Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months

SUMMARY Objective: This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)2] in the treatment of deep carious lesions by the direct complete caries removal technique. Methods and Materials: A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)2 (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05. Results: The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)2 (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively). Conclusions: Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

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Evaluation of clinical and radiological outcomes of mineral trioxide aggregate and calcium hydroxide as indirect pulp capping agents in the treatment of deep carious lesion of permanent teeth

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v9i3.29462 ◽

2016 ◽

Vol 9 (3) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Rafeza Sultana ◽

Mozammal Hossain ◽

Md. Shamsul Alam

Keyword(s):

Calcium Hydroxide ◽

Mineral Trioxide Aggregate ◽

Permanent Teeth ◽

Capping Agents ◽

Pulp Capping ◽

Carious Lesions ◽

Reparative Dentin ◽

Deep Carious Lesions ◽

Pulp Vitality ◽

Indirect Pulp Capping

<p>The maintenance of pulp vitality and conduction of reparative dentin can be possible by indirect pulp capping with mineral trioxide aggregate (MTA) and calcium hydroxide as pulp capping agents. The objective of the study is to assess the clinical and radiological outcomes of MTA and calcium hydroxide as indirect pulp capping agents in deep carious lesions of permanent teeth. The present study included 50 permanent teeth having deep carious lesions with reversible pulp status were selected and then randomly divided into two groups of 25 teeth in a group. Standard indirect pulp capping procedures were followed. Patients were recalled at 3, 6 and 12 months interval to assess postoperative pain, the vitality of the pulp and formation of reparative dentin. In all observation periods, MTA showed more capable of reducing pain and maintain pulp vitality which was statistically significant than that of calcium hydroxide. At 12 months observation period, 24 teeth (96%) of MTA and 19 teeth (76%) of calcium hydroxide showed reparative dentin formation. It can be concluded that MTA is more effective than that of calcium hydroxide.</p><p> </p>

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Microbiological Findings in Deep Caries Lesions

Stomatoloski glasnik Srbije ◽

10.1515/sdj-2016-0001 ◽

2016 ◽

Vol 63 (1) ◽

pp. 7-14 ◽

Cited By ~ 1

Author(s):

Irena Kuzmanović Radman ◽

Aleksandra Djeri ◽

Adriana Arbutina ◽

Jelena Milašin

Keyword(s):

Calcium Hydroxide ◽

Bacterial Species ◽

Permanent Teeth ◽

Microbiological Analysis ◽

Oral Diseases ◽

Pulp Capping ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Caries Lesions ◽

Indirect Pulp Capping

SUMMARY Introduction Caries is one of the most significant and widespread oral diseases. It has been confirmed that dental plaque, i.e. microorganisms in it, are the most important factor in the development of dental caries. Caries profunda represents deep carious lesion from where bacterial toxins may affect pulp through dentinal tubules. The aim of this study is to assess the efficacy of indirect pulp capping based on microbiological findings of bacteria present in deep carious lesions before and after the treatment. Material and Methods The clinical study included 29 patients of both genders, aged 16 to 40 and 45 permanent teeth with deep caries lesions. The first microbiological sample was taken after cavity preparation and removal of soft dentin from the bottom of the cavity. The second sample was taken after the removal of temporary filling and calcium hydroxide paste 60 days after the indirect pulp capping treatment. The collected samples were stored in special sterile micro tubes (Eppendorf) and kept at the temperature of −80°C until microbiological analysis was performed. Samples were tested for the presence of the following microorganisms: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Enterococcus faecalis using the multiplex polymerase chain reaction (PCR) method. Results The results showed that prior to the treatment of deep carious lesions the most common species was E. faecalis (80% of samples), followed by A. actinomycetemcomitans (32% of samples), while the least common was P. gingivalis (16% of samples). After the treatment with products based on calcium hydroxide, E. faecalis was registered in 18% of samples, A. actinomycetemcomitans in 16% of samples and P. gingivalis was not registered in any sample. Conclusion The most common bacterial species in teeth with deep caries lesions was E. faecalis, whereas A. actinomycetemcomitans and P. gingivalis were found in lower number of samples.

