Treatment Of Deep Caries Research Articles

Efficacy of vital pulp therapy for carious pulp injury in permanent teeth: a study protocol for an open-label randomized controlled noninferiority trial.

Vital pulp therapy (VPT) has recently been reported as an effective approach for preventing and treating carious pulp injury in permanent teeth. Compared with root canal treatment (RCT), which involves complete removal of the pulp tissue, VPT effectively maintains pulp vitality and retains the physiological functions of the pulp. In the research pool, large-scale randomized controlled trials evaluating the treatment outcome of VPT using calcium silicate cements and RCT in cariously exposed permanent teeth are lacking. Here, we present a monocentric clinical protocol to compare the effects of VPT using iRoot BP Plus (Innovative Bioceramix, Vancouver, BC, Canada) as a pulp-capping material with RCT. The proposed trial is an open-label, single-centre, randomized, controlled, noninferiority trial. In total, 462 patients will be included in this trial according to the following criteria: adult patients (18-50years old), pulp exposure during the treatment of deep caries in mature permanent teeth, a diagnosis of reversible or partially irreversible pulpitis without apical translucency on X-ray, without periodontitis or systemic disease. Patients with signed informed consent forms will be enrolled and randomly divided into two groups (VPT and RCT) with a balanced treatment allocation (1:1). Clinical evaluations will be conducted at baseline and at 3, 6, 12, and 24months after treatment, with the potential for extension. The primary outcome measure will be the duration of success. The secondary outcomes will include the success rate at the 1-year follow-up and any adverse reactions. The Kaplan‒Meier method and log-rank test will be used to compare the duration of success of both treatments. For other outcomes, the χ2 test or Fisher's exact test will be used for categorical variables, and the t test or Mann‒Whitney U test will be used for continuous variables to assess the differences between groups. The results of this trial will provide a clinical reference for selecting treatments for carious pulp injuries in permanent teeth. ClinicalTrials.gov ChiCTR2100051369. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn ). Registered on 21 September 2021.

Treatment of deep caries or pulpotomy in deciduous teeth

Treatment of deep caries or pulpotomy in deciduous teeth

Treatment strategies for deep caries

Deep caries occurs when caries progresses to the deep dentin layer, and further progression has the risk of pulp exposure, which may affect pulp vitality and tooth longevity. Currently, there are no objective standards for the diagnosis of deep caries. In addition, traditional therapy for deep caries emphasizes complete debridement of the decayed tissue, resulting in an incremental high risk of pulp exposure. There are different views on how to deal with the remaining dentin after caries removal, and root canal treatment is often adopted directly after pulp exposure. In recent years, due to advances in dental pulp biology, bioactive pulp-capping materials, and clinical evidence-based medicine, the principle of deep caries treatment has shifted to pulp protection. Based on the latest international research progress, evidence-based medicine and expert consensus, we present a series of advancements in this article, including the terminology of deep caries, pathological changes and defense mechanisms of the pulp close to the deep caries, treatment principles of deep caries, technical strategies for carious tissues removal, and the decision-making of treatment protocols after pulp exposure, with the aim of enhancing the understanding of deep caries among dentists, as well as providing a reference for the clinical diagnosis and treatment of deep caries.

One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial.

This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.

303 Investigation of the antibacterial and regenerative properties of a novel AHA dental coating for the treatment of deep caries

