Refining Pulpal Diagnostics for Predictable Vital Pulp Treatment

Vital pulp treatment (VPT) comprises a range of biologically based procedures aimed at preserving pulp vitality, reducing the need for invasive interventions, and improving long-term tooth survival. Despite growing evidence supporting these approaches, their implementation in clinical practice remains limited by the lack of reliable methods for accurately assessing the inflammatory status of the dental pulp and by the continued use of diagnostic terminology that does not adequately support pulp-preserving treatment strategies.

This narrative review examines the limitations of current pulp diagnostic methods and traditional classifications of pulp disease. It also explores emerging research and innovative approaches aimed at improving diagnostic accuracy and facilitating more effective application of VPT.

Contemporary evidence suggests that pulp disease is more appropriately viewed as a continuum rather than through the traditional dichotomous classification of reversible and irreversible pulpitis. Advances in the understanding of pulpitis pathophysiology at the molecular level have identified potential biomarkers that may enable the development of objective chairside diagnostic tests. These emerging technologies offer the potential to provide more precise assessment of pulpal inflammation and improve treatment decision-making.

Refinement of the terminology used to describe pulp disease, together with the integration of objective, biomarker-based diagnostic technologies, is essential for improving diagnostic accuracy. Such advances are expected to support wider adoption of VPT, enhance the predictability of clinical outcomes, and promote successful long-term preservation of natural teeth.