Purpose of Review <p>Vital pulp therapy (VPT) represents a biologically driven approach designed to preserve the vitality and function of the dental pulp, even in cases of deep caries, trauma, or symptomatic inflammation. Recent evidence has shown that pulpal inflammation is often localized, allowing successful healing when the procedure is properly performed. Purpose of review: This review aims to summarize the biological principles, historical development, and clinical evidence that support VPT as a predictable and definitive treatment for both immature and mature permanent teeth.</p> Recent findings <p>Advances in pulp biology have revealed that the dental pulp retains a strong capacity for repair when inflammation is controlled, and the tissue is sealed with bioactive materials. The evolution from calcium hydroxide to modern calcium silicate–based cements, such as MTA and Biodentine, has significantly improved clinical outcomes by promoting organized dentin bridge formation and stable long-term seals. Improved diagnostic methods—including intraoperative bleeding assessment, CBCT imaging, and the use of microscopes—have made case selection more precise and biologically relevant. Evidence from randomized clinical trials shows that full pulpotomy can achieve long-term success rates comparable to root canal treatment, even in mature teeth diagnosed with irreversible pulpitis, provided that hemostasis, asepsis, and immediate coronal sealing are achieved.</p> Summary <p>Vital pulp therapy has evolved from a provisional option into a reliable, biologically based treatment that aligns with modern concepts of minimally invasive dentistry. Its success relies on accurate diagnosis, use of bioactive materials, and high-quality restorative procedures. As clinical protocols and educational frameworks continue to modernize, VPT stands as a predictable, tissue-preserving alternative to conventional root canal therapy, reshaping the biological and ethical foundations of endodontic care.</p>