Which is the most effective biomaterial in indirect pulp capping? 4- year comparative randomized clinical trial

Purpose The aim of this study is to compare the clinical outcomes of Mineral Trioxide Aggregate (MTA) and calcium hydroxide pulp capping after complete caries removal. Materials and Methods In 73 regular patients (47 women, 26 men; age 20.65±3.02 years), having at least one deep carious lesion was recruited. Following complete caries removal, the pulp was indirectly capped with either MTA(n=51) or calcium hydroxide (n =49), randomly. Final restoration with a resin-based composite in a single session was performed. Clinical parameters including pulp vitality, sensitivity to cold or heat stimulants, percussion tests and discomfort during chewing and color were recorded after 6 months, 1 year, 2- year, 3- year and 4- year. Data were analysed statistically (p < 0.05). Results After 4- year, the survival rates were 86% (for MTA), and 82.9% (for calcium hydroxide). Totally, 8 teeth from calcium hydroxide group and 7 teeth from MTA group were endodontically treated. No significant difference was detected between the groups in terms of pulp vitality (p=0.613). Grey discoloration rate was 63% in MTA group. Conclusion Both pulp-capping materials, MTA and calcium hydroxide showed similar clinically successful performance in terms of pulp vitality in the treatment of deep dentin caries lesions after 4- year. 

___

  • 1. Schwendicke F. Contemporary concepts in carious tissue removal: A review. J Esthet Restor Dent. 2017;29(6):403-408.
  • 1. Schwendicke F. Contemporary concepts in carious tissue removal: A review. J Esthet Restor Dent. 2017;29(6):403-408.
  • 2. Seux D, Couble ML, Hartmann DJ, Gauthier JP, Magloire H. Odontoblast-like cytodifferentiation of human dental pulp cells in vitro in the presence of a calcium hydroxide-containing cement. Arch Oral Biol. 1991;36(2):117-128.
  • 2. Seux D, Couble ML, Hartmann DJ, Gauthier JP, Magloire H. Odontoblast-like cytodifferentiation of human dental pulp cells in vitro in the presence of a calcium hydroxide-containing cement. Arch Oral Biol. 1991;36(2):117-128.
  • 3. Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimitriou S. The dentinogenic effect of mineral trioxide aggregate (MTA) in short-term capping experiments. Int Endod J. 2002;35(3):245-254.
  • 3. Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimitriou S. The dentinogenic effect of mineral trioxide aggregate (MTA) in short-term capping experiments. Int Endod J. 2002;35(3):245-254.
  • 4. D'Arcangelo C, Di Nardo-Di Maio F, Patrono C, Caputi S. NOS evaluations in human dental pulp-capping with MTA and calcium-hydroxide. Int J Immunopathol Pharmacol. 2007;20(1 Suppl 1):27-32.
  • 4. D'Arcangelo C, Di Nardo-Di Maio F, Patrono C, Caputi S. NOS evaluations in human dental pulp-capping with MTA and calcium-hydroxide. Int J Immunopathol Pharmacol. 2007;20(1 Suppl 1):27-32.
  • 5. Asgary S, Eghbal MJ, Parirokh M, Ghanavati F, Rahimi H. A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(4):609-614.
  • 5. Asgary S, Eghbal MJ, Parirokh M, Ghanavati F, Rahimi H. A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(4):609-614.
  • 6. Nair PN, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with Mineral Trioxide Aggregate: a randomized controlled trial. 2008. Int Endod J. 2009;42(5):422-444.
  • 6. Nair PN, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with Mineral Trioxide Aggregate: a randomized controlled trial. 2008. Int Endod J. 2009;42(5):422-444.
  • 7. Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J. 2003;36(3):225-231.
  • 7. Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J. 2003;36(3):225-231.
  • 8. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. J Endod. 2000;26(9):525-528.
  • 8. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. J Endod. 2000;26(9):525-528.
  • 9. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978;4(8):232-237.
  • 9. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978;4(8):232-237.
  • 10. Mente J, Geletneky B, Ohle M, et al. Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. J Endod. 2010;36(5):806-813.
  • 10. Mente J, Geletneky B, Ohle M, et al. Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. J Endod. 2010;36(5):806-813.
  • 11. Okiji T, Yoshiba K. Reparative dentinogenesis induced by mineral trioxide aggregate: a review from the biological and physicochemical points of view. Int J Dent. 2009;2009:464280.
