, Retro MTA, MTA Plus, MTA Repair HP, and in the positive group, ProRoot MTA. A VITA Easyshade Compact 5.0 spectrophotometer was used before the application, after 1 week, 1 month, 3 months, and 6 months. The significance levels were set at p < 0.05. All materials significantly changed the teeth colour (p < 0.05). However, Ortho MTA, ProRoot MTA, MTA Plus, and Biodentine (ΔE > 6) caused maximum colour change after 6 months. While the ProRoot MTA, Ortho MTA, and MTA Plus caused grey discolouration, Biodentine darkened the shade of the base colour. Thus, Retro MTA and MTA Repair HP can be safely used in the aesthetic dentition zone. According to these clinical results, the possibility of using Biodentine, due to its lack of gray discoloration, can be considered.

<b>Purpose:</b> To develop permanent tooth vital pulp therapy (VPT) recommendations. <b>Methods:</b> GRADE framework recommendations developed from systematic review data of permanent tooth VPT through June 30, 2024. <b>Results:</b> Teeth with deep caries (extending to inner third or quarter of dentin with intact dentin barrier) diagnosed with normal pulp or reversible pulpitis (NP/RP) can be treated either with indirect pulp treatment (IPT), direct pup cap (DPC), partial pulpotomy (PP), or full pulpotomy (FP) (conditional recommendation, low certainty). Selective caries removal for IPT is strongly recommended (high certainty) for deep caries in NP/RP diagnosed teeth. In case of pulp exposure either DPC, PP, or FP using calcium silicate cement (CS) may be performed regardless of root maturation (conditional recommendation, low certainty). Using sodium hypochlorite (NaOCl) irrigation is strongly recommended for DPC hemostasis (high certainty) over saline and conditionally recommended (very low certainty) for pulpotomy. For permanent teeth with extremely deep caries (no discernible radiographic barrier) or deep carious teeth exhibiting spontaneous, nocturnal, or lingering pain but normal periapical appearance, complete (nonselective) caries removal to expose the pulp for assessment is strongly recommended (moderate certainty). If pulpotomy is indicated in these teeth, FP using CS is recommended over PP (conditional; low certainty). Also, PP and FP success will likely be higher if hemostasis occurs within six minutes (conditional; low certainty). Using magnification likely enhances pulp visualization, facilitating more accurate assessment of its status. Teeth with NP/RP having traumatic exposures, PP/FP is conditionally recommended over DPC. Using nonstaining CS is strongly recommended (high certainty) for VPT on teeth in esthetic areas. <b>Conclusions:</b> Selective caries removal is recommended for teeth having deep caries with NP/RP. CS utilization is recommended for DPC, PP, and FP using NaOCl for hemostasis. Complete caries removal and assessment of pulp status is recommended for teeth exhibiting spontaneous, nocturnal, or lingering pain; if pulp is diagnosed as vital and bleeding is controlled, FP is recommended.

Background: Vital pulp therapy (VPT) is essential for preserving the vitality of young permanent teeth. This systematic review and meta-analysis aimed to compare the efficacy of Biodentine with other bio-ceramic materials, specifically evaluating clinical success, radiographic success and tooth discoloration outcomes. Methods: A comprehensive literature search was performed in PubMed, Embase, Web of Science and The Cochrane Library databases for randomized controlled trials (RCTs) comparing Biodentine with other bio-ceramic materials in VPT for permanent teeth until 01 November 2024. Two independent reviewers screened studies based on predefined inclusion and exclusion criteria. Eligible RCTs were assessed for risk of bias, following data were extracted and the meta-analysis was performed. Results: A total of 8 RCTs met the inclusion criteria. The meta-analysis revealed that clinical success rates for Biodentine were 99.38% at 6 months, 94.20% at 12 months and 87.38% at 18 months. Other bio-ceramic materials achieved clinical success rates of 98.15%, 92.59% and 88.35% at the same time intervals. Radiographically, Biodentine demonstrated an overall success rate of 93.87%, compared to 91.04% for other bio-ceramic materials. No significant differences were observed in clinical or radiographic success rates between Biodentine and other materials over 6–18 months of follow-up (p &gt; 0.05). However, Biodentine exhibited a significantly lower tooth discoloration rate compared to mineral trioxide aggregate (MTA) at the final follow-up (p &lt; 0.05). Conclusions: Biodentine showed clinical and radiographic success rates comparable to other bio-ceramic materials in VPT for young permanent teeth, with the added advantage of significantly reducing the incidence of tooth discoloration. The PROSPERO Registration: number CRD42024599307.

