Indirect Pulp Capping Materials Research Articles

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.

Cone beam computed tomographic assessment of radiographic changes after indirect pulp capping using diode lasers and silver diamine fluoride in permanent molars with deep carious lesions

Aim: To compare the preservation of pulp vitality by indirect pulp capping using Diode laser and Silver Diamine Flouride in management of deep carious lesions. Methods: Thirty patients with an age range of 18-46 years were selected and randomly divided into 3 equal groups: Group 1 (Control group): indirect pulp capping was performed using Biodentine, Group 2: Diode laser with an output power of 0.5 watt was applied before Biodentine placement, and Group 3: Application of Silver Diamine Flouride followed by Biodentine. Pre-operative clinical assessment and radiographs were performed before intervention and then the patients received their treatment and final restorations. Follow-up with clinical assessments was performed after 3 and 6 months. Cone beam computed tomography was performed at the day of intervention and after 6 months. Clinical and Radiographic data were collected, tabulated and statistically analyzed to compare between the success rates of indirect pulp capping using diode laser, Silver Diamine Flouride and Biodentine in management of deep carious lesions. Results: The results of clinical assessment for all groups have shown success rate of 100%. The remaining dentin thickness was significantly increased in all study groups after application of intervention. Also, the remaining dentin density showed significant increase in all groups, where Diode laser application with an output power of 0.5 watt group was significantly higher than the control group, with no significant difference between other groups. Conclusions: Within the limitations of the current study, the following can be concluded: 1. Using Biodentine in indirect pulp capping is the treatment of choice in management of deep carious lesions. 2. Silver Diamine Flouride can be used as an alternative indirect pulp capping material. 3. Diode laser can show promising results in terms of Cavity Disinfection &amp; can have better biomodulating outcomes on the pulpal tissue healing and repair.

Evaluation of Indirect Pulp Capping Using MTA, Light-cured Calcium Silicate, and Propolis in Primary Teeth: A Clinical and Radiographic Study Using VistaScan.

Clinical and radiographic evaluation of mineral trioxide aggregate (MTA), TheraCal LC, and propolis when used as an indirect pulp capping agent in primary teeth over a period of 6 months. A total of 42 primary molar teeth from children aged 4-10 years were chosen for the study. The teeth were divided equally into three groups (group I: MTA, group II: light cured calcium silicate, and group III: propolis). The teeth were followed up clinically and radiographically at 3 and 6 months. The teeth that showed successful treatment outcomes clinically and radiographically were evaluated for the amount of dentin bridge formed at the end of 3 and 6 months, which was measured using CorelDRAW software. The data obtained was analyzed statistically using Statistical Package for the Social Sciences (SPSS) version 21. The mean change in dentin thickness from baseline to 3 months in group II was found to be the highest, followed by groups I and III. The mean change in dentin thickness from 3 months to 6 months was highest in group I, followed by groups III and II. The mean change in dentin thickness from baseline to 6 months in group II was found to be significantly higher than that of group I, followed by group III. Clinically and radiographically, all three materials showed favorable outcomes when used as an indirect pulp capping material with significant reparative dentin formation. The highest amount of dentin deposition was recorded with light-cured calcium silicate, followed by MTA and propolis, respectively. Saikia D, Yadav G, Saha S, et al. Evaluation of Indirect Pulp Capping Using MTA, Light-cured Calcium Silicate, and Propolis in Primary Teeth: A Clinical and Radiographic Study Using VistaScan. Int J Clin Pediatr Dent 2023;16(5):686-691.

A successful case of maturogenesis by stepwise excavation using calcium-enriched mixture cement

This case report demonstrates the successful induction of apexogenesis in an extensively carious lower right first molar with immature roots through the use of stepwise excavation and calcium-enriched mixture (CEM) cement as an indirect pulp capping material. The patient, an 8-year-old boy, presented with pain and carious pulp exposure. The initial treatment involved removing soft dentin and applying CEM cement as an indirect pulp cap. The patient experienced pain relief after 24 h, and subsequent follow-up appointments showed complete healing and maturation of the tooth. The case highlights the potential of indirect pulp treatment with CEM cement and emphasizes the importance of regenerative biomaterials in promoting healing and dentin bridge formation. Further clinical work and research are recommended to explore the efficacy of this treatment approach.

