Skip to main content

Advertisement

SpringerLink
Log in

Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The aim of this randomized, controlled, three-arm parallel group, and double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth.

Materials and methods

The study included a total of 109 patients aged 5–9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) hard-setting calcium hydroxide (Dycal) (control group) (n = 36), (II) bioactive tricalcium silicate (Biodentine) (n = 37), and (III) resin-based tricalcium silicate (TheraCal LC) (n = 36). All the teeth were evaluated clinically and radiographically at 6, 12, 18, and 24 months postoperatively. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24–40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation quality of the dentin formed, severity of pulpitis, and other pulpal changes. Data were analyzed using Fisher’s exact test, Pearson’s chi-square test, and McNemar’s test (p = 0.05).

Results

At the end of the 24-month follow-up period, the clinical and radiographic success rates for Dycal, Biodentine, and TheraCal LC were 100%, 100%, and 93.3%, respectively, and there was no significant difference among the groups (p > 0.05). However, the TheraCal LC group was statistically unsuccessful when compared to the other groups with regard to the integrity of the odontoblastic layer, severity of pulpitis, and other pulpal changes in histological examination (p < 0.05).

Conclusion

Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC.

Clinical relevance

Resin-free calcium silicate-based materials appear to be more favorable in the indirect pulp treatment of primary teeth, particularly in young-age groups that require long-term success.

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
Fig. 4

Similar content being viewed by others

References

  1. 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 36:1490–1493. https://doi.org/10.1016/j.joen.2010.06.006

    Article  PubMed  Google Scholar 

  2. Schwendicke F (2017) Contemporary concepts in carious tissue removal: a review. J Esthet Restor Dent 29:403–408. https://doi.org/10.1111/jerd.12338

    Article  PubMed  Google Scholar 

  3. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE (2013) Operative caries management in adults and children. Cochrane Database Syst Rev:CD003808. https://doi.org/10.1002/14651858.CD003808.pub3

  4. Parisay I, Ghoddusi J, Forghani M (2015) A review on vital pulp therapy in primary teeth. Iran Endod J 10:6–15

    PubMed  Google Scholar 

  5. Casagrande L, Dalpian DM, Ardenghi TM, Zanatta FB, Balbinot C, García-Godoy F, De Araujo FB (2013) Randomized clinical trial of adhesive restorations in primary molars. 18-month results. Am J Dent 26:351–355

    PubMed  Google Scholar 

  6. Mello BZ, Stafuzza TC, Vitor LL, Rios D, Machado MA, Oliveira TM (2016) Alternative approach for carious tissue removal in primary teeth. Eur Arch Paediatr Dent 17:413–417. https://doi.org/10.1007/s40368-016-0246-8

    Article  PubMed  Google Scholar 

  7. Fuks AB, Heling I, Nuni E (2012) Pulp therapy for the young permanent dentition. In: Casamassimo PS, Fields HW Jr, McTigue DJ, Nowak AJ (eds) Pediatric dentistry: infancy through adolescence, 5th edn. Elsevier Saunders, St. Louis, pp 490–494

    Google Scholar 

  8. American Academy of Pediatric D (2016) Guideline on pulp therapy for primary and immature permanent teeth. Pediatr Dent 38:280–288

    Google Scholar 

  9. Hilton TJ, Summitt JB (2006) Pulpal considerations. In: Summitt JB, Robbins JW, Hilton TJ, Schwartz RS (eds) Fundamentals of operative dentistry a contemporary approach, 3rd. edn. Hanover Park, Quintessence, pp 108–112

    Google Scholar 

  10. Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjorndal L (2019) European Society of Endodontology position statement: management of deep caries and the exposed pulp. Int Endod J 52:923–934. https://doi.org/10.1111/iej.13080

    Article  PubMed  Google Scholar 

  11. Innes NP, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Domejean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona A, Schwendicke F (2016) Managing carious lesions: consensus recommendations on terminology. Adv Dent Res 28:49–57. https://doi.org/10.1177/0022034516639276

    Article  PubMed  Google Scholar 

  12. Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L (2017) Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr Dent 39:16–123

    PubMed  Google Scholar 

  13. Marchi JJ, de Araujo FB, Froner AM, Straffon LH, Nor JE (2006) Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent 31:68–71

    Article  Google Scholar 

  14. Buyukgural B, Cehreli ZC (2008) Effect of different adhesive protocols vs calcium hydroxide on primary tooth pulp with different remaining dentin thicknesses: 24-month results. Clin Oral Investig 12:91–96. https://doi.org/10.1007/s00784-007-0152-x

    Article  PubMed  Google Scholar 

  15. Modena KC, Casas-Apayco LC, Atta MT, Costa CA, Hebling J, Sipert CR, Navarro MF, Santos CF (2009) Cytotoxicity and biocompatibility of direct and indirect pulp capping materials. J Appl Oral Sci 17:544–554