Vital pulp therapy (VPT) has gained prominence with the increasing trends towards conservative dental treatment with specific indications for preserving tooth vitality by selectively removing the inflamed tissue instead of the entire dental pulp. Although VPT has shown high success rates in long-term follow-up, adverse effects have been reported due to the calcification of tooth canals by mineral trioxide aggregates (MTAs), which are commonly used in VPT. Canal calcification poses challenges for accessing instruments during retreatment procedures. To address this issue, this study evaluated the mechanical properties of dural substitute intended to alleviate intra-pulp pressure caused by inflammation, along with assessing the biological responses of human dental pulp stem cells (hDPSCs) and human umbilical vein endothelial cells (HUVECs), both of which play crucial roles in dental pulp. The study examined the application of dural substitutes as pulp capping materials, replacing MTA. This assessment was conducted using a microfluidic flow device model that replicated the blood flow environment within the dental pulp. Computational fluid dynamics simulations were employed to ensure that the fluid flow velocity within the microfluidic flow device matched the actual blood flow velocity within the dental pulp. Furthermore, the dural substitutes (Biodesign; BD and Neuro-Patch; NP) exhibited resistance to penetration by 2-hydroxypropyl methacrylate (HEMA) released from the upper restorative materials and bonding agents. Finally, while MTA increased the expression of angiogenesis-related and hard tissue-related genes in HUVEC and hDPSCS, respectively, BD and NP did not alter gene expression and preserved the original characteristics of both cell types. Hence, dural substitutes have emerged as promising alternatives for VPT owing to their resistance to HEMA penetration and the maintenance of stemness. Moreover, the microfluidic flow device model closely replicated the cellular responses observed in live pulp chambers, thereby indicating its potential use as an in vivo testing platform.

<h4>Background</h4>Summarizing the association between patient age and vital pulp therapy (VPT) outcomes is important to improve clinical decision-making.<h4>Objectives</h4>To investigate whether patient age is a predictor of VPT success/survival, using a research question based on the PICOTS acronym: (P) participants presenting mature permanent teeth undergoing VPT; (I) participants age; (C) gender, systemic condition, preoperative symptoms/diagnosis, caries extent/location, restoration extent/type, bleeding time; (O) clinical and radiographic success/survival; (T) data collected immediately before and during the clinical procedure and follow-up performed at least 1 year later; (S) clinical trials and observational studies developed in dental schools and services.<h4>Methods</h4>PubMed, EMBASE, Lilacs and Web of Science databases were searched for studies published from inception to 29 June 2024. Two independent reviewers selected and extracted data; senior reviewers resolved disagreements. Study characteristics were tabulated, and a meta-analysis was conducted, using RevMan software. The QUIPS tool assesses the risk of bias, whilst the GRADE criteria assess the certainty of evidence.<h4>Results</h4>Thirty-four studies were included in the qualitative synthesis, and 23 in the meta-analysis. Bivariate associations showed higher direct pulp capping (DPC) success rates for participants younger than 40 years [OR = 4.85, 95% CI (2.27-10.39)]. The association between age and full pulpotomy (FP) + partial pulpotomy (PP) survival was not significant in multivariate meta-analysis [HR = 1.02, 95% CI (0.98-1.05)]. Bias related to outcome measurements, confounding/statistical analysis and reporting were the main concerns of the studies' quality, and the overall risk of bias was moderate to high. The certainty of the evidence was very low for the analysis of the DPC 25-year-old cut point, high for the multivariate analysis and moderate for the other analysis.<h4>Discussion</h4>Age did not influence PP and FP outcomes. In contrast, it is associated with DPC success, probably influenced by difficulties during direct inspection of pulp tissue. Further studies with multivariate-adjusted analyses are required to improve the certainty of the evidence.<h4>Conclusions</h4>Patient age is not associated with the outcomes of PP and FP in permanent teeth but should be considered a risk predictor for patients over 40 years old undergoing DPC.<h4>Registration</h4>CRD42021273826 (PROSPERO).