Effectiveness of silver diamine fluoride in indirect pulp capping in primary molars: A systematic review and meta-analysis

IntroductionRecently, clinical trials have assessed the effectiveness of Silver Diamine Fluoride (SDF) as an indirect pulp capping material (IPC) in primary teeth. This systematic review aimed to assess the evidence presented in these trials. Data sourcesA comprehensive search identified relevant studies through five electronic databases (PubMed, Scopus, ClinicalTrials.gov, ScienceDirect, and Cochrane). Search strategies were designed using the PICO model to identify all studies that investigated SDF as an IPC compared to calcium hydroxide (CaOH) or mineral trioxide aggregate (MTA). Quality assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to assess the level of evidence. Study selectionFour clinical trials were found to be suitable for inclusion in the qualitative synthesis and three studies were included in the quantitative analysis. Three studies compared SDF with CaOH and only one study compared SDF, CaOH, and MTA. Only one randomized controlled trial (RCT) had a low risk of bias, and the non-RCT study had a moderate risk of bias. The level of evidence based on the GRADE was low. Three out of four studies showed higher clinical and radiographic outcomes with SDF than with CaOH. One non-RCT study showed that SDF resulted in the least reparative dentin at the 6-months follow-up. The meta-analysis showed a non-significant difference between the SDF and CaOH groups (P = 0.36). ConclusionThere is little evidence showing a higher clinical and radiographic outcome of SDF compared to CaOH as an IPC material in primary molars. Clinical significanceThis systematic review updates pediatric dentists regarding the effectiveness of using SDF as indirect pulp caping in primary teeth.

Investigation of the effect of indirect pulp capping materials on dentin mineral density

Aim: To evaluate the potential of inducing mineral density changes of indirect pulp capping materials applied to demineralized dentin. Methods: A total of 50 cavities were prepared, 5 in each tooth, in extracted ten molars without caries, impacted or semi-embedded. The cavities were scanned by microcomputed tomography (μ-CT) after creating artificial caries by microcosm method (pre-treatment). Each cavity was subjected to one of 5 different experimental conditions: control (dental wax), conventional glass ionomer cement (Fuji IX GP Extra), resin-modified calcium silicate (TheraCal LC), resin-modified calcium hydroxide (Ultra-Blend Plus), MTA (MM-MTA) and the samples were kept under intrapulpal pressure using simulated body fluid for 45 days. Then, the second μ-CT scan was performed (post-treatment), and the change in dentin mineral density was calculated. Afterward, elemental mapping was performed on the dentinal surfaces adjacent to the pulp capping agents of 5 randomly selected samples using energy dispersive X-ray spectroscopy (EDS) apparatus attached to a scanning electron microscope (SEM). The Ca/P ratio by weight was calculated. Friedman test and Wilcoxon Signed Ranks test were used to analyze the data. Results: There was a significant increase in mineral density values of demineralized dentin after treatment for all material groups (p&lt;0.05). Resin-modified calcium silicate had similar efficacy to MTA and conventional glass ionomer cement, but was superior to resin-modified calcium hydroxide in increasing the mineral density values of demineralized dentin. Conclusions: Demineralized dentin tissue that is still repairable can be effectively preserved using materials with remineralization capability.

