Management of Deep Caries in Primary Molars: A Comparative Analysis of the American, European, and International Guidelines

Background: Early Childhood Caries (ECC) remains a pervasive global health challenge. Historically managed through aggressive mechanical excavation, contemporary pediatric dentistry has evolved toward biologically driven, minimally invasive therapies. This study aims to critically compare the most recent clinical practice guidelines from the American Academy of Pediatric Dentistry (AAPD 2024), the European Academy of Paediatric Dentistry (EAPD 2022), and the International Association of Paediatric Dentistry (IAPD 2026) regarding the management of deep carious lesions in primary molars. Methods: A comparative critical review was conducted focusing on four core clinical variables: caries removal strategies, direct pulp capping (DPC) utility, pulpotomy medicaments, and the implementation of the Hall Technique (HT). Data were systematically extracted and synthesized to establish points of global consensus and therapeutic divergence. Results: A definitive paradigm shift toward conservative management was identified across all organizations. There is unanimous consensus strongly recommending Selective Caries Removal (SCR) as the gold standard over complete excavation to minimize iatrogenic pulp exposure. For vital pulpotomies, Calcium Silicate Cements (CSCs), particularly Mineral Trioxide Aggregate (MTA), have categorically superseded traditional fixatives like formocresol due to superior biocompatibility and success rates. Furthermore, the Hall Technique is highly endorsed, predominantly by the EAPD and IAPD, as a definitive, cost-effective biological intervention. Conversely, Direct Pulp Capping remains cautiously restricted due to low success predictability.Conclusions: The synthesis of the AAPD, EAPD, and IAPD guidelines confirms a global convergence on minimally invasive dentistry. Given the inherent unreliability of traditional pulpal diagnostics in pediatric patients, clinicians are strongly urged to prioritize pulp vitality through SCR, HT, and CSC-based therapies, establishing a unified biological approach to deep caries management.