Consensus‐Based Recommendations for the Management of Deep and Extremely Deep Carious Lesions and Vital Pulp Treatment in Permanent Teeth: A National Delphi Study

AIM: To develop consensus-based recommendations for general dental practitioners on deep and extremely deep carious lesions (CLs) and vital pulp treatment (VPT) in mature and immature permanent teeth. METHODOLOGY: A national modified Delphi study was conducted with a purposively selected expert panel. Twenty-nine statements developed from international guidance were assessed through three anonymous online rounds using a 10-point agreement scale. Free-text justification for scores below 7 informed revision or merging. Positive consensus was predefined as a median score ≥ 7 with an interquartile range (IQR) ≤ 2; statements with greater dispersion could also be accepted when > 90% of experts scored them ≥ 7. Statements remaining uncertain after Round 3 were discussed at an online meeting and anonymously re-rated by the full panel. RESULTS: Of 34 experts invited, 22 enrolled and completed every rating stage; no item-level data were missing. Five statements reached consensus in Round 1, 10 in Round 2, and six in Round 3. Four merging procedures reduced the 29 initial statements to 24 final statements. The remaining three reached consensus after the meeting and post-meeting rating; none was rejected. Final median scores ranged from 7 to 10, IQRs from 0 to 2, and proportions of scores ≥ 7 from 59.1% to 100%. The recommendations support comprehensive and graded pulpal assessment, selective carious tissue removal for deep CLs when pulp exposure should be avoided, management of extremely deep CLs according to root maturity, and consideration of VPT after pulp exposure and in selected cases of severe pulpitis. They also address asepsis, biomaterial selection, definitive restoration and follow-up. CONCLUSIONS: This national Delphi study produced 24 consensus-based recommendations and a clinical decision-support pathway for managing deep and extremely deep CLs in permanent teeth. The framework may complement existing evidence-based guidance; however, its acceptability, feasibility, transferability, and impact on clinical and patient-reported outcomes require external evaluation.