Evaluation of indirect pulp capping using three different materials: A randomized control trial using cone-beam computed tomography Direct Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate, and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial A randomized controlled study of the use of ProRoot mineral trioxide aggregate and Endocem as direct pulp capping materials. A Randomized Controlled Study of the Use of ProRoot Mineral Trioxide Aggregate and Endocem as Direct Pulp Capping Materials: 3-month versus 1-year Outcomes. Human pulpal response to direct pulp capping with an adhesive system. Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. Effects of diode laser on direct pulp capping treatment Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth Pulp capping: advantages of using laser technology. Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. A clinical study of direct pulp capping applied to carious-exposed pulps. Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system. Response of human dental pulp capped with biodentine and mineral trioxide aggregate. Indirect pulp capping in the primary dentition: a 4 year follow-up study. Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate(®), Laser and Biodentine(TM)- an In Vivo Study. A clinical and histological evaluation of conservative pulpal therapy in human teeth. Efficacy of EMD versus calcium hydroxide in direct pulp capping of primary molars: a randomized controlled clinical trial.
Objective : The objective of this study was to determine the most suitable material for indirect pulp treatment ( IPT ) clinical ly and to determine the thickness ( in mm ) and type of tissue in terms of radiodensity ( in Hounsfield units [ HU ] ) formed after pulp capping using cone-beam computed tomography ( CBCT ) scan . Material s and Methods : A longitudinal interventional single-blind r and omized clinical trial was conducted on 94 children ( 7–12 years ) with a deep carious lesion in one or more primary second molar and permanent first molar without the history of spontaneous pain indicated for indirect pulp capping ( IPC ) procedure . About 109 teeth were treated using three material s , namely , calcium hydroxide ( setting type ) , glass ionomer cement ( Type VII ) , and mineral trioxide aggregate r and omly . The teeth were followed up at an interval of 8 weeks , 6 months , and 1 year for success of IPT as per the American Academy of Pediatric Dentistry clinical criteria . For determining the thickness and type of dentin tissue formed , a CBCT scan was done immediately postoperative and another scan at an interval of 6 months . The scans were compared to evaluate the average thickness of the dentin bridge formed . Results and Conclusions : Success rate for IPC was 96.85 % . A significant difference was obtained in the average thickness of reparative dentin at immediate postoperative and 6-month postoperative values in all three groups suggesting distinct barrier formation . Similar significant findings were obtained in radiodensity of barrier formed ( in HU ) . All three material s were found to be equally suitable as IPC agents suggesting mineral gain Introduction Direct pulp capping treatment is intended to preserve pulp vitality , to avoid or retard root canal treatment , and , in cases with an open apex , to allow continued root development . Historically , calcium hydroxide ( CH ) was the gold st and ard material , but nowadays calcium silicate material s ( CSMs ) are displacing CH because of their high bioactivity , biocompatibility , sealing ability , and mechanical properties . However , more r and omized clinical trials are needed to confirm the appropriateness of CSMs as replacement material s for CH in direct pulp capping procedures . Methods A r and omized clinical trial was conducted that included 169 patients ( mean age , 11.3 years ) from the Maipo district ( Chile ) . The inclusion criterion was patients with 1 carious permanent tooth with pulpal exposure , a c and i date for a direct pulp capping procedure . The patients were r and omly allocated to one of the experimental groups ( CH , Biodentine , or mineral trioxide aggregate [ MTA ] ) . Clinical follow‐up examinations were performed at 1 week , 3 months , 6 months , and 1 year . The Fisher exact test was performed . Results At the follow‐up examination at 1 week , the patients showed 100 % clinical success . At 3 months , there was 1 failure in the CH group . At 6 months , there were 4 new failures ( 1 in the CH group and 3 in the MTA group ) . At 1 year , there was another failure in the CH group . There were no statistically significant differences among the experimental groups . Conclusions CSMs appear to be suitable material s to replace CH . Although no significant differences were found among the material s studied , Biodentine and MTA offered some advantages over CH . HighlightsThis trial compared the efficacy of calcium hydroxide , MTA , and Biodentine as pulp capping material s in young permanent molars . MTA and Biodentine are suitable material s to replace calcium hydroxide in pulp capping procedures .Pulp capping in carious teeth is a successful treatment when done under good clinical protocol INTRODUCTION The purpose of the present study was to evaluate and compare the short-term clinical outcomes of direct pulp capping using ProRoot MTA ( Dentsply , Tulsa , OK ) or