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Aim: To assess the effectiveness of mineral trioxide aggregate (MTA) used as an indirect pulp-capping material in human
molar and premolar teeth. Methodology: We conducted a clinical evaluation of 60 teeth, which underwent an indirect pulpcapping procedure with either MTA or calcium hydroxide cement (Dycal). Calcium hydroxide was compared with MTA and
the thickness of the newly formed dentine was measured at regular time intervals. The follow-up was at 3 and 6 months, and
dentine formation was monitored by radiological measurements on digitised images using Mesurim Pro software. Results: At 3 months, the clinical success rates of MTA and calcium hydroxide were 93% and 73%, respectively
(P = 0.02). At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide
(P = 0.63). The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by
0.136 mm with calcium hydroxide at 3 months. At 6 months, there was an increase of 0.235 mm with MTA and of 0.221 mm
with calcium hydroxide. Conclusions: A higher success rate was observed in the MTA group relative to the Dycal group
after 3 months, which was statistically significant. After 6 months, no statistically significant difference was found in the
dentine thickness between the two groups. Additional histological investigations are needed to support these findings.
Key words: Calcium hydroxide, dentine bridge, mineral trioxide aggregate, pulp capping, randomised controlled trial
INTRODUCTION
The consequences of pulp exposure from caries, trauma
or unexpected tooth preparation procedures can be
severe, with pain and infection. Pulp capping, in which
a medicament is placed directly over the exposed pulp
(direct pulp cap), or a cavity liner or sealer is placed
over residual caries (indirect pulp cap), is an attempt to
maintain pulp vitality and avoid more extensive
treatments1.
There are key procedures in the management of vital
teeth with deep carious lesions24, which can be
performed with high predictable long-term success
rates5.
Calcium hydroxide is the gold standard for pulp
capping, following the initial publication by Zander6 in
1939. It allows for the formation of a reparative dentine
bridge through cellular differentiation, extracellular
matrix secretion and subsequent mineralisation7,8.
2012 FDI World Dental Federation
Pulp-capping procedure
MTA(ProRoot; Dentsply Tulsa Dental, Tulsa, OK,
USA) and calcium hydroxide material (Dycal Ivory,
Dentsply Caulk, Dentsply, L.D. Caulk, Milford, DE,
USA) were used as pulp-capping agents.
The operative procedure was performed as follows:
After local peri-apical or intraligamentary anaesthesia of the tooth, rubber dam isolation was provided
and carious lesions were removed using a three-step
Selection criteria
The teeth were selected from patients, aged 16
34 years, attending the faculty clinic of the Department
of Dentistry, University Cheikh Anta Diop, Dakar,
Senegal. The descriptive characteristics of the sample
are given in Table 1. The mean age of the patients was
23.37 4.92 years for the calcium hydroxide group
Table 1 Distribution of teeth according to the age and gender of the subjects and the type of pulp-capping material
Capping material
MTA
Ca(OH)2
Gender
Female
Male
Total
Female
Male
Total
12
18
30
14
16
30
Age (years)
t-test*
t-test*
Mean
SD
Min.
Max.
P value
P value
22.75
23.78
23.37
23.43
25.06
24.30
5.74
4.43
4.92
3.857
6.34
5.30
16
16
16
16
16
16
34
32
34
30
34
34
0.58
0.48
0.39
t-test between males and females in the two pulp-capping material groups.
34
Site of caries
Occlusal
n
Upper premolar
Lower premolar
1st upper molar
1st lower molar
2nd or 3rd upper molar
2nd or 3rd lower molar
Total
2012 FDI World Dental Federation
2
0
2
14
5
4
27
Total
Mesio-occlusal
(%)
(3.33)
(0)
(3.33)
(23.33)
(8.33)
(6.66)
(45.0)
Disto-occlusal
(%)
(%)
2
0
5
1
0
2
10
(3.33)
(0)
(8.33)
(1.66)
(0)
(3.33)
(16.7)
14
2
2
2
0
3
23
(23.33)
(3.33)
(3.33)
(3.33)
(0)
(5.00)
(38.3)
(%)
18
2
9
17
5
9
(60)
(30.00)
(3.33)
(15.00)
(28.33)
(8.33)
(15.00)
(100)
35
Allocated to calcium
hydroxide group
n = 30
3 months
lost to follow-up = 1
success = 28
fail = 1
analyzed = 30
none excluded
3 months
lost to follow-up = 4
success = 22
fail = 4
analyzed = 30
none excluded
6 months
lost to follow-up = 0
success = 27
fail due to lost of
restoration = 1
analyzed = 30
none excluded
6 months
lost to follow-up = 0
success = 22
fail = 0
analyzed = 30
none excluded
RESULTS
100
90
80
70
Percent
60
50
40
30
20
10
0
93.1
89.6
73.3
73.3
26.7
26.7
10.4
6.9
MTA
Ca(OH)2
Success rate at 3 months
MTA
Ca(OH)2
Success rate at 6 months
Follow-up duration
t-test*
t-test
3 months
6 months
P value
P value
28
0.121
0.059
27
0.235
0.110
0.000
<0.0001
22
0.136
0.060
22
0.221
0.059
0.000
SE
Significance Exp(B)
or OR
95% CI
Lower Upper
0.003
0.120
0.029
0.495
0.013
6.489
1.481 28.439
Statistical analysis
DISCUSSION
37
Score
df
P value
Age
Gender
Tooth localisation
Tooth type
Upper premolar
Lower premolar
1st upper molar
1st lower molar
2nd or 3rd upper molar
2nd or 3rd lower molar
Site of caries
Occlusal
Mesio-occlusal
Disto-occlusal
Pulp-capping material
Ca(OH)2
MTA
0.179
0.302
0.075
1
1
1
0.672
0.582
0.785
4.156
0.752
1.310
0.091
1.983
0.107
1
1
1
1
1
1
0.041
0.386
0.252
0.762
0.159
0.744
3.526
1.705
8.539
1
1
1
0.060
0.192
0.003
5.455
5.455
1
1
0.020
0.020
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Correspondence to:
Dr Fatou Leye Benoist,
Institute of Dentistry,
Service of Conservative Dentistry and Endodontics,
University Cheikh Anta Diop,
Route de lUniversite, BP16014,
Dakar-Fann 12522, Dakar, Senegal.
Email: fatou.leye@ucad.edu.sn
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