Determinants of Vital Pulp Therapy Success in Cariously Exposed Mature Permanent Teeth: An Umbrella Review

Vital pulp therapy (VPT) is a biologically conservative alternative to root canal treatment in mature permanent teeth; however, variability in success rates and uncertainty regarding prognostic and procedural factors necessitate higher-order evidence synthesis. This umbrella review aimed to synthesize systematic reviews evaluating determinants of VPT outcomes in cariously exposed mature permanent teeth, and to appraise methodological quality and primary study overlap. Electronic searches across major databases and grey literature were conducted. Methodological quality was assessed using AMSTAR-2, and overlap quantified using the corrected covered area (CCA). Fourteen reviews were included, with moderate overlap and predominantly low to critically low confidence. Material-related factors showed the most consistent association, with hydraulic calcium silicate-based materials reporting higher success. Other factors showed inconsistent or non-significant effects. Delayed restoration reduced success, and follow-up duration influenced outcomes. Material selection appears the most consistent determinant, although overall evidence certainty remains limited. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD420251275599.