Vital pulp therapy (VPT) and traditional root canal treatment (RCT) have historically been presented as opposing management pathways for the diseased dental pulp, with RCT regarded as the unconditional standard once carious or symptomatic pulp exposure occurs. Advances in the understanding of pulpal inflammation, together with the introduction of hydraulic calcium silicate cements such as mineral trioxide aggregate (MTA) and Biodentine, have repositioned VPT as a biologically driven, evidence-supported alternative even in mature teeth with signs suggestive of irreversible pulpitis. This review examines how traditional endodontic principles — meticulous case selection, disinfection, three-dimensional sealing, and long-term monitoring — can be integrated with contemporary VPT protocols to produce a Abstract combined, minimally invasive treatment philosophy. The biological rationale for pulp preservation, diagnostic tools for assessing pulp status, indications and techniques for indirect pulp capping, direct pulp capping, partial pulpotomy and full pulpotomy, and the properties of calcium hydroxide, MTA and Biodentine are discussed. Reported outcome data indicate that VPT performed with hydraulic calcium silicate cements achieves success rates broadly comparable to conventional RCT over one- to five-year follow-up periods, provided case selection and aseptic technique are rigorous. A decision framework is proposed in which VPT is attempted as a first-line, tooth-preserving option, with conversion to conventional RCT reserved for cases of uncontrolled haemorrhage, established necrosis, or treatment failure on review. Combining the biological philosophy of VPT with the technical discipline of traditional endodontics offers a pathway toward less invasive, more conservative pulp-preserving care without abandoning the safety net of definitive root canal treatment when biological healing is not achieved.

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