The Vital Pulp Treatment for Permanent Teeth workshop

Introduction
As soon as you mention the phrase “root canal treatment”, many people will respond by saying “I would rather walk barefoot in the snow for hours than having a root canal done”. The fact of the matter is that there is some truth behind this comment. It has been well established that root canal (endodontic) treatment is one of the most difficult treatment modalities within dentistry. Success rates are largely determined by factors including patient compliance and root canal complexity. To compound this, traditional radiographs only provide a two-dimensional (2D) view of a three-dimensional (3D) object. Most of the time we are working in an anatomical maze that is hidden from the naked eye.
The reality is that the root canal complex is unique and will often contain additional features such as accessory canals, isthmuses, root canal bifurcations and multiple canals. Root and canal morphology also differs between population groups and even between individuals. Furthermore, traditional root canal treatment can be quite invasive, and the procedure itself requires a series of steps to render an affected tooth functional in the dentition.5 The procedure requires proper access to all root canals, often achieved through the removal of additional tooth structure with specialised instruments. During the cleaning and shaping procedure further tooth structure is removed with endodontic files. This step is necessary to allow proper irrigation and disinfection of the entire root canal system and a proper 3D seal of the prepared spaces.
Considering the facts stated above, one can ask the question: if the procedure itself is so complicated, is there an alternative option? The answer is “yes”! In recent years, tremendous advances have been made towards a more conservative approach. In selected cases it is possible to preserve the vitality of the pulp by following a vital pulp treatment pathway. The benefits of maintaining the vitality of the pulp has been well documented: the preservation of normal physiological function, conservation of sound tooth structure (which is important for restorability and integrity) and there is also evidence that long term success is possible in appropriate cases.