    Article  Google Scholar 

  16. Casagrande L, Bento LW, Rerin SO, Lucas Ede R, Dalpian DM, de Araujo FB (2008) In vivo outcomes of indirect pulp treatment using a self-etching primer versus calcium hydroxide over the demineralized dentin in primary molars. J Clin Pediatr Dent 33:131–135

    Article  Google Scholar 

  17. Fernandes JM, Massoni AC, Ferreira JM, Menezes VA (2013) Use of calcium hydroxide in deep cavities of primary teeth. Quintessence Int 44:417–423. https://doi.org/10.3290/j.qi.a29503

    Article  PubMed  Google Scholar 

  18. Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, Kaczmarek W, Buczkowska-Radlinska J (2013) Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 39:743–747. https://doi.org/10.1016/j.joen.2013.01.005

    Article  PubMed  Google Scholar 

  19. Rajasekharan S, Martens LC, Cauwels R, Anthonappa RP, Verbeeck RMH (2018) Biodentine material characteristics and clinical applications: a 3 year literature review and update. Eur Arch Paediatr Dent 19:1–22. https://doi.org/10.1007/s40368-018-0328-x

    Article  PubMed  Google Scholar 

  20. Camilleri J, Laurent P, About I (2014) Hydration of Biodentine, Theracal LC, and a prototype tricalcium silicate-based dentin replacement material after pulp capping in entire tooth cultures. J Endod 40:1846–1854. https://doi.org/10.1016/j.joen.2014.06.018

    Article  PubMed  Google Scholar 

  21. Qureshi A, Soujanya E, Nandakumar, Pratapkumar, Sambashivarao (2014) Recent advances in pulp capping materials: an overview. J Clin Diagn Res 8:316–321. https://doi.org/10.7860/JCDR/2014/7719.3980

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gandolfi MG, Siboni F, Prati C (2012) Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J 45:571–579. https://doi.org/10.1111/j.1365-2591.2012.02013.x

    Article  PubMed  Google Scholar 

  23. Falster CA, Araujo FB, Straffon LH, Nor JE (2002) Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 24:241–248

    PubMed  Google Scholar 

  24. Koc Vural U, Kiremitci A, Gokalp S (2017) Randomized clinical trial to evaluate MTA indirect pulp capping in deep caries lesions after 24-months. Oper Dent 42:470–477. https://doi.org/10.2341/16-110-C

    Article  PubMed  Google Scholar 

  25. Garrocho-Rangel A, Quintana-Guevara K, Vazquez-Viera R, Arvizu-Rivera JM, Flores-Reyes H, Escobar-Garcia DM, Pozos-Guillen A (2017) Bioactive tricalcium silicate-based dentin substitute as an indirect pulp capping material for primary teeth: a 12-month follow-up. Pediatr Dent 39:377–382

    PubMed  Google Scholar 

  26. Schwendicke F, Dorfer CE, Paris S (2013) Incomplete caries removal: a systematic review and meta-analysis. J Dent Res 92:306–314. https://doi.org/10.1177/0022034513477425

    Article  PubMed  Google Scholar 

  27. Ricucci D, Loghin S, Siqueira JF Jr (2014) Correlation between clinical and histologic pulp diagnoses. J Endod 40:1932–1939. https://doi.org/10.1016/j.joen.2014.08.010

    Article  PubMed  Google Scholar 

  28. Ricucci D, Loghin S, Niu LN, Tay FR (2018) Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: a histological and histobacteriological study. J Dent 73:76–90. https://doi.org/10.1016/j.jdent.2018.04.007

    Article  PubMed  Google Scholar 

  29. Akcay M, Sari S, Duruturk L, Gunhan O (2015) Effects of sodium hypoclorite as disinfectant material previous to pulpotomies in primary teeth. Clin Oral Investig 19:803–811. https://doi.org/10.1007/s00784-014-1296-0

    Article  PubMed  Google Scholar 

  30. 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

    PubMed  Google Scholar 

  31. Coll JA (2008) Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? J Endod 34:S34–S39. https://doi.org/10.1016/j.joen.2008.02.033

    Article  PubMed  Google Scholar 

  32. Franzon R, Opdam N, Guimarães L, Demarco F, Casagrande L, Haas A, Araujo F (2015) Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth. J Dent 43:1235–1241

    Article  Google Scholar 

  33. Vij R, Coll JA, Shelton P, Farooq NS (2004) Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent 26:214–220

    PubMed  Google Scholar 

  34. Franzon R, Casagrande L, Pinto AS, Garcia-Godoy F, Maltz M, De Araujo FB (2007) Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. Am J Dent 20:189

    PubMed  Google Scholar 

  35. Menon NP, Varma BR, Janardhanan S, Kumaran P, Xavier AM, Govinda BS (2016) Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: a randomized clinical trial. Contemp Clin Dent 7:475–480. https://doi.org/10.4103/0976-237X.194109

