Guiding Caries Removal Through Biological Principles: A Narrative Review on Selective Caries Tissue Preservation

Background: Dental caries is one of the most prevalent chronic oral diseases worldwide. In the management of deep carious lesions, complete removal of decayed tissue disregards the biological heterogeneity of dentine and may increase the risk of iatrogenic pulp exposure, thereby predisposing teeth to pulpal inflammation and related complications. With the advancement of minimally invasive dentistry, selective caries removal (SCR) has emerged as a biology-guided treatment strategy and has gained increasing attention in clinical practice. Objective: SCR aims to precisely eliminate infected dentine while preserving remineralizable tissue and safeguarding the dental pulp. This narrative review provides an integrated overview of its biological basis and clinical techniques to support evidence-based clinical decision-making. Methods: A narrative review of the literature was conducted using three electronic databases - PubMed/MEDLINE, Scopus, and the Web of Science Core Collection. The search focused on controlled clinical studies addressing dental microbiology, caries removal techniques, and caries detection technologies. Relevant experimental, clinical, and epidemiological studies were included in the analysis. Given the narrative nature of this review, the synthesis is qualitative and does not include a quantitative meta-analysis. Results: Current evidence indicates that SCR achieves clean cavity margins and preserves demineralized dentine with remineralization potential near the pulp, thereby contributing to a reduced incidence of pulp exposure. Compared with non-SCR, this approach does not appear to increase postoperative symptoms or restoration failure rates and may help maintain pulp vitality. These findings suggest that SCR may be suitable for the treatment of deep carious lesions in both primary and permanent teeth. Nevertheless, it should be noted that the available evidence, while generally encouraging and clinically supportive, is characterized by limited follow-up durations, with most studies reporting outcomes within 12 to 24 months, as well as heterogeneous methodological quality, with only a subset of randomized controlled trials rated as low risk of bias. These variations in study design and follow-up across the literature warrant cautious interpretation of the overall findings. Conclusions: Based on the available evidence, SCR appears to be a safe, effective, and minimally invasive approach for the management of deep carious lesions. The current evidence, while encouraging and clinically supportive, is influenced by variability in study methodologies and follow-up durations. Further long-term follow-up studies are required to evaluate its sustained efficacy and broader applicability, particularly given the narrative nature of this review and the heterogeneity of the underlying evidence.