For deep lesions (defined as those lesions radiographically penetrating into the pulpal third or quarter of the dentin) in teeth with vital pulps, selective removal to soft dentin and stepwise carious tissue removal are two recommended options, while nonselective or selective removal to firm dentin often result in pulp exposure. The therapy of such exposures using direct capping has a poor prognosis, while initiating root canal treatment for exposed vital pulps is more successful, but nevertheless reduces the survival of teeth. We discuss the histologic basis for performing stepwise removal and describe the clinical procedure.