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Four working groups formulated key clinical questions regarding (1) caries removal strategies, (2) cavity liners, (3) management of exposed pulps and (4) materials for direct pulp capping and pulpotomy. Systematic reviews were conducted for each question and evidence was synthesized and graded for quality. A structured consensus process was used to formulate recommendations. In order to encourage its wide dissemination, this article is freely accessible on Clinical Oral Investigations\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"10.1007\/s00784-025-06727-1\" ext-link-type=\"doi\">https:\/\/doi.org\/10.1007\/s00784-025-06727-1<\/jats:ext-link>\n                      , International Endodontic Journal\u00a0\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"10.1111\/iej.70132\" ext-link-type=\"doi\">https:\/\/doi.org\/10.1111\/iej.70132<\/jats:ext-link>\n                      and Caries Research\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"10.1159\/000551659\" ext-link-type=\"doi\">https:\/\/doi.org\/10.1159\/000551659<\/jats:ext-link>\n                      journals\u2019 websites.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence supports selective (SE) or stepwise caries removal (SW) over non-selective removal (NSE) to reduce the risk of pulp exposure in deep caries. Routine use of cavity liners after caries removal showed no consistent clinical benefit and is not routinely recommended. For vital pulp therapy following pulp exposure, both direct pulp capping and pulpotomy are effective options in teeth without irreversible pulpitis, while pulpotomy is an acceptable alternative to pulpectomy in cases with signs of irreversible pulpitis. Hydraulic calcium silicate cements demonstrated superior clinical outcomes compared to calcium hydroxide and should be preferred for pulp capping and pulpotomy. The certainty of evidence ranged from very low to moderate across questions and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For deep caries, maintaining pulp vitality by using less invasive management strategies is supported by current evidence. Implementation of this guideline requires clinician training, patient-centered decision-making and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-025-06727-1","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T23:18:03Z","timestamp":1776813483000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Deep caries management: EFCD-ESE-ORCA S3-level clinical practice guideline"],"prefix":"10.1007","volume":"30","author":[{"given":"Falk","family":"Schwendicke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Kosan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avijit","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylin","family":"Baysan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bj\u00f8rndal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ceballos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry F.","family":"Duncan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Herbst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus W.","family":"Neuhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C.","family":"O\u2019Connell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Paris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Dujic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"6727_CR1","unstructured":"Fejerskov ONB, Kidd EA (2015) Pathology of dental caries. 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