Indirect Pulp Capping Research Articles

LIGHT-CURED CALCIUM SILICATE BASED-CEMENTS AS PULP THERAPEUTIC AGENTS: A META-ANALYSIS OF CLINICAL STUDIES.

To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents? The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison. Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21). Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries. This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.

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.

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

PurposeThe European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.MethodsThree expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.ResultsThere is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.ConclusionThe management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

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.

CLINICAL AND RADIOGRAPHIC EVALUATION OF BIOMATERIALS USED IN DIFFERENT ENDODONTIC PROCEDURES-CASE SERIES

Introduction:&#x0D; Endodontic treatment may be required for the permanent teeth due to different reasons in childhood. Biological materials such as MTA and Biodentine® have started to be used nowadays in different endodontic treatment. Studies have shown that these materials stimulated the formation of new vascularized tissue in the apical of mature teeth with necrotic pulp and with periapical lesions. In addition, MTA and Biodentine® are preferred in direct and indirect pulp capping due to their properties such as biocompatibility and impermeability.&#x0D; Purpose:&#x0D; The aim of this study is to examine the teeth clinically and radiologically after the use of Biodentine® and MTA as a barrier on the pulp capping, Cvek pulpotomy and regenerative endodontic treatment.&#x0D; Case Series:&#x0D; Case 1: A 12-year-old girl presented at our clinic with complaints of intermittent pain and cold sensitivity in her tooth #16. Direct pulp capping was performed with MTA. &#x0D; Case 2: An 7-year-old boy with a trauma associated complicated crown fracture in his tooth #11 was admitted to our clinic. Cvek pulpotomy was performed with Biodentine®. &#x0D; Case 3: An 8-year-old girl with trauma associated crown fracture in her tooth #11 was admitted to our clinic. Regenerative endodontic treatment was applied with Biodentine®. &#x0D; Case 4: Indirect pulp capping was performed with MTA to a 7-year-old boy admitted to our clinic with the complaint of cold sensitivity in his tooth # 46.&#x0D; &#x0D; Conclusion:&#x0D; Today, the success rate is high in vital pulp treatments with newly developed materials such as MTA and Biodentine®. In addition, root development continues after regenerative endodontic treatments with Mineral Trioxide Aggregate (MTA) or Biodentine® in non-vital and open-apex teeth.

Promotion Effect of Carboxymethyl Chitosan on Dental Caries via Intrafibrillar Mineralization of Collagen and Dentin Remineralization.

Objective: To observe ultrastructural changes during the process of carboxymethyl chitosan (CMC)-mediated intrafibrillar mineralization, we evaluated the biomimetic remineralization potential of CMC in type-I collagen fibrils and membranes, and further explored the bond strength as well as the bond interfacial integrity of the biomimetic remineralized artificial caries-affected dentin (ACAD). Methods: A mineralized solution containing 200 μg/mL CMC was used to induce type-I collagen biomimetic remineralization in ACAD, while traditional mineralization without CMC was used as a control. The process and pattern of mineralization were investigated by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) as well as structured illumination microscopy (SIM). The Vickers hardness test was used to quantify the dentin hardness, while the microtensile bond strength (µTBS) test was used to assess the bond strength and durability. The bond interfacial integrity was evaluated by a confocal laser scanning microscope (CLSM). Results: TEM, SEM, and SIM images showed that CMC had a positive effect on stabilizing amorphous calcium phosphate (ACP) and promoting intrafibrillar mineralization, while extrafibrillar mineralization was formed without CMC. Furthermore, hardness evaluation and µTBS proved that CMC significantly increased dentin hardness and bond strength. CLSM indicated that CMC could create a significantly better bond interfacial integrity with less of a micro-gap in ACAD. Significance: CMC possessed the ability to promote intrafibrillar mineralization and remineralization in demineralized caries dentin lesions, as well as improve bond performance, which implied its potential in carious dentin demineralization or dentin hypersensitivity and possibly even as a possible material for indirect pulp-capping, to deal with deep caries. Highlights: CMC possessed the ability to induce intrafibrillar mineralization effectively; the bond strength and bond durability of demineralized caries dentin were improved via CMC-induced remineralization; the CMC-induced remineralization complex is a potential material for indirect pulp-capping, to deal with deep caries.

