Management of deep caries and the exposed pulp

Area of Science:

• Operative Dentistry
• Endodontology
• Cariology

Background:

• High global caries prevalence disproportionately affects older and socially disadvantaged populations.
• Untreated caries progresses to pulpitis and necrosis, while conservative management allows pulpal recovery even in deep lesions.
• Traditional caries management was destructive; current trends favor minimally invasive, biologically based strategies like selective caries removal.

Purpose of the Study:

• To review the shift towards minimally invasive treatment strategies in caries management.
• To highlight the evolution of vital pulp treatment (VPT) techniques and materials.
• To identify critical unanswered questions and future research needs in operative dentistry and endodontology.

Main Methods:

• Review of current literature on caries management and vital pulp therapies.
• Discussion of selective caries removal (one-visit indirect pulp treatment, two-visit stepwise approach).
• Analysis of vital pulp treatment techniques (partial and complete pulpotomy) and biomaterials (e.g., mineral trioxide aggregate).

Main Results:

• Minimally invasive strategies, including selective caries removal and vital pulp treatments, are gaining prominence.
• Improved understanding of the pulp-dentine complex supports these conservative approaches.
• New materials like mineral trioxide aggregate offer more predictable outcomes for pulp capping.

Conclusions:

• There is an urgent need to promote minimally invasive strategies in operative dentistry and endodontology.
• Current evidence supporting these advanced techniques is relatively weak, often based on small studies.
• Further research is critical for developing accurate diagnostic tools, evidence-based management strategies, and education for managing exposed pulps.