Vital pulp preservation in deep caries:decision making and bioactive materials

Introduction: Dental caries is a bacterial infectious disease, and deep caries with pulp exposure represents a major clinical challenge in preserving tooth vitality.
Objective: To assess the prevalence of deep caries in daily practice and to evaluate therapeutic decision-making among dentists, with emphasis on vital pulp preservation and the use of bioactive materials.
Materials and Methods: A cross-sectional survey was conducted among 50 dentists in Strumica, Skopje and Shtip using a structured questionnaire. The survey analyzed the frequency of deep caries cases, preferred treatment approaches, and the influence of clinical experience on therapeutic choice.
Results: Most respondents (90%) reported frequently encountering patients with deep caries. Endodontic treatment was the most commonly selected approach (70%), while 30% preferred vital pulp therapy procedures. No statistically significant correlation was found between years of clinical experience and the choice of therapy. Among practitioners performing direct pulp capping, Biodentin was more frequently selected than MTA, indicating a growing preference for newer bioactive materials. All respondents agreed that the degree of pulp involvement is the decisive factor in treatment planning.
Conclusions: Although conventional endodontic therapy remains predominant, there is an increasing tendency toward vital pulp preservation supported by bioactive materials. Early diagnosis and appropriate case selection are essential for maintaining pulp vitality and improving long-term clinical outcomes.
Key words: deep caries, pulp exposure, vital pulp therapy, Biodentin, MTA