Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide

AimThe aim of this multicentre, parallel-group randomized clinical trial was to compare the effectiveness of mineral trioxide aggregate (MTA) and a conventional calcium hydroxide liner (CH) as direct pulp capping materials in adult molars with carious pulpal exposure. MethodologySeventy adults aged 18-55years were randomly allocated to two parallel arms: MTA (White ProRoot, Dentsply, Tulsa Dental, Tulsa, OK, USA; n=33) and CH (Dycal((R)), Dentsply DeTrey GmbH, Konstanz, Germany; n=37). The teeth were temporized for 1week with glass-ionomer (Fuji IX, GC Corp, Tokyo, Japan) and then permanently restored with a composite resin. The subjects were followed up after 1week and at six, 12, 24 and 36months. The primary outcome was the survival of the capped pulps, and the secondary outcome was postoperative pain after 1week. Survival was defined as a nonsymptomatic tooth that responded to sensibility testing and did not exhibit periapical changes on radiograph. At each check-up, the pulp was tested for sensibility and a periapical radiograph was taken (excluding the radiographs taken at the 1-week follow-up). Kaplan-Meier survival analysis and log-rank test were used to assess the significant difference in the survival curves between groups. Chi-square test was used to assess the association between the materials and preoperative and postoperative pain. ResultsAt 36months, the Kaplan-Meier survival analysis showed a cumulative estimate rate of 85% for the MTA group and 52% for the CH group (P=0.006). There was no significant association between the capping material and postoperative pain. ConclusionsMineral trioxide aggregate performed more effectively than a conventional CH liner as a direct pulp capping material in molars with carious pulpal exposure in adult patients. This study has been registered at ClinicalTrials.gov, number NCT01224925.