Over the past decade, there has been a paradigm shift in the realization that an inflamed pulp may be worth saving. Advancements in the fields of tissue engineering and biomaterials have made preservation and regeneration of the dentin-pulp complex the most sought-after goals of vital pulp therapy strategies. Although the evolution of biomaterials since the discovery of calcium hydroxide has been immense and revolutionary, the unique spatiotemporal nature of the dentin-pulp complex poses multiple challenges. This is further complicated by the inherent anatomical, physiological, and biological differences between the primary and the permanent dental pulps [17]. Furthermore, while the required outcome may be the same, indications and outcome assessment methods for pulpotomy procedures in primary and permanent teeth may be quite different. Indeed, in an era where personalized patient care will represent the future of medicine, bioactive vital pulp therapy agents that aim to regenerate anatomical and functional tissues like the native tissue are continuously being developed. These agents and strategies must therefore be carefully tailored not only to whether the tooth is primary or permanent but also according to the developmental and inflammatory status of the tooth in question [18].

Although pulpotomy procedures for primary teeth have long been practiced, the concept of a pulpotomy for a mature permanent tooth has only recently been addressed. Hence, we aimed to focus more on the last 10 years in which a peak in the publication of these papers was noted. Additionally, the use of bioactive cements and biodegradable scaffolds in randomized clinical trials focusing on pulpotomy is relatively new. Therefore, the goal of this scoping review was to elucidate the present knowledge gap and highlight the need for clear decision-making guidelines regarding outcome assessment methods of pulpotomy procedures utilizing regenerative agents in primary and permanent teeth. It was designed and reported with reference to the recently updated JBI scoping review guidelines [15, 19] and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR) [2, 20], and was reinforced by the diverse expertise of the authors who include methodologists, analysts, and clinicians sharing an intrigue in evidence-based health care.

While planning this review, the language was restricted to English only to avoid potential confusion in interpretation of data during translation of full text articles. As for exclusion of studies comparing different vital pulp therapy techniques, we wanted to focus the attention of this review on different materials without having the confounding variables of different procedural parameters. Furthermore, we intended to target randomized and non-randomized controlled clinical trials only to provide an overview of the available highest level of clinical evidence to answer the research question, and to determine where further research may be indispensable in this field. We did not set limits for the follow-up periods to include short- and long-term clinical, radiographic, as well as histological and inflammatory assessments. Most of the screened clinical trials (85.8%) comprised 12 months and longer follow-up intervals [18, 21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127]. As the objective of this review was focused on outcome assessment rather than treatment success, which is highly dependent on the initial inflammatory pulp status, we did not restrict our search according to the type of exposure being carious or traumatic to retrieve as many trials as possible in our search in primary and permanent teeth. Additionally, included studies did not stratify the outcomes according to the type of exposure. Remarkably, the pre-operative pulpal status was mainly distinguished as “reversible pulpitis” for both primary and permanent teeth [18, 21, 22, 26, 28,29,30,31,32,33,34,35,36, 39, 40, 43, 44, 47,48,49,50,51,52,53,54,55,56, 58,59,60, 62,