Pulp vital therapy as an alternative to endodontic treatment: A review of the literature

Introduction: Preservation of pulp tissue can extend the long-term survival of teeth through relatively simple restorative procedures. Objective: To analyze the literature on the success of indirect pulp capping in primary and permanent teeth, as well as direct pulp capping and partial and complete pulpotomy in mature and immature teeth. Methodology: An electronic search was performed during January 2022 in the PubMed, SCOPUS and Google Scholar databases, using Boolean logical operators AND, OR and NOT. Human or in vitro comparative studies were included and evaluated, the keywords used were:

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set.

BackgroundA large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision‐making.ObjectivesTo identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments.MethodsMultiple healthcare bibliographic databases, including PubMed/MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events.ResultsThirty‐six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician‐reported outcomes were used considerably more often than patient‐reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all.DiscussionConsiderable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision‐making.ConclusionsWhilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post‐operative pain and need for further intervention, have been identified which could inform the development of a COS for endodontic treatment.RegistrationCore Outcome Measures in Effectiveness Trials (COMET) (No. 1879).

Comparative Evaluation of Ozonoid Olive Oil and Calcium Hydroxide as an Indirect Pulp Capping Agent in Primary Mandibular Second Molar: A Randomized Controlled Trial

The aim of this study was to evaluate clinical and radiographical success of ozonoid olive oil as an indirect pulp capping (IPC) agent in primary mandibular second molar when compared to calcium hydroxide and to evaluate the antimicrobial efficacy of ozonoid olive oil on Streptococcus mutans and Lactobacilli. A split-mouth randomized controlled trial was conducted on 30 primary mandibular second molars in 15 children of age 5-9 years with deep dentinal carious lesion. Teeth were randomly allocated to two groups of 15 each. After achieving local anesthesia and rubber dam isolation, an IPC procedure was performed using ozonoid olive oil in group I and calcium hydroxide in group II. Teeth were evaluated clinically and radiographically at 6 and 12 months of follow-up for success or failure of IPC. The bacterial counts of S. mutans and Lactobacilli were measured before and after application of ozonoid olive oil for 60 seconds on dentinal tissue in group I and recorded as colony-forming units per mL (CFU/mL). There were no statistically significant differences found between the materials used for IPC (p >0.05). About 93.33% and 100% clinical and radiographical success rates were seen in group I and group II, respectively. Statistically significant differences were observed for bacterial reduction after the application of ozonoid olive oil (p <0.05) for both the microorganisms. The results of this study showed that the success of IPC is independent of capping material. Ozonoid olive oil, an antimicrobial agent, can also be used for IPC. The success of the IPC procedure depends on a reduction in the bacterial count and sealing of the tooth with hermetic restoration. More clinical studies with a larger sample size and longer follow-up duration are required for understanding the efficacy of this material. Ozonoid olive oil can be used as an IPC agent in primary molars and also for a bacterial reduction in dentinal caries.

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

Dental Pulp Response to Different Types of Calcium-Based Materials Applied in Deep Carious Lesion Treatment-A Clinical Study.

Dental pulp vitality preservation in dental caries treatment is a major goal in odontotherapy. The main objective of this study was to compare dental pulp tissue responses to vital therapies in deep carious lesions, using different calcium-based materials. An ambispective study was conducted on 47 patients. Ninety-five teeth with deep carious lesions were treated. Among them, 25 (26.32%) were diagnosed with pulpal exposures and treated by direct pulp capping. Indirect pulp capping was applied when pulp exposure was absent (n = 70; 73.68%). Fifty teeth (52.63%) were treated with TheraCal LC (prospective study), 31 teeth (32.63%) with Calcimol LC, and 14 teeth (14.74%) with Life Kerr AC (retrospective study). The results show that the survival rate for dental pulp was 100% for Life Kerr AC, 92% for TheraCal LC, and 83.87% for Calcimol LC, without significant differences. Apparently, self-setting calcium hydroxide material provided better dental pulp response than the two light-cured materials, regardless of their composition, that is, either calcium -hydroxide or calcium silicate-based. We will need a significant number of long-term clinical studies with the highest levels of evidence to determine the most adequate biomaterials for vital pulp therapies.

Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study.

AimsTo evaluate and compare three different treatment modalities in the management of deep carious lesions in primary molars.Material and methodsA total of 60 primary molars from patients aged 4-9 years were randomly divided into three groups with 20 samples each. Sample in Group I received indirect pulp therapy with Mineral Trioxide Aggregate [MTA] as lining material, Group II received the modified Hall technique, and Group III MTA pulpotomy. The patients were evaluated at 1, 3, 6, and 9 months as per evaluation criteria for success or failure of the same. A Chi-square test was used for proportions and for comparison between groups.ResultsClinically, the success rate for the modified Hall technique and MTA pulpotomy was higher than indirect pulp therapy. Radiographically, the modified Hall technique had the highest success rate of 100 percent among the indirect pulp therapy and MTA pulpotomy. This success rate was however not statistically significant.ConclusionAll three techniques had promising results clinically and radiographically. Since the results were not statistically significant, conservative treatment like Modified Hall's technique can be preferred over the surgical approach [MTA Pulpotomy].Clinical significanceThis study compares newer techniques called Hall's technique with traditional techniques like indirect pulp capping and MTA pulpotomy. Hall's technique is a quick and noninvasive procedure, which involves fitting the crown and seating it over the tooth without any caries removal/ tooth preparation and no local anesthesia is being practiced. In the present study Hall's technique showed higher rates of success compared to the other two procedures.How to cite this articlePoludasu M, Kumar Mallela GM, Puppala R, et al. Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(S-2):S201-S206.

Vital Pulp Therapy in Permanent Teeth

This review article aimed to evaluate the outcome of vital pulp therapy procedures including indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial pulpotomy (PP) and full pulpotomy (FP) in permanent teeth even with signs of reversible and irreversible pulpitis. Instead of complete pulp tissue removal by pulpectomy, vital pulp therapy has been considered as an alternative approach. Articles published after 2000 were searched in PubMed and GoogleScholar online databases according to PRISMA guidelines. Forty articles were selected according to the inclusion and exclusion criteria. Eighty-five cases from case series and case report studies and also results of 20 clinical articles were included in this study. The success rate of partial and full pulpotomy in permanent teeth with signs of reversible and irreversible pulpitis was 98.8%. The success rate for both partial and full pulpotomies with mineral trioxide aggregate and calcium silicate-based cements in the current review of clinical studies was 84.6%-100% and 78.9%-100%. Partial and full pulpotomies demonstrated favourable outcomes and a high success rate in treating permanent teeth. So the vital pulp therapy procedures in permanent teeth with signs of pulpitis can be more successful, cost-effective and time-saving compared to traditional root canal treatment. However further well-designed studies with longer follow-up periods are required to validate these findings.

