Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial
1Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, 11566 Cairo, Egypt
DOI: 10.22514/jocpd.2023.004 Vol.47,Issue 2,March 2023 pp.10-22
Submitted: 24 August 2022 Accepted: 03 November 2022
Published: 03 March 2023
*Corresponding Author(s): Mariem Wassel E-mail: mariem.wassel@dent.asu.edu.eg
Selecting an appropriate vital pulp therapy (VPT) for primary teeth with reversible pulpitis can sometimes be confusing for clinicians. Encouragingly, continuous developments in capping materials with bioactive properties help the selection of less-invasive treatments. This non-randomized clinical trial aimed to assess the clinical and radiographic success rates of indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP) and pulpotomy in primary molars utilizing TheraCal PT over a 12-month period. Different inclusion criteria were assigned for each treatment to assess the eligibility of each treatment type for specific clinical scenarios. Additionally, the association of tooth survival with some variables was assessed. The trial was registered at clinicaltrials.gov (NCT04167943) on 19 November 2019. Primary molars (n = 216) with caries extending into the inner dentin third or quarter were included. Selective caries removal was employed in IPT. Non-selective caries removal was employed in other groups, and treatment was decided according to pulp exposure characteristics, whereby the most conservative treatment was selected for the least clinically detectable pulp inflammation. Cox regression was performed to assess the effects of different variables on tooth survival using p ˂ 0.05 for detecting statistical significance. The 12-month combined clinical and radiographic success rates for IPT, DPC, PP and pulpotomy were 93.87%, 80.4%, 42.6% and 96.15%, respectively. Proximal surface involvement, provoked pain and first primary molars were associated with increased odds of treatment failure. According to the specified inclusion criteria, IPT, DPC and pulpotomy using TheraCal PT demonstrated acceptable results, while PP was associated with poor treatment outcomes. The odds of failure increased with proximal surface involvement, provoked pain and first primary molars. These results provide insights into different scenarios when managing deep carious lesions in primary teeth. The effects of clinical predictors on treatment outcomes may guide clinicians in case selection.
Indirect pulp treatment; Direct pulp capping; Partial pulpotomy; Pulpotomy; Primary teeth; TheraCal PT
Mariem Wassel,Dina Hamdy,Reham Elghazawy. Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial. Journal of Clinical Pediatric Dentistry. 2023. 47(2);10-22.
[1] Monteiro J, Ní Chaollaí A, Duggal M. The teaching of management of the pulp in primary molars across Europe. European Archives of Paediatric Dentistry. 2017; 18: 203–208.
[2] Dhar V, Marghalani AA, Crystal YO, Kumar A, Ritwik P, Tulunoglu O, et al. Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry. 2017; 39: E146–E159.
[3] Nematollahi H, Noorollahian H, Bagherian A, Yarbakht M, Nematollahi S. Mineral trioxide aggregate partial pulpotomy versus formocresol pulpotomy: a randomized, split-mouth, controlled clinical trial with 24 months follow-up. Pediatric Dentistry. 2018; 40: 184–189.
[4] Dos Santos NM, Leal SC, Gouvea DB, Sarti CS, Toniolo J, Neves M, et al. Sealing of cavitated occlusal carious lesions in the dentine of deciduous molars: a two-year randomized controlled clinical trial. Clinical Oral Investigations. 2022; 26: 1017–1024.
[5] BaniHani A, Santamaría RM, Hu S, Maden M, Albadri S. Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review. European Archives of Paediatric Dentistry. 2022; 23: 667–693.
[6] Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Advances in Dental Research. 2016; 28: 58–67.
[7] Garrocho-Rangel A, Quintana-Guevara K, Vázquez-Viera R, Arvizu-Rivera JM, Flores-Reyes H, Escobar-García DM, et al. Bioactive tricalcium silicate-based dentin substitute as an indirect pulp capping material for primary teeth: a 12-month follow-up. Pediatric Dentistry. 2017; 39: 377–382.
[8] Franzon R, Guimarães LF, Magalhães CE, Haas AN, Araujo FB. Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial. Caries Research. 2014; 48: 376–383.
[9] Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatric Dentistry. 2000; 22: 278–286.
[10] Boutsiouki C, Frankenberger R, Krämer N. Relative effectiveness of direct and indirect pulp capping in the primary dentition. European Archives of Paediatric Dentistry. 2018; 19: 297–309.
[11] Sujlana A, Pannu PK. Direct pulp capping: a treatment option in primary teeth? Pediatric Dental Journal. 2017; 27: 1–7.
[12] Chatzidimitriou K, Vadiakas G, Koletsi D. Direct pulp capping in asymptomatic carious primary molars using three different pulp capping materials: a prospective clinical trial. European Archives of Paediatric Dentistry. 2022; 23: 803–811.