ABSTRACT Background: Vital pulp treatment (VPT) is an essential clinical intervention used to maintain the integrity of the tooth pulp in situations with severe carious lesions. Due to their bioactivity, sealing ability, and compatibility with pulp tissues, bioceramic materials have attracted considerable interest. Materials and Methods: This research included a sample of 100 individuals who had acquired deep carious lesions. The participants were randomly allocated into two groups: Group A (n = 50) had ventral prosthetic treatment (VPT) using a bioceramic material, whereas Group B (n = 50) underwent VPT with a traditional calcium hydroxide-based material. Initial, 6 months, 12 months, and 24 months after treatment, clinical and radiographic assessments were conducted. The main outcome measures consisted of dental pulp vitality, lack of discomfort, and radiographic evidence of the development of a hard tissue barrier. Results: By the 24-month follow-up, 92% of the teeth in Group A, which used bioceramic material, retained their pulp vitality, but just 80% of the teeth in Group B, which used calcium hydroxide, did the same. Significantly reduced rates of postoperative discomfort were seen in Group A (10%) compared to Group B (25%). The radiographic examination revealed that 88% of patients in Group A displayed effective creation of a hard tissue barrier, whereas only 72% of cases in Group B exhibited comparable results. Conclusion: The research verifies that bioceramic materials provide better long-term results in vital pulp treatment for severe carious lesions as compared to traditional materials based on calcium hydroxide.

<h4>Purpose</h4>Nonsurgical root canal therapy (NSRCT) is indicated for management of permanent teeth diagnosed with symptomatic irreversible pulpitis. However, recent research has suggested that vital pulp therapy (VPT) may be a less invasive option in these cases. The purpose of this systematic review was to evaluate the outcomes of VPT, using hydraulic calcium silicate cements (HCSCs) including complete and partial pulpotomies in permanent posterior teeth with symptomatic irreversible pulpitis.<h4>Materials and methods</h4>The PRISMA recommendations were adhered to. The search approach used electronic databases from PubMed, EMBASE, the Cochrane Library, and grey literature. The Newcastle-Ottawa Scale, ROBINS-I, and Cochrane Collaboration Risk of Bias tools were used to evaluate the quality of the selected studies.<h4>Results</h4>The initial database search turned up 142 papers, of which 3 prospective cohort studies and 9 randomised controlled trials were selected for analysis. For three, seven, and two articles, the risk of bias was rated as 'high' or 'serious,' 'fair,' and 'low,' respectively. The success rates for VPT using HCSCs typically ranged from 78% to 90% one to five years following VPT. The results of the VPT and NSRCT were equivalent at one and five years, according to two articles. Although the intra-operative pulp assessment is essential for VPT treatments, most studies did not provide a thorough account of this process or the time required to achieve haemostasis. Three studies reported sample sizes that were 23 teeth. The 12 studies that were analysed revealed successful VPT procedures using HCSCs in permanent posterior teeth that had symptomatic irreversible pulpitis, with radiographic success rates ranging from 81% to 90%. Two articles claimed that the results of VPT and root canal therapy were equivalent.<h4>Conclusion</h4>When considering VPT as an alternative to NSRCT, appropriate case selection and outcome criteria must be created. This data highlights the need for additional studies contrasting the longer-term effects of different treatment regimens.

Purpose: To determine factors affecting permanent tooth vital pulp therapy (VPT) success from a systematic review (SR) and metaanalyses. Methods: SRs of databases were completed through June 2024, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for the certainty of evidence. Results: The 24-month indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP), and full pulpotomy (FP) successes (91 to 97 percent) were not statistically different (P=0.19) in teeth diagnosed with normal pulp/reversible pulpitis (NP/RP). IPT (94 percent) versus DPC (87 percent) success at 36 months was not significantly different when calcium silicate cement (CS) was used for DPC in teeth diagnosed with NP/RP (P=0.10). PP success versus DPC was equal (96 percent) after 24 months in teeth diagnosed with NP/RP if CS was used for DPC. Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not. One study's data on the five-year success rate for FP in teeth with SIP was 78 percent, and teeth without PPI showed significantly increased success (P=0.04). PP/FP success (90 percent) in teeth with SIP was not significantly different versus PP/FP success (97 percent) in NP/RP teeth (P=0.054). Selective caries removal minimized pulp exposures in teeth with deep caries diagnosed with NP/RP. For teeth diagnosed with SIP or extremely deep caries, complete caries removal is recommended to expose the pulp. If pulpal bleeding is controlled, it is recommended to perform a full pulpotomy. Hemo- stasis within six minutes likely improves pulpotomy success. Mineral trioxide aggregate was found to discolor teeth significantly more (83 percent) than Biodentine (zero percent) containing no bismuth oxide (P<0.001) PP/FP were significantly more successful for traumatic pulp exposures than DPC (P ≤ 0.001). Root maturity did not affect PP/FP success for NP/RP teeth. Conclusions: All vital pulp therapy methods are successful for teeth diagnosed with normal pulp/reversible pulpitis. Teeth diagnosed with symptomatic irreversible pulpitis can be treated successfully with a full pulpotomy.

