Traditionally, mature permanent teeth clinically diagnosed with irreversible pulpitis are treated with complete root canal therapy (RCT). However, recent studies have showed that mature permanent teeth with irreversible pulpitis could be successfully treated with vital pulp therapy (VPT). Complete RCT compared to VPT has following disadvantages: weakening of the teeth by removing tooth structure to accommodate root canal filling; higher prevalence of root fracture; poorer survival rate; prone to carious attack; and loss of apical healthy pulp to prevent development of apical periodontitis. In VPT, correct diagnosis of a pulp disease is important. Diagnosis of a pulp disease based on the patient’s subjective symptoms and objective clinical examination is a challenge. Control of pulp infection and bacteria-tight seal of pulp wound with capping materials with good coronal restoration are keys to the success. VPT of mature permanent teeth with irreversible pulpits can be an option – rather than complete RCT.