Selective caries removal

Selective caries removal is the deliberate decision, in a deep but vital and asymptomatic tooth, to leave some softened dentin near the pulp in place rather than excavating all the way down to hard structure, specifically to avoid the pulp exposure that aggressive complete removal can cause in a very deep lesion. It distinguishes between infected dentin at the outer, bacteria-loaded layer, which still needs to come out, and affected dentin closer to the pulp, which is partially demineralized but retains its structural collagen and can be sealed over rather than removed.

A 2021 Cochrane review of 27 trials found higher odds of failure with complete removal than with selective removal in permanent teeth, and the ADA's 2023 guideline conditionally recommends the more conservative approach, especially for advanced lesions: a real shift from the older instinct to excavate a deep cavity completely regardless of pulpal risk.

The technique still depends on the tooth being vital and asymptomatic, with all soft dentin cleared at the margins for a solid seal, and an immediate, well-bonded restoration to actually seal the affected dentin away from further bacterial activity.