Efficacy of different calcium silicate materials as pulp-capping agents: Randomized clinical trial

Background/purpose: Calcium hydroxide-based materials were the gold standard in vital pulp therapies for decades' despite of several shortcomings. However, calcium silicates have been discussed as an alternative to overcome these drawbacks. It was aimed to investigate the in-vivo effectiveness of different calcium silicates based materials in pulp capping in this study. Materials and methods: A parallel-design, randomized controlled trial with 213 patients who has deep dentin caries, vital pulps and without spontaneous pain or history of swelling was designed. 525M teeth were randomized, blinded and allocated to one of the five groups for pulp capping treatment (n = 105). All teeth were followed up clinically and radiographically (after 1st, 6th, 12th and 36th months) by blinded investigators. The clinical and radiographic success, and the effect of the pulp exposure to the success rate analyzed with Wald chi-square and Z tests. Results: Clinical and radiographic success of MTA+ (86.3%, 85.4%) and Biodentine (79.4%, 80.1%) were found the highest. Although results of Theracal LC group (72.1%, 73.6%) were better than Dycal group (69.4%, 70.2%), the difference was nonsignificant (p > 0.05). Only in light-cured groups, (TheraCal LC & LC Calcihyd) pulpal exposure size effected the success of the materials (p < 0.05). MTA+ and Biodentine resulted better scores, when compared with TheraCal LC in large pulpal exposures (p < 0.05). Conclusion: After 36-month follow-up, both MTA+ and Biodentine were found to be the appropriate material for direct pulp capping in permanent teeth. The filler ingredient of the Theracal-LC eases the usage of calcium silicates but decreases the success rate. (C) 2020 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.

Automated summary

The study aimed to investigate the effectiveness of different calcium silicate-based materials in pulp capping. MTA+ and Biodentine showed the highest clinical and radiographic success rates, while Theracal LC group had slightly better results than Dycal group. Pulp exposure size only affected the success of materials in light-cured groups, with MTA+ and Biodentine performing better in large pulp exposures. After 36 months, MTA+ and Biodentine were found to be suitable materials for direct pulp capping in permanent teeth.