Vital pulp therapy: A three-year clinical case series on regenerative potential and adhesive restoration strategies

Vital pulp therapy (VPT) aims to preserve the vitality and regenerative potential of the dental pulp following carious or mechanical exposure. The introduction of hydraulic calcium silicate cements has improved the clinical predictability and feasibility of VPT by supporting pulp healing and enabling reliable coronal sealing. This clinical case series reports ten VPT procedures performed in permanent posterior teeth using Biodentine XP, a pre-mixed hydraulic calcium silicate cement, including both direct (DPC) and indirect pulp capping (IPC). After caries removal, Biodentine XP was applied in all cases, with pulp hemostasis achieved exclusively in DPC procedures following mechanical or carious exposure. According to the clinical scenario, either a single-step protocol with immediate adhesive composite restoration or a two-step protocol, in which Biodentine XP served as a temporary bioactive restoration prior to definitive reconstruction, was adopted. DPC cases were preferentially managed using the single-step approach, whereas IPC cases were treated using single- or two-step protocols based on cavity depth and restorative complexity. Clinical, radiographic, and patient-reported outcomes were assessed at 6 months, 1 year, and 3 years of follow-up. All treated teeth maintained pulp vitality throughout the 3-year follow-up period, with absence of spontaneous pain, normal responses to pulp sensibility tests, favourable patient-reported outcomes, and no radiographic signs of periapical pathology. Both single-step and two-step protocols demonstrated stable clinical performance when an effective coronal seal was achieved. Within the limitations of a clinical case series, Biodentine XP allows predictable, biology-oriented VPT protocols by combining well-established bioactive properties with standardized handling and adhesive compatibility. The present findings support VPT as a conservative and function-preserving alternative to root canal treatment, with clinical outcomes primarily reflecting effective pulp repair rather than complete biological regeneration. • Three-year follow-up of vital pulp therapy cases using calcium silicate–based materials. • Demonstrated pulp vitality preservation due to dentin–pulp complex regeneration. • Integration of bioceramic cements with adhesive restorative techniques. • Evidence-based workflow for regenerative and restorative synergy.