Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease.

Aim: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.

Methods: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.

Results: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed.

Conclusion: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

背景：ESE之前于2006年发布了牙髓治疗质量指南；然而，不仅在临床牙髓学方面，而且在共识和指南制定过程中都发生了显著变化。在创建S3级临床实践指南(CPG)的过程中，遵循全面系统和方法稳健的指南咨询过程，以便为出现牙髓和根尖疾病的患者的管理提供循证建议。

目的：开发用于治疗牙髓和根尖疾病的S3节段CPG，重点关注诊断和管理所需治疗方法的实施表现为牙髓炎和根尖周炎(AP)的患者，最终目标是预防牙齿缺失。

方法：本S3级CPG由ESE在德国科学医学会协会提供的独立方法学指导的协助下，利用GRADE程序开发。一个稳健、严谨和透明的过程包括在评价证据的质量和强度之前，在14个特别委托的系统评价中分析相关的比较研究，与领先的牙髓专家和广泛的外部利益相关者组成一个结构化共识过程中制定特定证据和基于专家的建议。

结果：治疗牙髓和根尖疾病的S3节段CPG在在研究牙髓治疗在管理这些疾病中的有效性之前，一系列临床建议诊断牙髓炎和 AP 的有效性。治疗策略包括有和无自发性疼痛和牙髓暴露、活髓与非活髓牙病例的深龋管理的有效性，根管器械、冲洗、敷料、根管充填材料和辅助根管内手术治疗AP的有效性。在治疗计划之前，强调病史和病例评价、无菌技术、适当培训和治疗期间和治疗后再评价的关键重要性。

结论：牙髓病学中的第一个 S3 节段 CPG 告知临床实践、卫生系统、政策制定者、其他利益相关者和患者现有最有效的治疗方法来管理牙髓炎和 AP 患者，以便在患者的一生中保存牙齿，根据到目前可用的最佳比较证据。