Indirect Pulp Capping Research Articles

Comparative Efficacy of Biodentine® and Calcium Hydroxide in Pulp Capping Treatment

Background: This study is focused on — Assessing Biodentine and Calcium hydroxide in indirect pulp capping procedures. Various materials have been used in indirect pulp capping but this comparative study may help appreciate which material produces better results: Biodentine or Calcium hydroxide. Objective: To compare treatment outcomes post indirect pulp capping treatment using Biodentine® and Calcium hydroxide (Ca(OH)2) . Materials and Methods: A blinded, randomized clinical control trial involving 50 consenting subjects, comparing Biodentine® (test) and Ca(OH)2 (control). Cavity preparation was done and the cavity was dressed with either Biodentine® or Ca(OH)2 and then restored with Glass ionomer cement. The subjects’ teeth were later examined clinically and radiographically at 3, 6, and 9 months post treatment. The indicators of clinical success were absence of pain, swellings, sinus, fistula, abscess, mobility, tenderness to percussion, normal response to electric pulp tester, and Endo-ice cold test. The indicator of radiographic success was absence of periapical pathosis. The probability level of p<0.05 was considered significant. Results: The success rate at three months was 100% for both groups; at six months, it was 92% for both groups and at nine months, 92% of subjects were successful in the Biodentine® group while the Ca(OH)2 group recorded 88% which was statistically insignificant (P=0.74). Conclusion: Biodentine® and Calcium hydroxide have shown comparable effectiveness in improving treatment outcomes, thus, contributing to the longevity of the teeth, and the period of optimum efficaciousness of the pulp capping materials in this study was three months.

Total Pulpotomy with MTA in Young Permanent Teeth: Case Series

Vital pulp therapy is a way to preserve the vitality and function of pulp damaged by trauma, caries or restorative procedures. Vital pulp therapy procedures include direct pulp capping, indirect pulp capping, partial and coronal pulpotomy treatments where diseased pulp tissue is removed. Over the years, the focus of vital pulp therapy has been on the preservation of the radicular pulp in immature permanent teeth to ensure the completion of root formation (apexogenesis). Today, it has been reported that vital pulp therapy can be considered as an alternative to root canal treatment, including in teeth with certain conditions that are considered to have irreversibly inflamed pulp. Coronal amputation therapy, a vital pulp treatment, involves complete removal of the coronal pulp, placement of a biologically acceptable material into the pulp chamber and restoration. The covering material must be able to relieve inflammation and initiate healing of the pulp tissue and allow new dentin tissue to form. The oldest material used in pulpotomy is calcium hydroxide. Mineral trioxide aggregate, which is a more recent material, is frequently preferred today due to its biocompatible and bioactive properties. In this case report, the results of 4 cases of coronal pulpotomy with mineral trioxide aggregate in young permanent teeth with a follow-up of 18 months are presented.

A randomized controlled clinical trial of the performance of three bioactive endodontic cements in primary molar teeth diagnosed with reversible pulpitis: 1-year follow-up study

ObjectivesThe objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement—in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping. MethodsEighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal–Wallis H and Z test (P = 0.05). ResultsThe success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria. ConclusionsNovel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping. Clinical significanceNovel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping.

Recommended procedures for managing carious lesions in primary teeth with pulp involvement—a scoping review

BackgroundManaging dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.AimTo identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.MethodsA comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.ResultsAfter removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.ConclusionTreatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

Management of preeruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

Preeruptive intracoronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentin junction of unerupted teeth, particularly in mandibular molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive PEIR. In Cases 1 and 2, lesions were incidentally discovered in panoramic radiographs during orthodontic planning (mandibular permanent second molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly, in Case 3, the PEIR was not visible in earlier radiographs though the crown of the tooth was already mineralized (mandibular permanent second molar). For Case 4, the tooth presented with symptoms of reversible pulpitis (mandibular permanent first molar). All lesions were treated with indirect pulp capping using biocompat-ible material. The patients were followed up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (Case 2), 1.4 years (Case 4), 1.5 years (Case 1), and 8 years (Case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study.

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

Preserving the vital pulp in the permanent dentition: a simplified guide to indirect pulp capping

This article discusses vital pulp therapy in the adult dentition and describes two cases where a different strategy for caries removal has been used followed by dressing with a contemporary material and tooth restoration on the same visit. A simplified guide for best practice is given. CPD/Clinical Relevance: Vital pulp therapy is an important procedure that requires clinical skill and can be undertaken in general practice.

