# Consensus‐Based Recommendations on Pulp Therapies in Primary and Permanent Teeth: IAPD Porto Forum

## TL;DR

This paper presents 38 evidence-based recommendations for pulp therapies in primary and permanent teeth, emphasizing minimally invasive approaches and calcium silicate cements.

## Contribution

Provides updated, consensus-based clinical guidelines for pulp treatment using modern biological insights and materials.

## Key findings

- Calcium silicate cements are preferred for vital pulp therapy over traditional materials.
- Selective caries removal is recommended over complete excavation in deep caries cases.
- Conservative approaches are prioritized for managing irreversible pulpitis and traumatic injuries.

## Abstract

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.

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.

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).

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.

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.

Provides protocols for diagnosing and using a tiered approach, prioritizing conservative methods as the first‐line treatment for managing primary and young permanent teeth needing pulp therapies due to caries or trauma.The 38 recommendations and decision trees offer clear, evidence‐based guidelines for managing deep caries, extremely deep caries, and trauma.The consensus identifies calcium silicate cements as the preferred choice over traditional materials and advocates for selective caries removal rather than complete excavation in teeth with deep caries.

Provides protocols for diagnosing and using a tiered approach, prioritizing conservative methods as the first‐line treatment for managing primary and young permanent teeth needing pulp therapies due to caries or trauma.

The 38 recommendations and decision trees offer clear, evidence‐based guidelines for managing deep caries, extremely deep caries, and trauma.

The consensus identifies calcium silicate cements as the preferred choice over traditional materials and advocates for selective caries removal rather than complete excavation in teeth with deep caries.