Preserving pulp vitality for teeth with post-vital pulp therapy symptoms by retrying pulp-preserving procedures: A retrospective clinical study

Background/purpose: The occurrence of post-vital pulp therapy (VPT) symptoms is perplexing for dentists, and root canal treatment (RCT) is preferred for such conditions. Furthermore, managing post-VPT symptoms, rather than performing RCT, would preserve pulp vitality and enhance VPT outcomes. This study aimed to evaluate the efficacy of VPT retrials in preserving pulp vitality and substituting RCT in teeth with post-VPT symptoms. Materials and methods: VPT was performed on the exposed pulp during caries removal in symptomatic and asymptomatic teeth. VPTs were repeated in teeth with post-VPT symptoms. This study screened multi-time-practiced VPT cases from a VPT-performed data pool. The presence of vital pulp tissue after minimized pulp resection (MPR) was a prerequisite for substituting RCT with VPT retrials. A total of 22 cases from 19 patients were included in this study. MPR was introduced to maximize the preservation of the vital pulp. Results: After performing VPT, post-VPT symptoms occurred in pre-VPT asymptomatic teeth, or pre-VPT symptoms were modified in teeth with pre-VPT symptoms. The rate of pre-VPT irreversible pulpitis (IP), comprising symptomatic/asymptomatic IP, was 81.68%. The most prevalent post-VPT symptom was heightened sensitivity to thermal stimuli (68.2%), followed by spontaneous pain (45.5%). The post-VPT IP was 63.6%. VPT retrials resolved 90.9% of cases with post-VPT symptoms. Conclusion: VPT retrials using MPR could enhance VPT outcomes and be a viable alternative to RCT for teeth with post-VPT symptoms.