Clinical and microbiological evaluation of calcium silicate versus calcium hydroxide in two-step indirect pulp treatment: A randomized clinical trial

Abstract

Aim: To evaluate the clinical and microbiological performances of calcium silicate in comparison to calcium hydroxide in patients with deep carious lesions using two-step indirect pulp capping in 12 months follow-up. Materials and Methods: Fifty teeth with deep carious lesions received randomly either TheraCal (resin-modified calcium silicate pulp capping material) or Dycal (calcium hydroxide pulp capping material), application of both materials was done in accordance with the manufacturers’ instructions after the excavation of caries on the cavity walls and taking the caries sample from the central carious lesion for microbiological study then the cavities were sealed with conventional glass ionomer cement as a temporary restoration. After 6 months, pain assessment was performed, the cavities were reopened, temporary restorations and pulp capping material were removed, and another dentin sample was taken for microbiological study. In the same visit, caries was excavated to firm dentin and permanent resin composite restorations were applied. Then the patients were recalled after 6 months for pain assessment by a blinded assessor by the use of the visual analog scale system. Results: Pain score results showed a statistically significant difference between the two groups at 6 months and 12 months. Regarding bacterial reduction, there was a statistically significant difference between the two groups in all viable microorganisms except for lactobacilli and mutant streptococci. Conclusions: Resin-modified calcium silicate and calcium hydroxide can both be considered as effective pulp capping materials through relieving pain and possessing antibacterial properties.