[13] Canoğlu E, Güngör CH, Uysal S. Direct pulp capping of primary molars with calcium hydroxide or MTA following hemorrhage control with different medicaments: randomized clinical trial. Pediatric Dentistry. 2022; 44: 167–173.
[14] Winters J, Cameron AC, Widmer RP. Pulp therapy for primary and immature permanent teeth. Handbook of Pediatric Dentistry. 2013; 30: 103–122.
[15] Ibrahim S. Vital pulp therapy an insight over the available literature and future expectations. European Endodontic Journal. 2020; 5: 46–53.
[16] Koutroulis A, Kuehne SA, Cooper PR, Camilleri J. The role of calcium ion release on biocompatibility and antimicrobial properties of hydraulic cements. Scientific Reports. 2019; 9: 1–10.
[17] Varma B, Menon N, Janardhanan S, Kumaran P, Xavier A, Govinda B. Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: a randomized clinical trial. Contemporary Clinical Dentistry. 2016; 7: 475.
[18] Sanz JL, Soler-Doria A, López-García S, García-Bernal D, Rodríguez-Lozano FJ, Lozano A, et al. Comparative biological properties and mineralization potential of 3 endodontic materials for vital pulp therapy: Theracal PT, Theracal LC, and Biodentine on human dental pulp stem cells. Journal of Endodontics. 2021; 47: 1896–1906.
[19] Rodríguez-Lozano FJ, López-García S, García-Bernal D, Sanz JL, Lozano A, Pecci-Lloret MP, et al. Cytocompatibility and bioactive properties of the new dual-curing resin-modified calcium silicate-based material for vital pulp therapy. Clinical Oral Investigations. 2021; 25: 5009–5024.
[20] Duggal MS, Nooh A, High A. Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. European Journal of Paediatric Dentistry. 2002; 3: 111–114.
[21] Vafaei A, Azima N, Erfanparast L, Løvschall H, Ranjkesh B. Direct pulp capping of primary molars using a novel fast-setting calcium silicate cement: a randomized clinical trial with 12-month follow-up. Biomaterial Investigations in Dentistry. 2019; 6: 73–80.
[22] Nyvad B, Baelum V. Nyvad criteria for caries lesion activity and severity assessment: a validated approach for clinical management and research. Caries Research. 2018; 52: 397–405.
[23] Erfanparast L, Iranparvar P, Vafaei A. Direct pulp capping in primary molars using a resin-modified Portland cement-based material (TheraCal) compared to MTA with 12-month follow-up: a randomised clinical trial. European Archives of Paediatric Dentistry. 2018; 19: 197–203.
[24] Ali H, Raslan N. Direct pulp capping (DPC) in primary molars using (3Mix-MP) and the characteristics of the carious lesion as predictor factors for its success: a randomized controlled trial. European Archives of Paediatric Dentistry. 2021; 22: 633–642.
[25] Doǧan S, Durutürk L, Orhan AI, Batmaz I. Determining treatability of primary teeth with pulpal exposure. Journal of Clinical Pediatric Dentistry. 2013; 37: 345–350.
[26] Asl Aminabadi N, Satrab S, Najafpour E, Samiei M, Jamali Z, Shirazi S. A randomized trial of direct pulp capping in primary molars using MTA compared to 3Mixtatin: a novel pulp capping biomaterial. International Journal of Paediatric Dentistry. 2016; 26: 281–290.
[27] Dimitraki D, Papageorgiou SN, Kotsanos N. Direct pulp capping versus pulpotomy with MTA for carious primary molars: a randomized clinical trial. European Archives of Paediatric Dentistry. 2019; 20: 431–440.
[28] Trairatvorakul C, Koothiratrakarn A. Calcium hydroxide partial pulpo-tomy is an alternative to formocresol pulpotomy based on a 3-year randomized trial. International Journal of Paediatric Dentistry. 2012; 22: 382–389.
[29] Guven Y, Aksakal SD, Avcu N, Unsal G, Tuna EB, Aktoren O. Success rates of pulpotomies in primary molars using calcium silicate-based materials: a randomized control trial. BioMed Research International. 2017; 2017: 4059703.
[30] Smaïl-Faugeron V, Porot A, Muller-Bolla M, Courson F. Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review. European Journal of Paediatric Dentistry. 2016; 17: 107–112.
[31] Smaïl-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H. Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews. 2018; 5: CD003220.
[32] Sahin N, Saygili S, Akcay M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clinical Oral Investigations. 2021; 25: 3945–3955.
[33] Mathur V, Dhillon J, Logani A, Kalra G. Evaluation of indirect pulp capping using three different materials: a randomized control trial using cone-beam computed tomography. Indian Journal of Dental Research. 2016; 27: 623.
