VITAL PULP TREATMENTS IN TEETH WITH DEEP CARIOUS LESIONS
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 not always ends up with the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions which partly matches to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. As long as the carious lesion has not reached the pulp, treatments 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 are somewhat different between the ESE and national guidelines in Nordic countries. This is most probably due to 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 of VPTs aiming at avoiding root canal treatment. The VPTs will be further developed and changes to clinical recommendations are anticipated.