Comparison of two CBCT analysis techniques with conventional periapical radiographs in assessment of tertiary dentin after indirect pulp capping in young permanent teeth

Comparison of two <scp>CBCT</scp> analysis techniques with conventional periapical radiographs in assessment of tertiary dentin after indirect pulp capping in young permanent teeth

Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study.

This investigation aimed to observe the effects of Dycal, mineral trioxide aggregate (MTA), and TheraCal LC, as indirect pulp-capping materials in primary molars. About 75 children with lower primary molars aged between 4 and 7 years suggested for IPC were selected and randomly allocated into: Group I - Dycal, group II - MTA, and group III - TheraCal LC. An immediate postoperative radiograph was taken after the procedure. Recall examination was done after 3 and 6 months for clinical and radiographic assessment. The radiographs were digitized, and the amount of thickness of dentin was assessed using Corel Draw software. The values were tabulated and subjected to paired t-tests and independent t-tests for intra and intergroup analysis, respectively. The p-value < 0.05 was considered statistically significant. There was a statistically significant increase in dentin thickness in the first 3 months compared to the 6-month follow-up. At the end of the research phase, TheraCal LC had more tertiary dentin deposited than MTA, followed by Dycal. TheraCal LC can be a reliable indirect pulp-capping agent in primary teeth. Indirect pulp capping (IPC) is a very extensively employed treatment regimen to manage extensive caries. For many decades, calcium hydroxide has been regarded as the benchmark of pulp capping materials. With several advancements in materials for restoration, TheraCal LC a resin-modified, light-cured calcium silicate-filled liner serves as a pulp-capping agent and dentin protector, promoting pulp healing and preserving vitality as an obstacle cum protector of the dental pulp complex. How to cite this article: Thomas NA, Jobe J, Thimmaiah C, et al. Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study. J Contemp Dent Pract 2024;25(4):365-371.

Silver Diamine Fluoride as a Medicament for the Indirect Pulp Therapy in Primary Teeth: A Review of the Literature.

Silver diamine fluoride (SDF) has been demonstrated to be effective in arresting caries lesions and, recently, clinical trials have assessed the effectiveness of SDF as amedicament for indirect pulp therapy(IPT) in primary teeth. This review aims to summarize the literature related to the use of SDF and find out if SDF can be used as an effective material for IPT.A literature search was undertaken on electronic databases includingPubMed, MEDLINE, ScienceDirect, and Google Scholar, which elicited 50 studies employing different materials in the IPT of primary molars; however, of them, only four clinical trials used SDF as indirect pulp capping (IPC) material. SDF has the potential to be a useful material for IPT in primary teeth. It is a handy choice for pediatric dentists due to its minimum invasiveness, ease of application, and ability to stop the progression of caries.However, more studies are needed to determine whether SDF can be used routinely for IPT and whether it can even replace the currently available materials, as well as to fully realize its potential and establish criteria for its ideal application in IPT procedures.

Interpretation by literature review of the use of calcium hydroxide as an intra-ductal medication

The effectiveness of calcium hydroxide as an antiseptic agent in endodontics has recently gained relevance, being crucial to ensure optimal results in endodontic treatments. The aim of the study was to interpret the use of calcium hydroxide as an intra-endodontic medication by means of a literature review. A narrative review of the updated literature was performed, with the aim of describing the effects of CaOH and exposing the different clinical procedures in which it is used, as well as the results of its application in endodontic therapy. Clinical trials, meta-analyses and original and published articles from 2018 to 2023, in English or Spanish, were included. It was found that calcium hydroxide plays a key role in endodontics due to its dissociation into calcium and hydroxyl ions, which contributes to its antimicrobial and biological efficacy. Its clinical application is extensive, including preventive endodontics, direct and indirect pulp capping, pulp curettage and pulpotomies, especially in teeth with incomplete apical development. The mechanism behind its antimicrobial action lies in the diffusion of calcium ions and the increase in pH, which limit the rate and enhance the antimicrobial effect in root canals. It was concluded that, for an effective endodontic treatment, it is necessary to eliminate all microorganisms from the root canal. In addition, the microorganism such as E. faecalis has a high resistance to endodontic treatment, which is due to its ability to penetrate into the dentinal tubules, tolerate high alkalinity, and form biofilms

