Skip to main content

Advertisement

SpringerLink
Log in

Coronal discoloration induced by calcium silicate-based cements used in full pulpotomy in mature permanent molars: a randomized clinical trial

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to randomly compare in vivo coronal discoloration at 6 and 12 months after full pulpotomy in mature permanent molars using MTA, Biodentine, and TotalFill and to investigate the effect of variables such as remaining buccal wall thickness and time to achieve hemostasis.

Materials and methods

One hundred eight teeth that met the inclusion criteria received full pulpotomy and were randomly divided into 3 groups via a block randomization technique according to the calcium silicate cement (CSC): ProRoot WMTA, TotalFill, or Biodentine. Assessment of tooth color was carried out using a spectrophotometric device (VITA Easyshade Compact) after composite placement (T0), at 6- and 12-month follow-up. Buccal wall thickness and time to hemostasis were recorded. The primary outcome measure (color change ΔE) was calculated, and the results were analyzed by three-way ANOVA and crosstabulations in relation to material type and effect of variables.

Results

Four cases were excluded after pulpotomy failure; 81 teeth were evaluated at 6 months and 95 teeth at 12 months. All CSCs caused tooth discoloration (defined as ΔE > 3.7); MTA significantly caused the highest color change at 6- and 12-month follow-up (76% (19/25) and 87.5% (28/32), respectively) compared to Biodentine (41% (9/22), 48% (13/27)) and TotalFill (44% (15/34), 53% (19/53)) (p = 0.022, p = 0.002), while no significant difference was found between the Biodentine and TotalFill groups (p = 0.813, p = 0.8). Buccal wall thickness (above or below 2.7 mm) had a significant effect on the degree of discoloration (p = 0.004).

Conclusions

The 3 CSCs caused tooth discoloration based on the threshold of ΔE > 3; the remaining buccal wall thickness was a significant factor. The use of Biodentine and TotalFill instead of MTA is encouraged to minimize discoloration.

Clinical relevance

While experimental studies report coronal discoloration after CSCs use, clinical data is lacking. This study assessed discoloration using a spectrophotometric device. The use of materials with lower discoloration potential in pulpotomy is encouraged.

Trial registration

The study was registered with clinical trial registration number: NCT04346849 on 14.4.2020.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ford TRP, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP (1996) Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 127:1491–1494

    Article  PubMed  Google Scholar 

  2. Taha NA, Ahmad MB, Ghanim A (2017) Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. Int Endod J 50:117–125

    Article  PubMed  Google Scholar 

  3. Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P et al (2019) Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. J Dent 88:103158

    Article  PubMed  Google Scholar 

  4. Belobrov I, Parashos P (2011) Treatment of tooth discoloration after the use of white mineral trioxide aggregate. J Endod 37:1017–1020

    Article  PubMed  Google Scholar 

  5. Vallés M, Mercadé M, Duran-Sindreu F et al (2013) Influence of light and oxygen on the color stability of five calcium silicate–based materials. J Endod 39:525–528

    Article  PubMed  Google Scholar 

  6. Kang SH, Shin YS, Lee HS et al (2015) Color changes of teeth after treatment with various mineral trioxide aggregate–based materials: an ex vivo study. J Endod 41:737–741

    Article  PubMed  Google Scholar 

  7. Camilleri J (2014) Color stability of white mineral trioxide aggregate in contact with hypochlorite solution. J Endod 40:436–340

    Article  PubMed  Google Scholar 

  8. Guimarães BM, Tartari T, Marciano MA et al (2015) Color stability, radiopacity, and chemical characteristics of white mineral trioxide aggregate associated with 2 different vehicles in contact with blood. J Endod 41:947–952

    Article  PubMed  Google Scholar 

  9. Guimarães BM, Tartari T, Marciano MA et al (2017) Spectrophotometric analysis of tooth discolouration induced by mineral trioxide aggregate after final irrigation with sodium hypochlorite: an in vitro study. Aus Endod J 43:11–15

    Article  Google Scholar 

  10. Camilleri J (2016) Is mineral trioxide aggregate a bioceramic? ODOVTOS-Int J Dental Sc 18–1:13–17

    Article  Google Scholar 

  11. Laurent P, Camps J, About I (2012) Biodentine TM induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J 45:439–448

    Article  PubMed  Google Scholar 

  12. Taha NA, Abdelkhader SZ (2018) Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J 51:819–828

    Article  PubMed  Google Scholar 

  13. Uesrichai N, Nirunsittirat A, Chuveera P et al (2019) Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: a noninferiority randomized controlled trial. Int Endod J 52:749–759

    Article  PubMed  Google Scholar 

  14. Ma J, Shen YS, Stojicic S, Hapapasalo M (2011) Biocompatibility of two novel root repair materials. J Endod 37:793–798

    Article  PubMed  Google Scholar 

  15. Azimi S, Fazlyab M, Sadri D et al (2014) Comparison of pulp response to mineral trioxide aggregate and a bioceramic paste in partial pulpotomy of sound human premolars: a randomized controlled trial. Int Endod J 47:873–881