Vital pulp therapy (VPT) is a biologically conservative alternative to root canal treatment in mature permanent teeth; however, variability in success rates and uncertainty regarding prognostic and procedural factors necessitate higher-order evidence synthesis. This umbrella review aimed to synthesize systematic reviews evaluating determinants of VPT outcomes in cariously exposed mature permanent teeth, and to appraise methodological quality and primary study overlap. Electronic searches across major databases and grey literature were conducted. Methodological quality was assessed using AMSTAR-2, and overlap quantified using the corrected covered area (CCA). Fourteen reviews were included, with moderate overlap and predominantly low to critically low confidence. Material-related factors showed the most consistent association, with hydraulic calcium silicate-based materials reporting higher success. Other factors showed inconsistent or non-significant effects. Delayed restoration reduced success, and follow-up duration influenced outcomes. Material selection appears the most consistent determinant, although overall evidence certainty remains limited. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD420251275599.

<h4>Objectives</h4>Vital pulp therapy (VPT) is shifting from traditional materials toward regenerative strategies that modulate inflammation and stimulate angiogenesis. This review evaluates scaffold-based, scaffold-free, and cell-laden approaches targeting immunomodulatory and angiogenic responses in dental pulp regeneration.<h4>Materials and methods</h4>systematic search up to April 2025 in PubMed, Embase, and Scopus identified in vivo studies assessing VPT outcomes. Included interventions were direct pulp capping or pulpotomy using bioactive scaffolds, biomolecules, or stem cell-laden matrices. Outcomes included histologic or molecular markers of immunomodulation and angiogenesis. Risk of bias was assessed using the SYRCLE tool.<h4>Results</h4>Twenty-six studies met the inclusion criteria. Scaffold-based delivery of Resolvin E1/lipoxin A4, Nell-1, and Nell-1/BMP-2 suppressed key inflammatory mediators and promoted M2 macrophage polarization. Angiogenesis was enhanced by cell-laden scaffolds containing dental pulp stem cells, bone marrow mesenchymal stem cells, or endothelial cells, leading to consistent pulp-like tissue regeneration. However, most studies had short follow-ups, high or unclear bias risk, and methodological heterogeneity, precluding meta-analysis. Interpretation of these findings should be undertaken with caution due to substantial heterogeneity in study design, outcome assessment methods, and evaluation time points.<h4>Conclusions</h4>Biomolecule-loaded and stem cell-laden scaffolds show preliminary promise in modulating inflammation and promoting vascularization in animal models of VPT. However, evidence remains limited by short-term outcomes and inconsistent methods.<h4>Clinical relevance</h4>Scaffold-based delivery of Resolvin E1, Lipoxin A4, or Nell-1/BMP-2, and stem cell-laden matrices (e.g., DPSCs, BMSCs) may enhance immunomodulation and angiogenesis in preclinical VPT. These strategies could support pulp-like tissue regeneration, but standardized outcome measures and validation in large-animal models are needed before clinical application.

[Pulpectomy. Why? When?]. There are many circumstances under which the condition of the pulp calls for root canal work, due to the real or potential risk of pain, infection, inflammation or functional difficulties (acute, irreversible pulpitis, chronic pulpitic conditions, necrosis and its consequences, etc.). Other circumstances exist in which injury to the pulp is not necessarily irreversible: initial pulpitis, iatrogenic fracture of the pulp, traumatisms, dystrophic deteriorations. The high success rate for endodontic therapy could argue for elimination of impaired or necrose-prone pulp. In fact, however, unsuccessful pulpectomies often lead to loss of the dental organ and successful endodontic treatment severely weakens the whole tooth structure and often implies prosthetic restoration, with the consequent increase in tissular loss. In order to preserve pulp and crown tissues, pulpal vitality should be protected in all cases where such conservative efforts do not worsen the prognosis for maintaining the tooth on its arch or jeopardize a planned restoration. Solutions are presented for various types of situations, according to the risks encountered.