Single visit indirect pulp capping with Biodentine: clinical case report

Introduction. Dental caries is the most widespread dental disease worldwide; it affects population of different ages. If not treated promptly or addressed improperly, dental caries progresses in a deep cavity, with potential signs of pulp inflammation. The minimal invasive principles of treatment of deep carious lesions provide guidelines for the preservation of the dental pulp, techniques known as vital pulp therapies. Among these techniques, indirect pulp capping is a method that has shown high clinical rates of success over time, if performed properly. The applied bioactive dental material plays an important role. The aim of this clinical case report is to describe a clinical case of single-visit indirect pulp capping with Biodentine, along with the algorithm of diagnosis of the pulp health status and treatment used in deep caries lesion in a permanent tooth. Materials and methods. Description of a clinical case of a permanent upper molar with a deep carious lesion, treated by single-visit indirect pulp capping with Biodentine. Clinical and radiological methods of investigations were used; the patient was assessed after 3 and 6 months after the applied treatment. Results. The main complaint of sensitivity to sweet stimuli presented by the patient attenuated shortly after receiving the treatment. After 3 and 6 months, the tooth is asymptomatic; the clinical and radiological findings show no evidence of pulp inflammation. Conclusions. Biodentine showed successful results when used as a bioactive dental material for indirect pulp capping.

Treatment outcome of coronal pulpotomy and indirect pulp capping in mature permanent molars with symptoms of moderate pulpitis: A randomized clinical trial.

This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.

Bioactive Biosilicate Cements in Pediatric Dentistry – A Review of the Latest Materials

ABSTRACT Pediatric dentistry plays a critical role in ensuring the oral health and well-being of children and adolescents. The quest for effective dental materials that are safe, biocompatible, and capable of promoting natural remineralization has led to the emergence of biosilicate cements as a promising advancement in this field. Biosilicate cements are bioactive materials composed of amorphous silica, calcium oxide, phosphorus pentoxide, and other trace elements. The bioactivity of biosilicate cements allows them to interact with living tissues, promoting remineralization and stimulating the formation of hydroxyapatite, a vital component of teeth and bones. Their ability to release essential ions, such as calcium, phosphate, and fluoride, supports the natural healing processes, aiding in the preservation of pulp vitality and reducing the risk of secondary caries. Biosilicate cements offer versatility in pediatric dentistry, finding application indirect pulp capping, indirect pulp capping, and small-sized restorations. Their rapid setting time proves advantageous when treating young patients with limited cooperation. Furthermore, the continuous release of fluoride contributes to caries prevention and enhances the long-term oral health of children. While the advantages of biosilicate cements in pediatric dentistry are promising, this manuscript also discusses the limitations and challenges associated with their use. Some biosilicate cements may have different handling characteristics compared to traditional materials, necessitating adaptations in clinical techniques. In addition, long-term clinical data on the performance of these materials in pediatric patients are still limited, requiring further research to establish their efficacy and longevity. This manuscript explores the potential of biosilicate cements in pediatric dentistry.

The Effect of Indirect Pulp Capping Treatment on Oral Health Quality of Life at The Dental Hospital Universitas Muhammadiyah Yogyakarta

Background: Dental and oral health-related quality of life is an individual's assessment of the impact of oral disorders that can affect the overall quality and well-being of their lives. One of the oral disorders that is frequently experienced by the community is pulpitis, which, if left behind, can cause pain and cause the tooth to become necrotic. Indirect pulp treatment can be done to deal with pulpitis and improve the patient quality of life. The study aims to determine the impact of indirect pulp capping treatment on quality of life based on gender, age, educational level, and number of teeth treated. Methods: The data collection technique in this study uses primary data in the form of a questionnaire and secondary data, which is data from the medical records of patients performing pulp capping treatment. The sample in this study is a patient who has completed indirect pulp capping treatment in the dental hospital UMY. The data analysis used in this study is descriptive analysis as well as chi square tests and controls to test the hypothesis. The results of this study are patient gender, the education level, and the number of teeth treated have no influence on quality of life related to oral health (p&gt;0.05) otherwise the patient age has an influence on quality of life related to oral health (p&lt;0.05). Conclusion: Gender, education level, and number of teeth treated have no influence, while age has an influence on quality of life

