In recent times, an improved understanding of the pathophysiology of the layers of carious dentin seen in a lesion and renewed belief in the ability of the dental pulp to heal in a cario-protective environment have brought vital pulp procedures such as Indirect Pulp Treatment and Pulpotomy to the forefront. While Indirect Pulp Treatment based on the principles of Selective Caries Removal is now the preferred treatment for extensive-stage lesions, its success relies on the clinician’s ability to make an accurate diagnosis of the pulpal status of the tooth, based on patient history and clinical and radiographic assessment of the lesion. Pulpotomy is also a vital pulp therapy procedure that is performed if a pulpal exposure occurs during Selective Caries Removal. This chapter elaborates on the clinical indications, contraindications, and techniques for vital pulp therapy in primary teeth and suggests an evidence-based algorithm to help the clinician diagnose pulpal status and choose between the different treatment modalities.