Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline

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.