Abstract
Objectives
Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin–pulp complex of permanent and primary teeth treated with two-step IPT.
Materials and methods
In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n = 31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment.
Results
The IPT had a high success rate of 90.3 % regardless of the material used (p = 0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p < 0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p = 0.01/Mutans Strep. p = 0.07).
Conclusions
The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement.
Clinical relevance
The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.
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References
Miyashita H, Worthington HV, Qualtrough A, Plasschaert A (2007) Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev;18:CD004484
Kidd EAM, Bjørndal L, Beighton D, Fejerskov O (2008) Caries removal and pulpo-dentinal complex. In: Fejerskov O, Kidd EA (eds) Dental caries. The disease and its clinical management, 2nd edn. Blackwell Munksgaard, Singapore, pp 368–383
Ricketts D (2001) Management of the deep carious lesion and the vital pulp dentine complex. Br Dent J 191(11):606–610
Hayashi M, Fujitani M, Yamaki C, Momoi Y (2011) Ways of enhancing pulp preservation by stepwise excavation—a systematic review. J Dent 39(2):95–107
Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB (2003) Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent 25:29–36
Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C (2010) 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 3:290–297
Dammaschke T (2010) Direkte überkappung oder schrittweise kariesexkavation? Die Quintessenz 61(6):677–684
Gruythuysen RJ, van Strijp AJ, Wu MK (2010) Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions. J Endod 36(9):1490–1493, Erratum in: J Endod. 2010; 36(12):2015
Farooq NS, Coll JA, Kuwabara A, Shelton P (2000) Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent 22:278–286
Fuks AB (2000) Pulp therapy for the primary and young permanent dentitions. Dent Clin N Am 44(3):571–596
Maltz M, Oliveira EF, Fontanella V, Carminatti G (2007) Deep caries lesions after incomplete dentine caries removal: 40-month follow-up study. Caries Res 41:493–496
Marchi JJ, de Araujo FB, Fröner AM, Straffon LH, Nör JE (2006) Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent 31:68–71
Orhan AI, Oz FT, Orhan K (2010) Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent 32(4):347–355
Pinto AS, de Araujo FB, Franzon R, Figueiredo MC, Henz S, Garcia-Godoy F et al (2006) Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. Am J Dent 19:382–386
Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS (2003) Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J 36:225–231
Mente J, Geletneky B, Ohle M, Koch MJ, Friedrich Ding PG, Wolff D, Dreyhaupt J, Martin N, Staehle HJ, Pfefferle T (2010) Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome. J Endod 36(5):806–813
Qudeimat MA, Barrieshi-Nusair KM, Owais AI (2007) Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur Arch Paediatr Dent 8(2):99–104
Parirokh M, Torabinejad M (2010) Mineral trioxid aggregate: a comprehensive literature review—Part I: chemical, physical, and antibacterial properties. JOE 36:16–27
Parirokh M, Torabinejad M (2010) Mineral trioxid aggregate: a comprehensive literature review—Part II: leakage and biocompatibility investigations. JOE 36:190–202
Parirokh M, Torabinejad M (2010) Mineral trioxid aggregate: a comprehensive literature review—Part III: clinical applications, drawbacks, and mechanism of action. JOE 36:400–413
Steffen R, van Waes H (2009) Understanding mineral trioxide aggregate/Portland-cement: a review of literature and background factors. Eur Arch Paediatr Dent 10(2):93–97
Dammaschke T, Gerth HU, Züchner H, Schäfer E (2005) Chemical and physical surface and bulk material characterization of white ProRoot MTA and two Portland cements. Dent Mater 21:731–738
Lula EC, Almeida LJ Jr, Alves CM, Monteiro-Neto V, Ribeiro CC (2011) Partial caries removal in primary teeth: association of clinical parameters with microbiological status. Caries Res 45(3):275–280
Andree A, Finke C, Kneist S (2004) Zahnflächenspezifische Arealbe-impfung handelsüblicher chair-side-test zum nachweis von mutans-streptokokken und laktobazillen. Prophylaxe Implus 8:172–178
Statistic tools. http://www.stattools.net/SSizAOV_Pgm.php. Accessed 10 March 2010
Bjørndal L, Larsen T, Thylstrup A (1997) A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res 31:411–417
Bjørndal L, Thylstrup A (1998) A practice-based study on stepwise excavation of deep carious lesions in permanent teeth: a 1-year follow-up study. Community Dent Oral Epidemiol 26(2):122–128
Orhan AI, Oz FT, Ozcelik B, Orhan K (2008) A clinical and microbiological comparative study of deep carious lesion treatment in deciduous and young permanent molars. Clin Oral Investig 12(4):369–378
Paddick JS, Brailsford SR, Kidd EA, Beighton D (2005) Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol 71(5):2467–2472
Wicht M, Noack MJ (2010) “Endoprophylaxe” durch schonende Kariesentfernung. Welche therapieform ist wann erfolg versprechend? Die Quintessenz 61(9):1077–1086
Staehle HJ (1990) Zemente (Säuren mit Calciumhydroxid). In: Staehle HJ (ed) Calciumhydroxid in der zahnheilkunde. Hanser, München, pp 50–59
Fridland M, Rosado R (2005) MTA solubility: a long term study. J Endod 31:376–379
Torabinejad M, Parirokh M (2010) Mineral trioxide aggregate: a comprehensive literature review—Part II: leakage and biocompatibility investigations. J Endod 36(2):190–202
Kidd EA (2004) How ‘clean’ must a cavity be before restoration? Caries Res 38(3):305–313
Thompson V, Craig RG, Curro FA, Green WS, Ship JA (2008) Treatment of deep carious lesions by complete excavation or partial removal: a critical review. J Am Dent Assoc 139:705–712
Fairbourn DR, Charbeneau GT, Loesche WJ (1980) Effect of improved Dycal and IRM on bacteria in deep carious lesions. J Am Dent Assoc 100:547–552
Ribeiro CC, Baratieri LN, Perdigao J, Baratieri NM, Ritter AV (1999) A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence Int 30:591–599
Maltz M, Alves LS, Jardim JJ, Moura Mdos S, de Oliveira EF (2011) Incomplete caries removal in deep lesions: a 10-year prospective study. Am J Dent 24:211–214
Acknowledgments
The authors would like to thank associate professor Dr. H. Steffen for her advice in the study design, as well as Dr. C. Konschake for her contribution in the study.
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The authors declare that they have no conflict of interest.
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Petrou, M.A., Alhamoui, F.A., Welk, A. et al. A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment. Clin Oral Invest 18, 1383–1389 (2014). https://doi.org/10.1007/s00784-013-1107-z
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DOI: https://doi.org/10.1007/s00784-013-1107-z