  • 11. Okiji T, Yoshiba K. Reparative dentinogenesis induced by mineral trioxide aggregate: a review from the biological and physicochemical points of view. Int J Dent. 2009;2009:464280.
  • 12. Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996;127(10):1491-1494.
  • 12. Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996;127(10):1491-1494.
  • 13. Min KS, Kim HI, Park HJ, Pi SH, Hong CU, Kim EC. Human pulp cells response to Portland cement in vitro. J Endod. 2007;33(2):163-166. 14. Ricketts D. Management of the deep carious lesion and the vital pulp dentine complex. Br Dent J. 2001;191(11):606-610.
  • 13. Min KS, Kim HI, Park HJ, Pi SH, Hong CU, Kim EC. Human pulp cells response to Portland cement in vitro. J Endod. 2007;33(2):163-166. 14. Ricketts D. Management of the deep carious lesion and the vital pulp dentine complex. Br Dent J. 2001;191(11):606-610.
  • 15. Schwendicke F, Frencken JE, Bjorndal L, et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res. 2016;28(2):58-67.
  • 15. Schwendicke F, Frencken JE, Bjorndal L, et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res. 2016;28(2):58-67.
  • 16. Innes NP, Frencken JE, Bjorndal L, et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res. 2016;28(2):49-57.
  • 16. Innes NP, Frencken JE, Bjorndal L, et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res. 2016;28(2):49-57.
  • 17. Bjorndal L, Reit C, Bruun G, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010;118(3):290-297.
  • 17. Bjorndal L, Reit C, Bruun G, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010;118(3):290-297.
  • 18. Crespo-Gallardo I, Martin-Gonzalez J, Jimenez-Sanchez MC, Cabanillas-Balsera D, Sanchez-Dominguez B, Segura-Egea JJ. Dentist s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. J Clin Exp Dent. 2018;10(12):e1205-e1215.
  • 18. Crespo-Gallardo I, Martin-Gonzalez J, Jimenez-Sanchez MC, Cabanillas-Balsera D, Sanchez-Dominguez B, Segura-Egea JJ. Dentist s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions. J Clin Exp Dent. 2018;10(12):e1205-e1215.
  • 19. Koopaeei MM, Inglehart MR, McDonald N, Fontana M. General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis. J Am Dent Assoc. 2017;148(2):64-74.
  • 19. Koopaeei MM, Inglehart MR, McDonald N, Fontana M. General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis. J Am Dent Assoc. 2017;148(2):64-74.
  • 20. Schwendicke F, Meyer-Lueckel H, Dorfer C, Paris S. Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res. 2013;47(6):566-573.
  • 20. Schwendicke F, Meyer-Lueckel H, Dorfer C, Paris S. Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res. 2013;47(6):566-573.
  • 21. Stangvaltaite L, Kundzina R, Eriksen HM, Kerosuo E. Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway. Acta Odontol Scand. 2013;71(6):1532-1537.
  • 21. Stangvaltaite L, Kundzina R, Eriksen HM, Kerosuo E. Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway. Acta Odontol Scand. 2013;71(6):1532-1537.
  • 22. Alnahwi TH, Alhamad M, Majeed A, Nazir MA. Management preferences of deep caries in permanent teeth among dentists in Saudi Arabia. Eur J Dent. 2018;12(2):300-304.
  • 22. Alnahwi TH, Alhamad M, Majeed A, Nazir MA. Management preferences of deep caries in permanent teeth among dentists in Saudi Arabia. Eur J Dent. 2018;12(2):300-304.
  • 23. Smail-Faugeron V, Porot A, Muller-Bolla M, Courson F. Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review. Eur J Paediatr Dent. 2016;17(2):107-112.
  • 23. Smail-Faugeron V, Porot A, Muller-Bolla M, Courson F. Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review. Eur J Paediatr Dent. 2016;17(2):107-112.
  • 24. Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. J Public Health Dent. 2011;71(4):265-270.
  • 24. Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. J Public Health Dent. 2011;71(4):265-270.
  • 25. Oen KT, Thompson VP, Vena D, et al. Attitudes and expectations of treating deep caries: a PEARL Network survey. Gen Dent. 2007;55(3):197-203.
  • 25. Oen KT, Thompson VP, Vena D, et al. Attitudes and expectations of treating deep caries: a PEARL Network survey. Gen Dent. 2007;55(3):197-203.