    Article  PubMed  Google Scholar 

  16. Taha NA, Aboyounes FB, Tamimi ZZ (2021) Root-end microsurgery using a premixed tricalcium silicate putty as root-end filling material: a prospective study. Clin Oral Investig 25:311–317

    Article  PubMed  Google Scholar 

  17. Vallés M, Roig M, Duran-Sindreu F et al (2015) Color stability of teeth restored with Biodentine: a 6-month in vitro study. J Endod 41:1157–1160

    Article  PubMed  Google Scholar 

  18. Marconyak LJ Jr, Kirkpatrick TC, Roberts HW et al (2016) A comparison of coronal tooth discoloration elicited by various endodontic reparative materials. J Endod 42:470–473

    Article  PubMed  Google Scholar 

  19. Al-Hiyasat AS, Ahmad DA, Khader YS (2021) The effect of different calcium silicate-based pulp capping materials on tooth discoloration: an in vitro study. BMC Oral Health 21:330

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dhand NK & Khatkar MS (2014). Statulator: an online statistical calculator. Sample size calculator for comparing two independent proportions. Accessed 26 June 2022 at http://statulator.com/SampleSize/ss2P.html

  21. Taha NA, Al-Rawash MH, Imran ZA (2022) Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: a parallel, double blind, randomized controlled trial. Int Endod J. https://doi.org/10.1111/iej.13707

    Article  PubMed  Google Scholar 

  22. Commission Internationale De L’Eclairage (1978) Recommendations on uniform color spaces, color-difference equations, psychometric color terms. CIE, Paris

    Google Scholar 

  23. Johnston WM, Kao EC (1989) Assessment of appearance match by visual observation and clinical colorimetry. J Dent Res 68:819–822

    Article  PubMed  Google Scholar 

  24. Felman DP, Parashos P (2013) Coronal tooth discoloration and white mineral trioxide aggregate. J Endod 39:484–487

    Article  PubMed  Google Scholar 

  25. Parinyaprom N, Nirunsittirat A, Chuveera P et al (2018) Outcomes of direct pulp capping by using either ProRoot mineral trioxide aggregate or Biodentine in permanent teeth with carious pulp exposure in 6-to 18-year-old patients: a randomized controlled trial. J Endod 44:341–348

    Article  PubMed  Google Scholar 

  26. AlGhazali N, Burnside G, Smith PW et al (2011) Performance assessment of Vita Easy. Shade spectrophotometer on colour measurement of aesthetic dental materials. Eur J Prosthodont Restor Dent 19:168–174

    PubMed  Google Scholar 

  27. Lagouvardos PE, Fougia AG, Diamantopoulou SA et al (2009) Repeatability and interdevice reliability of two portable color selection devices in matching and measuring tooth color. J Prosthet Dent 101:40–45

    Article  PubMed  Google Scholar 

  28. Kohli MR, Yamaguchi M, Setzer FC, Karabucak B (2015) Spectrophotometric analysis of coronal tooth discoloration induced by various bioceramic cements and other endodontic materials. J Endod 41:1862–1866

    Article  PubMed  Google Scholar 

  29. Ramos JC, Palma PJ, Nascimento R et al (2016) 1-year in vitro evaluation of tooth discoloration induced by 2 calcium silicate–based cements. J Endod 42:1403–1407

    Article  PubMed  Google Scholar 

  30. Shokouhinejad N, Nekoofar MH, Pirmoazen S et al (2016) Evaluation and comparison of occurrence of tooth discoloration after the application of various calcium silicate–based cements: an ex vivo study. J Endod 42:140–144

    Article  PubMed  Google Scholar 

  31. Tan SY, Yu VSH, Lim KC et al (2020) Long-term pulpal and restorative outcomes of pulpotomy in mature permanent teeth. J Endod 46:383–390

    Article  PubMed  Google Scholar 

Download references

Funding

The study was funded by the Deanship of Research at Jordan University of Science and Technology, research grant number (46/2018).

Author information

Authors and Affiliations

  1. Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan

    Nessrin A. Taha, Abdullah M. Hamdan & Ahmad S. Al-Hiyasat

Authors
  1. Nessrin A. Taha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdullah M. Hamdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad S. Al-Hiyasat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Nessrin Taha: contributed with the design of the study, supervision of clinical work, follow-up results, and write up of the manuscript.

Ahmad Al-Hiyasat: co-supervision of work and statistical analysis.

Abdullah Hamdan: performed the clinical procedures.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nessrin A. Taha.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Ethics approval was obtained from the institutional review board (5/113/2018).

Consent to participate

A written informed consent was obtained from all participants.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 218 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taha, N.A., Hamdan, A.M. & Al-Hiyasat, A.S. Coronal discoloration induced by calcium silicate-based cements used in full pulpotomy in mature permanent molars: a randomized clinical trial. Clin Oral Invest 27, 1723–1730 (2023). https://doi.org/10.1007/s00784-022-04799-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04799-x

Keywords

Search

Navigation