Management of the deep carious lesion and the vital pulp dentine complex.

This article describes the relationship between the carious process and pulp-dentine complex reactions. Where the balance between the two is in favour of the carious process and where conventional cavity preparation leads to a direct pulp exposure, the direct pulp cap technique is described. The success of the technique is addressed and more importantly an alternative technique for caries removal, namely stepwise excavation, is described which may lead to a reduced risk of carious exposure and the need for the direct pulp cap technique.