Objective:

To evaluate whether vital pulp therapy (VPT) offers better clinical outcomes than root canal treatment (RCT) in immature permanent teeth with pulpal involvement, emphasizing the role of pulp vitality in apexogenesis.

Key Findings:

• VPT showed significantly higher odds of overall success compared to RCT (pooled OR = 1.37, 95% CI: 1.06–1.78).
• Marked benefit of VPT was observed in immature teeth (OR = 3.01, 95% CI: 1.43–6.33) and complete/coronal pulpotomy (OR = 2.47, 95% CI: 1.11–5.51).
• Bioceramic-based VPT achieved near-complete success in randomized trials, while RCT outcomes plateaued at 79%-98%.
• Meta-regression identified tooth immaturity, full pulpotomy, and longer follow-up as positive prognostic factors.

Interpretation:

VPT is associated with favorable long-term outcomes compared to RCT in immature permanent teeth, supporting pulp vitality and apexogenesis.

Limitations:

• Cumulative evidence did not reach the trial sequential monitoring boundary or required information size, indicating limited certainty in the findings.
• Insufficient evidence for a definitive conclusion regarding the superiority of VPT over RCT, necessitating further investigation.

Conclusion:

While VPT appears advantageous for immature permanent teeth, further large-scale studies are needed to confirm its superiority and address the limitations of current evidence.