Three-Dimensional Assessment of Radiographic Changes after Indirect Pulp Capping Using Silver Diamine Fluoride with or without Potassium Iodide in Young Permanent Teeth (12-Month RCT)

The aim of this study was to conduct a three-dimensional (3D) evaluation of radiographic changes after indirect pulp capping (IPC) with silver diamine fluoride (SDF) with or without potassium iodide (KI) and resin-modified glass ionomer cement (RMGIC) in deep carious young permanent molars using cone-beam computed tomography (CBCT). 108 first permanent molars with deep occlusal cavitated caries lesions, in forty-nine 6- to 9-year-old children, were randomly allocated to one of 3 groups (n = 36) and treated with SDF+KI, SDF, and RMGIC as IPC materials. CBCT scans were taken at 0 and 12 months to assess tertiary dentin formation (volume and grey level intensity), increase in root length, and pathological changes such as secondary caries, periapical radiolucency, internal resorption, and obliteration of the pulp. The 3D image analysis procedures were performed using ITK-SNAP and 3D Slicer CMF. Comparisons were made using analysis of variance with a fixed effect for treatment and random effects for patient and patient-by-treatment to account for within-patient correlations. A two-sided 5% significance level was used. There were no significant differences among the three groups regarding tertiary dentin volume (p = 0.712) and grey level intensity (p = 0.660), increase in root length (p = 0.365), prevention of secondary caries (p = 0.63), and periapical radiolucency (p = 0.80) in the analysed 69 CBCT scans. The study did not find differences among the groups regarding quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure as shown by CBCT. Clinical Significance: The results show no significant differences in radiographic outcomes (quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure) when using SDF+KI, SDF, and RMGIC in IPC. The results of this study can help guide treatment decision-making regarding use of SDF and SDF+KI as IPC materials in deep cavitated lesions.

Efficacy of Calcium Hydroxide and Mineral Trioxide Aggregate in the Formation of Dentin Bridge – A Randomized Controlled Trial

OBJECTIVE: This study is to compare the dentin bridge thickness achieved using calcium hydroxide and MTA using radiographs. METHODOLOGY: Single blinded randomized controlled trial conducted in the Operative Dentistry department at Fatima Jinnah Dental College and Hospital, Karachi. A total of 100 premolar and molar teeth with class I and II cavities were included in this study. The study participants were assigned into two groups, A and B of 50 participants each. Under local anesthesia, Group A was indirectly pulp capped with Calcium hydroxide (Dycal) and Group B received Mineral Trioxide Aggregate as an indirect pulp capping material. Both groups were then restored with Glass Ionomer Cement. Radiographic follow up was carried out at three and six months to determine mean dentin thickness of reparative dentin bridge. RESULTS: Statistical analysis was performed using SPSS v 23. Independent Sample t-test was applied to evaluate the formation of dentin bridge formation using Ca(OH)2 and MTA at 3 months &amp; 6 months, the outcomes were highly significant (p-value&lt;0.001). Paired sample t-test was applied to evaluate the difference in dentin bridge formation at three months and 6 months, the results were highly significant (p-value &lt;0.001). CONCLUSION: Statistically significant difference was observed in the dentin thickness of reparative dentin bridge amongst the two groups after three months and six months. A greater success rate was noted in the MTA group as compared to the Ca(OH)2 group after 6 months. KEYWORDS: Dentin bridge, Endodontic treatment, Indirect pulp capping, Reparative dentin, randomized controlled trial.

Twelve-month randomized controlled trial of 38% silver diamine fluoride with or without potassium iodide in indirect pulp capping of young permanent molars

BackgroundThe clinical and radiographic effectiveness of 38% silver diamine fluoride (SDF) with and without potassium iodide (KI) was tested and compared with resin-modified glass ionomer cement (RMGIC) in indirect pulp capping of deep carious lesions in young permanent molars. MethodsOne hundred eight permanent first molars with deep occlusal cavitated carious lesions in 49 children aged 6 through 9 years were randomly allocated into 3 groups (n = 36 molars per group) and treated with SDF plus KI, SDF, and RMGIC. RMGIC was used as a base and a resin-based composite restoration followed. Clinical assessments for secondary caries (primary outcome), postoperative pain, tooth vitality, and restoration success and quality rates according to Modified US Public Health Service and Ryge Criteria for Direct Clinical Evaluation of Restorations were performed after 3, 6, and 12 months. Periapical radiographs were obtained at baseline, 6 months, and 12 months. Outcomes were assessed using mixed effects multilevel logistic and linear regression analyses. ResultsThere were no significant differences (P = .26) among the groups at all times for secondary caries, postoperative pain, tooth vitality, clinical abscess, radiographic signs of pulpal pathology, restorations’ marginal adaption, anatomic form, and surface roughness. There was a significant difference (P = .03) in restoration color, marginal staining, and luster. The RMGIC group outperformed the 2 SDF groups in color and luster. ConclusionsThe authors did not find differences among the groups in preventing secondary caries or pain or in maintaining pulpal health. The RMGIC group had better restoration color and luster than both SDF groups and better marginal staining than the SDF group. Practical ImplicationsThe results of this study can help guide treatment decision making regarding use of SDF and SDF plus KI as indirect pulp capping materials in deep cavitated lesions.This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04236830.

