{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:09:36Z","timestamp":1792613376421,"version":"4.5.0"},"reference-count":68,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008341","name":"European Federation of Conservative Dentistry","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018187","name":"Offshore Robotics for Certification of Assets","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018187","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop an evidence\u2010based S3\u2010level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An evidence\u2010based medical guideline based on systematically searched and appraised evidence as well as a structured consensus (S3\u2010level) was jointly developed by the European Federation of Conservative Dentistry (EFCD), the European Society of Endodontology (ESE), the Organization for Caries Research (ORCA) and the German Society of Conservative Dentistry (DGZ), following the methodological framework of the Association of Scientific Medical Societies in Germany (AWMF) and the GRADE approach. 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 synthesised 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, International Endodontic Journal and Caries Research journals' websites.<\/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\u2010selective 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\u2010centered decision\u2010making and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70132","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:20:47Z","timestamp":1776856847000},"page":"1298-1315","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Deep Caries Management:\n                    <scp>EFCD<\/scp>\n                    \u2010\n                    <scp>ESE<\/scp>\n                    \u2010\n                    <scp>ORCA S3<\/scp>\n                    \u2010Level Clinical Practice Guideline"],"prefix":"10.1111","volume":"59","author":[{"given":"Falk","family":"Schwendicke","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry, Periodontology and Digital Dentistry LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Kosan","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Oral Medicine and Oral Surgery Charit\u00e9\u2014Universitaetsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avijit","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Oral and Craniofacial Sciences, Centre of Oral Clinical Translational Sciences\/Conservative and MI Dentistry King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aylin","family":"Baysan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, Institute of Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bj\u00f8rndal","sequence":"additional","affiliation":[{"name":"Section of Clinical Oral Microbiology, Cariology and Endodontics, Department of Odontology University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ceballos","sequence":"additional","affiliation":[{"name":"Area of Stomatology, Faculty of Health Sciences Rey Juan Carlos University  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry F.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Division of Restorative Dentistry and Periodontology Dublin Dental University Hospital, Trinity College\u2009Dublin, University of Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry, Periodontology and Digital Dentistry LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus W.","family":"Neuhaus","sequence":"additional","affiliation":[{"name":"Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1495-3983","authenticated-orcid":false,"given":"Anne C.","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Division of Public and Child Dental Health Dublin Dental University Hospital, Trinity College Dublin University of Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Paris","sequence":"additional","affiliation":[{"name":"Department of Operative, Preventive and Pediatric Dentistry Charit\u00e9\u2014Universitaetsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Dujic","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry, Periodontology and Digital Dentistry LMU University Hospital, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.53350\/pjmhs211551214"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201090824\u20100"},{"key":"e_1_2_10_4_1","unstructured":"Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)\u2010St\u00e4ndige Kommission Leitlinien.2023.\u201cAWMF\u2010Regelwerk \u2018Leitlinien\u2019.\u201dAuflage 2.1. 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