Guidelines for vital molar therapy are presented based on the best available evidence. Often the cause for vital intervention is due to caries, but seldom the depth of the carious lesion is mentioned in literature, which may hamper the evaluation of prognosis following treatment. Moreover, the lack of devices for monitoring objectively the degree of pulp inflammation makes the topic a clinical challenge where proper tooth selection is important. In this chapter, progressive stages of extensive deep caries lesions (deep lesions, DL, 1–3) are defined and linked to pragmatic treatment protocols, which includes both non-pulp-invasive as well as pulp-invasive procedures. Two pulp-capping scenarios are apparent that should be related to the cause of event as the predictability of the outcome is higher in traumatic non-infected exposures (class I) as opposed to infected environments (class II). In particular, for infection scenarios, an enhanced protocol is applied for the vital pulp therapy, including the use of the operating microscope, high concentration of a disinfection agent and a hydraulic calcium silicate cement (HCSC) containing pulp-capping agent. Notably, clinical controlled data questions the superiority of one pulp exposure modality as opposed to yet another. However, more work has been given for examining pulpotomy as a permanent modality, not at least in extensive stages of caries progression but the required evidence has yet to emerge. Pragmatic guidelines are presented.