Endocem ( Maruchi , Wonju , Korea ) as capping material s in a prospect i ve r and omized controlled study . MATERIAL S AND METHODS This study was conducted with subjects who were recruited from the pool of patients from the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between January and May 2013 . Of the 48 teeth confirmed to be eligible for direct pulp capping , a total of 46 teeth were r and omly assigned to either the ProRoot MTA or the Endocem group ( 23 teeth per group ) . Direct pulp capping was performed using these 2 material s , and clinical and radiographic evaluations were performed at 1 , 2 , 4 , and 12 weeks after the treatments . Teeth with no response to pulp vitality test and those exhibiting clinical or radiographic signs and /or symptoms of irreversible pulpitis or pulp necrosis were considered to be failures . RESULTS Thirty-two patients ( 43 teeth ) were examined at the 3-month follow-up ( patient recall rate = 91.4 % ) ; 22 of these teeth were in the ProRoot MTA group , and 21 were in the Endocem group . The overall success rate was 93 % , and the success rates in the ProRoot MTA and Endocem groups were 95.5 % ( 21/22 teeth ) and 90.5 % ( 19/21 teeth ) , respectively . Statistical analyses of these success rates did not reveal any significant difference between the groups ( P = .522 ) . CONCLUSIONS In this r and omized controlled study , no significant difference in the short-term clinical outcomes of direct pulp capping using ProRoot MTA or Endocem as the capping material was found . Furthermore , the favorable short-term outcome success rate of 93 % indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth INTRODUCTION The purpose of this study was to assess the long-term clinical outcomes of direct pulp capping ( DPC ) with ProRoot MTA ( Dentsply , Tulsa , OK ) and Endocem ( Maruchi , Wonju , Korea ) as pulp capping material s. To this end , the 1-year cumulative successes of both material s were evaluated and compared with those of the 3-month outcomes in a prospect i ve , r and omized controlled trial . METHODS Patients were recruited from the Department of Conservative Dentistry of the Yonsei University Dental Hospital , Seoul , South Korea , from January to May 2013 . Of the 48 teeth that met the inclusion criteria , 46 teeth were r and omly allocated to either ProRoot MTA or Endocem groups ( n = 23 ) . Direct pulp capping was performed , and clinical and radiographic examinations were conducted over 1 year after the treatment . Survival analyses were conducted to compare the cumulative successes between ProRoot MTA and Endocem and to evaluate other clinical variables . RESULTS Forty-one teeth were recalled 1 year after the treatments ( recall rate = 89.13 % ) . There were no significant differences between the cumulative successes  of ProRoot MTA and Endocem in either log-rank or Cox proportional hazard regression analyses ( P > .05 ) . Among the other clinical variables , cavity type ( class I , II , III vs class V ) was determined to be significant in both the log-rank test ( P = .001 ) and Cox regression analysis ( P = .006 ) . CONCLUSIONS Both ProRoot MTA and Endocem exhibited similar cumulative successes as direct pulp capping material s up to 1 year . The teeth restored with class V cavities exhibited significantly lower cumulative success rates after direct pulp capping compared with the teeth restored with other types of cavities PURPOSE To evaluate clinical ly and microscopically the human pulp response when directly capped with an adhesive system or calcium hydroxide over short ( 9 - 12 days ) and long ( 53 - 204 days ) experimental periods . MATERIAL S AND METHODS Fifty-one sound human premolars scheduled for orthodontic extraction , had their pulp horns gently exposed with a diamond point . Debris in the pulp wound was washed out with a sterile saline solution . The pulps were then capped with either an adhesive system ( Scotchbond Multi- Purpose Plus ) or calcium hydroxide . All teeth were subsequently restored with resin-based composite ( Z-100 ) according to the manufacturer 's instructions . After the experimental periods , the teeth were extracted and processed for light microscopic examination . RESULTS Short-term : the pulp tissue capped with SBMP-P exhibited dilated and congested blood vessels associated with a moderate inflammatory response and blanching of pulp cell nuclei . Long-term : no evidence of healing and bridge formation was observed . A persistent mild inflammatory pulp response was present . Micro-abscesses were detected in three cases associated with bacterial infiltration . Calcium hydroxide stimulated early pulp repair and dentin bridging which extended into the longest period PURPOSE This manuscript presents evidence -based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children . A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence -based recommendations on three vital pulp therapies : indirect pulp treatment ( IPT ; also known as indirect pulp cap ) , direct pulp cap ( DPC ) , and pulpotomy . METHODS The basis of the guideline 's recommendations was evidence from " Primary Tooth Vital Pulp Therapy : A Systematic Review and Meta- Analysis . " ( Pediatr Dent 2017;15;39[1]:16 - 23 . ) A systematic search was conducted in PubMed ® / MEDLINE , Embase ® , Cochrane Central Register of Controlled Trials , and trial data bases to identify