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This clinical guide addresses the complex challenges dental practitioners face when treating deep carious lesions, focusing on evidence-based strategies to avoid endodontic complications. It systematically reviews treatment modalities including selective carious tissue removal, lesion sealing, and non-restorative management for both primary and permanent dentition. Detailed pathophysiology, histopathology, and clinical symptomatology are analyzed to establish clear treatment thresholds and clinical pathways. Expert evaluations of each technique's advantages and disadvantages assist clinicians in making informed decisions for restorative and operative success.