Keep Your Tooth Alive — Without a Full Root Canal
Here’s something most people don’t realize: not every tooth with an exposed nerve needs a root canal.
For years, the standard approach was simple. If a cavity got deep enough to reach the nerve, or if a dentist accidentally exposed the pulp during a procedure, the answer was almost always the same — root canal. Remove the nerve. Fill the canals. Done.
But what if the nerve is still healthy? What if only a tiny portion of the pulp is damaged, and the rest is perfectly fine? Does it really make sense to take out everything?
Dr. Jason Phan doesn’t think so. And the research backs him up.
At our Torrance office, we offer vital pulp therapy — a conservative approach that saves the living tissue inside your tooth. Instead of removing all the pulp like a traditional root canal, we remove only the damaged portion and help the healthy pulp heal itself.
Your tooth stays alive. It keeps its blood supply. It keeps sensation. And it stays stronger for years to come.
Success Rate (Properly Selected Cases)
Minutes Per Appointment
Your Tooth Stays Living
What Is Vital Pulp Therapy, Exactly?
Let’s keep this simple.
Inside every tooth, underneath the hard enamel and dentin, there’s a soft tissue called the pulp. It’s basically the “living part” of your tooth — blood vessels, nerves, connective tissue. It’s what keeps your tooth nourished and able to feel temperature.
When decay gets deep, or when a crack or injury exposes this pulp, bacteria can start to damage it. The old-school approach was to remove all of it. That’s a root canal.
Vital pulp therapy takes a different path. If the damage is limited — meaning only part of the pulp is affected and the rest is still healthy — we can remove just the damaged portion. Then we place a biocompatible material over the healthy pulp to seal it off, protect it, and let it heal.
Think of it like this. If you cut your finger, you don’t amputate the whole hand. You clean the wound, bandage it, and let your body do the rest. Vital pulp therapy works on a similar idea.
The Three Types of Vital Pulp Therapy
Not all cases are the same. Depending on how much pulp is affected, Dr. Phan uses one of three approaches:
Indirect Pulp Capping
Least invasive option
- • Decay is very close to the pulp but hasn't reached it yet
- • A thin layer of affected dentin is left in place
- • Protective material placed over it
- • The tooth forms new protective dentin naturally
Direct Pulp Capping
Small pulp exposure
- • Pulp is exposed but the exposure is small
- • No sign of infection in the remaining pulp
- • Biocompatible material (MTA or Biodentine) placed directly on exposed pulp
- • Pulp heals and forms a dentin bridge
Pulpotomy
Partial pulp removal
- • Larger exposure or some inflammation present
- • Inflamed pulp tissue at the top is removed
- • Healthy pulp deeper in the roots is preserved
- • Tooth maintains blood supply and nerve function
Why Keeping the Pulp Alive Actually Matters
This is where Dr. Phan gets pretty passionate.
A tooth without its pulp is technically a dead tooth. It can still function — millions of root-canal-treated teeth work just fine for decades. But there are real differences between a living tooth and a dead one.
A Living Tooth vs. A Root-Canal-Treated Tooth
- Blood supply stays intact. A living tooth has its own blood flow that delivers nutrients and immune cells. This helps the tooth defend itself against future problems.
- Stronger dentin. Hydrated dentin (from a living tooth) is more flexible and resistant to fracture than dehydrated dentin from a pulpless tooth. This means less chance of cracking down the road.
- Sensation preserved. You can still feel hot and cold. That might sound like a downside, but sensation is actually a warning system. If something goes wrong with the tooth later, you'll know about it.
- May not need a crown. Root-canal-treated teeth almost always need a crown to prevent fracture. A tooth saved with vital pulp therapy often just needs a filling or an onlay.
Here’s Dr. Phan’s honest take: “A root canal is still a great treatment. I do them every day and they work. But if I can keep a tooth alive — if the conditions are right — that’s a better outcome for the patient. A living tooth is always stronger than a dead one.”
The Shift in How We Think About Teeth
For a long time, endodontics had one gear: remove the nerve.
Got a deep cavity? Root canal. Cracked tooth with pulp exposure? Root canal. Accidental exposure during a crown prep? Root canal.
It made sense with the materials available at the time. Old-school pulp capping materials like calcium hydroxide worked okay, but they weren’t great. They’d break down over time, sometimes leaked, and the success rates were mediocre. So dentists (and endodontists) just defaulted to root canals because they were more predictable.
Then something changed.
New biomaterials hit the market — specifically MTA (mineral trioxide aggregate) in the late ’90s, and later Biodentine. These materials are game-changers. They seal better, they’re biocompatible, and they actually encourage the pulp to form new dentin. The success rates jumped from around 50-60% with calcium hydroxide to 85-95% with these newer materials.