OBJECTIVES/GOALS: Our objective is to investigate the antibacterial and regenerative properties of a novel AHA dental coating for the prevention and treatment of deep caries (cavities). Further, we aim to investigate and compare these properties through in vivo murine models and assessment on human saliva samples and human pulpal cells collected from clinical samples. METHODS/STUDY POPULATION: In vitro antibacterial studies were performed by collecting and culturing human salivary bacteria with AHA substrates and quantifying survival of cariogenic Sm (S. mutans). In vivo, C57BL/6 mice were treated with AHA composite fillings, infected with Sm clinical isolates, and fed a high sucrose diet with cavity formation assessment after 6 weeks. To evaluate regeneration, mice were similarly given composite with AHA or MTA (standard of care) upon pulpal exposure with regeneration quantified by microCT and histological analysis of dentin bridge formation, ALP production, and odontoblast migration. In vitro, AHA substrates were cultured with MC3T3-E1 pre-osteoblast cells and dental pulp stem cells obtained from clinical samples over 21 days, with mineralization and ALP assessed indicating osteogenesis. RESULTS/ANTICIPATED RESULTS: In vivo studies have shown the reduction of cavity formation in mice treated with AHA as well as dentin regeneration upon pulpal exposure using microCT and histological image analysis. Coinciding with these findings, AHA substrates eradicated cariogenic Sm in human saliva samples and single species cultures in vitro. Further, preliminary results in vitro have shown increased mineralization of MC3T3-E1 cells when cultured with AHA substrates in comparison to uncoated substrates. We anticipate similar increased mineralization as well as increased ALP production of human pulpal stem cells from clinical samples when cultured with AHA substrates, suggesting osteogenesis. Further, we anticipate increased odontoblast migration and ALP production upon additional analysis of in vivo tissue samples. DISCUSSION/SIGNIFICANCE: This work will elucidate the antibacterial and regenerative properties of AHA dental coatings. These results further support the translation of AHA coatings into the clinic as a novel therapeutic for the prevention and treatment of dental decay, which may overcome the limitations associated with the current treatments.

Deep Caries Treatment with ART Restorations

Deep Caries Treatment with ART Restorations

Odontogenesis by Endocytosis of Peptide Embedding Bioactive Glass Composite

Limited therapeutic options are available for treating deep caries. Those materials with potential of a dual effect to remineralize hard tissue and regenerate defective dentin tissues could be used as a new strategy for deep caries treatment. However, the application of the single component remains a challenge mainly because they lack calcium and phosphorus, are easily degraded, and are difficult to retain in the intricate body fluid environment. Considering the abundant source of calcium and phosphorus as well as the delivery performance of mesoporous bioactive glass (MBG), an amelogenin-derived peptide (QP5), which has a significant role in hard tissue remineralization, was loaded to fabricate a novel composite. After the synthesis of highly ordered MBG using a sol-gel method, the QP5 peptide was loaded increasingly by its extensive porous structure and enhanced electrostatic absorption. When used in an acidic environment, the MBG/QP5 composite presented pH-responsiveness, releasing therapeutic ions and functional peptides in a sequential cascade, and eventually adjusted the pH to a neutral state. The composite was internalized by dental pulp cells through a clathrin-mediated pathway and influenced by cell membrane lipid raft regulation. It could be also transported through the macro-pinocytotic pathway. Compared to the single treatment of peptide QP5 in 48 h, the composite facilitated a higher level of retention of the intracellular peptides. The composite further promoted migration and odontogenesis of dental pulp cells, including the improved activity of alkaline phosphatase, increased formation of mineralized nodules, and upregulated expression of mineralization-related genes compared to using MBG or QP5 alone. The composite further induced the dentin-like layer in a rat pulp capping model. The results suggested that this intelligent material with pH-responsiveness provides a promising alternative treatment method for biomimetic restoration of deep caries.

Contemporary management of deep caries in primary teeth: a systematic review and meta-analysis.