r and omized controlled trials and systematic review s addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost . Quality of the evidence was assessed through the Grading of Recommendations Assessment , Development , and Evaluation approach ; the evidence -to-decision framework was used to formulate a recommendation . RESULTS The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions . The panel recommends use of  mineral trioxide aggregate ( MTA ) and formocresol in pulpotomy treatments ; these are recommendations based on moderate- quality evidence at 24 months . The panel made weak recommendations regarding choice of medicament in both IPT ( moderate- quality evidence [ 24 months ] , low quality evidence [ 48 months ] ) and DPC ( very-low quality evidence [ 24 months ] ) . Success of both treatments was independent of type of medicament used . The panel also recommends use of ferric sulfate  ( low- quality evidence ) , lasers ( low- quality evidence ) ,  sodium hypochlorite  ( very low- quality evidence ) , and  tricalcium silicate  ( very low- quality evidence ) in pulpotomies ; these are weak recommendations based on low- quality evidence . The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions . Conclusions and practical implication s : The guideline intends to inform the clinical practice s with evidence -based recommendations on vital pulp therapies in primary teeth with deep caries lesions . These recommendations are based upon the best available evidence to- date At the present time , evidence -based , best practice s have yet to be established for maintaining the vitality of teeth by managing caries-associated pulp exposure in permanent teeth . In terms of biomechanical and esthetic considerations , pulp capping has proven to be more effective than root-canal therapy . Given the low success rate of conventional methods , new techniques , such as laser-assisted repairs , should be developed . The purpose of this study was to compare the effectiveness of conventional and diode laser-assisted methods  in direct pulp capping of carious teeth . Ten patients ranging in age from 12 to 40 were assigned r and omly to experimental and control groups in this clinical trial in which the participants ’ teeth were treated with different techniques , i.e. , conventional treatment and diode 808-nm , laser-assisted treatment . For each of these groups , five cases were chosen for treatment with the same method under rubber dam isolation . The data were analyzed by the runs test using SPSS software . The success rate was significantly different between conventional ( 60 % ) and diode 808-nm , laser-assisted ( 100 % ) groups after one year ( P > 0.05 ) . The laser-assisted procedure proved to be more effective than the  conventional technique in enhancing the outcomes of pulp-capping therapy in carious exposures Aim To compare the clinical , radiographic and histological responses of the pulp to mineral trioxide aggregate ( MTA ) , calcium hydroxide ( CH ) and Portl and cement ( PC ) when used as a pulpotomy agent in human primary teeth . Study design Forty-five m and ibular primary molar teeth were r and omly assigned to CH , MTA or PC groups and treated by pulpotomy technique . Methods The teeth were treated by conventional pulpotomy technique , differing only in the capping material for each group . Clinical and radiographic evaluations were recorded at 6- , 12- and 24-month follow-up . Teeth in the regular exfoliation period were further processed for histologic analysis .Statistics Data were tested using parametric tests at a significance level of 5 % . The histological results were expressed descriptively . Results Clinical ly and radiographically , the MTA and PC groups showed 100 % success rates at 6 , 12 and 24 months . In CH group , several teeth presented clinical and radiographic failures detected throughout the follow-up period , and internal resorption was a frequent radiographic finding . Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups . CH group presented , in most of the sections , necrotic areas in the root canals . Conclusions MTA and PC may serve as effective material s for pulpotomies of primary teeth as compared to CH . Although our results are very encouraging , further studies and longer follow-up assessment s are needed in order to determine the safe clinical indication of Portl and cement AIM Pulp capping represents the boundary between conservative and endodontic therapy . The importance of this technique , which considerably improves the prognosis of the tooth , justifies the quest for new techniques and technologies : the most recent literature reports more predictable results ( approximately 90 % ) with cappings performed using laser of different wavelengths , compared to traditional procedures , which report a success rate of approximately 60 % . The purpose of this work is to assess the efficiency of laser technology combined with the use of a self-hardening calcium hydroxide base in pulp capping procedures performed on decayed permanent teeth . MATERIAL S AND METHODS This study was carried out on 34 patients , aged between 11 and 18 years ( average 14,5 ) who needed pulp cappings for deep caries affecting permanent teeth ( 8 front and 26 back ) . They were divided into three groups based on the operative protocol employed : traditional technique , laser-assisted technique