Abstract
Dental pulp-capping is done to preserve vital teeth when the pulp is exposed due to caries, trauma or instrumentation. Various materials are used as pulp-capping agents. The introduction of newer materials requires scientific studies to assess their clinical efficacy. The study was designed as a split-mouth randomized analysis of four pulp-capping agents (calcium hydroxide, mineral trioxide aggregate (MTA), Biodentine and EndoSequence root repair material (ERRM)). Based on selection criteria, 15 orthodontic patients requiring the extraction of four premolars (60 teeth total) were included in the study. After pulp-capping, the teeth were extracted after 8 weeks. We analyzed the extracted teeth using cone-beam computed tomography (CBCT) and histological sections to determine the quality of the dentinal bridge and the pulpal response. Ordinal scores were given based on the completeness of the dentinal bridge, the type of bridge and the degree of pulpal inflammation. Results were analyzed using a Kruskal–Wallis test (p < 0.05) with post hoc Conover values being used when applicable. All four pulp-capping materials elicited dentinal bridge formation (60/60). MTA had the highest scores (10/15) in dentinal bridge formation followed by ERRM (8/15). Both materials showed more samples with complete dentinal bridges (9/15 each) and a favorable pulpal response (15/15). Teeth capped with calcium hydroxide showed more cases of incomplete bridge formation (9/15) and pulpal inflammation. These differences in dentinal bridge formation and pulpal inflammation were statistically significant (p 0.001 and p 0.00005, respectively), with post hoc tests revealing no significant differences between MTA and ERRM (p 0.49 and p 0.71, respectively). MTA and ERRM performed better than the other pulp-capping materials but did not differ significantly from each other. The individual preference for a pulp-capping material may be based on clinical efficacy and handling characteristics.
Highlights
Direct pulp-capping is a common procedure for the treatment of unintentional or unavoidable pulpal exposures in clinical practice
A complete dentinal bridge formed in 9/15 cases of both Mineral trioxide aggregate (MTA)- and EndoSequence root repair material (ERRM)-treated teeth
Earlier studies by Monea and Stioca (2014) and others [2,3,4,8,10] reported high scores of dentinal bridge formation by MTA compared to calcium hydroxide in cone-beam computed tomography (CBCT) scan and histological evaluation
Summary
Direct pulp-capping is a common procedure for the treatment of unintentional or unavoidable pulpal exposures in clinical practice. Pulp-capping ensures tooth vitality by preserving the integrity of the hard tissues and protective responses to injury [1]. Pulpcapping involves the placement of a material on the pulpal exposure site followed by an intermediate or permanent restoration. The material should stimulate the pulpal cells to produce a reparative dentinal bridge, thereby sealing the pulp. These materials are biocompatible and bioactive (stimulating pulpal cells), aid the formation of apatite crystals and provide an adequate seal [2,3,4,5].
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