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Clinical Oral Investigations

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01-09-2019 | Original Article

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Authors: Carolin Sabine Harms, Edgar Schäfer, Till Dammaschke

Published in: Clinical Oral Investigations | Issue 9/2019

Abstract

Objectives

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.

Results

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).

Conclusion

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.

Clinical relevance

Direct pulp capping can be done successfully with this type of calcium silicate cement.

Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP (1996) Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 127:1491–1494CrossRef

Bogen G, Kim JS, Bakland LK (2008) Direct pulp capping with mineral trioxide aggregate: An observational study. J Am Dent Assoc 139:305–315CrossRefPubMed

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 71–110

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 CrossRefPubMed

Mente J, Hufnagel S, Leo M, Michel A, Gehrig H, Panagidis D, Saure D, Pfefferle T (2014) Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. J Endod 40:1746–1751. https://doi.org/10.1016/j.joen.2014.07.019 CrossRefPubMed

Kundzina R, Stangvaltaite, Eriksen HM, Kerosuo E (2017) Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J 50:924–932. https://doi.org/10.1111/iej.12719 CrossRefPubMed

Li Z, Cao L, Fan M, Xu Q (2015) Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: a meta-analysis. J Endod 41:1412–1417. https://doi.org/10.1016/j.joen CrossRefPubMed

Aguilar P, Linsuwanont P (2011) Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 37:581–587. https://doi.org/10.1016/j.joen.2010.12.004 CrossRefPubMed

Alqaderi H, Lee CT, Borzangy S, Pagonis TC (2016) Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: a systematic review and meta-analysis. J Dent 44:1–7. https://doi.org/10.1016/j.jdent.2015.12.005 CrossRefPubMed

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 CrossRef

11.

Dammaschke T, Gerth HUV, Züchner H, Schäfer E (2005) Chemical and physical surface and bulk material characterization of white ProRoot MTA and two Portland cements. Dent Mater 21:731–738CrossRefPubMed

12.

Berzins DW (2014) Chemical properties of MTA. In: Torabinejad M (ed) Mineral Trioxide Aggregate - Properties and clinical applications. Wiley Blackwell, Ames, pp 17–36

13.

Camilleri J, Sorrentino F, Damidot D (2013) Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, biodentine and MTA angelus. Dent Mater 29:580–593. https://doi.org/10.1016/j.dental.2013.03.007 CrossRefPubMed

14.

Setbon HM, Devaux J, Iserentant A, Leloup G, Leprince JG (2014) Influence of composition on setting kinetics of new injectable and/or fast setting tricalcium silicate cements. Dent Mater 30:1291–1303. https://doi.org/10.1016/j.dental.2014.09.005 CrossRefPubMed

15.

Kaup M, Schäfer E, Dammaschke T (2015) An in vitro study of different material properties of Biodentine compared to ProRoot MTA. Head Face Med 11:16. https://doi.org/10.1186/s13005-015-0074-9 CrossRefPubMedPubMedCentral

16.

Camilleri J, Laurent P, About I (2014) Hydration of biodentine, Theracal LC, and a prototype tricalcium silicate-based dentin replacement material after pulp capping in entire tooth cultures. J Endod 40:1846–1854. https://doi.org/10.1016/j.joen.2014.06.018 CrossRefPubMed

17.

Bhavana V, Chaitanya KP, Gandi P, Patil J, Dola B, Reddy RB (2015) Evaluation of antibacterial and antifungal activity of new calcium-based cement (biodentine) compared to MTA and glass ionomer cement. J Conserv Dent 18:44–46. https://doi.org/10.4103/0972-0707.148892 CrossRefPubMedPubMedCentral

18.

Laurent P, Camps J, About I (2012) Biodentine™ induces TGF-β 1 release from human pulp cells and early dental pulp mineralization. Int Endod J 45:439–448. https://doi.org/10.1111/j.1365-2591.2011.01995.x CrossRefPubMed

19.