[34] Boddeda K, Rani CR, V Vanga N, Chandrabhatla S. Comparative evaluation of biodentine, 2% chlorhexidine with RMGIC and calcium hydroxide as indirect pulp capping materials in primary molars: an in vivo study. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2019; 37: 60.
[35] Gurcan AT, Seymen F. Clinical and radiographic evaluation of indirect pulp capping with three different materials: a 2-year follow-up study. European Journal of Paediatric Dentistry. 2019; 20: 105–110.
[36] Maqbool M, Noorani TY, Samsudin NA, Awang Nawi MA, Rossi-Fedele G, Karobari MI, et al. Association of vital pulp therapy outcomes with tooth type, arch location, treatment type, and number of surfaces destroyed in deciduous teeth: a retrospective study. International Journal of Environmental Research and Public Health. 2021; 18: 7970.
[37] Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatric Dentistry. 2004; 26: 214–221.
[38] Fang RR, Chang KY, Lin YT, Lin YTJ. Comparison of long-term outcomes between ferric sulfate pulpotomy and indirect pulp therapy in primary molars. Journal of Dental Sciences. 2019; 14: 134–137.
[39] Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Treatment outcomes of primary molars direct pulp capping after 20 months: a randomized controlled trial. Iranian Endodontic Journal. 2013; 8: 149–152.
[40] Waterhouse PJ, Nunn JH, Whitworth JM. Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures. International Journal of Paediatric Dentistry. 2002; 12: 116–123.
[41] Garrocho-Rangel A, Esparza-Villalpando V, Pozos-Guillen A. Outcomes of direct pulp capping in vital primary teeth with cariously and non-cariously exposed pulp: a systematic review. International Journal of Paediatric Dentistry. 2020; 30: 536–546.
[42] Schröder U, Szpringer-Nodzak M, Janicha J, Wacińska M, Budny J, Mlosek K. A one-year follow‐up of partial pulpotomy and calcium hydroxide capping in primary molars. Dental Traumatology. 1987; 3: 304–306.
[43] Gateva RKN. Success of direct pulp capping and partial pulpotomy of primary teeth using MTA. International Journal of Science and Research. 2015; 4: 287–291.
[44] Mutluay M, Arikan V, Sari S, Kisa Ü. Does achievement of hemostasis after pulp exposure provide an accurate assessment of pulp inflammation?Pediatric Dentistry. 2018; 40: 37–42.
[45] SCHRÖDER U. Agreement between clinical and histologic findings in chronic coronal pulpitis in primary teeth. European Journal of Oral Sciences. 1977; 85: 583–587.
[46] Al Tuwirqi AA, El Ashiry EA, Alzahrani AY, Bamashmous N, Bakhsh TA. Tomographic evaluation of the internal adaptation for recent calcium silicate-based pulp capping materials in primary teeth. BioMed Research International. 2021; 2021: 1–10.
[47] Çelik BN, Mutluay MS, Arıkan V, Sarı Ş. The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth. Clinical Oral Investigations. 2019; 23: 661–666.
[48] El Meligy OAES, Alamoudi NM, Allazzam SM, El-Housseiny AAM. BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12–month randomized controlled clinical trial. BMC Oral Health. 2019; 19: 3.
[49] Vieira-Andrade RG, Drumond CL, Alves LPA, Marques LS, Ramos-Jorge ML. Inflammatory root resorption in primary molars: prevalence and associated factors. Brazilian Oral Research. 2012; 26: 335–340.
[50] Ahuja S, Surabhi K, Gandhi K, Kapoor R, Malhotra R, Kumar D. Comparative evaluation of success of Biodentine and mineral trioxide aggregate with formocresol as pulpotomy medicaments in primary molars: an in vivo study. International Journal of Paediatric Dentistry. 2020; 13: 167–173.
[51] Kassa D, Day P, High A, Duggal M. Histological comparison of pulpal inflammation in primary teeth with occlusal or proximal caries. International Journal of Paediatric Dentistry. 2009; 19: 26–33.
[52] Dalpian DM, Ardenghi TM, Demarco FF, Garcia-Godoy F, De Araujo FB, Casagrande L. Clinical and radiographic outcomes of partial caries removal restorations performed in primary teeth. American Journal of Dentistry. 2014; 27: 68–72.
[53] Casagrande L, Bento LW, Dalpian DM, García-Godoy F, De Araujo FB. Indirect pulp treatment in primary teeth: 4-year results. American Journal of Dentistry. 2010; 23: 34–38.
[54] Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatric Dentistry. 2003; 25: 29–36.
[55] Subramaniam P, Konde S, Mathew S, Sugnani S. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. Journal of Clinical Pediatric Dentistry. 2009; 33: 311–314.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Scopus: CiteScore 1.8 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Top