Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: A randomized clinical trial

Comparative Evaluation of the Efficacy of TheraCal LC, Mineral Trioxide Aggregate, and Biodentine As Direct Pulp Capping Materials in Patients With Pulpal Exposure in Posterior Teeth: A Triple-Blinded Randomized Parallel Group Clinical Trial

Background The aim was to evaluate and compare the efficacy of TheraCal LC, mineral trioxide aggregate (MTA), and Biodentine as direct pulp capping (DPC) materials in patients with pulpal exposure in the posterior teeth. Methodology A total of 54 samples were assessed for eligibility. Out of this, 12 teeth samples failed to meet the inclusion criteria. Finally, 42 teeth samples were selected which were randomly distributed into three groups (n = 14). Groups A, B, and C received the intervention of MTA, Biodentine, and TheraCal LC, respectively. The assessment was performed clinically to check for postoperative pain, tenderness, and neural sensibility, and the radiographs were used to check the presence of periodontal ligament (PDL) space widening, calcified barrier, and periapical radiolucency at the follow-up of 21 days, three months, and 12 months. The outcomes depended on the clinical and radiographic success rates recorded at 12 months of recall. Results Overall successful outcome of DPC clinically at different periods was 97.61% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. The overall radiographic success rate of DPC at different time periods was 83.33% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. Conclusion Resin-based calcium-silicate agent (TheraCal LC) showed good efficacy and can be used in practice with the predictability of a good success rate both clinically and radiographically. Thus, TheraCal LC can be utilized as an alternative to MTA or Biodentine in clinical practice, with the predictability of similar successful outcomes in patients with pulpal exposure in the posterior teeth.

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study

OBJECTIVES

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period.

METHODS AND MATERIALS

Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits.

RESULTS

There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner.

CONCLUSIONS

After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Evaluation of Indirect Pulp Capping Using MTA, Light-cured Calcium Silicate, and Propolis in Primary Teeth: A Clinical and Radiographic Study Using VistaScan

Aims

Clinical and radiographic evaluation of mineral trioxide aggregate (MTA), TheraCal LC, and propolis when used as an indirect pulp capping agent in primary teeth over a period of 6 months.

Materials and methods

A total of 42 primary molar teeth from children aged 4-10 years were chosen for the study. The teeth were divided equally into three groups (group I: MTA, group II: light cured calcium silicate, and group III: propolis). The teeth were followed up clinically and radiographically at 3 and 6 months. The teeth that showed successful treatment outcomes clinically and radiographically were evaluated for the amount of dentin bridge formed at the end of 3 and 6 months, which was measured using CorelDRAW software. The data obtained was analyzed statistically using Statistical Package for the Social Sciences (SPSS) version 21.

Results

The mean change in dentin thickness from baseline to 3 months in group II was found to be the highest, followed by groups I and III. The mean change in dentin thickness from 3 months to 6 months was highest in group I, followed by groups III and II. The mean change in dentin thickness from baseline to 6 months in group II was found to be significantly higher than that of group I, followed by group III.

Conclusion

Clinically and radiographically, all three materials showed favorable outcomes when used as an indirect pulp capping material with significant reparative dentin formation. The highest amount of dentin deposition was recorded with light-cured calcium silicate, followed by MTA and propolis, respectively.

How to cite this article

Saikia D, Yadav G, Saha S, et al. Evaluation of Indirect Pulp Capping Using MTA, Light-cured Calcium Silicate, and Propolis in Primary Teeth: A Clinical and Radiographic Study Using VistaScan. Int J Clin Pediatr Dent 2023;16(5):686-691.

A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial

Background

Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years.

Materials and Methods

In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4-6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05.

Results

Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I - P ≤ 0.001, Group II - P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups.

Conclusion

Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

LIGHT-CURED CALCIUM SILICATE BASED-CEMENTS AS PULP THERAPEUTIC AGENTS: A META-ANALYSIS OF CLINICAL STUDIES

OBJECTIVES

To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?

MATERIALS AND METHODS

The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison.