using Er , Cr : YSGG lasers ( 2780 nm ) and laser assisted technique using Erbium : YAG lasers ( 2940 nm ) ; all patients were asked to return for follow-up visits ( anamnesis , vitality testing and intraoral x-ray ) scheduled at 1 , 3 , 6 , 12 months , 2 and 4 years ; other 30 cases on adult patients ( 19 to 40 years , average 27,1 ) , treated with the same methods , were used as control group . RESULTS Traditional technique group showed a success of 63 % ( adult control group 50 % ) ; Er , Cr : YSGG laser-assisted technique showed a success rate of 80 % ( adult control group 80 % ) ; Erbium : YAG lasers laser-assisted technique showed a success rate of 75 % ( adult control group 70 % ) . All age groups had good success rates with the pulp capping technique , regardless of the technique used . CONCLUSION Laser technology proved effective in improving the prognosis of pulp capping procedures on teeth affected by deep caries pathology UNLABELLED Carious pulp exposure in permanent molars of children is a common incident . Mineral trioxide aggregate is a new material that possesses numerous exciting possibilities for pulp therapy . AIM The purpose of this study was to evaluate the efficiency of MTA as a direct pulp capping agent in young permanent teeth . METHODS Thirty asymptomatic permanent molars with pulp exposures were treated by pulp capping using MTA . At each recall ( 6 12 , 18 and 24 months ) , the teeth were assessed clinical ly , through pulpal sensitivity tests , as well as radiographically to evaluate periapical healing . RESULTS None of the cases reported spontaneous pain at the six months follow up and the pulp showed signs of vitality and absence of periapical radiolucency . At 24 months , the clinical and radiographic success rate was 93 % with evidence of continued root growth . CONCLUSION Pulp capping with MTA is recommended for teeth with carious pulp exposures specially immature teeth with high potential for healing Direct  pulp capping of carious-exposed pulp was performed on 44 teeth . We evaluated the success rates of these cases , and analyzed the relationships between the success rates and their clinical findings . Furthermore , we examined the length of time necessary for adequate postoperative follow-up . The success rate in this study was 81.8 % . Age of the patients , type of teeth , responses to thermal stimuli and percussion , and the diameter of pulpal exposure had no bearing on the success rate . However , the degree of bleeding on pulpal exposure was related to the success rate ( p = 0.042 ) . The success rates of cases in which postoperative follow-up periods were 3 to 18 months were similar ( 80 to 83 % ) , whereas those with follow-up for 21 months ( 91.7 % ) and 24 months ( 100 % ) showed higher success rates . These results showed that direct pulp capping was applicable to carious-exposed pulp , and the degree of bleeding is indicative of the prognosis of this treatment . The length of time necessary for adequate postoperative follow-up was suggested to be 21 months OBJECTIVES The objective was to evaluate the response of human pulps capped with different components from a total-etch three-step adhesive system . METHODS Direct pulp capping was performed in 25 caries-free human premolars scheduled for extraction due to orthodontic treatment . The teeth were r and omly divided in five groups , and capped with the following material s : Group 1-acid+primer+adhesive were used as recommended ; Group 2-only primer was applied ; Group 3-only bonding resin ( light-cured for 10s ) ; Group 4-only composite resin ( light-cured for 40s ) ; Group 5-calcium hydroxide . After capping , all teeth were restored with ScotchBond Multi Purpose Plus and Z-100 was placed incrementally . After 60 days , the teeth were extracted and processed for light microscopic examination ( H/E ) according to a histological score system . These were subjected to non-parametric tests ( alpha<0.05 ) . RESULTS Overall , the histological features showed that groups 1 - 4 were quite similar and inferior to group 5 . In groups 1 - 4 the pulp response varied from acute inflammatory cell infiltrate with varying degrees to necrosis . The groups 3 and 4 showed a trend towards better pulp response , since a normal connective tissue could be observed in more than half of the sample . All teeth from group 5 showed normal connective tissue below an amorphous dentin bridge . SIGNIFICANCE Adhesive components ( primer or adhesive ) as well as a composite should be avoided for pulp capping . Ca(OH)(2 ) should be the first choice for pulp capping INTRODUCTION Biodentine is a new bioactive cement that is similar to the widely used mineral trioxide aggregate ( MTA ) . It has dentin-like mechanical properties , which may be considered a suitable material for clinical indications of dentin-pulp complex regeneration such as direct pulp capping . The purpose of the present study was to compare the response of the pulp-dentin complex in human teeth after direct capping with this new tricalcium silicate-based cement with that of MTA . METHODS Pulps in 28 caries-free maxillary and m and ibular permanent intact human molars scheduled for extraction for orthodontic reasons were mechanically exposed and assigned to 1 of 2 experimental groups , Biodentine or MTA , and 1 control group . Assay of periapical response and clinical examination were