Consensus-Based Recommendations on Pulp Therapies in Primary and Permanent Teeth: IAPD Porto Forum.

BACKGROUND

Recent understanding of pulp biology has shifted treatment paradigms toward preservation-based approaches. Traditional diagnostic terminology and treatment protocols require updating to align with current evidence supporting the pulp's healing capacity.

AIM: Sixteen international specialists in pediatric dentistry and endodontics convened at the 3rd IAPD Summit in Porto, Portugal (November 2024) to develop consensus-based recommendations on pulp therapies in primary and permanent teeth.

METHODS

Following a structured three-phase approach, experts conducted systematic literature reviews and participated in Delphi surveys using a 7-point Likert scale. Recommendations achieving > 70% consensus were categorized as strong (based on RCTs/systematic reviews), conditional (observational studies), or consensus-based statements (expert opinion).

RESULTS

Thirty-eight evidence-based recommendations were developed across four key areas: pulp inflammation and diagnosis, caries excavation, management of pulpitis in primary and permanent teeth, and traumatic dental injuries. Key findings emphasized selective caries removal over complete excavation, calcium silicate cements as preferred materials for vital pulp therapy, and conservative approaches for managing irreversible pulpitis. Decision trees were created to support clinical implementation.

CONCLUSIONS

These consensus recommendations provide evidence-based guidance for managing pulpal diseases using minimally invasive, biologically driven tiered approaches that prioritize pulp preservation in both primary and permanent teeth.