Background <p>Vital pulp therapies are treatment approaches that preserve the health and function of the primary tooth pulp. This study aimed to evaluate the clinical and radiographic outcomes of indirect pulp treatment (IPT) and direct pulp capping (DPC) performed with MTA in deeply carious primary second molars.</p> Methods <p>This clinical outcome study evaluated IPT (<i>n</i> = 30) and DPC (<i>n</i> = 30) treatments using MTA in 60 deeply carious second primary molars. Clinical and radiographic assessments were conducted at 6 and 12&#xa0;months to determine treatment success based on predefined criteria<b>.</b> Categorical variables for both treatment groups were analyzed using Fisher’s exact test. A <i>p</i>-value &lt; 0.05 was considered statistically significant.</p> Results <p>The overall success rate of the IPT group was 96.55%, with clinical and radiographic success rates of 96.67% at 6&#xa0;months and 100% at 12&#xa0;months. In the DPC group, the overall success rate was 86.21%, showing clinical success of 96.67% and radiographic success of 90% at the 6-month follow-up, and both clinical and radiographic success rates of 96.15% at the 12-month follow-up. Despite these numerical differences, no statistically significant difference was found between the treatment outcomes (<i>p</i> = 0.352).</p> Conclusions <p>IPT and DPC treatments using MTA demonstrated high clinical and radiographic success in primary molars over the 12-month follow-up period. Under appropriate clinical conditions, including proper case selection, appropriate material selection, and meticulous technique, IPT and DPC can be considered successful conservative treatments.</p> Trial registration <p>ClinicalTrials.gov Identifier: NCT07382115, registered on 26 January 2026, retrospectively registered.</p>