Mathieu S, Jeanneau C, Sheibat-Othman N, Kalaji N, Fessi H, About I (2013) Usefulness of controlled release of growth factors in investigating the early events of dentin-pulp regeneration. J Endod 39:228–235. https://doi.org/10.1016/j.joen.2012.11.007 CrossRefPubMed

20.

Laurent P, Camps J, De Méo M, Dejou J, About I (2008) Induction of specific cell responses to a Ca₃SiO₅-based posterior restorative material. Dent Mater 24:1486–1494. https://doi.org/10.1016/j.dental.2008.02.020 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

22.

Pedano MS, Li X, Li S, Sun Z, Cokic SM, Putzeys E, Yoshihara K, Yoshida Y, Chen Z, Van Landuyt K, Van Meerbeek B (2018) Freshly mixed and setting calcium-silicate cements stimulate human dental pulp cells. Dent Mater 34:797–808. https://doi.org/10.1016/j.dental.2018.02.005 CrossRefPubMed

23.

About I (2018) Recent trends in tricalcium silicates for vital pulp therapy. Curr Oral Health Rep 5:178–185. https://doi.org/10.1007/s40496-018-0186-y CrossRef

24.

Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, Kaczmarek W, Buczkowska-Radlińska J (2013) Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 39:743–747. https://doi.org/10.1016/j.joen.2013.01.005 CrossRefPubMed

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 CrossRefPubMed

26.

Atmeh AR, Chong EZ, Richard G, Festy F, Watson TF (2012) Dentin-cement interfacial interaction: calcium silicates and polyalkenoates. J Dent Res 91:454–459. https://doi.org/10.1177/0022034512443068 CrossRefPubMedPubMedCentral

27.

Kaup M, Dammann CH, Schäfer E, Dammaschke T (2015) Shear bond strength of Biodentine, ProRoot MTA, glass ionomer cement and composite resin on human dentine ex vivo. Head Face Med 11:14. https://doi.org/10.1186/s13005-015-0071-z CrossRefPubMedPubMedCentral

28.

Schmidt A, Schäfer E, Dammaschke T (2017) Shear bond strength of lining materials to calcium silicate cements at different time intervals. J Adhes Dent 19:129–135. https://doi.org/10.3290/j.jad.a38100 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

31.

Katge FA, Patil DP (2017) Comparative analysis of 2 calcium silicate-based cements (Biodentine and mineral trioxide aggregate) as direct pulp-capping agent in young permanent molars: a split mouth study. J Endod 43:507–513. https://doi.org/10.1016/j.joen.2016.11.026 CrossRefPubMed

32.

Jang Y, Song M, Yoo I-S, Song Y, Roh B-D, Kim E (2015) A randomized controlled study of the use of ProRoot Mineral Trioxide Aggregate and Endocem as direct pulp capping materials: 3-months versus 1-year outcome. J Endod 41:1201–1206. https://doi.org/10.1016/j.joen.2015.03.015 CrossRefPubMed

33.

Marques MS, Wesselink PR, Shemesh H (2015) Outcome of direct pulp capping with mineral trioxide aggregate. J Endod 41:1026–1031. https://doi.org/10.1016/j.joen.2015.02.024 CrossRefPubMed

34.

Hegde S, Sowmya B, Mathew S, Bhandi SH, Nagaraja S, Dinesh K (2017) Clinical evaluation of mineral trioxide aggregate and Biodentine as direct pulp capping agents in carious teeth. J Conserv Dent 20:91–95. https://doi.org/10.4103/0972-0707.212243 CrossRefPubMedPubMedCentral

35.

Linu S, Lekshmi MS, Varunkumar VS, Sam Joseph VG (2017) Treatment outcome following direct pulp capping using bioceramic materials in mature permanent teeth with carious exposure: a pilot retrospective study. J Endod 43:1635–1639. https://doi.org/10.1016/j.joen.2017.06.017 CrossRefPubMed

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 CrossRefPubMed

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 1310–1329

38.

Kang CM, Sun Y, Song JS, Pang NS, Roh BD, Lee CY, Shin Y (2017) A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. J Dent 60:8–13. https://doi.org/10.1016/j.jdent.2016.07.015 CrossRefPubMed

39.

