Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial—2-year results (original) (raw)
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Journal of Clinical Medicine
Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries’ lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory m...
SciDoc Publishers, 2021
Objective: The aim of this study was to evaluate the efficacy of vital pulp therapy using bioceramic Endosequense Root Repair Material (ERRM) compared to Enriched Mixture Cement (CEM) in Mature permanent posterior teeth suffering from symptoms of non-reversible acute pulpitis due to caries. Methods: The sample consisted of60 permanent human posterior teeth suffering from non-reversible pulpitis in 53 male and female patients aged between 18-40 years. An assessment of the dental condition was conducted clinically and radiologically before starting the treatment based on: the presence of a history of the disease (persistent spontaneous pain that does not go away with the disappearance of the cause), the results of the cold test, in addition to the radiological findings. Vital pulp therapy was performed (partial or complete pulp amputation)after haemostasis using either (ERRM) or (CEM). The final restoration was applied in the same session, then an x-ray radiograph was taken immediately after the treatment procedure. Patient were re-called after 24 hours to ensure the disappearance of symptoms and then according to the following time intervals: (a week, 3 months, 6 months, a year) to evaluate the cases clinically and radiographically. Results: This study showed that there were no statistically significant differences in the frequencies of clinically and radiographically assessment results between the CEM group and ERRM group, in each of the studied time periods (after one week, after one month, after three months, after six months, after one year) Conclusion: Vital pulp Therapy using ERRM and CEM showed a high success rate after a one-year observation period in permanent teeth suffering from non-response pulpitis, and it can be a staged alternative to traditional endodontic treatments.
Clinical Oral Investigations, 2013
Objectives Root canal therapy (RCT) and tooth extraction have been conventional treatment options for management of human mature teeth with irreversible pulpitis. Excellent short-term treatment outcomes of vital pulp therapy with calcium-enriched mixture cement (VPT/CEM), as a new treatment option, on postoperative pain relief was demonstrated; if intermediate-and long-term treatment outcomes of the new treatment are also non-inferior compared to RCT, then VPT/CEM may become a viable treatment option for management of mature teeth with irreversible pulpitis. Materials and methods In 23 healthcare centers, 407 9-to 65year-old patients were randomly allocated into two study arms including one-visit RCT (reference treatment; n0202) and VPT/CEM (alternative treatment; n0205). Six-and twelvemonth clinical and radiographic successes were assessed. Results Mean follow-up times at 6-and 12-month follow-ups were "6.70±0.68 and 6.72±0.71 months" and "12.96±0.67 and 12.90±0.66 months" in the available cases of RCT and VPT/CEM arms, respectively. Favorable clinical success rates in the two study arms did not show statistical difference; however, the radiographic success rate in the VPT/CEM was significantly greater than RCT arm at the two follow-ups (P<0.001). The patients' age had no effect on the treatment outcomes (P00.231). Conclusions Treatment outcomes of VPT/CEM may be superior to RCT in mature molars with irreversible pulpitis. The performance of biomaterials such CEM cement may assist in the shift towards more biologic treatments. Clinical relevance VPT/CEM may be a realistic alternative treatment for human mature molar teeth with symptoms of irreversible pulpitis; the use of VPT/CEM is highly beneficial for patients as well as general dentists.
materials, 2024
Vital pulp therapy aims to preserve the vitality of dental pulp exposed due to caries, trauma, or restorative procedures. The aim of the present review was to evaluate the clinical, radiographic, and histological outcomes of different calcium silicate-based cements used in vital pulp therapy for both primary and permanent teeth. The review included 40 randomized controlled trials from a search across PubMed, LILACS, and the Cochrane Collaboration, as well as manual searches and author inquiries according to specific inclusion and exclusion criteria. A critical assessment of studies was conducted, and after data extraction the results were submitted to a quantitative statistical analysis using meta-analysis. The studies, involving 1701 patients and 3168 teeth, compared a total of 18 different calcium silicate-based cements in both dentitions. The qualitative synthesis showed no significant differences in short-term outcomes (up to 6 months) between different calcium silicate-based cements in primary teeth. ProRoot MTA and Biodentine showed similar clinical and radiographic success rates at 6 and 12 months. In permanent teeth, although the global results appeared to be well balanced, ProRoot MTA generally seemed to perform better than other calcium silicate-based cements except for Biodentine, which had comparable or superior results at 6 months. Meta-analyses for selected comparisons showed no significant differences in clinical and radiographic outcomes between ProRoot MTA and Biodentine over follow-up periods. The present review highlights the need for standardized definitions of success and follow-up periods in future studies to better guide clinical decisions. Despite the introduction of new calcium silicate-based cements aiming to address limitations of the original MTA. ProRoot MTA and Biodentine remain the most used and reliable materials for vital pulp therapy, although the results did not deviate that much from the other calcium silicate-based cements. Further long-term studies are required to establish the optimal CSC for each clinical scenario in both dentitions.
