Vital pulp therapy is the group of procedures indicated to maintain pulp vitality allowing for continued root development and apical closure in the presence of pulp exposure due to caries or trauma. Complete maturation results in stronger tooth structure that is more able to withstand occlusal forces. Historically, calcium hydroxide (Ca(OH)2) was the material of choice for a vital pulpotomy. Recently mineral trioxide aggregate (MTA) has been used as a pulp sealing material because of its biocompatibility and its ability to induce hard tissue barrier formation. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of vital pulp therapy procedures performed with MTA. All patients receiving MTA pulpotomies and MTA pulp caps at Virginia Commonwealth University School of Dentistry Graduate Endodontic Practice between November 30, 2009 and August 15, 2013 were recalled and evaluated for presence or absence of clinical symptoms, pulp vitality, radiographic evaluation of continued root development, dentin bridge formation or pulp canal obliteration. Results were analyzed descriptively. At time of treatment caries was found to be the most common etiologic factor. Fifty-seven percent of cases were symptomatic at time of treatment (43% asymptomatic). Forty-seven percent of the teeth presented with immature apices (53% with radiographically closed apices). Overall recall rate was 50%. At recall all teeth were clinically asymptomatic. Forty seven percent of teeth tested normally to cold (33% were non-responsive to cold) at recall. Pulp canal obliteration was seen in 6 cases, 4 molars and 2 anterior teeth. In conclusion, MTA pulpotomy and MTA direct pulp caps are a predictable treatment modality for young vital permanent teeth affected by caries or trauma.