Consensus-Based Recommendations on Pulp Therapies in Primary and Permanent Teeth: IAPD Porto Forum
Vineet Dhar1, Ikhlas El-Karim2, James A Coll1
1Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, Maryland, USA.
Background:
Recent understanding of pulp biology has shifted treatment paradigms toward preservation-based approaches. Traditional diagnostic terminology and treatment protocols require updating to align with current evidence supporting the pulp's healing capacity.
Aim:
Sixteen international specialists in pediatric dentistry and endodontics convened at the 3rd IAPD Summit in Porto, Portugal (November 2024) to develop consensus-based recommendations on pulp therapies in primary and permanent teeth.
Methods:
Following a structured three-phase approach, experts conducted systematic literature reviews and participated in Delphi surveys using a 7-point Likert scale. Recommendations achieving > 70% consensus were categorized as strong (based on RCTs/systematic reviews), conditional (observational studies), or consensus-based statements (expert opinion).
Results:
Thirty-eight evidence-based recommendations were developed across four key areas: pulp inflammation and diagnosis, caries excavation, management of pulpitis in primary and permanent teeth, and traumatic dental injuries. Key findings emphasized selective caries removal over complete excavation, calcium silicate cements as preferred materials for vital pulp therapy, and conservative approaches for managing irreversible pulpitis. Decision trees were created to support clinical implementation.
Conclusions:
These consensus recommendations provide evidence-based guidance for managing pulpal diseases using minimally invasive, biologically driven tiered approaches that prioritize pulp preservation in both primary and permanent teeth.
Related Concept Videos
01:15Teeth
In the bud stage, the tooth germ (an aggregation of cells) starts to form in the developing jawbone. During the cap stage, the tooth germ differentiates into enamel organ, dental papilla, and dental sac, which will later develop into the tooth's enamel, dentin...
00:59Gene Therapy
01:26Group Therapy
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
01:22Behavior Therapy
Exposure therapy is a cornerstone of behavioral treatment for anxiety disorders. It involves systematic exposure to feared stimuli, either in real...
01:28Drug Therapy
Antianxiety Medications