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Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study

  • Domenico Ricucci
    Correspondence
    Address requests for reprints to Domenico Ricucci, Center for the study of Pulp Biology, Piazza Calvario, 7, 87022 Cetraro, Italy.
    Affiliations
    Private Endodontic Practice, Cetraro, Italy
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  • Isabela N. Rôças
    Affiliations
    Postgraduate Program in Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil

    Genetics Laboratory, Grande Rio University, and Human Genetics Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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  • Flávio R.F. Alves
    Affiliations
    Postgraduate Program in Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil

    Genetics Laboratory, Grande Rio University, and Human Genetics Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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  • Pedro H. Cabello
    Affiliations
    Postgraduate Program in Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil

    Genetics Laboratory, Grande Rio University, and Human Genetics Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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  • José F. Siqueira Jr.
    Affiliations
    Postgraduate Program in Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil

    Genetics Laboratory, Grande Rio University, and Human Genetics Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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Published:November 11, 2022DOI:https://doi.org/10.1016/j.joen.2022.11.005

      Abstract

      Introduction

      This retrospective study evaluated the long-term outcome of direct pulp capping in mature teeth using specific case selection and treatment procedures.

      Methods

      Teeth with pulp exposure due to advanced caries and clinical diagnosis of reversible pulpitis were treated by direct pulp capping. Treatments were conducted over a period of 15 years by a single operator. Under magnification, caries was completely removed, the exposed pulp examined, and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the long-term outcome evaluated from 1 to >35 years. Teeth that were asymptomatic, responded to sensibility pulp tests within normal limits, and showed no radiographic periapical changes were categorized as success. Teeth with no response to pulp tests and/or showing radiographic evidence of apical periodontitis were classified as failures. The effects of independent variables (sex, age, symptoms, number and size of pulp exposures, bleeding time, capping material, bases used over the capping material, and final coronal restoration) on the outcome were evaluated.

      Results

      In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods. The success rate of the direct pulp capping procedure was 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-up examination, respectively. The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001). Other isolated variables associated with the outcome included the size and number of pulp exposures at the 20-year follow-up, and the exposure size, capping material, and restoration type at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P < .05), and disclosed a higher proportion of failures at 5 years when varnish was used as the base.

      Conclusions

      A very high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome was the quality of the coronal restoration.

      Key Words

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