Comparative Evaluation of the Efficacy of Light-Cured Calcium Hydroxide and a Fourth-Generation Calcium Silicate Cement (TheraCal LC) as Indirect Pulp Capping Materials in Patients With Deep Carious Lesions: A Randomized Parallel-Group Clinical Trial.

AimThe current study aims to evaluate and compare the efficacy of light-cured calcium hydroxide and a fourth-generation calcium silicate cement (TheraCal LC®) as indirect pulp capping (IPC) materials in patients with deep carious lesions.Materials and methodsA total of 28 patients were randomly divided into two groups (n=14). Group A was managed by light-cured calcium hydroxide, while group B was treated with TheraCal LC (a fourth-generation calcium silicate cement). Clinical examination was conducted to check for postoperative pain, tenderness, and neural sensibility, and radiographical examination was conducted to check for periodontal ligament space widening, presence of calcific barrier, and periapical radiolucency at patient recall of 21 days, three months, and six months. Primary and secondary outcome variables were based on clinical and radiographical success rates noted at six months’ follow-up.ResultsSuccess rate for light-cured calcium hydroxide group at follow-up came out to be 0% at 21 days, 85.71% at three months, and 92.85% at six months. The success rate for TheraCal LC group came out to be 0% at 21 days, 92.85% at three months, and 100% at six months. The overall success rate for IPC procedure was 89.28% at three months’ follow-up and 96.42% at six months’ follow-up for both groups. The difference was statistically non-significant at the end of three and six months’ follow-up.ConclusionWithin the limitations of our study, it was concluded that TheraCal LC can be used alternatively with light-cured calcium hydroxide in IPC, with a predictability of similar success outcome in patients with deep carious lesions.

Knowledge, Attitude and Practice regarding dental pulp treatment in teaching sector of South Punjab

Objective: This study had four-fold objective; to evaluate the dentists’ choice about removal of caries, to know the preferred material for direct and indi¬rect pulp capping and to find out the influence of clinical experience, post-graduation and workplace on treatment modalities. Methodology: A cross-sectional study was performed on 460 dentists belonging to dental colleges of South Punjab. Non-probability convenience sampling was done. Information about work experience, post-graduation and workplace, caries removal, direct and indirect pulp capping material was collected. SPSS version 22 was used to analyze data. Frequencies, percentages and association of treatment options with other variables were found out. Results: Out of 429 participants, 50% selected to remove total caries and restore temporarily in first visit then permanent filling in second. Calcium hydroxide was the most preferred material (61%) for direct pulp capping, whereas for indirect, it was a combination of CH, GIC and adhesive, also opted by post-graduates significantly more than graduates (p=0.02). No association of work experience and post-graduation had no association with questions about treatment modalities (p = 0.19 and 0.16 respectively). In private sector, first treatment option and a combination of CH, GIC, adhesive and composite for indirect capping was opted significantly more than public sector (p=03 and p=02 respectively), whereas, for direct capping CH was opted significantly more in public than private (p=0.01). Conclusion: The preferred treatment was the complete caries removal and temporary filling in first visit followed by per¬manent filling in second. Calcium hydroxide was the material of choice for pulp capping, also significantly more in public sector than private. In deep cavities, the combination of CH and GIC was preferred for lining under composite resin. The work experience and post-graduation of dentists had no significant influence on treatment options or material used for pulp capping. Keywords: Biodentine, pulp capping, calcium hydroxide, mineral trioxide aggregate

