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Related Experiment Video

Updated: Apr 23, 2026

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease
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Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline.

Falk Schwendicke1, Esra Kosan2, Avijit Banerjee3

  • 1Department of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital, LMU Munich, Munich, Germany.

International Endodontic Journal
|April 22, 2026
PubMed
Summary

Selective or stepwise caries removal reduces pulp exposure risk in deep caries management. Hydraulic calcium silicate cements are preferred for vital pulp therapy, supporting less invasive strategies to maintain tooth vitality.

Keywords:
clinical practice guidelinedeep cariesdirect pulp cappingevidence‐based dentistrynon selective caries removalpulpotomyselective excavationstepwise caries removalvital pulp treatment

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Area of Science:

  • Dentistry
  • Conservative Dentistry
  • Endodontology

Background:

  • Deep caries management is complex, often involving risk of pulp exposure.
  • Evidence-based guidelines are crucial for optimal clinical decision-making.

Purpose of the Study:

  • To develop an evidence-based S3-level clinical practice guideline for managing deep and extremely deep caries in vital permanent teeth.
  • To provide clinicians with recommendations on caries removal, cavity liners, and vital pulp therapy.

Main Methods:

  • Systematic reviews and structured consensus process (S3-level) involving multiple European dental societies.
  • Formulation of key clinical questions and grading of evidence quality using the GRADE approach.

Main Results:

  • Selective or stepwise caries removal is recommended over non-selective removal to minimize pulp exposure.
  • Routine cavity liners offer no consistent benefit; hydraulic calcium silicate cements show superior outcomes for pulp capping and pulpotomy.
  • Direct pulp capping and pulpotomy are effective vital pulp therapies; pulpotomy is an alternative to pulpectomy in irreversible pulpitis.

Conclusions:

  • Less invasive strategies for deep caries management support pulp vitality.
  • Guideline implementation requires clinician training, patient-centered care, and consideration of practical factors.
  • Further research is needed for extremely deep caries and long-term outcomes.