Abstract
Aim:
To assess and compare the treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) and Biodentine, after complete excavation of caries in permanent dentition with a 2-visit treatment protocol.
Materials and Methods:
Direct pulp capping with white MTA was performed in 70 teeth. Direct pulp capping with Biodentine was also done in 72 teeth. In the subsequent visits after 2 weeks, pulp sensibility tests were attempted in both studied groups. All clinical outcomes were categorized as success or failure.
Results:
The success rate of the pulp capping procedure in the MTA group at the end of 12 months study was 94.3% in the Class I subgroup and 93.3% in the Class II subgroup.
Conclusion:
Direct pulp capping with MTA and Biodentine, after pulp exposure during excavation of deep caries could maintain pulp vitality in permanent teeth.
KEYWORDS: Biodentine, deep caries, direct pulp capping, mineral trioxide aggregate
INTRODUCTION
Pulp capping method is a feasible option for maintaining pulp vitality after carious involvement.[1,2] Habitual material like calcium hydroxide has been used for pulp capping. Nevertheless, mineral trioxide aggregate (MTA) has become a trendy option for calcium hydroxide.[3,4] Although MTA has a long setting time, poor handling characteristics, and gray MTA can potentially discolor dental tissue.[5,6] Biodentine has been shown to exert a positive effect on the pulp milieu and accelerates tertiary and reparative dentin development. The aim of this study was to evaluate the outcome of direct pulp capping procedures in asymptomatic Class I and Class II deeply carious permanent teeth with MTA and Biodentine. The null hypothesis was that there was no significant difference in the response of pulp dentin complex to two different pulp capping materials on pulp capping of cariously exposed maxillary and mandibular first and second molars.
MATERIALS AND METHODS
Following ethical approval, a total of 142 maxillary and mandibular first and second molars with deep carious lesions were studied in the study. Pulp sensibility tests were conducted before pulp capping. White MTA was placed over the pulp exposure spot (70 teeth). After 10 min, cavit was placed over the MTA. In the Biodentine group (72 teeth), Biodentine was placed over the exposure spot until completely packed. After 2 weeks, electric pulp test (EPT) and cold test were attempted in both groups. MTA setting was confirmed and its color was determined with final composite restoration. Patients were recalled at the interval of 3, 6, 9, and 12 months after treatment to estimate pulp responsiveness using EPT and cold test. These clinical parameters were used: no spontaneous pain, no tenderness on percussion, no tooth discoloration, and positive pulp test.
RESULTS
The success rate for MTA was 94% and Biodentine was 100% (not significant). In the MTA group, two patients in Class I and one patient in the Class II cavity subgroup reported with sensitivity and pain after 2 weeks (not significant). In the Biodentine group, 48 teeth with Class I and 24 teeth with Class II were enrolled, and no patient from the beginning of the study to the completion reported with any sensitivity and pain [Table 1]. The success rate for Class I and class II subgroups was 100% (not significant). The dropout rate of MTA and Biodentine at the end of 12 months is explained in Table 2.
Table 1.
MTA | ||||||||||||
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MTA 70 | 2 weeks 60 | 3 months 58 | 6 months 54 | 9 months 50 | 12 months 50 | |||||||
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Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | |
Success | 45 | 25 | 38 (40) | 19 (20) | 38 (40) | 17 (18) | 36 (38) | 15 (16) | 33 (35) | 14 (15) | 33 (35) | 14 (15) |
Failure | 45 | 25 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 1 |
| ||||||||||||
Biodentine | ||||||||||||
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Biodentine 72 | 2 weeks 68 | 3 months 64 | 6 months 60 | 9 months 60 | 12 months 56 | |||||||
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Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | Class I | Class II | |
| ||||||||||||
Success | 48 | 24 | 47 (47) | 21 (21) | 44 (44) | 20 (20) | 43 (43) | 17 (17) | 43 (43) | 17 (17) | 40 (40) | 16 (16) |
Failure | 48 | 24 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
MTA: Mineral trioxide aggregate
Table 2.
Group | Class I (%) | Class II (%) |
---|---|---|
MTA | 22.2 | 40 |
Biodentine | 16.7 | 33.3 |
MTA: Mineral trioxide aggregate
DISCUSSION
Biodentine can be utilized effectively as a dentin replacement in a similar manner such as MTA.[7] In our study, we found a higher failure rate of MTA pulp capping procedures as compared to Biodentine. Spontaneous pain, tenderness on percussion, tooth discoloration, pulp testing, and widening of the periodontal ligament space on the recall periapical radiograph were assessed at the interval of 2 weeks, 3 months, 6 months, 9 months, and 12 months. We believe that Biodentine had better handling characteristics and performance after restoration placement in comparison to MTA. The placement of MTA was more time-consuming and technically difficult, although it is necessary to use a dental triturator for the preparation of Biodentine. On the other hand, MTA does not require any additional equipment. Furthermore, there was no tooth discoloration in either the MTA group or Biodentine group during the evaluation of 12 months. Authors proposed that asymptomatic teeth with pulpal exposure after caries removal can be restored predictably using the newer bioactive materials as pulp capping agents.
CONCLUSION
Direct pulp capping with MTA and Biodentine, after pulp exposure during excavation of deep caries in reversible pulpitis is a successful treatment option that was able to maintain pulp vitality in permanent teeth at the end of a 1-year follow-up when a 2-visit treatment protocol is observed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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