  • 26. Maltz M, Alves LS, Jardim JJ, Moura Mdos S, de Oliveira EF. Incomplete caries removal in deep lesions: a 10-year prospective study. Am J Dent. 2011;24(4):211-214.
  • 26. Maltz M, Alves LS, Jardim JJ, Moura Mdos S, de Oliveira EF. Incomplete caries removal in deep lesions: a 10-year prospective study. Am J Dent. 2011;24(4):211-214.
  • 27. Koc Vural U, Kiremitci A, Gokalp S. Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months. Oper Dent. 2017;42(5):470-477.
  • 27. Koc Vural U, Kiremitci A, Gokalp S. Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months. Oper Dent. 2017;42(5):470-477.
  • 28. Witherspoon DE. Vital pulp therapy with new materials: new directions and treatment perspectives--permanent teeth. Pediatr Dent. 2008;30(3):220-224.
  • 28. Witherspoon DE. Vital pulp therapy with new materials: new directions and treatment perspectives--permanent teeth. Pediatr Dent. 2008;30(3):220-224.
  • 29. Schuurs AH, Gruythuysen RJ, Wesselink PR. Pulp capping with adhesive resin-based composite vs. calcium hydroxide: a review. Endod Dent Traumatol. 2000;16(6):240-250.
  • 29. Schuurs AH, Gruythuysen RJ, Wesselink PR. Pulp capping with adhesive resin-based composite vs. calcium hydroxide: a review. Endod Dent Traumatol. 2000;16(6):240-250.
  • 30. Accorinte Mde L, Holland R, Reis A, et al. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod. 2008;34(1):1-6.
  • 30. Accorinte Mde L, Holland R, Reis A, et al. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod. 2008;34(1):1-6.
  • 31. Chisini LA, Conde MC, Correa MB, et al. Vital Pulp Therapies in Clinical Practice: Findings from a Survey with Dentist in Southern Brazil. Braz Dent J. 2015;26(6):566-571.
  • 31. Chisini LA, Conde MC, Correa MB, et al. Vital Pulp Therapies in Clinical Practice: Findings from a Survey with Dentist in Southern Brazil. Braz Dent J. 2015;26(6):566-571.
  • 32. Witherspoon DE, Small JC, Harris GZ. Mineral trioxide aggregate pulpotomies: a case series outcomes assessment. J Am Dent Assoc. 2006;137(5):610-618.
  • 32. Witherspoon DE, Small JC, Harris GZ. Mineral trioxide aggregate pulpotomies: a case series outcomes assessment. J Am Dent Assoc. 2006;137(5):610-618.
  • 33. Sawicki L, Pameijer CH, Emerich K, Adamowicz-Klepalska B. Histological evaluation of mineral trioxide aggregate and calcium hydroxide in direct pulp capping of human immature permanent teeth. Am J Dent. 2008;21(4):262-266.
  • 33. Sawicki L, Pameijer CH, Emerich K, Adamowicz-Klepalska B. Histological evaluation of mineral trioxide aggregate and calcium hydroxide in direct pulp capping of human immature permanent teeth. Am J Dent. 2008;21(4):262-266.
  • 34. Akhlaghi N, Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dent Res J (Isfahan). 2015;12(5):406-417.
  • 34. Akhlaghi N, Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dent Res J (Isfahan). 2015;12(5):406-417.
  • 35. Smail-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2018;5:CD003220.
  • 35. Smail-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2018;5:CD003220.
  • 36. Tran XV, Salehi H, Truong MT, et al. Reparative Mineralized Tissue Characterization after Direct Pulp Capping with Calcium-Silicate-Based Cements. Materials (Basel). 2019;12(13).
  • 36. Tran XV, Salehi H, Truong MT, et al. Reparative Mineralized Tissue Characterization after Direct Pulp Capping with Calcium-Silicate-Based Cements. Materials (Basel). 2019;12(13).
  • 37. Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008;139(3):305-315; quiz 305-315.
  • 37. Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008;139(3):305-315; quiz 305-315.
  • 38. Mente J, Hufnagel S, Leo M, et al. Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. J Endod. 2014;40(11):1746-1751.
  • 38. Mente J, Hufnagel S, Leo M, et al. Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. J Endod. 2014;40(11):1746-1751.
  • 39. Hilton TJ, Ferracane JL, Mancl L, Northwest Practice-based Research Collaborative in Evidence-based D. Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. J Dent Res. 2013;92(7 Suppl):16S-22S.
