What Outcomes Matter in Vital Pulp Therapy? Current Concepts and Challenges

Vital pulp therapy (VPT) has re-emerged as a practical and biologically sound alternative for managing deep caries and carious pulp exposures. Although its clinical use is now widespread, the outcomes used to judge the success of VPT remain inconsistent and often difficult to compare across studies. This review brings together the current concepts surrounding VPT outcomes and explores why defining 'success' in this context is more complex than it first appears. Across the VPT spectrum, whether stepwise excavation, indirect and direct pulp capping, or partial and full pulpotomy, reported success rates vary considerably. Much of this variation stems from differences in diagnostic terminology, operator technique, follow-up intervals and the continued reliance on surrogate measures such as sensibility tests, which give only a limited picture of the pulp's true biological state. Although radiographic assessments and the presence or absence of symptoms remain widely used, patient-centred measures such as comfort, function and quality of life are still underrepresented in the literature. Economic evaluations, although limited in number, generally favour VPT over more invasive alternatives. Moving forward, clearer terminology, more consistent reporting and outcome measures that reflect both clinical reality and patient priorities will be essential in determining what genuinely matters when evaluating the success of vital pulp therapy.