RESULTS

Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21).

CONCLUSIONS

Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries.

CLINICAL SIGNIFICANCE

This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.

Clinical Efficacy of Biomimetic Bioactive Biomaterials for Dental Pulp Capping: A Systematic Review and Meta-Analysis

Recently, biomimetic bioactive biomaterials have been introduced to the market for dental pulp capping. This systematic review and meta-analysis aimed to determine any variation between the effect of using TheraCal LC and other bioactive biomaterials for pulp capping is different, as measured by dentin increment and clinical success. The risk of bias was assessed using the Risk of Bias 2 and Newcastle−Ottawa tools for randomized clinical trials and observational studies. A search for relevant articles was performed on five databases. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. The odds ratio of data from clinical success was combined using a random-effects meta-analysis. The meta-analysis results showed homogeneity between the studies (I2 = 0%). They revealed that the clinical success showed no differences between the patients who received TheraCal LC, light-cured calcium silicate-based biomimetic biomaterial, for dental pulp capping or the comparator biomaterials (p > 0.5). However, the certainty of the evidence was low to moderate due to the risk of bias in the included studies.

Tomographic Evaluation of the Internal Adaptation for Recent Calcium Silicate-Based Pulp Capping Materials in Primary Teeth

Objectives

To evaluate the internal adaptation of recent pulp capping materials (TheraCal and Biodentine) relative to MTA when used as indirect pulp capping for primary teeth.

Materials and Methods

Thirty primary molars were randomly allocated into three groups, group (A) was TheraCal, group (B) was Biodentine, and MTA was the control group (C). A standardized round class-V cavity (1.5 mm diameter and 2 mm depth) was prepared using a milling machine on the buccal surface of each tooth with the pulpal floor located on the dentin. Then, pulp-capping materials were applied. Finally, all teeth were restored by composite restoration. The internal adaptation of the pulp-capping materials to the dentinal surface was investigated by microcomputed tomography (Micro-CT) to determine the internal gap volume, and by optical coherence tomography (OCT) to determine the high-intensity reflection of light from the floor.

Results

Based on Micro-CT findings, TheraCal showed significantly higher internal gap volume than both MTA and Biodentine (p < 0.001), while MTA and Biodentine did not show a significant difference in the gap volume. Based on the OCT findings, TheraCal showed a significantly higher intensity of light reflection than both MTA and Biodentine (p < 0.001); however, there was no significant difference between MTA and Biodentine. Pearson's correlation test showed that there was a strong positive correlation between Micro-CT and OCT (r = 0.686, N = 30, p < 0.001).

Conclusions

Biodentine and MTA showed a comparable result in terms of their internal adaptation on the dentinal surface of the primary teeth, and both were better than TheraCal. There is a moderate to a strong positive correlation between Micro-CT and OCT in the measurement of internal adaptation of the tested pulp capping materials. OCT can be helpful and beneficial for the clinical setting and allow dentists to screen and evaluate restorations during follow-up.

Two-Dimensional Analysis of Digital Images through Vector Graphic Editors in Dentistry: New Calibration and Analysis Protocol Based on a Scoping Review

This review was carried out to analyse the functions of three Vector Graphic Editor applications (VGEs) applicable to clinical or research practice, and through this we propose a two-dimensional image analysis protocol in a VGE. We adapted the review method from the PRISMA-ScR protocol. Pubmed, Embase, Web of Science, and Scopus were searched until June 2020 with the following keywords: Vector Graphics Editor, Vector Graphics Editor Dentistry, Adobe Illustrator, Adobe Illustrator Dentistry, Coreldraw, Coreldraw Dentistry, Inkscape, Inkscape Dentistry. The publications found described the functions of the following VGEs: Adobe Illustrator, CorelDRAW, and Inkscape. The possibility of replicating the procedures to perform the VGE functions was analysed using each study’s data. The search yielded 1032 publications. After the selection, 21 articles met the eligibility criteria. They described eight VGE functions: line tracing, landmarks tracing, linear measurement recording, angular measurement recording, image calibration, image overlay, file transfer, and vector graphics development. The features offered by the VGEs bring great precision and objectivity to two-dimensional image analysis. The image analysis and editing procedures are currently not protocolised. Thus, a protocol for image calibration and measurement recording is proposed in order to guarantee the protocol’s replication.

Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial

OBJECTIVES

The aim of this randomized, controlled, three-arm parallel group, and double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth.

MATERIALS AND METHODS

The study included a total of 109 patients aged 5-9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) hard-setting calcium hydroxide (Dycal) (control group) (n = 36), (II) bioactive tricalcium silicate (Biodentine) (n = 37), and (III) resin-based tricalcium silicate (TheraCal LC) (n = 36). All the teeth were evaluated clinically and radiographically at 6, 12, 18, and 24 months postoperatively. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24-40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation quality of the dentin formed, severity of pulpitis, and other pulpal changes. Data were analyzed using Fisher's exact test, Pearson's chi-square test, and McNemar's test (p = 0.05).

RESULTS

At the end of the 24-month follow-up period, the clinical and radiographic success rates for Dycal, Biodentine, and TheraCal LC were 100%, 100%, and 93.3%, respectively, and there was no significant difference among the groups (p > 0.05). However, the TheraCal LC group was statistically unsuccessful when compared to the other groups with regard to the integrity of the odontoblastic layer, severity of pulpitis, and other pulpal changes in histological examination (p < 0.05).

CONCLUSION

Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC.

CLINICAL RELEVANCE

Resin-free calcium silicate-based materials appear to be more favorable in the indirect pulp treatment of primary teeth, particularly in young-age groups that require long-term success.

Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review

Aim

To provide an overview of the techniques of indirect pulp treatment (IPT) and the new materials used.

Background

Indirect Pulp Treatment (IPT) is a conservative treatment approach that can be used in primary molars. Pulpotomy has been adopted as the treatment of choice for deep caries in primary molars. IPT showed higher success rates in recent researches.

Materials and methods

Electronic search of English scientific papers was accomplished using PubMed, ScienceDirect, and Scopus. Papers published from 1995 to 2019 were included. Search terms used were recent advances, indirect pulp treatment, mineral trioxide aggregate (MTA), biodentine, TheraCal–LC, chlorhexidine gluconate (CHX), resin-modified glass ionomer (RMGI), and calcium hydroxide.

Review results

Seventy two papers were obtained from the electronic search and references of selected studies. Thirty five papers explained recent advances in IPT materials for primary molars. MTA produces more dentinal bridging with superior quality than calcium hydroxide. Similarly, Biodentine can form reparative dentin in a very short period. TheraCal–LC has increased stability and durability with strong physical properties and low solubility. Furthermore, CHX is a chemical disinfectant which can aid in increasing the success rate of IPT when conjugated with other materials. It produced highly successful IPT when combined with RMGI or calcium hydroxide.

Conclusion

IPT is the preferred treatment approach for preservation of primary dentition. CHX is an emerging material that can provide promising results in IPT when combined with other materials.

Clinical significance

Up to date, no material had replaced the popular use of calcium hydroxide in IPT. The use of CHX with RMGI can increase the success rate while preserving the advantages of the latter as it is considered the liner of choice for primary teeth, making IPT a suitable substitute for pulpotomy in primary molars.

How to cite this article

Saber AM, El Meligy OA, Alaki SM. Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review. Int J Clin Pediatr Dent 2021;14(6):795–801.

Antibacterial activities and mineral induction abilities of proprietary MTA cements

Mineral trioxide aggregate (MTA) cements are used in direct pulp capping and many other applications, and several types of these products have been commercialized. The aim of this study was to examine the antibacterial effects and mineral induction abilities of three conventional MTA cements and one resin-modified MTA cement. Agar diffusion tests revealed that, after setting, all four cements exhibited little antibacterial effects against Enterococcus faecalis and Streptococcus mutans, with no significant differences among the materials. After 24 h, E. faecalis and S. mutans suspensions incubated in the presence of each cement did not exhibit reduced numbers of viable bacteria, compared with those same bacterial suspensions incubated without any cement; this indicated that none of the cements inhibited bacterial growth. Furthermore, the resin-modified MTA cement exhibited lower mineral induction ability, compared with that of the three conventional MTA cements.

