Preserving pulp vitality in deep carious lesions has long been one of the most debated areas in restorative dentistry. For many years, the conventional approach to carious pulp exposure in mature teeth was pulpectomy followed by root canal therapy. But as our understanding of pulp biology has evolved, so too has our confidence in vital pulp therapy — a more conservative alternative that can maintain vitality and function without the need for full endodontic treatment.
Still, one important question remains: when a carious exposure occurs in a tooth with reversible pulpitis, should we choose direct pulp capping or partial pulpotomy?A new double-blind, randomised clinical trial published in the Journal of Endodontics (2025) provides robust evidence to guide that choice.
Vital Pulp Therapy: A Renewed Perspective
Advances in bioactive materials, better understanding of pulp healing, and improved diagnostic precision have led to a resurgence of interest in vital pulp therapy (VPT). For mature teeth with carious exposures, the key lies in distinguishing between reversible and irreversible inflammation — and then choosing the least invasive procedure that can achieve a reliable seal and biological recovery.Historically, direct pulp capping was considered suitable only for small, mechanical exposures, while partial pulpotomy was reserved for traumatic or deeper carious cases. However, with newer bioceramic capping materials such as NeoPUTTY, this distinction is becoming less rigid. The question now is not simply which procedure works, but which is most predictably successful in preserving vitality over time.
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Study Design and Methodology
This trial enrolled 140 mature permanent teeth diagnosed with reversible pulpitis following carious exposure. After caries removal and pulp exposure, haemostasis was achieved with sodium hypochlorite — an essential step in determining pulpal health.
The teeth were then randomly assigned to one of two groups:
- Direct Pulp Capping (DPC): Bioceramic material (NeoPUTTY) applied directly over the exposure.
- Partial Pulpotomy (PP): 2–3 mm of inflamed coronal pulp tissue removed before placing the same bioceramic material.
All restorations were completed in a single visit using adhesive composite. Follow-up evaluations at 6 and 12 months included clinical and radiographic assessment, with success defined by:
- Absence of spontaneous pain or tenderness,
- Positive pulp vitality testing,
- Normal periapical radiographs.
The Findings
At the 6-month review, the partial pulpotomy group achieved a 94.4% success rate, compared with 84.4% for the direct pulp capping group. After 12 months, both procedures maintained high success: 91.5% for partial pulpotomy and 81.3% for direct capping.
Although the difference between the two groups was not statistically significant, the trend suggests that removing a small portion of inflamed pulp may slightly enhance healing outcomes.
Importantly, both techniques resulted in significant pain reduction within a week, and no patient- or tooth-related factors — such as age, tooth type, or caries depth — were found to influence success.
Over 95% of patients reported little or no pain postoperatively, reflecting high satisfaction and comfort with both procedures.
Clinical Interpretation
For clinicians, the choice between the two procedures should be guided by intraoperative findings rather than a predetermined protocol.
- Direct pulp capping is suitable when the exposure site is small and bleeding stops rapidly (typically within a few minutes).
- Partial pulpotomy may be advantageous if haemostasis is delayed or inflammation appears more extensive — the removal of a few millimetres of tissue can eliminate superficially inflamed pulp and improve healing potential.
In both cases, the quality of the coronal seal remains critical. Immediate placement of a bonded restoration is essential to prevent bacterial leakage, which remains the main cause of failure in vital pulp therapy.
Limitations
The authors acknowledge that the study’s 12-month follow-up limits the ability to draw conclusions about long-term survival. Longer observational periods will be needed to assess whether either technique offers superior durability over several years.
Still, the randomised, double-blind design, operator calibration, and high recall rate lend strong validity to the results.
About Dr. Jamal
Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.
Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.
Dr. Jamal teaches on the Diploma in Orthodontics and Dentofacial Orthopaedics at the London Dental Institute.
Read More
Taha NA, Jaradat HB, Dkmak A, Abidin IZ. Carious pulp exposure in mature teeth with reversible pulpitis: a randomized clinical trial of direct pulp capping and partial pulpotomy. Journal of Endodontics. 2025; 51(10): 1342–1350.
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