To systematically evaluate the available evidence regarding contemporary management of deep caries in vital primary teeth. This review was carried out to facilitate the development of European Academy of Paediatric Dentistry (EAPD) guidelines on deep caries management of primary teeth in paediatric dentistry. A systematic electronic literature search was conducted to locate studies reporting on interventions and medicaments used for the treatment of deep caries in vital primary teeth. To facilitate this, the Cochrane Library (1992 to up to December 6th, 2020), MEDLINE (PubMed, 1946 to December Week 1, 2020), Ovid MEDLINE (In-Process & Other Non-Indexed Citations, December 6th, 2020); EMBASE (Embase.com, 1974 to December 6th, 2020) and LILACS (1982 to December 6th, 2020) were accessed. Hand search of reference lists of included articles, as well as handbooks and grey literature search was also performed. Study screening was done in duplicate and study inclusions were agreed upon by all authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies. Overall success rate of each intervention and medicament within the intervention was reported. Meta-analysis was also performed for high-quality studies reporting similar interventions and comparable outcomes in homogeneous population. A total of 1332 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the review. Of these, 8 papers were deemed to represent 4 individual studies, leaving a total of 32 unique studies eventually included in the final analysis. These studies were further categorized into three main vital pulp treatment methods for analysis: indirect pulp capping (IPC), direct pulp capping (DPC), and pulpotomy (PP). Overall, IPC, DPC and PP interventions have high success rates with the reported clinical success rates higher than radiographic success rates. Medicaments used for IPC and DPC have similar success rates. Mineral trioxide aggregate (MTA), ferric sulfate (FS) and formocresol (FC) PP showed similar success rates, and which were all higher than calcium hydroxide (CH). Majority of included studies (n = 22; 63%) were rated low in terms of their potential risk of bias, 6 studies were ratedhigh(17%), and 7 studies were of unclear risk (20%). Within the limitations of the studies included, IPC, DPC, and PP can be recommended as effective treatment modalities for primary teeth with deep caries under specific conditions.

Pulp hyperemia: analysis of treatment based on the results of a survey of dentists

The purpose of the study: to analyze the methods of treatment of deep caries by dentists of the Samara region.Materials and methods. In 2021, 220 specialists of the Samara region were surveyed on the treatment of deep dental caries on the bases of budgetary and extra-budgetary organizations. The questionnaires contained 20 questions that provided information about the level of professional training of specialists, the degree of their awareness of quality criteria and standards, the use of modern technologies and the implementation of each stage of deep caries treatment. The statistical significance of the obtained results (p) was calculated using the Student’s criterion (t) and its interpretation based on the standard table of critical values of the Student’s coefficient. Spearman’s rank correlation method was used to determine the strength and direction of the correlation.Results. The majority of dentists – 89.9% use a medical pad in the treatment of deep caries, of which 38.7% of respondents use this pad only when accidentally opening the tooth cavity. Based on the answers to the questionnaire, 77.0% of respondents prefer calcium-containing self-hardening medical pads and only 4.6% use MTA-based pads. A comparative analysis of doctors with rare early complications and doctors with frequent early complications showed that doctors of the second group apply a medical pad when opening the tooth cavity 25% more often than doctors of the first group when performing necrectomy in full volume in both groups. A comparative analysis of doctors with rare late complications and frequent late complications did not reveal a statistical significance between the imposition of a medical pad and the opening of the tooth cavity during a complete necrectomy in doctors of the first and second groups. Complications after the treatment of deep caries may be due to an incorrect interpretation of reversible and irreversible changes in the pulp, and in this regard – incorrectly chosen treatment tactics.Conclusion. The success of the treatment of deep carisea largely depends on the correct determination of reversible and irreversible changes in the pulp of the tooth.

Calcium Hydroxide-based Therapeutic Pads as the Main Material in the Treatment of Deep Caries

The article is devoted to increasing the efficiency of treatment of deep caries, which is an urgent problem of modern dentistry. The aim of this study was to evaluate the results of the treatment of deep caries using the KERR "Life" calcium hydroxide treatment liner, which is a radiopaque, durable material based on calcium hydroxide and salicylate ester, recommended for direct or indirect pulp capping and as a cementitious base for all restorative filling materials. The study involved 26 patients. The studies carried out have confirmed the efficiency of the treatment of deep caries with the Life pad and confirmed the possibility of its widespread use in practice.

Comparison of the effectiveness of Trioxident and Сanal Mineral Trioxide agregate for capping perforations in the pulp cavity

