Abstract

Background: Contemporary deep and extremely deep caries management increasingly favors selective or stepwise excavation because these strategies reduce pulpal exposure and preserve tooth structure. However, clinical survival is often interpreted beyond its biological meaning.

Objective: This perspective examines why asymptomatic tooth survival, retained sensibility, absence of radiographic disease, and lack of retreatment are incomplete markers of pulpal health.

Conclusions: Pulp conservation requires an evidence model that separates clinical success, diagnostic stability, biological recovery, and long-term disease control. Randomized trials should be interpreted alongside tissue-level, mechanism-level, diagnostic, patient-reported, economic, and long-term outcomes. Lesion depth, restoration quality, and study settings also matter. The goal of deep caries management should be survival with health, not survival alone.

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