Trends and Outcomes of Vital Pulp Therapy in Korea: A Nationwide Retrospective Cohort Study

Vital pulp therapy (VPT) has gained increasing attention as a pulp-preserving treatment, particularly with advances in bioceramic materials and policy-driven reimbursement changes in Korea. However, real-world evidence regarding long-term utilization and outcomes is limited. This study investigated temporal trends in VPT utilization and evaluated 5-year survival outcomes in Korea using a nationwide insurance database.

A retrospective cohort study was conducted using Korean National Health Insurance Service claims data from 2003 to 2018. Teeth treated with pulp capping or pulpotomy were identified. Utilization trends before and after 2015 were analyzed. Five-year survival was assessed using Kaplan-Meier analysis, and prognostic factors were evaluated using log-rank tests and multivariable Cox proportional hazards regression models.

A total of 1,638,422 teeth underwent VPT, including 1,090,501 pulp capping and 547,921 pulpotomy. Utilization increased markedly after 2015. Contrary to expectations, 5-year survival declined post-2015 for both pulp capping (from 87.58% to 82.73%) and pulpotomy (from 72.62% to 60.93%). Older age was associated with a higher failure risk for both procedures. Failure predominantly occurred early in follow-up, with a more pronounced long-term decline for pulpotomy.

Despite increased VPT utilization following material advancements and reimbursement changes, long-term survival outcomes in Korea did not improve. These findings emphasize that accurate diagnosis and appropriate case selection remain more critical to VPT survival than material or procedural innovations, while also highlighting the key areas that endodontists should prioritize when educating general practitioners.