Background/Objectives: Deep caries lesions represent an actual concern in preserving tooth vitality and preventing irreversible pulpitis. As presently the non-selective approach is considered an overtreatment, the concept of selective caries removal is highly recommended. The goal of this narrative review is to focus on current trends in carious dentine excavation and adjunctive therapies. Methods: A keyword-based selection of scientific publications issued in the last six years, i.e., 2019–2024, was conducted with the search engine of PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: deep carious lesion; caries removal; indirect pulp capping; adjunctive antimicrobial therapy; adjunctive anti-enzymatic therapy; biomimetic restorative dentistry. Discussions: In deep caries management, the current trends of carious dentine excavation recommend preferentially partial caries removal technique as less risky to pulp exposure and more conservative compared to the stepwise technique (SW). Presently, advanced additional procedures such as antimicrobial photodynamic therapy and an anti-enzymatic approach are also considered for caries arrest. Conclusions: Selective caries removal and adjunctive photodynamic antimicrobial therapy are procedures of choice in preserving pulp vitality. Anti-enzymatic therapies impede decoupling with time of adhesive restorations from the smear layer. Biomimetic restorative dentistry and smart materials introduce the principles of artificial intelligence in the therapeutic approach of deep caries.

The objectives of root canal treatment are to prevent the apical parodontitis, to heal the acute or cronic apical periodontits and to maintain the results, keeping the teeth on the arch in a functional stage. Thus, accuratelly elimination of soft and hard tissues (cleaning and shaping of the root canal system), disinfection and complete, homogeneous and tridimensional filling of the root canal system are very important to successful endodontic treatment. Modern concepts in endodontic treatment rely on technological progress and therefore many cases are successfully fulfilled, but the practitioner may be put in front of procedural erorrs both during and after endodontic treatment. Apical blockage, ledging, zipping, stripping, perforations in the floor of the pulp canal chamber or root canals perforations are the most common errors, but in many clinical situations they can be prevented and even surpassed once happened.

The odontogenic maxillary sinus disease (endo-antral syndrome; EAS) is directly related to the spread of endodontic infections from upper premolars and molars with necrotic pulp. Cone-beam computed tomography (CBCT) images proved to be a reference diagnostic aid for detecting the etiological relationship between chronic apical periodontitis and maxillary sinusitis. There were retrospectively evaluated a total of 109 CBCT images (47 males and 62 females) from a pool of CBCT scans taken for routine diagnosis and treatment planning in consecutive 353 patients. The CBCT images were acquired with Veraviewepocs 3D P (R100) equipment (J. Morita MFG Corp., Kyoto, Japan). The scan parameters were 90 kV, 5 mA, 9.4 s exposure time, 125 μm spatial resolution and 40×40 mm field of view (FoV). The aim of this CBCT study was to find out the influence of space separating apical lesions and sinus floor on subsequent EAS. There were observed four categories of anatomical rapports, such as tangent contact, protruding contact, 1–2 mm separating interval, and over 2 mm separating interval. The highest incidence was recorded in molars for tangent contact (47.69%) and in premolars when the apical lesions were situated at 1–2 mm distance from sinus floor (7.69%). The abnormalities revealed on CBCT scans of maxillary sinus have been mucosal hyperplasia, dome-shaped opacification, periostitis, and sinus opacification with air-bubbles. A four class classification related to the anatomical distance between the chronic apical lesions and sinus floor was suggested.

In recent decades, all cosmetic and dental cosmetic treatments have become an integral part of the patient’s complex approach, in association with orthodontic treatments, orthognathic surgery and restorative dental treatments using new esthetic materials. Dental bleaching is the starting point in the field of cosmetic dentistry, but today it is associated with other procedures such as microabrasion, dental veneers, gingival contouring procedures, the use of all ceramic or zirconia based ceramic prosthetic restorations. All these new trends in cosmetic dentistry also come with challenges for the dentist, because the demands of patients are high, sometimes unrealistic. The most complete information of the patient, in the process of obtaining informed consent, truly understood, can be a solution to solve this ethical problem in terms of cosmetic dental cosmetic approach, along with compliance with detailed practice guidelines, which are increasingly elaborate today. In this way, subsequent accusations of medical malpractice can be avoided.