Refining pulpal diagnostics for predictable Vital Pulp Treatment

Vital pulp treatment (VPT) encompasses a range of biologically based procedures that aim to preserve the dental pulp, minimise intervention and improve long-term tooth survival. However, a lack of reliable, accurate diagnostic tests to assess the inflammatory status of the dental pulp coupled with use of outdated diagnostic nomenclature that does not support pulp preservation strategies, are two major limitations in effective implementation of VPT in clinical practice. This narrative review aims to discuss the limitations of the current diagnostic methods and the classification of pulp disease, while exploring emerging research on solutions designed to overcome these limitations. Contemporary evidence supports adoption of a pulp disease classification that best describes the disease as continuum, rather than dichotomous approach of reversible/irreversible pulpitis. The recent advances in understanding the pathophysiology of pulpitis at molecular level could be exploited for development of novel biomarker-based diagnostic chairside tests. Moving forward, a refinement of the nomenclatures describing pulpitis, together with integration of objective diagnostic technologies are crucial for improving the diagnostic accuracy and enabling more successful application of pulp preservation therapies and predictable treatment outcomes for patients.