## 3 Criteria of Vital Pulp Therapy
### Vital Pulp Therapy  
Vital pulp therapy (VPT) aims to maintain the health and function of the dental pulp following injury or carious exposure. The 2024 AAPD Clinical Practice Guidelines emphasize that VPT is indicated for both primary teeth with a vital pulp and no signs of radicular pathology, and for immature permanent teeth with vital pulp, regardless of whether pulpitis is reversible or in early stages of irreversible inflammation [31; 32]. Indirect pulp treatment (IPT) is a method used to manage deep carious lesions near the pulp without direct pulp exposure. This approach leaves a layer of affected, but not infected, dentin to avoid pulpal exposure and places a biocompatible material--often a calcium hydroxide or calcium silicate-based liner--over it [4]. The goal is to arrest caries progression, preserve pulp vitality, and promote reparative dentin formation without repeated caries excavation (Figure 1a). Direct pulp capping (DPC) is the application of a biocompatible material directly onto a small, exposed pulp site, typically due to trauma or iatrogenic injury. According to the AAPD, DPC may be considered for primary teeth only in mechanical or traumatic exposures with normal pulp and no symptoms, and for immature permanent teeth with small carious or mechanical exposures when bleeding is controlled [31; 33]. The procedure relies on an effective coronal seal and the regenerative potential of the selected material to promote dentin bridge formation and preserve pulp vitality [4; 31] (Figure 1b). Pulpotomy involves removing the inflamed coronal pulp while preserving the vital articular pulp. In primary teeth, full pulpotomy is recommended as the treatment of choice in cases of carious pulp exposure with vital pulp and controlled bleeding. The AAPD recommends bioactive materials like MTA and Biodentine over formocresol due to superior success rates and favorable biological response. In permanent teeth with immature roots, partial pulpotomy (Cvek pulpotomy) is indicated when exposure is recent, and bleeding is controlled, allowing the remaining pulp to facilitate root development and apexogenesis [34; 35; 36]. Partial pulpotomy (Figure 1c) removes 2-3 mm of inflamed tissue beneath the exposure site, preserving deeper, healthy pulp in immature permanent teeth. Partial pulpotomy is advantageous over full pulpotomy in the preservation of cell-rich coronal pulp tissue, allowing dentin apposition and the ability to perform pulp testing [37; 38]. The partial pulpotomy has a 98% success rate in reversible pulpitis cases and a 75% success rate in irreversible pulpitis cases after one year [35]. Success rates remain high (>90%) when appropriately diagnosed and managed, even in cases previously classified as irreversible pulpitis. A full pulpotomy (Figure 1d) removes all coronal pulp tissue from the pulp chamber and places bioactive material, leaving healthy radicular pulp with the indication of reversible pulpitis or after a traumatic pulp exposure without evidence of radiographic signs of infection or pathologic resorption [31]. It is considered appropriate for both primary molars and immature permanent teeth when pulp vitality can be confirmed, and bleeding is controlled within 5-10 min. This procedure is commonly used in primary molars with extensive caries [39; 40; 41] and it has been considered a treatment choice for exposed permanent teeth with mild symptoms or irreversible pulpitis [42]. In a systematic review, pulpotomy was performed on teeth with irreversible pulp without any other symptoms, and had a clinical success rate of 97.4% at one year and 93.97% at three years [43].