Effectiveness of Three Agents in Pulpotomy Treatment of Permanent Molars with Incomplete Root Development: A Randomized Controlled Trial

Abstract

The aim of this study was to investigate and compare, radiographically and clinically, the impacts of calcium-silicate based-cement (CSBC), nano-hydroxyapatite and platelet-rich fibrin (PRF) as pulpotomy agents in permanent immature molars with incomplete root development. Sixty-three participants (63 permanent immature molars) were included in this study. The patients were randomly divided into three equal groups. Fast setting MTA (MM-MTA), nano-hydroxyapatite and platelet-rich fibrin were used as pulpotomy agents. The teeth were evaluated clinically and radiographically after 6 and 12 months by two blinded examiners. Apical closure and pulp canal obliteration percentages were recorded. The in vitro reaction of the tested materials after a 7-day immersion period of the different materials in phosphate-buffered solution was analyzed using scanning electron microscopy to associate the in vitro mineralization with in vivo pulp canal obliteration percentages. Data were analyzed using Chi-square and ANOVA tests (α = 0.05). No significant difference was found between the three tested groups in terms of clinical and radiographic success (p > 0.05). All cases demonstrated evidence of root growth, including complete apical closure or continued apical closure. At 12 months, complete apical closure was found among the MM-MTA group (50%), nano-hydroxyapatite group (55%) and platelet-rich fibrin group (60%) (p > 0.05). After 12 months, pulp canal obliteration was more observed in the MM-MTA and nano-hydroxyapatite groups than in the PRF group (p < 0.05). MM-MTA (auto-mixed), NHA (hand-mixed) and PRF (autologous) could be used as pulpotomy agents since they exhibit comparable high clinical and radiographic success rates. However, the fact that the groups managed with MM-MTA and NHA have a higher tendency to canal obliteration might indicate that PRF should be considered the first choice material as pulpotomy agent, as it would make retreatment considerably easier.

The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

“…Relevant clinical studies have also confirmed this [29][30][31][32]. Related research on bioceramic materials is also available, whereby most studies show the excellent prospects of new bioceramic materials in pulpotomy treatment [33][34][35][36][37]. Some studies have used Biodentine, MTA, and CH to perform partial pulpotomy in terms of caries treatment of immature permanent molars.…”

Evaluation of the Shear Bond Strength of Four Bioceramic Materials with Different Restorative Materials and Timings

“…Adequate bond strength between bioceramic materials and restorative materials is very crucial to the success rate of VPT [24]. A variety of restorative materials are used in VPT including zinc oxide-eugenol cement base (ZOE), IRM, resin-modified glass ionomer (RMGI), and resin composite (RC) [25][26][27][28]. The shear bond strength (SBS) between MTA and RC has been evaluated in multiple studies using different etching and bonding techniques, which resulted in a wide range of values [29][30][31][32][33][34][35][36][37][38].…”

Bond Strength of Adhesive Systems to Calcium Silicate-Based Materials: A Systematic Review and Meta-Analysis of In Vitro Studies

“…A variety of pulp capping agents with specific properties, advantages, and drawbacks are available nowadays [4]. Novel biomaterials, specifically called calcium silicate-based materials, were introduced into the dental market under sealer and cement forms [5][6][7][8]. Calcium silicate-based cement (named bioceramics) is used as an alternative to the historically used calcium hydroxide.…”

“…Calcium silicate-based cement (named bioceramics) is used as an alternative to the historically used calcium hydroxide. Nowadays there is a wide variety of calcium silicate-based cement in dentistry, and due to their biocompatibility, bioactivity, and biomineralization properties, they have been applied in different clinical procedures including direct and indirect pulp capping, regenerative endodontic treatments, pulpotomy and repairing of perforations [5,6].…”