Dental caries
Also known as: caries · cavities · tooth decay
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Evidence-Based Clinical Practice Guideline on Restorative Treatments for Caries Lesions
American Dental Association (ADA) Council on Scientific Affairs / ADA Science & Research Institute · 2023 · 2023 guideline
An ADA expert panel guideline covering how moderate and advanced cavitated caries lesions are restored in vital, non-endodontically treated primary and permanent teeth. It compares direct restorative materials and carious tissue removal strategies, and is published alongside chairside summary tools on the ADA site. It sits within a wider ADA caries series that also includes a 2018 nonrestorative guideline, with caries prevention and caries detection guidelines listed as still in development.
- Scope is restorative management of moderate and advanced caries lesions in both primary and permanent dentition, based on a systematic review commissioned by the ADA. source
- Recommendations address both choice of restorative material and how much carious tissue to remove, rather than prescribing a single approach. source
- The ADA caries guideline portal lists this 2023 guideline plus a 2018 nonrestorative caries treatments guideline; prevention and detection guidelines are marked in progress. source
Deep Caries Management: EFCD-ESE-ORCA S3-Level Clinical Practice Guideline
European Federation of Conservative Dentistry (EFCD), European Society of Endodontology (ESE), Organization for Caries Research (ORCA) and German Society of Conservative Dentistry (DGZ) · 2026 · S3-level clinical practice guideline
A joint European S3-level guideline on managing deep and extremely deep caries lesions in vital permanent teeth. Developed using the AWMF methodological framework and GRADE, it addresses how much carious tissue to remove, whether cavity liners add benefit, how to handle a pulp exposure, and which materials to use for pulp capping and pulpotomy. Published in Caries Research and simultaneously in the International Endodontic Journal.
- Four working groups covered caries removal strategy, cavity liners, management of exposed pulps, and materials for direct pulp capping and pulpotomy. source
- The guideline was produced jointly by EFCD, ESE, ORCA and DGZ using GRADE within the AWMF S3 framework. source
- Its overall direction favours less invasive strategies that aim to keep the pulp vital rather than routine complete caries removal. source
US vs EU key differences
- Both sides converge on conservative excavation: the ADA guideline endorses selective carious tissue removal for most moderate and advanced lesions, and the European S3 guideline supports selective or stepwise removal over non-selective removal to cut the risk of pulp exposure. source
- Scope differs: the ADA guideline covers restoration of moderate and advanced cavitated lesions in vital primary and permanent teeth including choice of direct restorative material (16 recommendations), while the European guideline is confined to deep and extremely deep lesions in vital permanent teeth and pulp-preserving procedures. source
- The European guideline makes explicit material calls the ADA document does not: hydraulic calcium silicate cements are preferred over calcium hydroxide for pulp capping and pulpotomy, and routine cavity liners after caries removal are not recommended, whereas the ADA evidence base found broad equivalence among direct restorative materials. source
- Version currency differs: the ADA guideline was published in 2023, while the EFCD-ESE-ORCA S3-level deep caries guideline is a 2026 document. source
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