Pulp Capping with Mineral Trioxide Aggregate (MTA): A Retrospective Analysis of Carious Pulp Exposures Treated by Undergraduate Dental Students

Abstract

©Operative Dentistry, 2010, 35-1, 20-28 JP Miles • AH Gluskin D Chambers • OA Peters Clinical RelevanceCarious pulp exposures present a therapeutic challenge for clinicians. Mineral trioxide aggregate (MTA) is a treatment option that may provide successful outcomes for the capping of carious pulp exposures in adult patients. However, the success measured as pulp survival over a period of one and two years of pulp caps performed by undergraduate dental students may be low. This study provides data regarding the impact of exposure sizes and other pre-operative variables on outcomes of MTA pulp caps in adults. SUMMARYThe current study estimated pulpal vitality after MTA pulp caps were performed by undergraduate student clinicians. At recall after 12 to 27 months, 51 pulp caps were clinically and radiographically assessed. Kaplan-Meier analyses were used to estimate overall success at 12 and 24 months, determined as the presence of a vital pulp, as well as impact of preoperative variables on pulp vitality at recall. Overall, one-year pulp survival was 67.7%, while the two-year survival rate was 56.2%. Tarone-Ware statistics indicated that neither age of the patient nor size of the exposure ("minimal" or "moderate") and the amount of bleeding ("none," "minimal" or "moderate") had a significant effect on survival rates.Within the limitations of the current study on procedures performed by student clinicians, it may be concluded that, for MTA pulp caps applied to carious exposures in adults, certain preoperative conditions-patient age, exposure size and amount of bleeding-are not predictive of clinical outcome. Considering the comparatively low success rate for the current cohort, more research is needed to define predictive criteria for successful pulp capping with MTA.

Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study

“…In a clinical trial, a lower success rate of 56.2% was reported after direct pulp capping with MTA (19). However, no attempt was made to fully remove carious dentin as soon as pulpal bleeding was observed.…”

Vital Pulp Therapy in Vital Permanent Teeth with Cariously Exposed Pulp: A Systematic Review

“…Only calcium hydroxide or MTA was used as medicament for vital pulp therapy. Articles were excluded for the following reasons: non-carious exposed teeth studies that mostly were trauma studies (55-57); inadequate clinical or radiograph examination (10, 58); success rate was not stated or could not be recalculated (52,59); calcium hydroxide or MTA was not used as pulp capping materials (60,61). Statistical comparison of the success rates among direct pulp capping, partial pulpotomy, and full pulpotomy might not be appropriate for various reasons.…”

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

“…Another case series study, restricted to adults who were at least 18 years of age, demonstrated a comparatively low success rate (56%) for direct pulp capping using MTA after a 2‐year follow‐up (Miles et al . ).…”