Suddenly, keeping the pulp alive wasn’t just wishful thinking. It was a real, evidence-based option.
The Materials That Made This Possible
MTA (Mineral Trioxide Aggregate)
The gold standard
- • Highly biocompatible — your body doesn't reject it
- • Creates an alkaline environment that kills bacteria
- • Stimulates the pulp to form a protective dentin bridge
- • Excellent long-term seal
Biodentine
Next-generation option
- • Sets faster than MTA (about 12 minutes vs. several hours)
- • Excellent handling properties
- • Similar biocompatibility and success rates
- • Good option when time is a factor
Calcium Hydroxide
Traditional material
- • Been around for decades — long track record
- • Still used in some situations
- • Lower success rates than MTA and Biodentine
- • Can dissolve over time
A Real Patient Story
A 22-year-old patient came to our Torrance office last year. She’d been referred by her general dentist in Redondo Beach after a routine filling went deeper than expected. During the procedure, the dentist hit the nerve — the pulp was exposed.
She was told she’d need a root canal. At 22. On a tooth that had no infection, no pain, no swelling. The only problem was that small pinpoint exposure from the filling.
She came to see Dr. Phan for a second opinion.
After taking a CBCT 3D scan and examining the tooth under the microscope, the picture was clear: the pulp exposure was small (about 1mm), there was no sign of infection, and the remaining pulp tested healthy.
Dr. Phan performed a direct pulp cap with MTA. The whole procedure took about 35 minutes. She went home with a temporary filling, came back two weeks later for the permanent restoration, and that was it.
At her six-month follow-up, the tooth tested completely normal. Responded to cold. No sensitivity. No pain. The CBCT showed a healthy-looking dentin bridge forming right where the MTA was placed.
That’s a 22-year-old who gets to keep a fully living tooth instead of starting down the road of root canal, crown, and whatever comes after that. That’s a big deal.
When Vital Pulp Therapy Works — And When It Doesn’t
Dr. Phan is the first to say: this isn’t for every situation. Picking the right cases is everything.
Good Candidates for Vital Pulp Therapy
- Small, recent pulp exposure
- Healthy remaining pulp tissue
- Tooth responds normally to pulp tests
- No signs of infection on X-ray or CBCT
- Young patients with immature root tips
- Mechanical exposure during dental work
When You Still Need a Root Canal
- Spontaneous, throbbing pain
- Abscess or swelling present
- Pulp is necrotic (dead)
- Tooth doesn't respond to pulp testing
- Large area of infection on CBCT
- Prolonged lingering pain to hot/cold
How Dr. Phan Evaluates Your Tooth
Case selection is everything with vital pulp therapy. Get it right, and you save a living tooth. Get it wrong, and you’ve wasted the patient’s time and money.
That’s why Dr. Phan uses a multi-step evaluation process:
Symptom History
What kind of pain are you having? When did it start? Does cold linger or go away quickly? Spontaneous throbbing vs. sensitivity to cold tells us very different stories about pulp health.
CBCT 3D Imaging
A regular X-ray is two-dimensional and misses a lot. Our CBCT scan shows the tooth in 3D — we can see exactly how deep the decay goes, whether there's any bone loss around the roots, and if there are signs of infection that aren't visible on a flat X-ray.
Pulp Vitality Testing
We test the tooth with cold and electric pulp testing. A healthy, responsive pulp is a good sign. A tooth that doesn't respond at all usually means the pulp is already dead — and a root canal is the right call.
Microscope Evaluation
During the procedure itself, Dr. Phan examines the exposed pulp under 25x magnification. The color and bleeding pattern of the pulp tissue tells us whether it's healthy enough to save. Bright red, controlled bleeding = healthy. Dark, stagnant, or no bleeding = not salvageable.
This is where seeing a specialist matters. A general dentist doesn’t usually have a CBCT scanner or a surgical microscope. Dr. Phan uses both, and that makes the difference between guessing and knowing.
Vital Pulp Therapy vs. Root Canal: Side by Side
| Feature | Vital Pulp Therapy | Root Canal |
|---|---|---|
| What's Removed | Only damaged pulp tissue | All pulp tissue |
| Tooth Status After | Alive — blood supply intact | Non-living — no blood supply |
| Sensation | Preserved — feels hot/cold | Lost — no temperature sensation |
| Tooth Strength | Stronger — hydrated dentin | More brittle over time |
| Treatment Time | 30-45 minutes | 60-90 minutes |
| Usually Needs Crown? | Often just a filling or onlay | Almost always needs a crown |
| Typical Cost | $500-$1,200 | $1,000-$1,800 + crown |
| Success Rate | 85-95% (selected cases) | 90-95% |
Both treatments are good. A root canal is still one of the best procedures in dentistry. The point isn't that root canals are bad — it's that sometimes there's a less invasive option that gives you a better long-term result. Vital pulp therapy is about choosing the right treatment for the right situation.
