Evidence map›Paper›PMID 42018467›Full record

GuidelineCaries research2026

Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline.

Falk Schwendicke, Esra Kosan, Avijit Banerjee, Aylin Baysan, Lars Bjørndal, Laura Ceballos, Henry F Duncan, Sascha Herbst, Klaus W Neuhaus, Anne C O Apos Connell and 2 more

Abstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Caries research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Falk SchwendickeDepartment of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital, LMU Munich, Munich, Germany, falk.schwendicke@med.uni-muenchen.de.
Esra KosanDepartment of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
Avijit BanerjeeCentre of Oral Clinical Translational Sciences, Conservative and MI Dentistry, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
Aylin BaysanInstitute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
Lars BjørndalDepartment of Odontology, Section of Clinical Oral Microbiology, Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
Laura CeballosArea of Stomatology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
Henry F DuncanDivision of Restorative Dentistry and Periodontology, Trinity College Dublin, Dublin Dental University Hospital, University of Dublin, Dublin, Ireland.
Sascha HerbstDepartment of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital, LMU Munich, Munich, Germany.
Klaus W NeuhausDepartment of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.
Anne C O Apos ConnellDivision of Public and Child Dental Health, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland.
Sebastian ParisDepartment of Operative, Preventive and Pediatric Dentistry, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
Helena DujicDepartment of Conservative Dentistry, Periodontology and Digital Dentistry, LMU University Hospital, LMU Munich, Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe objective of this study was to develop an evidence-based S3-level clinical practice guideline for the management of deep and extremely deep caries in vital permanent teeth.

methodsAn evidence-based medical guideline based on systematically searched and appraised evidence as well as a structured consensus (S3-level) 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 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, International Endodontic Journal, and Caries Research journals' websites.

resultsEvidence 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.

conclusionFor deep caries, maintaining pulp vitality by using less invasive management strategies is supported by current evidence. Implementation of this guideline requires clinician training, patient-centred decision-making, and consideration of economic and practical factors. Further research is needed, particularly for extremely deep caries and towards long-term outcomes.

Indexed as

Clinical practice guidelineDeep cariesDirect pulp cappingEvidence-based dentistryNon-selective caries removalPulpotomySelective excavationStepwise caries removalVital pulp treatment

Identifiers

PMID42018467
PMCPMC13102370

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.