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.