Vital Pulp Therapy for Endodontic Treatment of Mature Teeth: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

( Last Updated : July 10, 2019)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:



  1. What is the clinical effectiveness of vital pulp therapy on mature teeth?

  2. What is the cost-effectiveness of vital pulp therapy on mature teeth?

  3. What are the evidence-based guidelines for vital pulp therapy on mature teeth?

Key Message

Evidence from one very low-quality systematic review, and four very low to moderate-quality primary studies suggest that clinical success rates for teeth treated with vital pulp therapy or pulpotomy may not significantly differ from teeth treated with root canal therapy or pulpectomy. Findings were comparable between vital pulp therapy and root canal or in favour of vital pulp therapy for short-term (one week) post-operative pain reduction. One well-conducted economic evaluation from Germany found that direct pulp capping was cost-effective when compared with root canal in most cases, including when the willingness-to-pay ceiling value was adjusted (from 0 to 250 euro). Sensitivity analyses found direct pulp capping was not cost-effective in patients over 40 years of age or with teeth with a proximal pulp exposure.No guidelines regarding vital pulp therapies with any materials were identified.