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Pre‐operative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used. A search was conducted in the PubMed‐MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Twenty‐eight studies published between 1961 and 2021 were included. Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. There was no significant difference in the ‘tooth survival’, ‘post‐operative pain’ and ‘evidence of apical radiolucency’ outcomes of RCTx in teeth with vital or necrotic pulps.
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