BACKGROUND: The modern trend of dentistry is the principle of minimal invasiveness. Preservation of the vitality of the tooth is an actual principle of operation. In the treatment of deep caries or pulpitis by a biological method, the pulp chamber is often opened. Even with bleeding, there is a chance to leave the tooth vital. After hemostasis, antibacterial treatment of the carious cavity and padding were performed. Domestic manufacturers offer two analogues for these purposes "Trioxident" and "Kanal MTA.&#x0D; AIM: The purpose of the study is to compare the effectiveness of domestic materials "Trioxident" and "Kanal MTA" when used as a therapeutic and insulating coating of pulp.&#x0D; MATERIALS AND METHODS: 27 clinical cases were analyzed in patients aged 2335 with a diagnosis of "deep dentine caries" K02.2 (according to ICD-10) of molars and premolars of the upper and lower jaws. All clinical cases combined patients' complaints of intermittent aching pains, the depth of carious cavities and the opened tooth cavity at one point. The patients were divided into two groups, in each of which the following stages of diagnosis and treatment were carried out. Diagnostics was carried out before the start of work and during examination after 7 days, 6, 12, 18 months. The stages of caries treatment were the same, only the materials for closing the perforations differed: in group 1 "Trioxidant", in group 2 "Kanal MTA".&#x0D; RESULTS: It is noted that the use of materials "Trioxident" and "Kanal MTA" is an effective choice for closing perforations of the pulp chamber in the treatment of deep caries and chronic pulpitis. Pain was absent in 30.8% and 42.1% of patients in groups 1 and 2, respectively. After 6, 12, 18 months, patients did not complain about the treated teeth, the cold test was positive for a short time in 26 cases, the average current at electroodontodiagnostic (minimum value 4, maximum value 8) was 5.6 A, 25 restorations had an Alpha rating according to Ryge criteria, in one case in group 1, the tooth crown darkened pointwise from the vestibular surface.&#x0D; CONCLUSION: The materials "Trioxident" and "Kanal MTA" are recommended for use in the biological method of pulpitis treatment. They have therapeutic potential to cover the pulp and are competitive in relation to the foreign equivalent of "MTA Prorut", which gives them an economic advantage in providing dental care within the framework of compulsory medical insurance.

Comparative evaluation of the application of calcium hydroxide and material on the basis of mineral trioxide of the bio-dent unit in the treatment of deep caries with temporary teeth with low invasive methods

The aim of the work was to evaluate the comparative clinical efficacy of the use of a material based on calcium hydroxide, which has successfully proven itself in pediatric dental practice, and the innovative material "Bio-Dent" (Dentals Pfarma), the experience of which is limited in the treatment of deep caries of deciduous teeth using minimally invasive methods. Clinical studies were carried out on the basis of the Department of Hospital and Clinical Dentistry at the Children's Regional Dental Clinic in Andijan. The basis for the clinical analysis was the data obtained during the examination and treatment of 52 somatically healthy children 4–5 years of age with a compensated form of caries. Summarizing the results of the studies, it was concluded that the use of the "Bio-Dent" material in the teeth of temporary occlusion is the most effective and promising in the treatment of deep caries while maintaining the vitality of the pulp.

Treatment methods of deep caries in immature permanent teeth

Caries was qualified by UN as non-communicable disease – NCD. It can be avoided by preventive measures. Especially, deep caries lesions in immature permanent teeth constitute a serious clinical problem for contemporary pediatric dentistry. It is caused by a different anatomical and histological structure compared to mature permanent teeth. The aim of the study was to present contemporary methods of deep caries treatment in histologically and morphologically immature teeth with currently used materials. The literature review was based on Pubmed and Elsevier databases (2005-2018) and two articles out-of-range. The search criteria were: “caries”, “remineralization”, “indirect capping” and “immature teeth”. Development in medicine and biomedical science leads to creating more modern procedural records when it comes to deep caries treatment. They are based on minimally invasive dentistry. Development of bioengineering enables creation of more biocompatible materials which do not have irritating influence on dental pulp. These materials allow deeper remineralization of dental tissues. Deep caries treatment still involves usage of restorations with calcium hydroxide, zinc oxide with eugenol and glass ionomers. Good cooperation with patient, prospects of early diagnosis, and regular examinations of treated teeth have great impact on success of treatment. Further research on methods of diagnosis and treatment needs to be carried out. They should allow regeneration of early qualitative changes to avoid quantitative damages in a tooth’s hard tissue.

