Vital pulp therapy (VPT) encompasses a spectrum of biologically based, minimally invasive procedures — including indirect pulp capping, direct pulp capping, and partial or full pulpotomy — that aim to preserve the vitality of a pulp exposed to, or threatened by, caries, trauma, or iatrogenic injury. Over the past two decades, VPT has undergone a substantial conceptual shift, moving away from the traditional paradigm in which any sign of pulp exposure or symptomatic pulpitis mandated root canal treatment, toward an evidence-based, tissue-preserving philosophy supported by the introduction of bioactive calcium silicate-based materials. This narrative review synthesizes current literature on the biological rationale, diagnostic criteria, clinical techniques, and material science underlying VPT, and appraises reported outcomes across primary and permanent dentitions. Calcium hydroxide, long regarded as the historical gold standard, has been progressively superseded by hydraulic calcium silicate cements such as mineral trioxide aggregate (MTA), Biodentine, and related bioceramic formulations, which demonstrate superior sealing ability, biocompatibility, and induction of reparative dentinogenesis.Contemporary evidence, including recent systematic reviews and clinical practice guidelines from the American Academy of Pediatric Dentistry and the European Society of Endodontology, indicates that indirect pulp treatment, direct pulp capping, and pulpotomy achieve comparably high success rates in teeth with normal pulp or reversible pulpitis, and that full pulpotomy can be a predictable option even in select cases of symptomatic irreversible pulpitis. Factors influencing prognosis include accurate pulpal diagnosis, hemorrhage control, selection of a bioactive capping material, and coronal seal integrity. Persisting controversies include the classification of pulpal disease based on clinical symptoms alone, the optimal depth of caries removal, material-related tooth discoloration, and the long-term fate of retained pulp tissue. This review concludes that VPT represents a scientifically sound, minimally invasive alternative to root canal treatment for appropriately selected cases and outlines directions for future research, including regenerative and bioactive material development.

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