Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years
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This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.
Materials and methods
A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s exact test, respectively.
After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).
Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.
Direct pulp capping can be done successfully with this type of calcium silicate cement.
KeywordsBiodentine Calcium silicate cement Direct pulp capping Treatment outcome
Compliance with ethical standards
Conflict of interest
Carolin Sabine Harms declares that she has no conflict of interest.
Edgar Schäfer declares that he has no conflict of interest.
Till Dammaschke declares that he has no conflict of interest.
All treatments were conducted strictly in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki (version 2008).
The treatments were undertaken with the understanding and written consent of each patient and according to ethical principles, including the Declaration of Helsinki.
- 3.Dammaschke T, Camp JH, Bogen G (2014) MTA in Vital Pulp Therapy. In: Torabinejad M (ed) Mineral Trioxide Aggregate - Properties and Clinical Applications. Wiley Blackwell, Ames, pp 71–110Google Scholar
- 4.Hilton TJ, Ferracane JL, Mancl L, For northwest practice-based research collaborative in evidence-based dentistry (NWP) (2013) Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. J Dent Res 92(Suppl):16S–22S. https://doi.org/10.1177/0022034513484336 CrossRefGoogle Scholar
- 10.Chailertvanitkul P, Paphangkorakit J, Sooksantisakoonchai N, Pumas N, Pairojamornyoot W, Leela-Apiradee N, Abbott PV (2014) Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of permanent molars. Int Endod J 47:836–842. https://doi.org/10.1111/iej.12225 CrossRefGoogle Scholar
- 12.Berzins DW (2014) Chemical properties of MTA. In: Torabinejad M (ed) Mineral Trioxide Aggregate - Properties and clinical applications. Wiley Blackwell, Ames, pp 17–36Google Scholar
- 21.Araújo LB, Cosme-Silva L, Fernandes AP, Oliveira TM, Cavalcanti BDN, Gomes Filho JE, Sakai VT (2018) Effects of mineral trioxide aggregate, Biodentine™ and calcium hydroxide on viability, proliferation, migration and differentiation of stem cells from human exfoliated deciduous teeth. J Appl Oral Sci 26:e20160629. https://doi.org/10.1590/1678-7757-2016-0629 CrossRefGoogle Scholar
- 25.Nowicka A, Wilk G, Lipski M, Kołecki J, Buczkowska-Radlińska J (2015) Tomographic evaluation of reparative dentin formation after direct pulp capping with Ca(OH)2, MTA, Biodentine, and dentin bonding system in human teeth. J Endod 41:1234–1240. https://doi.org/10.1016/j.joen.2015.03.017 CrossRefGoogle Scholar
- 29.Lipski M, Nowicka A, Kot K, Postek-Stefańska L, Wysoczańska-Jankowicz I, Borkowski L, Andersz P, Jarząbek A, Grocholewicz K, Sobolewska E, Woźniak K, Droździk A (2018) Factors affecting the outcomes of direct pulp capping using Biodentine. Clin Oral Investig 22:2021–2029. https://doi.org/10.1007/s00784-017-2296-7 CrossRefGoogle Scholar
- 30.Brizuela C, Ormeño A, Cabrera C, Cabezas R, Silva CI, Ramírez V, Mercade M (2017) Direct pulp capping with calcium hydroxide, mineral trioxide aggregate, and Biodentine in permanent young teeth with caries: a randomized clinical trial. J Endod 43:1776–1780. https://doi.org/10.1016/j.joen.2017.06.031 CrossRefGoogle Scholar
- 36.Parinyaprom N, Nirunsittirat A, Chuveera P, Na Lampang S, Srisuwan T, Sastraruji T, Bua-On P, Simprasert S, Khoipanich I, Sutharaphan T, Theppimarn S, Ue-Srichai N, Tangtrakooljaroen W, Chompu-Inwai P (2018) Outcomes of direct pulp capping by using either ProRoot mineral trioxide aggregate or Biodentine in permanent teeth with carious pulp exposure in 6- to 18-year-old patients: a randomized controlled trial. J Endod 44:341–348. https://doi.org/10.1016/j.joen.2017.10.012 CrossRefGoogle Scholar
- 37.Bogen G, Chandler NP (2008) Vital pulp therapy. In: Ingle JI, Bakand LK, Baumgartner JC (eds) Ingle’s endodontics, 6th edn. BC Decker, Hamilton, pp 1310–1329Google Scholar
- 41.Abbott PV, Yu C (2008) A clinical classification of the status of the pulp and the root canal system. Aust Dent J 52(1 Suppl):S17–S31Google Scholar
- 45.Auschill TM, Arweiler NB, Hellwig E, Zamani-Alaei A, Sculean A (2003) Success rate of direct pulp-capping with calcium hydroxide. Schweiz Monatsschr Zahnmed 113:946–952Google Scholar
- 46.Pereira JC, Segala AD, Costa CAS (2000) Human pulpal response to direct pulp capping with an adhesive system. Am J Dent 13:139–147Google Scholar
- 48.Gutmann JL, Lovdahl PE (2011) Problem Solving in the Diagnosis of Odontogenic Pain. In: Gutmann JL, Lovdahl PE (eds) Problem Solving in Endodontics, 5th edn. Mosby, Saint Louis, pp 1–21Google Scholar
- 54.Stanley HR (1998) Criteria for standardizing and increasing credibility of direct pulp capping studies. Am J Dent 11(Spec Iss):S17–S34Google Scholar
- 55.Ahrens G, Reuver J (1973) Follow-up studies of direct pulp capping in the daily dental practice. Dtsch Zahnärztl Z 28:862–865Google Scholar
- 59.Stockton LW (1999) Vital pulp capping: a worthwhile procedure. J Can Dent Assoc 65:328–331Google Scholar