Pulp Therapies Rooted in Evidence: IAPD Porto Declaration

Recent advances in our understanding of pulpal biology and inflammatory responses have led to a fundamental shift in our approach to pulpal and periapical diseases. The traditional dichotomy of reversible versus irreversible pulpitis has been challenged by evidence suggesting that pulpal inflammation exists on a continuum, rather than as discrete states [1, 2]. This continuum includes initial, mild, moderate and severe pulpitis [1]. Pulpitis may also progress apically in a manner that allows incremental removal of the affected portion of the inflamed pulp, which can help alleviate the accompanying severe symptoms. Pulpal inflammation represents a complex defensive response that can result in either tissue healing or degeneration and necrosis if left untreated. While clinical symptoms and radiographic signs and pulp sensibility tests provide guidance, they do not accurately indicate the healing potential of the inflamed pulp. In addition, they often correlate poorly with the actual histological status of the pulp [3]. This biological reality, coupled with improved bioactive materials, demands a reconsideration of conventional treatment approaches. These considerations include diagnostic classifications that more accurately reflect the biological continuum of pulpal disease, treatment decisions based on objective clinical findings, protocols that prioritise pulp preservation when biologically feasible, and long-term outcome assessments that validate contemporary methods. The translation of these scientific advances to clinical practice requires updated evidence-based guidelines that can inform decision-making while acknowledging the complexity of pulpal biological responses.