18/10/2026
“Did you remove all the caries?” 🦷
In a deep lesion, that may not be the most useful first question.
Because the closer excavation gets to the pulp, the more the biological risk becomes part of the decision.
A 2026 systematic review and network meta-analysis compared:
→ Non-selective excavation
→ Selective excavation
→ Stepwise excavation
across 19 studies in vital permanent teeth with deep carious lesions and no signs of irreversible pulpitis.
The interesting part?
No strategy showed a statistically significant superiority in overall success.
And the evidence itself deserves context:
More than half of the included studies had a high risk of bias, while much of the evidence was rated low or very low certainty.
So I would be careful with both extremes:
❌ “Always remove everything.”
❌ “Always leave caries.”
Neither is a treatment plan.
Before deciding how far to excavate, I want to know:
→ Is the pulp healthy enough to preserve?
→ How deep is the lesion?
→ What is the risk of exposure?
→ Can I achieve a predictable peripheral seal?
The amount of caries removed is part of the decision.
The tissue we are trying to keep alive is the other part.
📌 Save the sequence:
Pulp → Depth → Excavation strategy.
