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

Authors

• Vineet Dhar, University of Maryland - Baltimore
• Ikhlas El-Karim, Queen's University - Belfast
• James A. Coll, University of Maryland - Baltimore
• Ashraf F. Fouad, University of Alabama
• Anne C. O'Connell, Trinity College - Dublin
• Saeed Asgary, University of Medical Sciences - Tehran
• Lars Bjorndal, University of Copenhagen
• Zafer C. Cehreli, Hacettepe University
• Yasmi O. Crystal, New York University
• Manikandan Ekambaram, University of Otago
• Brian Hodgson, Marquette UniversityFollow
• Nicola P. Innes, College of Biomedical and Life Sciences
• Jonas Almeida Rodrigues, Universidade Federal do Rio Grande do Sul (UFRGS)
• Nessrin A. Taha, Jordan University of Science and Technology
• Nitesh Tewari, All India Institute of Medical Sciences
• Tugba Turk, Ege University

Document Type

Article

Publication Date

3-2026

Publisher

Wiley

Source Publication

International Journal of Paediatric Dentistry

Source ISSN

0960-7439

Abstract

Background

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.

Aim

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.

Methods

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).

Results

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.

Conclusions

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.

Comments

Published version. International Journal of Paediatric Dentistry, Vol. 36, No. 2 (2026): 371-386. DOI. © 2026 Wiley. Used with permission.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Dhar, Vineet; El-Karim, Ikhlas; Coll, James A.; Fouad, Ashraf F.; O'Connell, Anne C.; Asgary, Saeed; Bjorndal, Lars; Cehreli, Zafer C.; Crystal, Yasmi O.; Ekambaram, Manikandan; Hodgson, Brian; Innes, Nicola P.; Rodrigues, Jonas Almeida; Taha, Nessrin A.; Tewari, Nitesh; and Turk, Tugba, "Consensus-Based Recommendations on Pulp Therapies in Primary and Permanent Teeth: IAPD Porto Forum" (2026). School of Dentistry Faculty Research and Publications. 588.
https://epublications.marquette.edu/dentistry_fac/588