Vital Pulp Therapy for Adults — Yes, It Works
Here’s a common misconception: vital pulp therapy is just for kids.
That used to be mostly true. Pulpotomies on baby teeth have been done for decades. But on adult permanent teeth? Dentists were skeptical for a long time.
The evidence has changed the conversation. Multiple studies published in the last 10 years show that adult vital pulp therapy with MTA or Biodentine works just as well as it does in younger patients. A 2022 meta-analysis found success rates above 90% for adult pulpotomies at 2-year follow-up. Other long-term studies show these results holding at 5 and even 10 years.
The key is the same for adults and kids: the remaining pulp needs to be healthy. Age alone isn’t a disqualifier. Dr. Phan has successfully performed vital pulp therapy on patients in their 50s and 60s. It all comes down to what the pulp looks like under the microscope and what the CBCT shows.
If you’ve been told you need a root canal and you’re wondering if there’s another option, it’s worth getting an evaluation. Especially if the tooth has no spontaneous pain, no swelling, and the nerve was exposed during a dental procedure rather than from a long-standing infection.
What to Expect: The Procedure and Recovery
The procedure itself is straightforward:
Anesthesia
The tooth is completely numbed. You won't feel a thing during the procedure.
Isolation with Rubber Dam
A rubber dam keeps the tooth clean and dry. No bacteria from your mouth can contaminate the pulp during treatment. This step is non-negotiable.
Decay Removal & Pulp Assessment
Dr. Phan removes the decay under the microscope, evaluates the pulp exposure, and determines whether to proceed with a cap or partial pulpotomy based on what he sees.
Material Placement
MTA or Biodentine is placed directly over the healthy pulp. This seals it off and creates the environment for healing.
Restoration & Follow-Up
A temporary or permanent filling is placed. You'll come back for a check at 1-2 weeks, then again at 3-6 months to confirm everything is healing well with a repeat CBCT or X-ray.
Recovery is easy. Most patients have mild sensitivity for a few days — nothing more than what you’d feel after a regular filling. Over-the-counter ibuprofen handles it. You can eat and drink normally once the numbness wears off. No special diet. No restrictions.
If the tooth starts having spontaneous pain, prolonged sensitivity to hot, or swelling after the procedure — that could mean the pulp isn’t healing as hoped. That’s rare in well-selected cases, but if it happens, Dr. Phan can step in and convert to a root canal. Nothing is lost.
Why See an Endodontist for Vital Pulp Therapy?
General dentists can do pulp caps. Some do them well. But here’s the thing — the difference between success and failure with this procedure often comes down to details that require specialist tools and training.
- The microscope matters. Evaluating pulp health at 25x magnification is very different from looking with your eyes or loupes. The color, consistency, and bleeding pattern of the pulp tissue under a microscope tells you things you simply can’t see otherwise.
- CBCT changes the diagnosis. A regular X-ray can miss early periapical changes that would rule out vital pulp therapy. Our CBCT scanner catches what 2D imaging misses.
- Material handling takes practice. MTA and Biodentine have specific protocols. How you mix them, how you place them, how you manage moisture — it all affects the outcome.
- If it doesn’t work, you’re already in the right office. If Dr. Phan determines mid-procedure that the pulp isn’t salvageable, he can convert to a root canal right then and there. No second appointment, no second referral. Same visit.
Serving Torrance and the South Bay
Our office is located in Torrance, and we regularly see patients from all over the South Bay — Redondo Beach, Manhattan Beach, Hermosa Beach, Palos Verdes, Gardena, Carson, and Lomita. Many of our vital pulp therapy patients are referred by general dentists in these communities who want a specialist opinion before committing to a full root canal.
If your dentist found a deep cavity or accidentally exposed the nerve during a procedure, ask them about a referral to our office. A quick evaluation can tell us whether your tooth is a good candidate.
Insurance and Cost
Vital pulp therapy typically costs between $500-$1,200, depending on the complexity. That’s often less than the combined cost of a root canal plus a crown.
Most dental insurance plans cover vital pulp therapy. We verify your benefits before treatment so you know what to expect. We also accept CareCredit for those who prefer payment plans.
Schedule Your Evaluation
Not sure if you need a root canal or if vital pulp therapy might work for your tooth? That’s exactly what the consultation is for.
Call our Torrance office or contact us online to schedule an appointment. Dr. Phan will review your imaging, test the tooth, and give you an honest recommendation — whether that’s vital pulp therapy, a root canal, or just monitoring the situation.
Your tooth might have more life left in it than you think.