Direct Pulp Capping in Treatment of Reversible Pulpitis in Primary Teeth- Clinical Protocol
Journal of IMAB - Annual Proceeding (Scientific Papers)
The pulp of primary teeth is identical morphologically and physiologically to that of permanent teeth and it is capable to answer to pathological stimuli by producing tertiary dentin. When the inflammation of the pulp is in its reversible stage vital methods of treatment are indicated in order to stimulate the healing processes in it and protect its vitality. In Bulgaria the most popular method of treatment of inflammation diseases of the pulp in primary dentition is the mortal amputation. The biological way of treatment is not very common even in cases where there are indications for it. Purpose: The aim of this paper is to present the approbated by us protocol for application of direct pulp capping for treatment of reversible pulpitis in primary teeth. Material and methods: On the base of world experience and our contemporary meta-analysis of the researches published in the last 15 years concerning the problems of diagnostics. We determined clinical and radiographic diagnostic criteria for reversible pulpitis in primary teeth and indications for application of direct pulp capping as a method of treatment. We give clinical steps for application of the method and summarized the clinical and radiographic criteria for success after treatment. Results/conclusion: We gather all the information for applying direct pulp cappingfor treatment of reversible pulpitis in primary dentition. We offer the method of direct pulp capping as a clinical protocol "step by step" and illustrated by scheme which can be useful for students and dentists in their everyday practice.
The Journal of Contemporary Dental Practice
Aim and objective: The aim of the study was to evaluate and compare radiographically, Pulpotec cement and Biodentine as direct pulp-capping agents in mature teeth, individually and in combination with photo-activated disinfection (PAD). Material and methods: In the present study, 80 mature teeth with deep occlusal caries were selected for direct pulp-capping procedure and randomly assigned to one of the four groups [Pulpotec (I), Biodentine (II), Pulpotec + PAD (III), and Biodentine + PAD (IV)] allocating 20 teeth to each group. Direct pulp capping and cavity disinfection were performed based on the group allotted followed by permanent restoration with composite. The teeth were evaluated radiographically (densitometric analysis) at intervals of 3, 6, and 12 months. The radiographic gray values obtained at follow-up periods for each group were subjected to two-way analysis of variance (ANOVA) with repeated measures. Results: There was a significant improvement (p <0.0001) in the scores of all the groups at follow-ups as compared to the baseline. There was a significant difference between group I/group II with groups III and IV (p = 0.000) with group IV scoring highest at all follow-ups. However, the difference between groups I/II and groups III/IV was nonsignificant. Conclusion: Both, Biodentine and Pulpotec can be used for direct pulp capping of mature teeth. Furthermore, PAD prior to material application significantly improved the radiographical success of Biodentine and Pulpotec, with Biodentine showing better results than Pulpotec. Clinical significance: Biodentine and Pulpotec demonstrated comparable success as a pulp-capping agent and PAD application exhibited a synergistic effect when used in conjunction with these materials.
Journal of Pharmaceutical Research International
Aim: To evaluate the clinical success of Calcium Hydroxide (CH), Mineral trioxide aggregate (MTA) and Biodentine as pulp capping materials for Direct pulp capping in carious molars. Materials and Methods: Thirty-six molars of thirty-six patients with deep caries lesions, diagnosed with reversible pulpitis were subjected to direct pulp capping treatment. They were randomly divided into three groups, Biodentine (12 teeth) or MTA group (12 teeth) or CH group (12teeth). Simple randomization of three was employed to allocate the treatment materials. Patients were recalled at one, three and six months to evaluate the clinical success of the treatment outcome. Results: In clinical trial/study, the pulp capping materials gave different success rate, 91.67% success in the Biodentine group, 75% success in the MTA group and 41.67% success in Calcium Hydroxide group. Conclusion: In our study the materials tested at 1 month, 3 month and 6-month follow-up, Calcium Silicate materials are better th...
Medicina, 2021
Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias...
International Journal of Clinical Pediatric Dentistry
Glass ionomer cement (GIC) suffers from longer setting times, so the maximal mechanical properties of this material are not achieved immediately after the placement of the restoration. Besides, GICs can be difficult to handle, leading to cervical gaps due to inadequate adaptation to the cavity walls. 9 Alternative materials have been launched trying to overcome the problems of GIC. Recently a new category of filling material, Cention N, classified as a subgroup of the composite material class (alkasite composites) was launched. It was developed as an alternative to GICs and amalgam. 10 It is a power-liquid dual-cure resin-based material that which, after manipulation, exhibits a paste-like consistency, facilitating the insertion into the cavities, and allowing its use as a bulk material. 11 According to the IntroductIon When restoring a carious lesion, dentists should aim the inactivation/control of the disease process, preservation of dental hard tissues, avoidance of initiating the cycle of restoration, and the maintenance of the tooth as long as possible. 1 These principles were defined at the International Caries Consensus Collaboration meeting in 2015, and they are based on a biological and minimally invasive approach for dental restorations. Therefore, when a restoration is needed, the preparation of the tooth should focus on selective removal of the carious dentin; and the restoration on the protection of pulp-dentine complex and good cavity seal. 1,2 In agreement with these up-to-date concepts, one of the best choices of restorative treatment for deciduous teeth is the selective removal of carious dentin followed by an adhesive restoration of the cavity, as preconized by the Atraumatic Restorative Treatment protocol (ART), that comprises the removal of soft, completely demineralized carious tooth tissue, using hand instruments, followed by the restoration of the cavity with a high-viscosity glass ionomer cement (HVGIC). 3 This approach also represents a patient-friendly restorative procedure 4 and it was shown similar longevity rates when compared to "conventional" restoration procedures in deciduous teeth. 5-8 The longevity rates for multiple surfaces restorations is still lower than single surface ones, and this finding may be related to the fact that HVGICs show some features that still need
Journal of Conservative Dentistry, 2017
Background: Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures. Aim: The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth. Subjects and Methods: Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I-MTA and Group II-biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis. Results: Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance. Conclusion: MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.