Comparative Analysis of Biodentine, Calcium Hydroxide, and 2% Chlorhexidine with Resin-modified Glass Ionomer Cement as Indirect Pulp Capping Materials in Young Permanent Molars

This study was carried out to compare the effectiveness of biodentine, calcium hydroxide, and 2% chlorhexidine gluconate used along with resin-modified glass ionomer cement (RMGIC) as indirect pulp capping (IPC) materials in young permanent molars. In this study, 54 patients were selected. Among these patients, 72 young permanent molars were selected randomly in which IPC was required. These teeth were randomly categorized into three different groups and each group consisted of 24 teeth. The first group was group A consisting of teeth treated with biodentine, the second group was group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC, while the third was group C consisting of teeth treated with calcium hydroxide. All cases were subjected to follow-up for clinical and radiographic evaluation at 4, 8, and 16 months. The data were recorded and analyzed statistically by utilizing the Chi-square test. After 16 months, 95.83% of cases in group A consisting of teeth treated with biodentine showed successful results both clinically and radiographically. While 87.5% of cases in group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC showed successful results. And finally, 91.66% of cases in group C consisting of teeth treated with calcium hydroxide showed successful results. Biodentine can be efficiently used as an IPC agent in young permanent molars although all three materials were effective in IPC with a nonsignificant difference statistically. This study highlights the success of IPC in young permanent molars and the choice of better IPC material can be biodentine. Indirect pulp capping is one of the procedures in which preservation of carious affected dentin nearest to the pulp is carried out to protect the pulp. Several new IPC agents like biodentine have been introduced. Hence, it is necessary to evaluate their effectiveness. How to cite this article: Kaul S, Kumar A, Jasrotia A, et al. Comparative Analysis of Biodentine, Calcium Hydroxide, and 2% Chlorhexidine with Resin-modified Glass Ionomer Cement as Indirect Pulp Capping Materials in Young Permanent Molars. J Contemp Dent Pract 2021;22(5):511-516.

The effect of current pulp capping materials against intrapulpal temperature increase in primary teeth. An in-vitro study by pulpal microcirculation simulation model

Background/purposeWidespread use of light-cured materials has raised the issue of possible thermal effects on pulp tissue. It was aimed to investigate the effectiveness of pulp capping materials (PCM) against intrapulpal temperature increases (ITI) in primary teeth during light-curing of compomers in this study. Materials and methodsA Class-I cavity was prepared on the primary mandibular second molar tooth. An experimental mechanism was used for pulpal microcirculation and temperature regulation of the tooth. There are eight groups in the study: in Groups 1–6: MTA-Angelus, Biodentine, TheraCal LC, Dycal, conventional Glass Ionomer Cement (GIC) and resin-modified GIC were used as PCM, respectively. In Group-7 no PCM was used. In Group-8 only light was applied to the cavity without any PCM or compomer. Compomer restorations were applied in Groups 1–7 with the same material (Dyract XP, DENTSPLY, Weybridge, UK) and light cured for 10sec with the same light-curing unit (Kerr, Demi Plus, 1200 mW/cm2). Temperature changes (Δt) in the pulp chamber were measured and statistically analysed with Kruskal–Wallis and Mann Whitney U tests. ResultsThe highest Δt-value (4.57 ± 0.11 °C) was measured in Group-4 and 7. The lowest Δt-value (3.94 ± 0.4 °C) was measured in Group-8. Δt-values measured in the Groups 2, 3 and 6 were significantly lower than the values measured in Group-4 and 7 (p = 0.001). ITI during the light-curing of the PCM used in Group-3 and 6 exceeded the critical value (5.5 °C) reported in the literature. ConclusionIn protecting the pulp from the harmful thermal effects of restorative procedures Biodentine which is a self-cured material, may be most acceptable choice as an indirect PCM.