  • 39. Hilton TJ, Ferracane JL, Mancl L, Northwest Practice-based Research Collaborative in Evidence-based D. Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. J Dent Res. 2013;92(7 Suppl):16S-22S.
  • 40. Youssef AR, Emara R, Taher MM, et al. Effects of mineral trioxide aggregate, calcium hydroxide, biodentine and Emdogain on osteogenesis, Odontogenesis, angiogenesis and cell viability of dental pulp stem cells. BMC Oral Health. 2019;19(1):133.
  • 40. Youssef AR, Emara R, Taher MM, et al. Effects of mineral trioxide aggregate, calcium hydroxide, biodentine and Emdogain on osteogenesis, Odontogenesis, angiogenesis and cell viability of dental pulp stem cells. BMC Oral Health. 2019;19(1):133.
  • 41. Parolia A, Kundabala M, Rao NN, et al. A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J. 2010;55(1):59-64.
  • 41. Parolia A, Kundabala M, Rao NN, et al. A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J. 2010;55(1):59-64.
  • 42. Zhu C, Ju B, Ni R. Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis. Int J Clin Exp Med. 2015;8(10):17055-17060.
  • 42. Zhu C, Ju B, Ni R. Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis. Int J Clin Exp Med. 2015;8(10):17055-17060.
  • 43. Marchi JJ, de Araujo FB, Froner AM, Straffon LH, Nor JE. Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent. 2006;31(2):68-71.
  • 43. Marchi JJ, de Araujo FB, Froner AM, Straffon LH, Nor JE. Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent. 2006;31(2):68-71.
  • 44. Mozynska J, Metlerski M, Lipski M, Nowicka A. Tooth Discoloration Induced by Different Calcium Silicate-based Cements: A Systematic Review of In Vitro Studies. J Endod. 2017;43(10):1593-1601.
  • 44. Mozynska J, Metlerski M, Lipski M, Nowicka A. Tooth Discoloration Induced by Different Calcium Silicate-based Cements: A Systematic Review of In Vitro Studies. J Endod. 2017;43(10):1593-1601.
  • 45. Alsubait S, Al-Haidar S, Al-Sharyan N. A Comparison of the Discoloration Potential for EndoSequence Bioceramic Root Repair Material Fast Set Putty and ProRoot MTA in Human Teeth: An In Vitro Study. J Esthet Restor Dent. 2017;29(1):59-67.
  • 45. Alsubait S, Al-Haidar S, Al-Sharyan N. A Comparison of the Discoloration Potential for EndoSequence Bioceramic Root Repair Material Fast Set Putty and ProRoot MTA in Human Teeth: An In Vitro Study. J Esthet Restor Dent. 2017;29(1):59-67.
  • 46. Marciano MA, Duarte MA, Camilleri J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clin Oral Investig. 2015;19(9):2201-2209.
  • 46. Marciano MA, Duarte MA, Camilleri J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clin Oral Investig. 2015;19(9):2201-2209.
  • 47. Adl A, Javanmardi S, Abbaszadegan A. Assessment of tooth discoloration induced by biodentine and white mineral trioxide aggregate in the presence of blood. J Conserv Dent. 2019;22(2):164-168.
  • 47. Adl A, Javanmardi S, Abbaszadegan A. Assessment of tooth discoloration induced by biodentine and white mineral trioxide aggregate in the presence of blood. J Conserv Dent. 2019;22(2):164-168.
  • 48. Savadi Oskoee S, Bahari M, Jafari Navimipour E, Ajami AA, Ghiasvand N, Savadi Oskoee A. Factors affecting marginal integrity of class II bulk-fill composite resin restorations. J Dent Res Dent Clin Dent Prospects. 2017;11(2):101-109.
  • 48. Savadi Oskoee S, Bahari M, Jafari Navimipour E, Ajami AA, Ghiasvand N, Savadi Oskoee A. Factors affecting marginal integrity of class II bulk-fill composite resin restorations. J Dent Res Dent Clin Dent Prospects. 2017;11(2):101-109.
  • 49. Zhang C, Yang B. Long-term marginal adaptation and nanoleakage of class V cavity restored with organic filler filled 4-META/MMA-TBB resin. J Biomed Mater Res B Appl Biomater. 2019;107(6):2050-2056.
  • 49. Zhang C, Yang B. Long-term marginal adaptation and nanoleakage of class V cavity restored with organic filler filled 4-META/MMA-TBB resin. J Biomed Mater Res B Appl Biomater. 2019;107(6):2050-2056.