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Comparison of Clinical Success between Three Different Materials- Direct Pulp Capping of Carious Molars- An In-vivo Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i49a33320 ◽

2021 ◽

pp. 192-200

Author(s):

K. E. Selvendran ◽

A. Shafie Ahamed ◽

Madhuram Krishnamurthy ◽

V. Naveen Kumar ◽

Vignesh Guptha Raju

Keyword(s):

Clinical Trial ◽

Calcium Hydroxide ◽

Clinical Success ◽

Mineral Trioxide Aggregate ◽

Direct Pulp Capping ◽

Pulp Capping ◽

Carious Lesions ◽

Deep Carious Lesions ◽

Better Than

Aim: To evaluate the clinical success of Calcium Hydroxide (CH), Mineral trioxide aggregate (MTA) and Biodentine as pulp capping materials for Direct pulp capping in carious molars. Materials and Methods: Thirty-six molars of thirty-six patients with deep caries lesions, diagnosed with reversible pulpitis were subjected to direct pulp capping treatment. They were randomly divided into three groups, Biodentine (12 teeth) or MTA group (12 teeth) or CH group (12teeth). Simple randomization of three was employed to allocate the treatment materials. Patients were recalled at one, three and six months to evaluate the clinical success of the treatment outcome. Results: In clinical trial/study, the pulp capping materials gave different success rate, 91.67% success in the Biodentine group, 75% success in the MTA group and 41.67% success in Calcium Hydroxide group. Conclusion: In our study the materials tested at 1 month, 3 month and 6-month follow-up, Calcium Silicate materials are better than calcium hydroxide and comparably Biodentine is better than MTA for Direct pulp capping. Clinical Significance: The findings of this clinical trial could promote the reliability of pulp capping materials for treatment of deep carious lesions by conservative approach rather than opting endodontic management.

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Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BMC Oral Health ◽

10.1186/s12903-021-01637-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jan E. Clarkson ◽

Craig R. Ramsay ◽

David Ricketts ◽

Avijit Banerjee ◽

Chris Deery ◽

...

Keyword(s):

Dental Health ◽

Controlled Clinical Trial ◽

Trial Registry ◽

Posterior Teeth ◽

Carious Lesions ◽

Randomised Controlled Clinical Trial ◽

Deep Carious Lesions ◽

Caries Removal ◽

Randomised Controlled ◽

Selective Caries Removal

Abstract Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

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Clinical assessment of mineral trioxide aggregate in the treatment of deep carious lesions

Nigerian Journal of Clinical Practice ◽

10.4103/1119-3077.183252 ◽

2017 ◽

Vol 20 (5) ◽

pp. 600 ◽

Cited By ~ 2

Author(s):

UK Vural ◽

A Kiremitçi ◽

S Gökalp

Keyword(s):

Clinical Assessment ◽

Mineral Trioxide Aggregate ◽

Carious Lesions ◽

Deep Carious Lesions

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Histologic Evaluation of Tertiary Dentine after Indirect Pulp Capping Procedures

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.695.260 ◽

2016 ◽

Vol 695 ◽

pp. 260-263

Author(s):

Monica Monea ◽

Mihai Pop ◽

Alexandra Stoica ◽

Teodora Ștefănescu

Keyword(s):

Calcium Hydroxide ◽

Mineral Trioxide Aggregate ◽

Time Interval ◽

Permanent Molar ◽

Tertiary Dentin ◽

Carious Lesions ◽

Histologic Evaluation ◽

Diffuse Calcification ◽

Histological Characteristics ◽

Secondary Dentine

Early carious lesions induce odontoblast stimulation in tertiary dentine formation even before the lesion reaches the dentine. The most used material for these procedures was calcium hydroxide, which was recently replaced by Mineral Trioxide Aggregate (MTA).The purpose of our study was to assess the histological characteristics of tertiary dentine induced by these materials in permanent molar teeth.We used 23 molars scheduled for extraction due to orthodontic reasons, in patients of 17-24 years of age. In a time interval of 4-8 weeks prior to extraction, occlusal cavities were prepared and filled with MTA or calcium hydroxide and glass ionomer cement.In teeth filled with MTA we noticed an early development of tertiary dentin layer, with a tubular structure, similar to secondary dentine. In the case of calcium hydroxide, the process of new dentine deposition was delayed and diffuse calcification, with formation of pulp stones was noticed.MTA proved to be superior to calcium hydroxide in inducing tertiary dentine formation, which appeared early after treatment. In time the differences in the amount of tertiary dentine between these materials are reduced, but there is a tendency of diffuse mineralization induced by calcium hydroxide.

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Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study

International Journal of Dentistry ◽

10.1155/2021/3059129 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Jutharat Manuschai ◽

Supitcha Talungchit ◽

Supawadee Naorungroj

Keyword(s):

Permanent Teeth ◽

Carious Lesion ◽

Micro Ct ◽

Silver Diamine Fluoride ◽

Carious Lesions ◽

Significant Difference ◽

Group A ◽

Deep Carious Lesions ◽

Caries Removal ◽

Group B

Background. When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective. The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods. Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results. The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed ( p value = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion. Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

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