ЛЕЧЕНИЕ ОБРАТИМОГО ПУЛЬПИТА С ИСПОЛЬЗОВАНИЕМ ГИДРОКСИДА КАЛЬЦИЯ ДЛЯ НЕПРЯМОГО ПОКРЫТИЯ ПУЛЬПЫ

Vital pulp therapy is a biologic and conservative treatment to preserve the vitality and function of the pulp tissue. Indirect pulp capping is one of the techniques which can be done with Ca(OH)2. The success rate of using Ca(OH)2 during treatment of reversible pulpitis isn’t so high. And the reactivity of the vital pulp is reduced when exposed to an aggressive calcium hydroxide-based material. According to the international classification of diseases, reversible pulpitis is considered as K04.00 – initial pulpitis.&#x0D; The purpose of this review article is to assess systematically the available scientific evidence about the clinical response of pulp-dentin complex after using Ca(OH)2 for indirect pulp capping. &#x0D; Materials and methods: The study of publications was produced in the electronic databases such as Google Scholar, PubMed during a systematic review of the literature. Included articles contain information about using Ca(OH)2 during treatment of initial pulpitis and its side effects. The publication date criterion was selected from January 2011 to July 2021.&#x0D; Results: 55 articles were viewed during the review. After analyzing the literature for inclusion criteria, the total number of publications has become 10.&#x0D; Conclusions: According to literature data, the using calcium hydroxide for indirect pulp capping during treatment of the reversible (initial) pulpitis is decreasing due to the side effects and clinical response from dentin pulp complex.

Assessment of Pediatric First Permanent Molar Management under General Anesthesia at the King Abdulaziz Medical City, Jeddah, Saudi Arabia

Background: The use of general anesthesia (GA) among children has seen an increase globally. Both tooth extraction and restoration treatments on children were done under GA, but there are consequences in using GA in children, which also include changes in the treatment plan. First permanent molar (FPM) treatment under GA is a very strategic treatment, but there is a notable lack of studies that assess in detail this type of treatment, especially its frequency of administration under GA. This study determines the treatment frequency and the type of FPM treatment in children under GA at the King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia.&#x0D; Methods: Our study is a cross-sectional study that reviewed the cases of dental rehabilitation in children between the ages of 5 and 14 years old from 2015 to 2018. These children had erupted first permanent molars and were treated under GA.&#x0D; Results: This study included 394 children, with 1330 FPMs treated under general anesthesia for (27%) preventive, (56%) restorative, and (17%) extraction treatments. The frequency of FPM treatments administered were color restoration (49%), fissure sealant application (37%), SSC (8.9%), and amalgam filling (4.5%). Low pulpal treatment was reported which was mostly involved indirect pulp capping. Most of the final restorations that were done covered only one surface, followed by the two-surface restorations, and then by SSC. &#x0D; Conclusions: The pediatric dentists’ decision for FPMs treatment under general anesthesia at KAMC was following AAPD guideline and its frequency was mostly restorative followed by preventive, and the least treatment was extraction treatments. The type of FPMs treatment administered on children was significantly influenced by their ages, gender, and health conditions. The type of tooth restoration and pulp therapy treatments were significantly dependent on children’s age. KAMC pediatric dentist efforts should be directed to initiate more preventive programs and effective dental home care utilization at PHC centers.

Contemporary management of deep caries in primary teeth: a systematic review and meta-analysis.

To systematically evaluate the available evidence regarding contemporary management of deep caries in vital primary teeth. This review was carried out to facilitate the development of European Academy of Paediatric Dentistry (EAPD) guidelines on deep caries management of primary teeth in paediatric dentistry. A systematic electronic literature search was conducted to locate studies reporting on interventions and medicaments used for the treatment of deep caries in vital primary teeth. To facilitate this, the Cochrane Library (1992 to up to December 6th, 2020), MEDLINE (PubMed, 1946 to December Week 1, 2020), Ovid MEDLINE (In-Process & Other Non-Indexed Citations, December 6th, 2020); EMBASE (Embase.com, 1974 to December 6th, 2020) and LILACS (1982 to December 6th, 2020) were accessed. Hand search of reference lists of included articles, as well as handbooks and grey literature search was also performed. Study screening was done in duplicate and study inclusions were agreed upon by all authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies. Overall success rate of each intervention and medicament within the intervention was reported. Meta-analysis was also performed for high-quality studies reporting similar interventions and comparable outcomes in homogeneous population. A total of 1332 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the review. Of these, 8 papers were deemed to represent 4 individual studies, leaving a total of 32 unique studies eventually included in the final analysis. These studies were further categorized into three main vital pulp treatment methods for analysis: indirect pulp capping (IPC), direct pulp capping (DPC), and pulpotomy (PP). Overall, IPC, DPC and PP interventions have high success rates with the reported clinical success rates higher than radiographic success rates. Medicaments used for IPC and DPC have similar success rates. Mineral trioxide aggregate (MTA), ferric sulfate (FS) and formocresol (FC) PP showed similar success rates, and which were all higher than calcium hydroxide (CH). Majority of included studies (n = 22; 63%) were rated low in terms of their potential risk of bias, 6 studies were ratedhigh(17%), and 7 studies were of unclear risk (20%). Within the limitations of the studies included, IPC, DPC, and PP can be recommended as effective treatment modalities for primary teeth with deep caries under specific conditions.