Correction of Anterior Cross Bite in Mixed Dentition period using Quadhelix and Catalans appliance - A Case Report

The case report addresses the challenge of correcting anterior cross bite in mixed dentition period. It emphasizes the complexity of treating skeletal Class III malocclusion, especially in young patients, and highlights the importance of choosing appropriate orthodontic appliances for effective treatment. The subject of the case report is a 9-year-old girl, MK, who presented with a prognathic profile, upper and lower incisor proclination, and bimaxillary protrusion. The treatment plan was multifaceted, incorporating oral prophylaxis, fluoride application, indirect pulp capping, and strategic extractions. Key appliances used were the Quadhelix and Catalans appliances, supplemented by a lower inclined plane, removable Jack Screw appliance with a posterior bite plane, and a Nance Palatal Arch space maintainer. The report meticulously documents the treatment progression with detailed photographs and radiographs, capturing changes at 10 days, 24 days, and 3.5 months intervals. The case report concludes that the use of Quadhelix and Catalans appliances, in conjunction with a comprehensive treatment plan, effectively corrected the anterior crossbite in this patient. The treatment led to significant dental and skeletal improvements, as evidenced by the post-treatment cephalometric analysis. This case underscores the effectiveness of these appliances in pediatric orthodontic cases with similar presentations. Bangladesh Journal of Medical Science Vol.23 (Special Issue) 2024 p.S43-S47

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Effectiveness of a needle-free local anesthetic technique compared to the traditional syringe technique for the restoration of young permanent molars: a single-blind randomized clinical trial.

The sensation of pain can elevate anxiety levels, establishing a cyclical pattern that may result in the avoidance or premature termination of dental procedures. Previous endeavors employing various methods and products have produced varied outcomes. Jet injection systems, employing high pressure and velocity to deliver anesthesia without needles, offer a non-invasive option for local anesthesia administration. To assess and measure pain perception levels in a pediatric population during the restoration of young permanent teeth, comparing a needle-free injection system with the traditional dental needle method. Sixty participants with young permanent first molars requiring indirect pulp capping were enrolled, all under the care of a single operator. A simple randomization method was employed, utilizing sequentially numbered, opaque, sealed envelopes to allocate participants into two intervention groups: Group 1 and Group 2. Group 1 received traditional needle syringe anesthesia, while Group 2 received the needle-less injection system, Injex (INJEX Pharma AG, Germany). Following topical anesthesia application, local anesthesia was administered, and indirect pulp capping was performed. The Face, Legs, Activity, Cry, Consolability Scale (FLACC), Wong-Baker Scale, Time of local anesthesia (LA) Administration, Frankl Behavior Rating Scale (FBRS), and Pulse rate were evaluated and recorded at various intervals. The needle-less injection system required approximately 26.2 seconds for anesthesia administration, significantly less time than the traditional syringe (p < 0.001). FBRS score analysis revealed no significant differences between groups at all intervals. FLACC score analysis during anesthesia administration indicated lower scores in the needle-free injection group (p < 0.001). Evaluation of Wong Baker Scale (WBS) scores showed higher values in the traditional syringe needle group (p < 0.05). Using the Injex system presents a promising alternative for dental anesthesia administration, enhancing patient comfort and alleviating fear associated with traditional injections.

Three case reports of different clinical applications of mineral trioxide aggregate

Introduction. Calcium silicate dental cements have a wide range of applications in clinical dentistry. Many formulations were developed in the last decade and successfully employed for dental healing. In this paper, several clinical applications of mineral trioxide aggregate (MTA+, Cerkamed, Stalowa Wola, Poland) were presented. Outlines of cases. The first case report reflects the application of the MTA+ for the healing of the root perforation of the upper premolar. The second case report was the usage of MTA+ for indirect pulp capping in patient who came with pain of the tooth previously restored with composite filling. The third case report was a patient with periapical cystic lesion that was removed surgically and root canal filled retrogradely with MTA+. Conclusion. Altogether, current calcium silicate based dental cements bear a great potential for solving numerous issues in the dental practice regarding huge or problematic defects of dentine or alveolar bone.

Comparison of Efficiency and Responses of Biodentine with Other Agents on Direct and Indirect Pulp Capping in Primary and Permanent Teeth - A Review

Comparison of Efficiency and Responses of Biodentine with Other Agents on Direct and Indirect Pulp Capping in Primary and Permanent Teeth - A Review