<h4>Objectives</h4>This network meta-analysis aimed to generate clinically credible, decision-ready evidence on the comparative effectiveness of bioactive materials used in vital pulp therapy (VPT) of mature permanent teeth with carious exposures, including symptomatic presentations.<h4>Materials and methods</h4>Following PRISMA 2020 and PRISMA-NMA standards (PROSPERO: CRD420251074110), randomized controlled trials evaluating full pulpotomy (FP), partial pulpotomy (PP), direct pulp capping (DPC), and indirect pulp capping (IPC) were systematically identified across six databases. The primary outcome was composite success (clinical and radiographic) at 6, 12, 24, and 36 months. Arm-based Bayesian random-effects network meta-analyses and frequentist sensitivity models (REML-Hartung-Knapp) were performed. Certainty of evidence was graded using CINeMA.<h4>Results</h4>The primary meta-analysis included a total of thirty-five RCTs with a total of 2906 teeth, of which a total of twenty-four RCTs involving mature/ permanent teeth were included. Success rates across all VPT types and time points of the 24 RCTs were generally comparable at >93%. Hydraulic calcium silicate materials (MTA & Biodentine) showed a greater likelihood of success than Ca(OH)2 in direct pulp caps and partial pulpotomy procedures. The difference was established with high-certainty evidence for the comparison of MTA vs. Ca(OH)2 and moderate-certainty evidence for the comparison of Biodentine vs. Ca(OH)2. In contrast, the comparisons of calcium silicate materials were frequently overlapped in their credible intervals with moderate certainty evidence; thus, no explicit difference was found between the calcium silicate materials (e.g., MTA & Biodentine). If adjunctive therapies (e.g., platelet-rich plasma & laser therapies) have a promising effect on success rates, they were supported with low-certainty evidence based on limited data and network sparsity. The meta-analysis met the requirement for network coherence (<i>p</i> > 0.10) and the amount of heterogeneity found was low (<i>τ</i> ² = 0.09).<h4>Conclusion</h4>Vital pulp therapy in mature permanent teeth demonstrates consistently high success rates, particularly when using calcium silicate-based materials. These findings are supported by high-certainty evidence for comparisons with calcium hydroxide. However, differences among calcium silicate materials remain uncertain due to overlapping credible intervals and moderate certainty of evidence, while adjunctive therapies are supported by low-certainty evidence and should be interpreted cautiously.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251074110, PROSPERO CRD420251074110.

Secondary objectives: 1. To evaluate patient-reported outcomes such as pain, swelling, sinus tract etc. post-operatively. 2. To determine the clinical success rates of both materials by assessing the Periapical index of healing over a 6 months follow-up period. NULL HYPOTHESIS: The null hypothesis (H0) is that there is no difference between CaSi+hTDM and MTA in maintaining pulp vitality when used as a Miniature Pulpotomy (MP) biomaterial in carious lesions. Literature Review: Vital pulp therapy is defined as a treatment aimed at conserving and sustaining compromised dental pulp tissue that has been impacted by extensive dental caries, dental trauma, and restorative interventions. or due to other iatrogenic reasons. Pulp preservation and vital pulp therapies have taken center stage in the last few years. It is important to take into consideration the entire history and genesis of pulp preservation techniques along with the newer ones that are becoming popular. Pulp preservation techniques are quite old, with reports of gold being placed directly over the injured pulp by Pfaff in the 18th century.

The dental pulp is a specialized connective tissue that maintains tooth vitality. Excessive wear or bacterial infiltration can cause irreversible pulp inflammation, often requiring pulpectomy or tooth extraction. Vital pulp therapy is considered a pulp-conserving treatment for permanent teeth. This study aims to evaluate the knowledge of Libyan dental interns and clinical-level students regarding vital pulp therapy (VPT) for permanent teeth, while also examining its correlation with their sociodemographic characteristics. A comprehensive survey consists of two parts: demographic and general information, followed by 22 questions assessing the understanding of vital pulp therapy’s indications, procedures, and materials. The questionnaire was mailed (as a soft copy) and distributed by hand (as hard copies) to internship dentists and clinical dental students from two Libyan academic centers in Benghazi. Descriptive statistics and the Chi-square test were used to analyze the responses to the questions. 71% of the 224 respondents were final year dental students, and 28.6% were internship dentists. (76.8%) Of the respondents were females; 23.2% were males. Only 36.2% of respondents knew that (VPT) may be successfully applied in teeth with signs and symptoms of irreversible pulpitis. 72.8% of respondents were familiar with the definition of indirect pulp capping. About 73.7% knew that any leakage to the capping materials would cause failure in VPT. 33.5% reported that Biodentine and