Pulpal Responses to Direct Capping with Betamethasone/Gentamicin Cream and Mineral Trioxide Aggregate: Histologic and Micro-Computed Tomography Assessments

Introduction: This clinical trial was conducted to evaluate the response of human dental pulp to direct capping with betamethasone/gentamicin (BG) cream and mineral trioxide aggregate (MTA). We hypothesized that the results of direct pulp capping with a topical BG combination would be similar to or better than those with MTA. Methods: Thirty-six human first premolar teeth scheduled for orthodontic extraction were randomly divided into 4 groups: BG1 group (n = 9), BG cream with 2-week follow-up; BG2 group (n = 10), BG cream with 8-week follow-up; MTA1 group (n = 8), MTA with 2-week follow-up; and MTA2 group (n = 9), MTA with 8-week follow-up. Teeth were extracted and evaluated at respective time intervals. Micro computed tomography scanning and histologic analyses were performed for all specimens. Pulp pathology (inflammation, pulp abscesses, and pulp necrosis) and reparative reaction (formation of dentin bridges) were recorded. Results: Both BG cream and MTA resulted in significantly better pulpal responses at 8 weeks than at 2 weeks. Dentin bridge formation was significantly thicker in the MTA group at 8 weeks than in any other group (P <.05). Inflammation was of the acute type in all groups; no statistically significant differences in the distribution of inflammatory cells were found among the groups. Pulpal abscesses and/or necrosis were observed more often in teeth capped with BG than with MTA. Conclusions: Direct pulp capping with both BG cream and MTA was associated with dentin bridge formation. MTA resulted in a significantly better pulpal response, with less inflammation and a thicker dentin bridge at 8 weeks.