Predicting Vital Pulp Therapy Outcomes Using Pulpal Biomarkers and Clinical Indicators: A Prospective Clinical Study

The aim of this prospective clinical study was to investigate whether patient history, preoperative clinical findings and intraoperative parameters, including pulpal biomarker profiles, are associated with the outcome of vital pulp therapy (VPT) in mature permanent teeth and to evaluate their potential prognostic value.

Fifty mature permanent teeth diagnosed with reversible or irreversible pulpitis underwent partial or full pulpotomy and were followed for 6 months and 1 year. Patient history, including spontaneous and nocturnal pain, preoperative cold response time and intraoperative bleeding time, were recorded. Following removal of clinically unsuitable pulp tissue, pulpal blood samples were collected from the clinically evaluable and preservable pulp surface using sterile paper points. Samples were stored in phosphate-buffered saline at -80°C until analysis. MMP-1, MCP-1, IL-1β, MDA, MMP-12, SOD, RANTES, TIMP-1, TGF-β, TNF-α, TAS and TOS were quantified by ELISA. Demographic, clinical and biochemical parameters were compared between successful and failed cases.

All 50 included cases were available for analysis at the 1-year follow-up; 41 were classified as successful and nine as failed, yielding an overall success rate of 82%. Patient-reported symptoms and the preoperative diagnosis of reversible or irreversible pulpitis were not associated with treatment outcome (p > 0.05). In contrast, prolonged cold response time and bleeding time were significantly greater in failed cases than in successful cases (p < 0.05). ROC analysis demonstrated good discriminatory ability for both cold response time (AUC = 0.764, p = 0.014) and bleeding time (AUC = 0.809, p = 0.004). Among the intraoperative biomarkers, levels of MMP-1, MCP-1, IL-1β, MDA, MMP-12, TGF-β and TNF-α were significantly higher in failed cases, whereas SOD, TIMP-1 and TAS levels were significantly higher in successful cases (p < 0.05).

Within the study cohort, prolonged cold response time and bleeding time were associated with treatment failure, whereas conventional classification as reversible or irreversible pulpitis was not significantly associated with outcome. Cold response > 30 s and bleeding time > 350 s were associated with failure, and pulpal biomarker profiles may provide complementary prognostic information but should not be considered definitive predictors of VPT success.

ClinicalTrials.gov identifier: NCT07073573 (18 July 2025).