Success Rate of Direct Pulp Capping with Conventional Procedures Using Ca (OH)2 and Bioactive Tricalcium Silicate Paste vs. Laser-Assisted Procedures (Diode 980 nm, CO2, and Er: YAG)

Direct pulp capping (DPC) is reliable in pulp exposure management. Objective: This study aimed to assess the success rate of DPC materials and different laser protocols. The included procedures were CO2 laser (n = 1147), Er: YAG laser (n = 69), and 980 nm diode laser (n = 124), on the one hand, and Ca (OH)(2) (n = 376) and bioactive tricalcium silicate paste, on the other (n = 279). Materials and methods: Data from 1995 DPC cases were included. For laser groups, irradiation was used to coagulate the pulp exposure followed by Ca (OH)(2) placement. Data with follow-up at 12, 24, and 36 months post-treatment were included. The irradiation parameters for the CO2 laser were as follows: energy density per pulse of 141 J/cm(2), 1 W power, 0.3 mm beam diameter, 100 ms pulse duration, and 1 Hz, and a series of five pulses maximum were delivered during 5 s. For the 980 diode lasers: 1.5 W power, continuous wave (CW), 400 & mu;m fiber diameter, contact mode, 190.98 W/cm(2) power density, and total delivered energy density of 2387 J/cm(2). For the Er: YAG laser: 0.5 W output power, 9.95 J/cm(2) energy density, a beam diameter of 0.8 mm, 300 & mu;sec pulse duration, 10 Hz, non-contact mode, irradiation with air without water spray, and an average irradiation time of 8-10 s. Results: At the 3-year follow-up, the success percentages were as follows: CO2 (88.01%) > Ca (OH)(2) (75.72%) > diode (70.01%) > Er: YAG (54.55%) > bioactive tricalcium silicate paste (51.1%). The timing of permanent filling (immediate or delayed), patient age, size of pulp exposure, tooth type, and exposure etiology significantly affected the success rate. Patients aged & LE; 35 years presented higher success (70.91%) compared to those & GE; 36 years (61.2%). Immediate permanent fillings increase the success rate (71.41%) compared to delayed permanent fillings (65.93%). Exposure in molars and premolars significantly lowers the success rate (60.3%) compared to canines and incisors (72.1%). Idiopathic pulp exposure presented higher success (72.58%) compared to caries-related causes (63.7%). Conclusion: The highest success rate was in the CO2 laser group followed by the diode and Ca (OH)(2), Er: YAG, and bioactive tricalcium silicate material (biodentine) groups. The age factor, filling timing, size of exposure, tooth type, and exposure etiology can significantly affect the success rate of DPC.

Automated summary

This study aimed to evaluate the success rate of different lasers and materials in direct pulp capping. The results showed that the CO2 laser group had the highest success rate, followed by the Er: YAG laser, 980 nm diode laser, and Ca(OH)2 group. Factors such as patient age, filling timing, size of exposure, tooth type, and exposure etiology significantly influenced the success rate.