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

• Published in: Journal of endodontics Vol. 41; no. 7; pp. 1026 - 1031
• Main Authors: Marques, Miguel Seruca, DDS, Wesselink, Paul R., DDS, PhD, Shemesh, Hagay, DMD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Adult; Aluminum Compounds - therapeutic use; Calcium Compounds - therapeutic use; Complete excavation; Dental Caries - pathology; Dental Caries - therapy; Dental Cements - therapeutic use; Dental Pulp Capping - methods; Dental Pulp Exposure - therapy; Dental Restoration, Permanent - methods; Dentistry; direct pulp capping; Drug Combinations; Endocrinology & Metabolism; Female; Humans; Male; mineral trioxide aggregate; Oxides - therapeutic use; Prospective Studies; Silicates - therapeutic use; Treatment Outcome; direct pulp capping; mineral trioxide aggregate; Complete excavation
• ISSN: 0099-2399; 1878-3554
• DOI: 10.1016/j.joen.2015.02.024

Abstract Introduction The aim of this experimental study was to assess the outcome of direct pulp capping with mineral trioxide aggregate (MTA) after complete excavation of caries in permanent dentition with a 2-visit treatment protocol. Methods Sixty-four teeth with deep carious lesions were consecutively selected. The mean age of the patients was 36.1 ± 15 years. An initial diagnosis of deep caries, with no irreversible pulp involvement, was made. Excavation of caries was performed under a rubber dam and operating microscope magnification. White MTA was applied, and a provisional restoration was placed. At the following appointment, positive sensibility testing and the MTA setting were confirmed. Bonded composite restorations were placed afterward. The patient was recalled at least 1 year after treatment for clinical and radiographic control. Outcome was described as success or failure. Success was defined as lack of complaints from the patient, positive reaction to cold testing, no sensitivity to percussion, and no widening of the periodontal ligament on the recall periapical radiograph. Results Forty-six teeth (77.9%) were recalled after 3.6 years (standard deviation = 1.1 years). The overall success rate was 91.3%. The success rate in occlusal caries was 100% and 89.7% in proximal caries (difference = 10.3%; 95% confidence interval [CI], 8.5–89.1). The success rate in initial caries was 94.7% and 88.9% in secondary caries (difference = 5.8%; 95% CI, −48.1 to 59.7). The success rate in patients younger than 40 years was 100% and 80% in patients aged 40 years or older (difference = 20%; 95% CI, 4.2–35.8). Conclusions Direct pulp capping with MTA after pulp exposure during excavation of deep caries could maintain pulp vitality in permanent teeth when a 2-visit treatment protocol is observed.