CLINICAL AND LABORATORY ANALYSIS OF THE EFFECTIVENESS OF TREATMENT OF DEEP CARIES WITH CALCIUM-CONTAINING PADS

The task of a dentist in the treatment of deep caries (pulp hyperemia) is not only to restore the integrity of the tooth, but also to stimulate the production of replacement dentin with the help of a medical pad, to ensure reliable isolation of the pulp from the toxic effects of materials. Having a wide range of different therapeutic pads, but not having methods to objectively assess the condition of the pulp, doctors have to «blindly» give preference to a particular manufacturer. In this work, based on a clinical and laboratory study, an analysis of the effectiveness of calcium-containing pads «Life» and «Dycal» - was performed. The clinical stage was performed on patients in the treatment of deep caries. Changes in the pulp microcirculation were evaluated using laser Doppler flowmetry. During histological examination, samples of tooth cuts were studied for analysis of micro-flows of the dye at the «seal-tooth» border and the depth of penetration of the dye. The clinical results are consistent with laboratory results, which can be used to draw conclusions about the benefits of the «Life» treatment pad in the treatment of deep caries.

Current views on the treatment of deep dental caries

A generalized analysis of the data of contemporary foreign and national scientific literature on a widespread pathology – the treatment of deep dental caries is carried out. This article sets out the views of scientists on the pathogenesis and treatment of this disease. It was concluded that the treatment of deep caries according to the «gold standard» does not guarantee in the future the absence of recurrence and complications of caries. Therefore, the justification and development of new more effective methods of treating deep dental caries are promising.

Prevalence and distribution of deep caries and abscess formation in children who required emergency dental general anaesthesia. A retrospective analysis.

The aim of this study was the assessment of prevalence, distribution, and treatment of deep caries and odontogenic abscess formation in children who received emergency dental general anaesthesia (DGA) at the University Hospital of Cranio-Maxillofacial and Oral Surgery of Innsbruck, Austria. The study population was composed of 1,184 consecutive cases of emergency DGA from January 2008 to June 2014, in patients ?16 years who had presented with odontogenic pain and/or swelling. Under DGA, the tooth causative for the acute pain, and all teeth with deep caries had been routinely removed. From patient files, demographic data, abscess location and therapy, and the number of teeth extracted under DGA were recorded and analysed by means of descriptive statistics. In 549 cases (46.4%) (mean age 5.29±2.39 years), an abscess formation was recorded; 90.5% of all abscesses were submucous, and 9.5% affected fascial spaces. Decayed primary molars and maxillary primary incisors and canines were most often causative for abscess formation. Drainage was in most cases performed by tooth extraction with/without an intraoral incision under antibiotic therapy. Per case, a mean of 5.91±4.04 primary teeth were extracted. In 77 individuals (mean age 9.83± 2.59), a mean of 1.92±1.02 permanent first molars were extracted. In the study population, prevalence of deep caries and abscess formation was alarmingly high. In consideration of the medical risks and high efforts immanent in DGA, educational measures should address parents in order to raise awareness of their responsibility for their children´s health.

Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure

ObjectivesVital pulp therapy (VPT) encompasses distinct treatment modalities for deep caries that approximate the pulp chamber in vital teeth. Confusion exists in the literature in terms of the indication and rationale for each VPT approach. The objectives of the present study are to elucidate the indications for VPT and to present a set of histopathology and histobacteriology-based guidelines for VPT in teeth with deep caries. MethodsTwo hundred and sixty-four carious, unrestored and VPT-treated human teeth, which were extracted for reasons not related to the present study. The teeth were processed for histological and histobacteriological examination. Other 757 clinical cases that received different VPT procedures were followed-up to identify success rates, with the longest observational period of 30 years. ResultsFollow-up of the clinical cases indicated that direct pulp capping was successful in 73.2%, partial pulpotomy in 96.4% and full pulpotomy in 77.8% of the cases. Histological and histobacteriological examination showed a localised inflammatory response that commonly occurred in the subjacent pulp tissue as soon as the enamel was penetrated by caries. If the softened and infected dentine were completely excavated, without pulp exposure, and the cavity restored with an adequate restoration, pulp inflammation frequently subsided. In teeth showing pulp exposure, the extent of bacterial penetration varied and areas of infection presented severe pulp inflammation, including micro-abscesses. However, the pulp tissue apical to the infected/inflamed area was usually uninflamed and normal. Guidelines based on the present histopathological, histobacteriological and clinical findings are proposed for VPT and mainly involve direct examination of dentine and the exposed pulp tissue under deep caries for decision-making, and require strict asepsis during procedures. ConclusionsVital pulp therapy following the guidelines proposed in the present article has the potential to improve the outcome of the conservative treatment of mature teeth with deep caries and in some occasions may be an alternative to pulpectomy. Clinical SignificanceA guideline for VPT in the treatment of deep caries is proposed, focusing on direct observation of dentine and the exposed pulp tissue under deep caries. Stringent aseptic techniques are mandatory for VPT procedures to be successful.

