Purpose: The purpose of this retrospective chart review was to determine if the survival of two methods of vital pulp therapy (VPT) were influenced by the pre-operative radiographic depth and location of caries. Methods: Electronic patient records (axiUm®) that contained the procedure codes D3120, Indirect Pulp Therapy (IPT), or D3220, Therapeutic Pulpotomy (TP), were queried. Qualifying charts’ pre-operative and post-operative radiographs were viewed in MiPACS® by two raters. Visit records were queried again to identify any other treatment failures. Results: A total of 568 primary molars met the eligibility criteria. There was a difference in survival depending upon the treatment procedure (P < .0001), with D3220 having a significantly higher failure rate than D3120. In the 182 total cases with caries 2/3 to encroaching the pulp, therapy success was greater with IPT (P < .0001). Conclusion: IPT results in longer overall clinical success even at the deepest level of caries.