Abstract
The aim of this study was to investigate and compare, radiographically and clinically, the impacts of calcium-silicate based-cement (CSBC), nano-hydroxyapatite and platelet-rich fibrin (PRF) as pulpotomy agents in permanent immature molars with incomplete root development. Sixty-three participants (63 permanent immature molars) were included in this study. The patients were randomly divided into three equal groups. Fast setting MTA (MM-MTA), nano-hydroxyapatite and platelet-rich fibrin were used as pulpotomy agents. The teeth were evaluated clinically and radiographically after 6 and 12 months by two blinded examiners. Apical closure and pulp canal obliteration percentages were recorded. The in vitro reaction of the tested materials after a 7-day immersion period of the different materials in phosphate-buffered solution was analyzed using scanning electron microscopy to associate the in vitro mineralization with in vivo pulp canal obliteration percentages. Data were analyzed using Chi-square and ANOVA tests (α = 0.05). No significant difference was found between the three tested groups in terms of clinical and radiographic success (p > 0.05). All cases demonstrated evidence of root growth, including complete apical closure or continued apical closure. At 12 months, complete apical closure was found among the MM-MTA group (50%), nano-hydroxyapatite group (55%) and platelet-rich fibrin group (60%) (p > 0.05). After 12 months, pulp canal obliteration was more observed in the MM-MTA and nano-hydroxyapatite groups than in the PRF group (p < 0.05). MM-MTA (auto-mixed), NHA (hand-mixed) and PRF (autologous) could be used as pulpotomy agents since they exhibit comparable high clinical and radiographic success rates. However, the fact that the groups managed with MM-MTA and NHA have a higher tendency to canal obliteration might indicate that PRF should be considered the first choice material as pulpotomy agent, as it would make retreatment considerably easier.
Highlights
Dental caries can be prevented by improving diet, limiting the ingestion of free sugars, by improving the exposure to fluoride as well as the measures of tooth brushing and facilitating access to dental care for all social classes, it is estimated that of all oral diseases, carious disease is the most common, affecting around 2.3 billion people worldwide [1,2,3,4]
The present study demonstrated equal clinical and apical closure results of nano-hydroxyapatite comparing to platelet-rich fibrin (PRF) and MM-MTA (p > 0.05)
The three biomaterials used in this study, MM-MTA, NHA and PRF, as pulpotomy agents have shown a high rate of clinical and radiographic success since they allowed the root development, including complete apical closure or continued apical closure, in immature permanent mandibular molars
Summary
Dental caries can be prevented by improving diet, limiting the ingestion of free sugars, by improving the exposure to fluoride as well as the measures of tooth brushing and facilitating access to dental care for all social classes, it is estimated that of all oral diseases, carious disease is the most common, affecting around 2.3 billion people worldwide [1,2,3,4]. Incidence of carious disease is reported to be much more frequent in pediatric patients and, as shown in different studies, to frequently affect the permanent molars, which are more susceptible to early caries soon after eruption [4,5,6]. Considering the aforementioned, the management of deep caries in permanent molars, especially those with incomplete root development, should be managed using vital pulp therapy (VPT) rather than pulpectomy or extraction. VPT allows the preservation of root dentin, apexogenesis and the preservation of mechanoreceptors, reducing the probability of tooth fracture due to overloading. Pulpectomy in many cases is not cost-effective as it is time-consuming and difficult for both patient and clinician [8,9,10,11]
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