MORPHOLOGICAL SUBSTANTIATION OF APPLICATION OF THE DEVELOPED STOMATOLOGIC MEDICAL PREPARATION BY THE BIOLOGICAL METHOD OF TREATINMENT OF THE PULPITIS

Aim. This study was designed for the morphological assessment of the state of tooth pulp tissues after simulated acute 29 Kubanskij nauchnyj medicinskij vestnik 2018; 25 (5) trauma under the influence of the developed dental treatment pad and three analogues in the treatment of deep caries and acute focal pulpitis.Materials and methods.In the course of the experiment the study was conducted on white laboratory rats. The cavities on the molar chewing surface of the upper jaw were formed by spherical burs. The experimentally formed lesions of the surface layer of the pulp were treated using the developed dental preparation and three analogues. Laboratory animals were withdrawn from the experiment on days 3, 7 and 30. Animal teeth were put in a 10% neutral formalin solution, decalcified for 3 days and then put into a mounting medium. The slices obtained had a thickness of 5-15 μm.Results. In the course of the experimental study we detected the activation of reactive and compensatory processes in the tooth pulp tissue with the preservation of its viability by using the developed dental therapeutic preparation and the Biodentin as a comparison preparation on the 30th day of the experiment. Histologically, these changes were expressed in an increase in the level of metabolic processes and in the activation of cellular elements of the tooth pulp tissue on the 30th day of the experiment.Conclusion. As a result of an experimental study of the developed dental therapeutic preparation for the treatment of deep caries and acute focal pulpitis, there was established a specific and multifunctional property in preventing and prophylaxis of the inflammation development and enhancing the protective properties of the pulp tissue under the influence of this preparation.Morphological evaluation of the application of the developed dental treatment pad showed a rapid arrest of the inflammatory response of the pulp tissue within 30 days and the normalization of the main components of the tooth pulp.Developed during the conducted experimental research dental therapeutic preparation confirmed its stated properties, in particular, anti-inflammatory, antiseptic, analgesic, moreover, it is not inferior in its properties to the drugs presented in the course of the experimental study.

Treatment of deep caries

Treatment of deep caries

Stepwise Excavation.

The most recent inspiration for stepwise carious tissue removal in 2 stages originates from the knowhow on intralesion changes in deep carious lesions. The environmental change that takes place during the first stage of carious tissue removal is aiming for the arrest of the deep lesion, by placing a temporary restoration on top of the soft carious dentine. The cavity is optimised during the second stage for a final restoration, as potential shrinkage of the retained dentine may occur during the period of carious dentine arrestment. However, basic clinical limitations on the objective evaluation of pulp inflammation creates dilemmas in treating the deep lesions. Also, a global consensus is lacking for the definition of a so-called deep lesion. Finally, an optimal evidence goal for choosing the best approach for deep lesion treatment in adults has still not been fully defined. Taken together, it may not be a surprise that treatment variation is reported amongst general dental practitioners on deep caries treatment. Here, facts are presented supporting the treatment, including some drawbacks, as well as updated guidelines for the procedure. Recent clinical high evidence data from randomised clinical trials significantly favour the stepwise approach as a predictable and reliable treatment for well-defined deep carious lesions located in the pulpal quarter of the dentine in terms of avoiding pulp exposure, keeping the tooth vital and without the development of apical pathosis.