Comparison of efficacy of Ledermix and Calcium hydroxide in the management of deep caries

Background:Pulp capping is a treatment that enables pulp to recover and maintain its vitality and function by applying a protective agent to an exposed pulp. Ca (OH)2 has been considered the gold standard for this procedure. Despite its wide use, Ca (OH)2 is not ideally suited for pulp capping. Recently ledermix cement used for indirect pulp capping material in the outer world broadly.&#x0D; Objective: To assess the clinical and radiological evidence of the formation of secondary dentin and compare the degree of short time post operating pain after indirect pulp treatment.&#x0D; Methods: A Randomized control trial in vivo study was directed in the Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University for one year (January 2012-January 2013). We took the patients with 40 deep carious permanent teeth as a sample. The selected teeth were divided into two test groups. All odd number teeth (20) were included in group-1(where pulp capping was done with ledermix cement). All even number teeth (20) were included in group-2(where pulp capping was done with Ca(OH)2). We assessed all the patients clinically and radiographically at the interval of 3, 6, and 12 months simultaneously for the assessment of dentinal bridge formation and also collected data was analyzed using statistical package for social science (SPSS) version 17.&#x0D; Results: Among the full scale 40 models, ledermix (20) and Ca(OH)2(20), minor to direct irritaion of the teeth was experienced premium to treatment and found comparable in the two gatherings. Regardless, after 24 hrs of treatment, this value was shockingly higher in the Ca(OH)2 (p&lt;0.01)group than in the Ledermix gathering (p &lt; 0.001, t-test). Following 7 days, there was no basic differentiation between them. Follow up evaluation revealed, failure of 3 teeth treated with Ca(OH)2 and 2 teeth treated with ledermix due to pain and swelling. The remaining 35 teeth radiated an impression of being clinically and radiologically successful a year postoperatively.&#x0D; Conclusion: No post-operative pain was experienced in both groups in the long term. However, within the first hours after cementation, there was a sensation of pain significantly higher in the Ca(OH)2 group than in the Ledermix group. Ledermix can be considered a predictable treatment and may be an alternative to calcium hydroxide in indirect pulp capping.&#x0D; Update Dent. Coll. j: 2020; 10 (1): 6-12

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

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.

Assessment of Biodentine as an indirect pulp capping material in young permanent molars

Objective Assess Biodentine as an indirect pulp capping material for treatment of young first permanent molars with deep carious lesions and its microleakage (in vitro). Materials and methods Indirect pulp capping was performed on 60 young permanent molars in 30 children aged 6–10 years then were randomly divided into two treatment groups of 30 molars for each group. Group I: The pulp was indirectly capped with Biodentine. Group II: The pulp was indirectly capped with Dycal. At the same appointment, the tooth was restored with Medifil as a semipermanent restoration. Clinical evaluation and standardized periapical radiographs were done after 3, 6 and 9 months. Microleakage test was assessed by dye penetration technique and followed up after 24 h, 1 and 3 months. Results The two groups were clinically successful as Biodentine showed 100% success rate and Dycal showed 92.6%. There was no statistically significant difference (P > 0.05) between the two groups regarding to their clinical performance. While the radiographic examinations showed that Dycal had lower radiographic success rate (85.2%) in comparison to Biodentine (100%). Biodentine showed superior sealing ability than Dycal, with no statistically significant difference in the microleakage between the two tested materials (P > 0.05). Conclusion Biodentine is a promising material as an indirect pulp capping agent and exhibits superior sealing ability than Dycal.

Clinical performance of mineral trioxide aggregate versus calcium hydroxide as indirect pulp-capping agents in permanent teeth: A systematic review and meta-analysis

