Velayutham GOPIKRISHNA, Lars BJØRNDAL, Nessrin TAHA, Ikhlas EL KARIM, James L. GUTMANN
European Endodontic Journal - 2026;11(8):357-365
Pulpitis is a progressive inflammatory disease of the dental pulp, traditionally classified using histopathological or symptom-based schemes such as 'reversible' vs. 'irreversible'. While these frameworks have aided understanding, they often fail to reflect the dynamic biological state of the pulp that can aid in precise, minimally invasive treatment decisions. The aim of this article is to introduce a clinically meaningful classification of pulpitis that combines preoperative and intraoperative diagnostic assessment criteria to enable objective therapeutic choices. Drawing on the medical staging model used in other progressive diseases, the proposed classification is defined by (i) preoperative clinical and radiographic characteristics, (ii) intraoperative clinical observation of time-to-haemostasis and (iii) evidence-based therapeutic recommendations from conservative vital pulp therapy to pulpectomy. The proposed staging system comprises Stage 0: normal healthy pulp, Stage 1: mild pulpitis, Stage 2: severe pulpitis, Stage 2.1: partial coronal pulpitis, Stage 2.2: complete coronal pulpitis, Stage 2.3: total pulpitis and Stage 3: pulp necrosis. This staging system provides a structured, objective framework for communication with patients, prognostic assessment, research comparability, and health system integration (coding, record-keeping and reimbursement). It also represents a shift from theoretical disease labels towards actionable, biologically driven treatment pathways. The current staging classification provides a structured clinical framework to guide evidence-based treatment selection and aids the clinician to choose the most appropriate therapeutic approach for each case.
