Haemostasis Time and Tampon Pulpotomy in Vital Pulp Therapy: Mechanistic Rationale and Clinical Evidence.

Tampon pulpotomy is an emerging modification of vital pulp therapy (VPT) in which a hydraulic calcium silicate cement (HCSC) is placed with controlled pressure over persistently bleeding vital pulp, allowing haemorrhage control to occur during biomaterial placement. This narrative review examines two related but distinct issues: the clinical significance of haemostasis time and the rationale and evidence for tampon pulpotomy. Evidence from conventional VPT suggests that prolonged haemostasis time alone may not reliably predict treatment failure, including recent prospective data showing favourable outcomes when haemostasis required up to 15 minutes. These findings, however, do not directly test cement placement during active bleeding. Direct tampon-specific evidence consists mainly of case reports and observational experience, while HCSCs provide a plausible biological and material basis through sealing, ion release, alkalinity, and mineralisation-related effects. Blood-material interactions and proposed tampon-specific effects on clot volume, intrapulpal pressure, microcirculation, inflammation, and angiogenesis require further study. Tampon pulpotomy therefore represents a testable procedural modification for persistent pulpal bleeding, and independent, standardised comparative studies are needed to define its safety, indications, mechanisms, and relative effectiveness.