Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide

Abstract

Aim The aim of this multicentre, parallel-group randomized clinical trial was to compare the effectiveness of mineral trioxide aggregate (MTA) and a conventional calcium hydroxide liner (CH) as direct pulp capping materials in adult molars with carious pulpal exposure.Methodology Seventy adults aged 18 to 55 years were randomly allocated to two parallel arms:MTA (White ProRoot, Dentsply, Tulsa Dental, Tulsa, OK, USA) (n=33) and CH (Dycal ® , Dentsply DeTrey GmbH, Konstanz, Germany) (n=37). The teeth were temporized for one week with glass ionomer (Fuji IX, GC Corp, Tokyo, Japan), and then permanently restored with a composite resin.The subjects were followed up after 1 week and at 6, 12, 24, and 36 months. The primary outcome was the survival of the capped pulps, and the secondary outcome was postoperative pain after 1 week.Survival was defined as a non-symptomatic tooth that responded to sensibility testing and did not exhibit periapical changes on radiograph. At each check-up, the pulp was tested for sensibility and a periapical radiograph was taken (excluding the radiographs taken at the 1-week follow up). KaplanMeier survival analysis and log-rank test was used to assess the significant difference in the survival curves between groups. Chi-square test was used to assess the association between the materials and preoperative and postoperative pain. Accepted ArticleThis article is protected by copyright. All rights reserved.Results At 36 months, the Kaplan-Meier survival analysis showed a cumulative estimate rate of 85% for the MTA group and 52% for the CH group (p=0.006). There was no significant association between the capping material and postoperative pain.Conclusions MTA performed more effectively than a conventional CH liner as a direct pulp capping material in molars with carious pulpal exposure in adult patients. This study has been registered at ClinicalTrials.gov, number NCT01224925.

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

“…, Kundzina et al . ). Operator skill and experience may also be an important, if not independently tested, variable determining the success of VPT.…”

“…, Kundzina et al . ). However, data on the carious penetration depth in these studies were not well defined (Marques et al .…”

“…, Kundzina et al . ), and some of the sample material in these studies comprised mechanical exposures (class I pulp caps) (Mente et al . ).…”

Management of deep caries and the exposed pulp

“…A recent randomized clinical multicenter trial demonstrated that MTA performed better than Ca(OH) 2 (Kundzina et al . 2017 2017). Although the study contained information about the depth of the carious lesion, depth was not randomly distributed between the two materials (MTA and Ca(OH) 2 ) investigated.…”

Role of Mineral Trioxide Aggregate (MTA) and Calcium Hydroxide in Conservative Dentistry as Pulp Capping Material: A Review

“…[46] tooth survival was set as a primary outcome which was defined as asymptomatic tooth that responds normally to vitality testing and periapical radiographs don't show any bone rarefaction, the survival rate in MTA group was 53% while in the Calcium hydroxide group was 52%.…”