Editor's note: Doctor Wang Dongqing is a chief physician at the International Medical Department of Beijing Stomatological Hospital, affiliated with Capital Medical University, and vice president of the Inner Mongolia Forestry General Hospital.

I often reflect on a fundamental question: what is the shared goal of oral medicine practitioners? Whether we are maintaining the foundation of the tooth, the periodontal tissues, or safeguarding its "heart" – the dental pulp, our ultimate aspiration is the same: to allow every natural tooth to remain healthy, functional and vital in the oral cavity for as long as possible.

I would like to share some progress in vital pulp therapy, an approach that is changing dental practice worldwide and embodies the collective wisdom of Chinese scholars. It is gently yet decisively reshaping a century-old belief: even for teeth with severe pain that were once routinely considered to require "nerve killing," we now have treatment options that are less invasive and more forward-looking.

Traditionally, for a mature permanent tooth diagnosed with irreversible pulpitis, the standard treatment has been root canal therapy. While effective in relieving pain, this procedure essentially removes the nerve of the tooth, rendering it non-vital and progressively more brittle. In the long term, this increases the risk of tooth fracture. Moreover, root canal treatment is technically demanding, time-consuming and relatively costly.

Modern biological research has revealed an encouraging fact: in many cases, pulp inflammation resembles a localized wildfire, primarily confined to the coronal pulp, while healthy tissue in the radicular pulp often remains intact. Based on this understanding, pulpotomy has emerged as a viable treatment option. Rather than completely removing the pulp, this procedure – performed under high-magnification dental microscopy – involves precisely removing the infected coronal pulp while preserving the healthy radicular pulp, and covering it with bioactive materials to create favorable conditions for healing, much like the work of a meticulous gardener.

In the past, vital pulp preservation was mainly applied to immature permanent teeth with incomplete root development. Today, an increasing body of clinical evidence demonstrates that this technique is also safe and effective for adults, and even middle-aged and elderly patients with fully developed roots. For example, a study conducted by Nanjing Medical University on patients over 40 years old with severe tooth wear showed that the success rate of pulpotomy was comparable to that of root canal therapy, at approximately 88.9 percent. This indicates that even teeth affected by aging still possess intrinsic vitality that can be preserved, offering a minimally invasive treatment option for many older patients.

A well-executed pulpotomy represents an investment with multiple benefits in oral health.

For the tooth itself, the preservation of natural defense, sensory and reparative functions results in greater structural strength and higher long-term survival rates.

For the patient, a minimally invasive procedure with shorter treatment time and fewer visits significantly improves the treatment experience and reduces the risk and cost of future complex restorations caused by tooth brittleness.

For overall oral health, a vital natural tooth is fundamental to maintaining normal occlusion, the stability of adjacent teeth and alveolar bone health.

The key to the success of this procedure lies in precision, including accurate preoperative assessment (based on symptoms and diagnostic findings), critical intraoperative diagnosis (evaluation of pulp bleeding and tissue status under magnification), strict aseptic procedures (mandatory rubber dam isolation), and the use of clinically validated bioactive pulp-capping materials. Timely and well-sealed coronal restoration after treatment is the final crucial step in safeguarding long-term outcomes.

This therapeutic transformation, driven by advances in biological understanding, microscopic technology and bioactive materials, is reshaping modern endodontics. Through rigorous clinical research, forward-looking clinical practice and systematic consensus-building, the Chinese dental community is contributing valuable insights and practical experience to this global evolution.

This is not merely a technical upgrade. It represents a profound shift in dental philosophy from "lesion removal" to "functional restoration and vitality preservation." Preserving the nerve of the tooth not only safeguards its biological function but also fundamentally protects a person's chewing ability, quality of life and long-term oral health. This, perhaps, is the strongest health commitment that modern dentistry can offer to every patient.