Abstract: Dental caries remains the most prevalent dental condition, with a heavy burden and significant impacts on the quality of life. If left untreated, caries extends into the pulp-dentin complex, leading to pulp damage necrosis; and eventually tooth loss. The improved understanding of the pulp–dentine complex’s defensive and reparative response to various irritations opened the door to new, minimally invasive strategies that preserve pulp vitality and avoid exhaustive pulp therapy. In addition, there is advancement in the development of bioactive restorative materials. The important guiding principles are to preserve pulp vitality, seal the cavity, and maximize restoration success. Traditionally, deep caries management was destructive with nonselective removal of all carious dentine; however, selective caries removal is now advocated to reduce the risk of pulp exposure. Management strategies for treating the caries exposed pulp are also shifting with the avoidance of pulpectomy and the re-emergence of vital pulp treatment techniques such as partial and complete pulpotomy. Dentists should tailor their clinical decisions regarding carious tissue removal strategy according to tooth type and, more importantly, lesion depth. These decisions must be balanced against removing adequate tissue to maximize restoration longevity.
Objectives: 1. understand the paradigm shift in caries management
2. understand challenges in restorative management of deep caries lesions and how to overcome them
3. Describe different strategies of managing deep caries lesions while preserving pulp vitality