Clinical Comparison of Eggshell Derived Calcium Hydroxyapatite with Dycal® as Indirect Pulp Capping Agents in Primary Molars

Suravarapu Pavani Reddy,Ambati Naga Radhakrishna,Kvk Santosh Kumar,Dangeti Venkata Divya,Rayala Venkata Sandeep,Madu Ghanashyam Prasad

doi:10.1590/pboci.2020.151

Suravarapu Pavani Reddy, Ambati Naga Radhakrishna + Show 4 more

Open Access

https://doi.org/10.1590/pboci.2020.151

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Abstract

Objective: To evaluate and compare the efficacy of eggshell derived calcium hydroxyapatite with Dycal ® as indirect pulp capping material in primary molars. Material and Methods: A total of 32 carious primary molars from 22 children (6-10-years) were screened, of which 26 primary molars meeting inclusion criteria were selected and equally divided into two groups. At the first appointment, the infected dentin was excavated using a spoon excavator after treating the carious part with Carie-Care™ chemomechanical caries removal agent. After this, eggshell derived calcium hydroxyapatite in Group 1 and Dycal ® in Group 2 were used as liners followed by restoration of the cavity with type IX glass ionomer cement. Clinical assessment for pain and radiographic assessment for measurement of the amount of reparative dentin thickness formation was performed at baseline, 8 weeks and 3 months. The data were subjected to statistical analysis by one-way ANOVA and Kruskal-Wallis tests . Results: Higher mean reparative dentin formation was found in eggshell derived calcium hydroxyapatite group than Dycal ® group at the end of 8 weeks and 3 months and the difference was significant statistically (p<0.001) . Conclusion: Eggshell derived calcium hydroxyapatite seems to be a suitable alternative to Dycal ® (calcium hydroxide) that can be used as a liner for indirect pulp capping in primary molars.

Highlights

Deciduous teeth in the dental arch are essential for the proper growth of facial and skeletal complex.To preserve the deciduous teeth with deep dental caries until their natural exfoliation, pulp therapy has to be performed [1]
The criteria for participation in the research were: teeth with deep carious lesions without involvement of pulp; teeth exhibiting symptoms of reversible pulpitis; on radiographic interpretation, the depth of caries should be greater than two-third of dentin thickness approaching pulp with no radiolucency in the periapical or furcation area of the teeth [13]; and children with carious primary molar teeth belonging to the ICDAS-3 to ICDAS-4 category on occlusal surfaces according to the ADA Caries Classification System [14]
When the mean thickness of reparative dentin formed in Group 1 was calculated, it showed a mean of 0.062 ± 0.001 in the first 8 weeks and 0.091±0.003 at 3 months follow-up

Summary

Introduction

To preserve the deciduous teeth with deep dental caries until their natural exfoliation, pulp therapy has to be performed [1]. Pulp therapy is a treatment objective to maintain the integrity and health of teeth and their supporting tissues and to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes [2]. Treating reversible pulpal injuries and maintaining pulp vitality/function are the primary objectives of vital pulp therapy (VPT) in deciduous teeth. Three VPT therapeutic approaches include indirect pulp capping (IDPC) for teeth with dentinal cavities and reversible pulpitis, direct pulp capping (DPC) and pulpotomy, which are considered in cases of pulp exposure [3]. “Indirect pulp treatment is a procedure performed in a tooth without signs or symptoms of pulp degeneration but with a deep carious lesion approximating the pulp. The surface of pulp is covered with a biocompatible material and caries surrounding the pulp is left in place to avoid pulp exposure” [2]

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