Data sources Embase, MEDLINE, Web of Science, Trip Pro, Cochrane Library, the International Clinical Trials Registry Platform and ClinicaTrials.gov, including a grey literature search. Study selection Randomised or quasi-randomised clinical trials (RCT). Data extraction and synthesis Two reviewers screened independently and extracted data separately with focus on study and population characteristics, treatment, pulp capping materials and clinical and radiographical outcome measures. Incremental cost effective ratios were collated. Results Seventeen studies reported in 21 articles were included. Three were completed trials and one ongoing trial comparing (partial/full) pulpotomy with other interventions for vital pulp therapy. The remaining 13 studies compared hydraulic calcium silicate cements with calcium hydroxide. Only three studies were considered as low risk of bias, except for performance bias (the inherent impossible task of blinding the clinician). Five trials comparing the capping materials were the basis of a quantitative synthesis. No cost-effectiveness studies were found. Conclusions Firm evidence has not been reached with respect to pulpotomy being the preferred intervention substituting root canal treatment; however better pulpotomy outcomes were reported when hydraulic calcium silicate cements are used, when compared to procedures where calcium hydroxide was used.