Remineralization ability of two hydraulic calcium-silicate based dental pulp capping materials: Cell-independent model

BACKGROUND

This study aimed to evaluate remineralizing ability of two hydraulic calcium-silicate cements (Biodentine and TheraCal LC).

MATERIAL AND METHODS

Artificial carious lesions were introduced into the pulpal floors (1-1.5 mm) and axial walls of occlusal prepared cavity halves through pH cycling. Cycling was made through demineralizing solution (pH 3), for 8 hours and remineralizing solution (pH 7) for 16 hours. The total period of pH cycling was 14 days. Prepared cavities with the tested materials seated directly on the pulpal floor and in contact with the axial walls were stored in phosphate buffer solutions (PBS) (pH 7.2-7.4). The changes in the weight percentages (wt%) of calcium (Ca) and phosphorus (P) were detected using SEM and energy dispersive X-ray spectroscopy with reference to sound dentin after three intervals (one week, 3 and 6 months). Data were statistically analyzed using two-way ANOVA and Tukey's post hoc test.

RESULTS

Demineralized dentin, next to Biodentine, showed statistically higher intensities of Ca and P wt% after the three periods of incubation (p< 0.05). Surface mapping of both tested cements and their adjacent demineralized dentin showed increase in overall distribution of previous ions. SEM of subsurface layer under both materials showed filling of most intra-tubular areas with rod-like mineralized structure without significant difference.

CONCLUSIONS

Biodentine has a higher ability to enrich the artificial carious dentin with significantly higher mineral contents available for remineralization. Both pulp-capping materials have significantly induced remineralization of demineralized dentin beneath them after total period of incubation. Key words:Artificial Caries, Hydraulic Cements, pH Cycling, Remineralization.

Clinical and Radiographic Success of Selective Caries Removal to Firm Dentin in Primary Teeth: 18-Month Follow-Up

The selective caries removal is increasingly spreading in daily clinical practice because this minimally invasive technique treats deep carious lesion and decreases the risk of pulp exposure. This case report was aimed at describing the selective removal to firm dentin on the primary mandibular left first molar of a girl aged 7 years and 6 months. The Mineral Trioxide Aggregate (MTA Angelus™) was used as liner, and the tooth was definitively restored with resin-modified glass ionomer cement (Vitremer™). The clinical and radiographic following-up was performed at 6, 12, and 18 months after treatment. The treatment showed satisfactory results after 18-month following-up, suggesting that this minimally invasive approach for carious lesion removal can replace the total removal, when properly indicated. Notwithstanding, further randomized clinical trials with longer following-up periods are still necessary.

TheraCal LC: From Biochemical and Bioactive Properties to Clinical Applications

Background

Direct pulp capping is a popular treatment modality among dentists. TheraCal LC is a calcium silicate-based material that is designed as a direct/indirect pulp capping material. The material might be very attractive for clinicians because of its ease of handling. Unlike other calcium silicate-based materials, TheraCal LC is resin-based and does not require any conditioning of the dentine surface. The material can be bonded with different types of adhesives directly after application. There has been considerable research performed on this material since its launching; however, there are no review articles that collates information and data obtained from these studies. This review discusses the various characteristics of the material with the aim of establishing a better understanding for its clinical use.

Methods

A search was conducted using search engines (PubMed and Cochrane databases) in addition to reference mining of the articles that was used to locate other papers. The process of searching for the relevant studies was performed using the keywords pulp protection, pulp capping, TheraCal, and calcium silicates. Only articles in English published in peer-reviewed journals were included in the review.

Conclusion

This review underlines the fact that further in vitro and in vivo studies are required before TheraCal LC can be used as a direct pulp capping material.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.