Abstract
Introduction
This controlled, historic cohort study project continues a previously reported trial
aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate
(MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated
on the basis of a larger sample size and longer follow-up periods.
Methods
Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between
2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months).
Pre-, intra-, and postoperative information was evaluated and statistically analyzed
using a logistic regression model as well as generalized estimating equation logit
models.
Results
Two hundred five patients (229 teeth) were available for follow-up (74% recall rate).
The overall success rates were 80.5% (95% confidence interval [CI], 74.5–86.5) of
teeth in the MTA group (137/170) and 59% (95% CI, 46.5–71.5) of teeth in the CH group
(35/59). Multivariate analyses (generalized estimating equation logit model) indicated
a significantly increased risk of failure for teeth that were directly pulp capped
with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36–5.25; P = .001). Teeth that were permanently restored ≥2 days after direct pulp capping had
a significantly worse prognosis irrespective of the pulp capping material chosen (odds
ratio = 3.18; 95% CI, 1.61–6.3; P = .004).
Conclusions
The results of this study indicate that MTA provides better long-term results after
direct pulp capping compared with CH. Placing a permanent restoration immediately
after direct pulp capping is recommended.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of EndodonticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review.J Endod. 2011; 37: 581-587
- Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study.J Endod. 2000; 26: 525-528
- Pulp cap study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1965; 15: 1505-1509
- Simplified method of pulp capping adult teeth with calcium hydroxide.U S Armed Forces Med J. 1957; 8: 979-984
- Direct capping of the artificial exposed pulp in teeth with deep caries.Stomatol DDR. 1990; 40: 246-249
- A retrospective study of direct pulp capping with calcium hydroxide compounds.Endod Dent Traumatol. 1985; 1: 29-34
- Success rate of direct pulp capping with calcium hydroxide.Schweiz Monatsschr Zahnmed. 2003; 113: 946-952
- The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study.J Am Dent Assoc. 2006; 137: 1699-1705
- Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.J Endod. 2010; 36: 806-813
- Mineral trioxide aggregate: a comprehensive literature review–part II: leakage and biocompatibility investigations.J Endod. 2010; 36: 190-202
- Mineral trioxide aggregate: a comprehensive literature review—part I: chemical, physical, and antibacterial properties.J Endod. 2010; 36: 16-27
- Mineral trioxide aggregate: a review of the constituents and biological properties of the material.Int Endod J. 2006; 39: 747-754
- Vital pulp therapy with new materials: New directions and treatment perspectives–permanent teeth.J Endod. 2008; 34: S25-S28
- Vital pulp therapy with new materials for primary teeth: new directions and Treatment perspectives.Pediatr Dent. 2008; 30: 211-219
- Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth.J Clin Pediatr Dent. 2006; 31: 72-76
- Direct pulp capping with mineral trioxide aggregate: An observational study.J Am Dent Assoc. 2008; 139: 305-315
- Prognostic factors for clinical outcomes according to time after direct pulp capping.J Endod. 2013; 39: 327-331
- Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial.J Dent Res. 2013; 92: 16S-22
- Mineral trioxide aggregate: a comprehensive literature review—part III: clinical applications, drawbacks, and mechanism of action.J Endod. 2010; 36: 400-413
- Treatment outcome of mineral trioxide aggregate: repair of root perforations—long-term results.J Endod. 2014; 40: 790-796
- The periapical index: a scoring system for radiographic assessment of apical periodontitis.Endod Dent Traumatol. 1986; 2: 20-34
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- A clinical study of direct pulp capping applied to carious-exposed pulps.J Endod. 1996; 22: 551-556
- Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report.Int Endod J. 2003; 36: 225-231
- Tunnel defects in dentin bridges: their formation following direct pulp capping.Oper Dent. 1996; 21: 4-11
- The effect of composition on the erosion properties of calcium hydroxide cements.J Dent Res. 1982; 61: 1431-1435
- Using mineral trioxide aggregate as a pulp-capping material.J Am Dent Assoc. 1996; 127: 1491-1494
- Histological evaluation of mineral trioxide aggregate and calcium hydroxide in direct pulp capping of human immature permanent teeth.Am J Dent. 2008; 21: 262-266
- Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial.Int Endod J. 2008; 41: 128-150
- Pulp capping of dental pulp mechanically exposed to oral microflora: a 1-2 year observation of wound healing in the monkey.J Oral Pathol. 1985; 14: 156-168
- Biocompatibility of surface-sealed dental materials against exposed pulps.J Prosthet Dent. 1987; 57: 1-8
- The presence of bacteria in cavities filled with silicate cement and composite resin materials.Sven Tandlak Tidskr. 1971; 64: 149-155
- Bacterial leakage around dental restorations: its effect on the dental pulp.J Oral Pathol. 1982; 11: 439-450
- Long term clinical assessment of direct pulp capping.Int Endod J. 1981; 31: 251-260
- Review of calcium hydroxide.Int Endod J. 1990; 23: 283-297
- Protein synthesis in vitro, in the presence of Ca(OH)2 containing pulp-capping medicaments.J Oral Pathol. 1983; 12: 356-365
- pH values of pulp-capping agents.J Endod. 1989; 15: 365-368
- Inactivation of root canal medicaments by dentine, hydroxylapatite and bovine serum albumin.Int Endod J. 2001; 34: 184-188
- MTA solubility: a long term study.J Endod. 2005; 31: 376-379
- Antibacterial effects of some root end filling materials.J Endod. 1995; 21: 403-406
- Evaluation of the antifungal effects of mineral trioxide aggregate materials.Aust Endod J. 2006; 32: 120-122
- In vitro antimicrobial activity of endodontic sealers, MTA-based cements and Portland cement.J Oral Sci. 2007; 49: 41-45
- Direct pulp capping treatment: a long-term follow-up.J Am Dent Assoc. 1978; 97: 607-612
- Expected outcomes in the prevention and treatment of apical periodontitis.in: 2nd ed. Essential Endodontology: Prevention and Treatment of Apical Periodontitis. Blackwell Munksgaard Ltd., Oxford2008: 408-469
- Endodontic success—who's reading the radiograph?.Oral Surg Oral Med Oral Pathol. 1972; 33: 432-437
Article info
Publication history
Published online: September 14, 2014
Identification
Copyright
© 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
