Assessment-Based Pulp And Dentin Removal Protocols For Vital Pulp Therapy

Pulpal pathology is a progressive process that may be reversible in early stages if vital tissue remains and pulpal irritants are eliminated. Therefore, vital pulp therapy should aim to preserve pulp vitality by minimizing unnecessary tissue removal. In conventional pulpotomy, the extent of pulp resection is predetermined (e.g., partial or full), and stepwise pulpal evaluation is not performed, which may lead to removal of viable tissue. Here, we present a protocol for assessment-based removal of dentin and pulp using Minimized Dentin Removal (MDR) and Minimized Pulp Resection (MPR). The MPR technique selectively removes the pathologically altered superficial layer of exposed pulp while preserving deeper viable tissue. MDR removes caries indicator-stained dentin while maintaining dentin adjacent to the pulp to support underlying tissue preservation. The protocol is applied iteratively, with continuous assessment guiding the extent of tissue removal until a clinically acceptable pulpal surface and dentin free of indicator staining are achieved. In contrast to conventional approaches that rely on predetermined resection levels, this method incorporates real-time evaluation to guide intervention. Overall, the MDR-MPR protocol provides a structured, minimally invasive approach to dentin and pulp management and may support preservation of pulp vitality.