Clinical Challenges and Therapeutic Approaches in Managing Deep Carious Lesions Close to the Pulp in Permanent Teeth:...

This narrative review aims to evaluate the clinical challenges and therapeutic approaches for managing deep carious lesions (DCLs) in permanent teeth close to the pulp, with a focus on minimally invasive, pulp-preserving strategies.

A literature review was conducted using PubMed and Google Scholar, with studies searched up to August 2025. Inclusion criteria were clinical trials, systematic reviews, and narrative reviews focusing on DCL management. Emphasis was placed on the biological basis of pulp preservation, diagnostic methods for assessing pulpal health, and the clinical performance of conservative techniques, including selective and stepwise caries removal, indirect and direct pulp capping, and pulpotomy.

The review highlights a paradigm shift from traditional complete caries removal to minimally invasive strategies aimed at preserving pulp vitality. Selective and stepwise caries removal showed success rates up to 97%, while pulpotomy procedures using bioactive materials demonstrated superior biocompatibility and dentin bridge formation. Pulpotomy success rates ranged from 86% to 98% in vital mature teeth, comparable to those of root canal therapy but with lower invasiveness and cost.

Minimally invasive, biologically driven approaches for managing DCLs offer effective pulp vitality preservation and high success rates. The use of bioactive materials, including mineral trioxide aggregate (MTA) and Biodentine, enhances treatment outcomes. These findings are clinically significant, providing evidence-based guidelines for practitioners seeking to adopt conservative treatment methods for DCLs in vital permanent teeth.