    Article  PubMed  PubMed Central  Google Scholar 

  36. Leye Benoist F, Gaye Ndiaye F, Kane AW, Benoist HM, Farge P (2012) Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal((R)) ) in the formation of a dentine bridge: a randomised controlled trial. Int Dent J 62:33–39. https://doi.org/10.1111/j.1875-595X.2011.00084.x

    Article  PubMed  Google Scholar 

  37. Maltz M, de Oliveira EF, Fontanella V, Bianchi R (2002) A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quintessence Int 33:151–9

  38. American Academy on Pediatric D and American Academy of P (2017) Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatr Dent 39:146–159

    Google Scholar 

  39. Oliveira EF, Carminatti G, Fontanella V, Maltz M (2006) The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14-18 months. Clin Oral Investig 10:134–139. https://doi.org/10.1007/s00784-006-0033-8

    Article  PubMed  Google Scholar 

  40. Bressani AE, Mariath AA, Haas AN, Garcia-Godoy F, de Araujo FB (2013) Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial. Am J Dent 26:196–200

    PubMed  Google Scholar 

  41. Trairatvorakul C, Sastararuji T (2014) Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars. Int J Paediatr Dent 24:23–31. https://doi.org/10.1111/ipd.12022

    Article  PubMed  Google Scholar 

  42. Giraud T, Jeanneau C, Rombouts C, Bakhtiar H, Laurent P, About I (2018) Pulp capping materials modulate the balance between inflammation and regeneration. Dent Mater 35:24–35. https://doi.org/10.1016/j.dental.2018.09.008

    Article  PubMed  Google Scholar 

  43. Casagrande L, Falster CA, Di Hipolito V, De Goes MF, Straffon LH, Nor JE, de Araujo FB (2009) Effect of adhesive restorations over incomplete dentin caries removal: 5-year follow-up study in primary teeth. J Dent Child (Chic) 76:117–122

    Google Scholar 

  44. Tuculina MJ, Raescu M, Dascalu IT, Popescu M, Andreescu CF, Daguci C, Cumpata CN, Nimigean VR, Banita IM (2013) Indirect pulp capping in young patients: immunohistological study of pulp-dentin complex. Romanian J Morphol Embryol 54:1081–1086

    Google Scholar 

  45. Choung HW, Lee DS, Lee JH, Shon WJ, Lee JH, Ku Y, Park JC (2016) Tertiary dentin formation after indirect pulp capping using protein CPNE7. J Dent Res 95:906–912. https://doi.org/10.1177/0022034516639919

    Article  PubMed  Google Scholar 

  46. Monea M, Stoica A, Monea A (2014) Histological evaluation of indirect pulp capping procedures with calcium hydroxide and mineral trioxide aggregate. Eur Sci J 2:315–318

    Google Scholar 

  47. Trowbridge H (2002) Histology of pulpal inflammation. Seltzer and Benders Dental Pulp Carol Stream: Quintessence:227–45

  48. Giraud T, Jeanneau C, Bergmann M, Laurent P, About I (2018) Tricalcium silicate capping materials modulate pulp healing and inflammatory activity in vitro. J Endod 44:1686–1691. https://doi.org/10.1016/j.joen.2018.06.009

    Article  PubMed  Google Scholar 

  49. Kim I, Moon SO, Kim SH, Kim HJ, Koh YS, Koh GY (2001) Vascular endothelial growth factor expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin through nuclear factor-kappa B activation in endothelial cells. J Biol Chem 276:7614–7620. https://doi.org/10.1074/jbc.M009705200

    Article  PubMed  Google Scholar 

  50. Estrela C, Holland R (2003) Calcium hydroxide: study based on scientific evidences. J Appl Oral Sci 11:269–282. https://doi.org/10.1590/s1678-77572003000400002

    Article  PubMed  Google Scholar 

  51. Cox CF, Subay RK, Ostro E, Suzuki S, Suzuki SH (1996) Tunnel defects in dentin bridges: their formation following direct pulp capping. Oper Dent 21:4–11

    PubMed  Google Scholar 

Download references

Funding

This study was supported by the Izmir Katip Celebi University Scientific Research Projects Coordinatorship (Project No: 2014-1-TEZ-54).

Author information

Authors and Affiliations

  1. Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey

    Nur Sahin & Merve Akcay

  2. Department of Histology and Embryology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey

    Suna Saygili

Authors
  1. Nur Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suna Saygili
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Merve Akcay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Merve Akcay.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All parents of the participants gave their informed consent prior to their inclusion in the study.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sahin, N., Saygili, S. & Akcay, M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clin Oral Invest 25, 3945–3955 (2021). https://doi.org/10.1007/s00784-020-03724-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03724-4

Keywords

Search

Navigation