PB-4 - Management of Deep Caries Lesions

Decision-making in healthcare with sufficient attention to evidence may lead to improved effectiveness, efficiency, and fairness, and in the case of caries management it can also positively impact caries and patient outcomes. This presentation will briefly summarize the state of the evidence in management of caries lesions and caries removal (none, selective or non-selective), and will review existing systematic reviews and evidence-based recommendations by US and global expert groups as it relates to caries removal. A brief update on caries pathology and consequences on pulp biology will be presented. Evidence that diagnosis of advanced stages of carious lesion depth could be improved when specifying radiographic penetration depth will be discussed, suggesting that some well-defined deep stages of caries lesions can be treated without exposing the pulp by using less invasive modalities of vital pulp treatments, whereas extremely deep lesion stages are obvious candidates for pulpal invasive treatment modalities. Position statements by the European Society of Endodontology and the American Association of Endodontists approach this topic from different perspectives and agree about certain features but disagreed about others. A comprehensive discussion of these different perspectives will be provided, as well as the best path forward for vital pulp treatment in modern practice.