For a deep occlusal lesion with proximity to the pulp but no exposure, which MID approach is most appropriate?

• A. Indirect pulp capping or selective caries removal with a liner and restoration
• B. Extraction
• C. Pulpotomy
• D. Immediate full crown without liner

Answer: (A)

Preserving pulp vitality when a deep occlusal caries lesion is approaching the pulp, but not exposed, is best achieved with a conservative caries removal strategy paired with pulp protection. Indirect pulp capping or selective caries removal aims to remove infected tissue while leaving a thin layer of dentin near the pulp to avoid exposure, then sealing with a liner before restoring. The liner acts as a protective barrier and can support dentin healing and remineralization, while the final restoration creates a tight seal to prevent bacterial ingress. This approach aligns with minimally invasive dentistry by treating the caries in a way that maintains tooth vitality and tissue, rather than proceeding to more invasive options.

Extraction would be excessive when the tooth’s vitality can be preserved. Pulpotomy is a vital-pulp therapy typically used when the pulp is inflamed or in primary teeth, not the ideal choice for a asymptomatic deep lesion in a tooth with an intact pulp. An immediate full crown without a liner skips essential pulp protection and can trap bacteria, increasing the risk of pulpal irritation or failure.