Five-Year Success of Endodontics Plus Vital Pulp Therapy in a Symptomatic Maxillary Molar: A Case Report

This case report details the integration of nonsurgical endodontic treatment (NSET) and vital pulp therapy (VPT) for symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP) in a mature maxillary molar, with 5-year follow-up. A 23-year-old female presented with sensitivity in tooth #26 due to extensive distal caries. Initial pulpotomy with Five Mineral Oxides (5MO) failed after 1 month, revealing SIP/SAP. Selective NSET was performed on buccal canals (MB1, MB2, DB), while 5MO preserved vitality in the palatal canal. Buccal canals were obturated; the tooth was restored with amalgam. Annual follow-ups over 60 months showed no symptoms, intact periodontal ligament spaces, and transient sensibility response in the palatal canal on electric pulp testing a flexible treatment plan Selective NSET plus VPT provided long-term clinical and radiographic success in this case, suggesting a conservative, biology-based alternative to full pulpectomy in selected multirooted teeth with localized pathology.