Alghaithy RA, Qualtrough AJ (2017) Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review. Int Endod J 50:135–142. https://doi.org/10.1111/iej.12611 CrossRefPubMed

40.

Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S (1986) Assessment of reliability of electrical and thermal pulp testing agents. J Endod 12:301–305CrossRefPubMed

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–S31

42.

Arun A, Mythri H, Chachapan D (2015) Pulp vitality tests - an overview on comparison of sensitivity and vitality. Indian J Oral Sci 6:41–46. https://doi.org/10.4103/0976-6944.162622 CrossRef

43.

Gopikrishna V, Pradeep G, Venkateshbabu N (2008) Assessment of pulp vitality: a review. Int J Paediatr Dent 19:3–15. https://doi.org/10.1111/j.1365-263X.2008.00955.x CrossRef

44.

Weisleder R, Yamauchi S, Caplan DJ, Trope M, Teixeira FB (2009) The validity of pulp testing: a clinical study. J Am Dent Assoc 140:1013–1017CrossRefPubMed

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 113:946–952PubMed

46.

Pereira JC, Segala AD, Costa CAS (2000) Human pulpal response to direct pulp capping with an adhesive system. Am J Dent 13:139–147PubMed

47.

Ræder J (2017) Objective measurement of subjective pain-experience: real nociceptive stimuli versus pain expectation. Scand J Pain 16:136–137. https://doi.org/10.1016/j.sjpain.2017.05.005 CrossRefPubMed

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 1–21

49.

Matsuo T, Nakanishi T, Shimizu H, Ebisu S (1996) A clinical study of direct pulp capping applied to caries-exposed pulps. J Endod 22:551–556CrossRefPubMed

50.

Taha NA, Abdelkhader SZ (2018) Outcome of full pulpotomy using biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J 51:819–828. https://doi.org/10.1111/iej.12903 CrossRefPubMed

51.

Gopikrishna V, Tinagupta K, Kandaswamy D (2007) Evaluation of efficacy of new custom-made pulse oximeter dental probe in comparison with electrical and thermal tests for assessing pulp vitality. J Endod 33:411–414. https://doi.org/10.1016/j.joen.2006.12.003 CrossRefPubMed

52.

Christensen GJ (1998) Pulp capping 1998. J Am Dent Assoc 129:1297–1299CrossRefPubMed

53.

Langeland K (1981) Management of the inflamed pulp associated with deep carious lesion. J Endod 7:169–181CrossRefPubMed

54.

Stanley HR (1998) Criteria for standardizing and increasing credibility of direct pulp capping studies. Am J Dent 11(Spec Iss):S17–S34PubMed

55.

Ahrens G, Reuver J (1973) Follow-up studies of direct pulp capping in the daily dental practice. Dtsch Zahnärztl Z 28:862–865PubMed

56.

Dammaschke T, Leidinger J, Schäfer E (2010) Long-term evaluation of direct pulp capping-treatment outcomes over an average period of 6.1 years. Clin Oral Investig 14:559–567. https://doi.org/10.1007/s00784-009-0326-9 CrossRefPubMed

57.

Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA (2006) The radiographic outcome of direct pulp-capping procedures performed by dental students. A retrospective study. J Am Dent Assoc 137:1699–1705CrossRefPubMed

58.

Tobias RS (1988) Antibacterial properties of dental restorative materials: a review. Int Endod J 21:155–160CrossRefPubMed

59.

Stockton LW (1999) Vital pulp capping: a worthwhile procedure. J Can Dent Assoc 65:328–331PubMed

60.

Możyńska J, Metlerski M, Lipski M, Nowicka A (2017) Tooth discoloration induced by different calcium silicate-based cements: a systematic review of in vitro studies. J Endod 43:1593–1601. https://doi.org/10.1016/j.joen.2017.04.002 CrossRefPubMed

Title: Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years
Authors: Carolin Sabine Harms
Edgar Schäfer
Till Dammaschke
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 9/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-018-2767-5

At a glance: The STEP trials

Springer Medicine

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

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