Abstract
The article is aimed at analyzing the available research and comparing the properties of bio-inductive materials in direct and indirect pulp capping procedures. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured calcium silicate-based material (TheraCal LC) and an enhanced resin-modified glass-ionomer (ACTIVA BioACTIVE) are widely discussed. A correlation of in vitro and in vivo data revealed that, currently, the most validated material for pulp capping procedures is still MTA. Despite Biodentine’s superiority in relatively easier manipulation, competitive pricing and predictable clinical outcome, more long-term clinical studies on Biodentine as a pulp capping agent are needed. According to available research, there is also insufficient evidence to support the use of TheraCal LC or ACTIVA BioACTIVE BASE/LINER in vital pulp therapy.
Highlights
The major challenge for the modern approach in restorative dentistry is to induce the remineralization of hypomineralized carious dentine, and protecting and preserving the vital pulp
Development of minimally invasive biologically based therapies aimed at preservation of the pulp vitality remains the key theme within contemporary clinical endodontics
The present findings confirm that both Mineral trioxide aggregate (MTA) and Biodentine are reliable materials in the matter of inducing dentin bridge formation while keeping a vital pulp in both direct and indirect pulp capping procedures [71,104,108,112,140]
Summary
The major challenge for the modern approach in restorative dentistry is to induce the remineralization of hypomineralized carious dentine, and protecting and preserving the vital pulp. According to recent position statement of the ESE, deep caries management should focus on avoidance of pulp exposure by the means of choosing selective one-stage carious-tissue removal or stepwise excavation treatment, rather than redefined indirect pulp capping procedure [13]. Direct pulp capping (DPC) treatment is used when the vital asymptomatic pulp is visibly exposed due to caries or trauma, or due to a misadventure during tooth preparation or caries removal [7] It includes the application of a biomaterial directly onto the exposed pulp, followed by immediate placement of a permanent restoration. As another factor indirectly indicating state of the pulp, cannot be controlled after 5 min, further caries excavation is necessary after exposure; in that case partial or even full pulpotomy may be preferable
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