performed . After 6 weeks , the teeth were extracted , stained with hematoxylin-eosin , and categorized by using a histologic scoring system . RESULTS The majority of specimens showed complete dentinal bridge formation and an absence of inflammatory pulp response . Layers of well-arranged odontoblast and odontoblast-like cells were found to form tubular dentin under the osteodentin . Statistical analysis showed no significant differences between the Biodentine and MTA experimental groups during the observation period . CONCLUSIONS Within the limitations of this study , Biodentine had a similar efficacy in the clinical setting and may be considered an interesting alternative to MTA in pulp-capping treatment during vital pulp therapy PURPOSE Evaluate clinical and radiographic changes in primary teeth su bmi tted to indirect pulp capping ( IPC )  over a 48-month-period . METHODS Twenty seven primary molars with deep caries , but without preoperative signs of irreversible pulpits , were treated with IPC . The teeth were r and omly divided into two groups , according to the material used for protection of the dentin-pulp complex . ( 1 ) a calcium hydroxide liner ( Dycal ) and ( 2 ) glass ionomer cement ( Vitremer ) . RESULTS After 48 months , Group-1 showed a success rate of 88.8 % and Group-2 of 93 % . No statistical significant difference between the groups was observed ( P = 0.62 ) . CLINICAL SIGNIFICANCE The results of this study suggested that indirect pulp capping in primary teeth arrests the progression of the underlying caries , regardless of the material used as a liner INTRODUCTION Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament . It is the most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp . AIM To evaluate the success and efficacy of Mineral Trioxide Aggregate ( MTA ) , Lasers and Biodentine as pulpotomy agents both clinical ly and radiographically . MATERIAL S AND METHODS In the present study , 60 primary molars in children whose pulpal status warranted pulpotomy were selected and r and omly assigned into three groups that included MTA , Laser and Biodentine allocating 20 teeth to each group . The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns . Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation . RESULTS Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria . Kruskal-Wallis ANOVA , Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months . The results showed that maximum success rate was found in MTA group . However , the comparison between three groups was statistically not significant ( p<0.05 ) . CONCLUSION Pulpotomies performed with either MTA , Laser or Biodentine are equally efficient with similar clinical /radiographic success and hence can be considered as alternatives to Formocresol Three intermediary base material s , a zinc oxide-eugenol ( Cavitec ) and two calcium hydroxide liners ( Life and Dycal ) , were selected at r and om for use as a base beneath  amalgam or composite restorations on humans following complete caries removal .  Life and Dycal , selected at r and om , were also used as direct and indirect pulp capping agents as clinical ly indicated . Clinical evaluations of signs and symptoms were made before treatment and at one-week , six-month , and one-year intervals following treatment . Histological evaluations were performed on three complete caries removal teeth and 18 direct pulp capping teeth six months following treatment . No significant differences in clinical symptomatology result ed between the material s in the complete caries removal group or the indirect and direct pulp capping groups OBJECTIVE The aim was to compare the clinical and radiographic efficacy of enamel matrix derivative and self-hardening calcium hydroxide as direct pulp capping material s on decayed primary molars , with observation periods of 1 , 6 , and 12 months . STUDY DESIGN A clinical , r and omized , controlled trial was performed , following the " split-mouth " design . A total of 90 primary molars were treated . Assignation of material s and operative initial side were selected in a r and omized manner . Five outcome variables were considered : internal dentin resorption , pain , gingival sinus tract , root external resorption , and pathologic mobility . The appearance of any of these signs or symptoms was considered to be a failure of treatment . RESULTS Significant statistical or clinical differences were not found between the study groups . Two treatments were judged as failures , 1 per study group ; both occurred during the first postoperative month . CONCLUSIONS The technique used for direct pulp capping on primary molars in this study is recommended on the basis of the obtained clinical and radiographic results
Conclusions MTA cements have a higher success rate , with a lower inflammatory response and a more predictable hard dentin barrier formation  than calcium hydroxide cements .
However , there were no differences , in these parameters , when MTA cement was compared with tricalcium silicate cements .
Dental adhesives systems showed the lowest success rates
Introduction Direct pulp capping therapies use bio material s to protect exposed tissues , inducing repair through the production of a mineralized barrier .
The purpose of this study was to compare the effectiveness of bio material s and techniques by means of a systematic review and meta‐ analysis .