Conventional management of permanent tooth pulpitis predominantly involves root canal therapy (RCT), which is associated with several limitations, including prolonged treatment time, increased costs, the necessity for complete removal of pulp tissue, and diminished postoperative fracture resistance of the tooth. Vital pulp therapy (VPT), which focuses on excising infected or inflamed pulp tissue, establishing an effective seal, and employing bioactive materials to promote tissue repair, has recently broadened its application. Initially reserved for reversible pulpitis and immature permanent teeth, VPT is now increasingly utilized in selected cases involving mature permanent teeth and clinical presentations suggestive of irreversible pulpitis, facilitated by advancements in biomaterials and clinical methodologies. This review examines the diagnostic and preoperative evaluation processes, caries excavation techniques, pulp capping and pulpotomy procedures, innovations in therapeutic materials, adjunctive physical technologies, and follow-up assessment protocols pertinent to VPT in mature permanent teeth, structured according to the clinical workflow. Furthermore, it critically appraises the current limitations, ongoing debates, and prospective research avenues within the existing literature, with the objective of informing clinical decision-making and promoting standardized treatment practices.