Clinical Research| Volume 41, ISSUE 7, P1026-1031, July 2015

Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study

Published:April 01, 2015DOI:



      The aim of this experimental study was to assess the outcome of direct pulp capping with mineral trioxide aggregate (MTA) after complete excavation of caries in permanent dentition with a 2-visit treatment protocol.


      Sixty-four teeth with deep carious lesions were consecutively selected. The mean age of the patients was 36.1 ± 15 years. An initial diagnosis of deep caries, with no irreversible pulp involvement, was made. Excavation of caries was performed under a rubber dam and operating microscope magnification. White MTA was applied, and a provisional restoration was placed. At the following appointment, positive sensibility testing and the MTA setting were confirmed. Bonded composite restorations were placed afterward. The patient was recalled at least 1 year after treatment for clinical and radiographic control. Outcome was described as success or failure. Success was defined as lack of complaints from the patient, positive reaction to cold testing, no sensitivity to percussion, and no widening of the periodontal ligament on the recall periapical radiograph.


      Forty-six teeth (77.9%) were recalled after 3.6 years (standard deviation = 1.1 years). The overall success rate was 91.3%. The success rate in occlusal caries was 100% and 89.7% in proximal caries (difference = 10.3%; 95% confidence interval [CI], 8.5–89.1). The success rate in initial caries was 94.7% and 88.9% in secondary caries (difference = 5.8%; 95% CI, −48.1 to 59.7). The success rate in patients younger than 40 years was 100% and 80% in patients aged 40 years or older (difference = 20%; 95% CI, 4.2–35.8).


      Direct pulp capping with MTA after pulp exposure during excavation of deep caries could maintain pulp vitality in permanent teeth when a 2-visit treatment protocol is observed.

      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 access
      One-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 to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mente J.
        • Geletneky B.
        • Ohle M.
        • et al.
        Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.
        J Endod. 2010; 36: 806-813
        • Baume L.J.
        • Holz J.
        Long term clinical assessment of direct pulp capping.
        Int Dent J. 1981; 31: 251-260
        • Guthrie T.J.
        • Mcdonald R.E.
        • Mitchell D.F.
        Dental pulp hemogram.
        J Dent Res. 1963; 44: 678-682
        • Seltzer S.
        • Bender I.
        • Ziontz M.
        The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp.
        Oral Surg Oral Med Oral Pathol. 1963; 16: 969-977
        • Langeland K.
        Tissue response to dental caries.
        Endod Dent Traumatol. 1987; 3: 149-171
        • Bogen G.
        • Kim J.S.
        • Bakland L.K.
        Direct pulp capping with mineral trioxide aggregate: an observational study.
        J Am Dent Assoc. 2008; 139: 305-315
        • Cvek M.
        A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture.
        J Endod. 1978; 4: 232-237
        • Bjørndal L.
        • Reit C.
        • Bruun G.
        • et al.
        Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy.
        Eur J Oral Sci. 2010; 118: 290-297
        • Horsted P.
        • Sandergaard B.
        • Thylstrup a
        • et al.
        A retrospective study of direct pulp capping with calcium hydroxide compounds.
        Endod Dent Traumatol. 1985; 1: 29-34
        • Nair P.N.R.
        • Duncan H.F.
        • Pitt Ford T.R.
        • Luder H.U.
        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
        • Asgary S.
        • Eghbal M.J.
        • Parirokh M.
        • et al.
        A comparative study of histologic response to different pulp capping materials and a novel endodontic cement.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 609-614
        • Fontana M.
        Limited evidence for main reason for failure of partially excavated and restored teeth.
        Evid Based Dent. 2014; 15: 16-17
        • Schwendicke F.
        • Meyer-lueckel H.
        • Do C.
        Failure of incompletely excavated teeth—a systematic review.
        J Dent. 2013; 41: 569-580
        • Cox C.F.
        • Sübay R.K.
        • Ostro E.
        • et al.
        Tunnel defects in dentin bridges: their formation following direct pulp capping.
        Oper Dent. 1996; 21: 4-11
        • Ricucci D.
        • Loghin S.
        • Lin L.M.
        • et al.
        Is hard tissue formation in the dental pulp after the death of the primary odontoblasts a regenerative or a reparative process?.
        J Dent. 2014; 42: 1156-1170
        • Farsi N.
        • Alamoudi N.
        • Balto K.
        • Al Mushayt A.
        Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth.
        J Clin Pediatr Dent. 2006; 31: 72-76
        • Hilton T.J.
        • Ferracane J.L.
        • Mancl L.
        Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial.
        J Dent Res. 2013; 92: 16S-22S
        • Kassa D.
        • Day P.
        • High A.
        • Duggal M.
        Histological comparison of pulpal inflammation in primary teeth with occlusal or proximal caries.
        Int J Paediatr Dent. 2009; 19: 26-33
        • Miles J.P.
        • Gluskin A.H.
        • Chambers D.
        • Peters O.A.
        Pulp capping with mineral trioxide aggregate (MTA): a retrospective analysis of carious pulp exposures treated by undergraduate dental students.
        Oper Dent. 2010; 35: 20-28
        • Kawashima N.
        Characterisation of dental pulp stem cells: a new horizon for tissue regeneration?.
        Arch Oral Biol. 2012; 57: 1439-1458
        • Waterhouse P.J.
        • Nunn J.H.
        • Whitworth J.M.
        An investigation of the relative efficacy of Buckley’s Formocresol and calcium hydroxide in primary molar vital pulp therapy.
        Braz Dent J. 2000; 188: 32-36
        • Roberts H.W.
        • Toth J.M.
        • Berzins D.W.
        • Charlton D.G.
        Mineral trioxide aggregate material use in endodontic treatment: a review of the literature.
        Dent Mater. 2008; 24: 149-164
        • Belobrov I.
        • Parashos P.
        Treatment of tooth discoloration after the use of white mineral trioxide aggregate.
        J Endod. 2011; 37: 1017-1020
        • Camilleri J.
        Color stability of white mineral trioxide aggregate in contact with hypochlorite solution.
        J Endod. 2014; 40: 436-440
        • Vallés M.
        • Mercadé M.
        • Duran-Sindreu F.
        • et al.
        Color stability of white mineral trioxide aggregate.
        Clin Oral Investig. 2013; 17: 1155-1159
        • Barrieshi-Nusair K.M.
        • Qudeimat M.A.
        A prospective clinical study of mineral trioxide aggregate for partial pulpotomy in cariously exposed permanent teeth.
        J Endod. 2006; 32: 731-735
        • Accorinte Mde L.
        • Holland R.
        • Reis A.
        • et al.
        Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth.
        J Endod. 2008; 34: 1-6
        • Massler M.
        Therapy conductive to healing of the human pulp.
        Oral Surg Oral Med Oral Pathol. 1972; 34: 122-130
        • Matsuo T.
        • Nakanishi T.
        • Shimizu H.
        • Ebisu S.
        A clinical study of direct pulp capping applied to carious-exposed pulps.
        J Endod. 1996; 22: 551-556
        • Heintze S.D.
        • Rousson V.
        Clinical effectiveness of direct class II restorations—a meta-analysis.
        J Adhes Dent. 2012; 14: 407-431

      Linked Article

      • Corrigendum
        Journal of EndodonticsVol. 44Issue 1
        • Preview
          Corrigendum to ‘Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study’ [Journal of Endodontics 41 (2015) 1026–1031]
        • Full-Text
        • PDF