Advantages of Glass Ionomer Cement as A Base Rather than A Varnish in Pulp Capping

Indirect pulp treatment (IPT) or indirect pulp capping (IPC) is a conservative alternative therapy for primary and permanent teeth that have deep carious lesions nearing the pulp in the absence of any symptomatology related to pulp degeneration. This is achieved by removing only weakened, humid dentinal tissue that does not resist manual excavation, and intentionally leaving behind the deep most layer adjacent to the pulp. The healing mechanism in pulp capping involves the repair in the dento-pulpal complex through the formation of a dentin-like matrix known as tertiary dentin by dental pulp. Several dental materials have been used as IPC agents for the maintenance of vitality of deeply carious teeth. Glass ionomer cement (GIC) offers a combination of strength, rigidity and fluoride dispensing properties of silicate particles along with the biocompatibility and adhesive properties of a polyacrylic acid. The cement’s adhesion, based on an ion exchange mechanism with the dental tissue, is a unique phenomenon. Although, the adhesive strength has only been understood scarcely so far, it is known that the occurrence of bond failure in case of GIC is mostly from cohesive breakdown in the cement as opposed to adhesive failure at the dento-cement interface. Due to low amounts of polymerization related material contraction, GIC has proven to retain better than composite resins and provides a superior quality of bacterial seal. This seal prevents the progression of pulpal inflammation by preventing further microleakage of bacteria, endotoxins, and lipopolysaccharides at the dentin and glass ionomer interface. New generations of light cure GIC offer even greater retention to dentinal surfaces than traditional chemically cured GIC. However, the cement is appropriate only as an IPC.

Tooth Fracture and Associated Risk Factors in Permanent Molars Treated with Vital Pulp Therapy and Restored with Direct Resin Composites: A Retrospective Survival Analysis in Young Patients.

This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients. The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model. A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34+-20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89-74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively. In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth. (EEJ-2022-08-097).

Outcome of Direct Pulp Capping in Teeth Diagnosed as Irreversible Pulpitis: Systematic Review and Meta-Analysis.

BackgroundThis review and meta-analysis investigates the outcome of direct pulp capping in teeth diagnosed as irreversible pulpitis. Material and MethodsThis systematic review includes experimental and descriptive clinical studies according to the PRISMA criteria, using PubMed and Scopus as database. We have included studies that performed direct pulp capping on human permanent teeth previously diagnosed with irreversible pulpitis and that carried out a subsequent follow-up. The outcome of interest was the clinical success of direct pulp capping. ResultsA total of four studies met the inclusion criteria for this review, however only three of these could be included in the meta-analysis. These three studies represent a total sample of 62 teeth with irreversible pulpitis treated with direct pulp capping that showed an overall success rate of 0.953 (CI=0.900-1.005; p<0.001; I²=0). Additionally, the success rates of vital pulp therapies were compared, all of them being greater than 75%; and the success rates of the materials used were analyzed, giving values above 80% in all cases. The risk of bias of the included articles was established using the ROBINS-I tool, showing that two of the articles had a moderate risk of bias and the remaining two had a very high risk of bias. ConclusionsBased on the results of this review, direct pulp capping should be clinically included as a successful technique for the treatment of irreversible pulpitis. However, a larger number of studies with more rigorous methodologies are necessary to confirm the efficacy of this technique. Key words:Irreversible pulpitis, direct pulp capping (DPC), vital pulp therapy (VPT), indirect pulp capping (IPC), partial pulpotomy, total pulpotomy.