Aims and Objectives: The aim of this study was to compare the clinical performance of mineral trioxide aggregate (MTA) and calcium hydroxide as indirect pulp-capping agents in permanent teeth. Materials and Methods: Search strategy includes randomized control trials and clinical trials from the databases of PubMed Central, Cochrane, EBSCO, and MEDLINE from January 1998 to May 2018. A total of six clinical trials that met all inclusion criteria were included in this systematic review. Meta-analysis was performed for three among the included studies. The primary clinical outcome of the included studies was to evaluate the pulp vitality with a normal response to thermal, electrical, and tactile tests without signs of spontaneous pain. The radiological outcome was to evaluate the absence of periapical radiolucency, periodontal ligament space widening, and the dentin bridge formation. The primary and predominant results were assessed based on the success or failure of pulp capping. The restorations were considered failure when there are clinical symptoms such as pain and tenderness and radiographic evidence of radiolucency in periapical region or widening of periodontal ligament. Results: In the six trials that are included, two studies are judged as low risk and four as medium risk of bias. With the help of meta-analysis, the evidence produced concluded that after six-month and one-year follow-up there was no statistically significant difference between MTA and calcium hydroxide as an indirect pulp-capping material. Conclusion: This systematic review of the available evidence reveals that MTA and calcium hydroxide demonstrated good consistent endurance in clinical studies and indistinguishable performance.

Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial\u20142-year results

ObjectivesAssess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations.Materials and methodsSeventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24.ResultsAt 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations.ConclusionsBiodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria.Clinical significanceTeeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years.Trial registrationNCT02201641

Evaluation of calcium (Ca2+) and hydroxide (OH-) ion diffusion rates of indirect pulp capping materials.

The aim of this study was to evaluate and compare the calcium (Ca2+) and hydroxide (OH-) ion release of 4 artificially produced pulp capping materials (MTA, Biodentin, TheraCal LC, Calsimol) used for indirect pulp capping treatment. In total, 70 freshly extracted human third molar teeth were used for the study. Cavities of extracted teeth were prepared by round burs. The remaining dentin thickness (1 ± 0.3 mm) tissue was measured by a micrometer and cone beam computerized tomography. Indirect pulp capping was performed in the cavities using Calcimol, MTA, TheraCal LC and Biodentin. The leached Ca2+ were measured using optical emission spectrometry and the release of OH- ions using a pH meter. The measurements were performed after 24 hours, 7 days and 28 days in saline solution. Statistical analysis was performed using 1-way and 2-way analysis of variance (ANOVA) tests (p<0.05). Ca2+ ions were detected in treated saline solution during the experimental period for all materials. All the measurements of Biodentin and Theracal LC levels for Ca2+ ions were higher than those of the other materials (p<0.05). For all materials, Ca2+-ion release increased during the first 7 days followed by a linear decrease during the subsequent study periods. The Biodentine group showed the highest OH- ion rates compared to the other materials in the 24-hour examination period, while the scores gradually decreased during the subsequent measurement periods (p<0.05). Tricalcium silicate materials such as Biodentine and TheraCal LC used in this study may be preferable for indirect pulp capping because of their stimulation of hard tissue formation and ion-releasing ability.

Tertiary Dentin Formation after Indirect Pulp Capping Using Protein CPNE7

If there is a partial loss of dentin, the exposed dentinal surface should be protected by an indirect pulp capping (IPC) procedure to preserve pulp vitality and prevent symptoms of dentin hypersensitivity. In our previous study, copine7 (CPNE7) induced odontoblast differentiation in vitro and promoted dentin formation in vivo. The aim of this study was to investigate the possibility of IPC therapy using the CPNE7 protein at the exposed dentinal surface and the resulting effects on tertiary dentin formation in a beagle model. CPNE7 promoted mineralization of odontoblasts and had high calcium ion-binding capacity. The in vivo IPC model with canine teeth showed that regeneration of physiologic reactionary dentin with dentinal tubule structures was clearly observed beneath the remaining dentin in the CPNE7 group, whereas irregular features of reparative dentin were generated in the mineral trioxide aggregate (MTA) group. The CPNE7+MTA group also showed typical reactionary dentin without reparative dentin, showing synergistic effects of CPNE7 with MTA. A scanning electron microscopy analysis showed that dentinal tubules beneath the original dentin were occluded by the deposition of peritubular dentin in the CPNE7 and CPNE7+MTA groups, whereas those in the control group were opened. Therefore, CPNE7 may be able to serve as a novel IPC material and improve symptoms of dentin hypersensitivity.