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Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline
Falk Schwendicke1,2, Esra Kosan3, Avijit Banerjee4
1Department of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital, LMU Munich, Munich, Germany, falk.schwendicke@med.uni-muenchen.de.
Caries Research
|April 22, 2026
Summary
For deep caries, selective removal strategies and vital pulp therapy are recommended to maintain tooth vitality. Hydraulic calcium silicate cements show superior outcomes for pulp capping and pulpotomy, guiding conservative dentistry practices.
Area of Science:
- Dental research
- Conservative dentistry
- Caries management
Background:
- Deep and extremely deep caries pose significant challenges in vital permanent teeth.
- Current management strategies require evidence-based guidelines for optimal patient outcomes.
Purpose of the Study:
- To develop an evidence-based S3-level clinical practice guideline for managing deep and extremely deep caries.
- To provide clinicians with recommendations on caries removal, cavity liners, and vital pulp therapy.
Main Methods:
- Systematic reviews and structured consensus process (S3-level) were employed.
- Key clinical questions addressed caries removal, cavity liners, and pulp management.
- Evidence was appraised using the GRADE approach and synthesized for guideline formulation.
Main Results:
- Selective or stepwise caries removal is recommended over non-selective removal to minimize pulp exposure risk.
- Cavity liners are not routinely recommended due to inconsistent clinical benefits.
- Direct pulp capping and pulpotomy are effective for vital pulp therapy; hydraulic calcium silicate cements outperform calcium hydroxide.
Conclusions:
- Less invasive strategies for deep caries management support pulp vitality.
- Guideline implementation requires clinician training, patient-centered decisions, and consideration of practical factors.
- Further research is needed for extremely deep caries and long-term outcomes.
Keywords:
Clinical practice guidelineDeep cariesDirect pulp cappingEvidence-based dentistryNon-selective caries removalPulpotomySelective excavationStepwise caries removalVital pulp treatmentMore Related Videos
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