Vital pulp therapy (VPT) in mature permanent teeth with carious pulp exposure has been a matter of debate, with root canal therapy being the conventional standard of care. Previously reported negative outcomes for VPT inthese teeth were based on data from studies that have used calcium hydroxidein direct pulp capping, partial and full pulpotomy. The introduction of hydraulic calcium silicate based materials with sealing and bioactive potentialshave opened a new era in VPTwith more favorableresults. Understanding the histopathology and histobacteriology of the cariously exposed pulp and the healing potential of the inflamed pulp could guide the decision making processtoward an ultraconservative management of these teeth. However,proper case selection,strict aseptic condition, capping material and good coronal seal are crucial for long term success.