Direct pulp capping of primary molars using a novel fast-setting calcium silicate cement: a randomized clinical trial with 12-month follow-up

Abstract

Objective: Novel fast-setting calcium silicate cement with fluoride (Protooth) has been developed for potential applications in tooth crowns. The aim of this study was to evaluate the success rate of direct pulp capping in primary molars using two-layer mineral trioxide aggregate (MTA) and overlying glass ionomer cement versus one-layer novel calcium silicate cement with 4 to 10 minutes setting time. Materials and methods: Ninety bilaterally symmetrical primary molars in the same jaw in 45 patients aged 5 to 7 years were included. Exposed pulps following caries removal were randomly capped with one-layer novel calcium silicate cement or two-layer MTA and glass ionomer cement. All cavities were filled with amalgam. Clinical and radiographic evaluations were performed after six and twelve months. 41 patients were available for the evaluations at the end of the 12-month follow-up. Results: The overall success rate of direct pulp capping, in a split-mouth design, using MTA covered with glass ionomer cement or one-layer novel calcium silicate cement after 12 months were 90% (37 out of 41 cases) and 85% (35 out of 41 cases), respectively, without statistically significant differences after 6 and 12 months. Conclusion: Within the limitations of this study, clinical and radiographic evaluations suggested one-layer novel calcium silicate cement would be successfully used in direct pulp capping of primary molars as a practical alternative to two-layer MTA and overlying glass ionomer cement.

Bond strength between dentine and a novel fast‐setting calcium silicate cement with fluoride

“…To date, the fast setting time, improved mechanical properties , apatite‐forming or mineralizing ability , biocompatibility , acceptable clinical results , interfacial gap closure capability , and superior long‐term bonding to dentine, as observed in this study, support further testing on Protooth for potential applications in the tooth crown. Accordingly, Protooth may be a candidate for pulp protection, treatment of endodontic complications, caries sealing, and post or crown cementation.…”

“…An in‐vitro cytotoxicity evaluation revealed a non‐cytotoxic potential of Protooth comparable with that of CSCs (ProRoot MTA and Biodentine) and superior biocompatibility compared with resin‐modified glass ionomer cements, calcium hydroxide cements, zinc oxide eugenol‐containing temporary filling material, and zinc phosphate cement . A recent case report with a 3‐year follow‐up demonstrated an acceptable clinical performance and excellent biocompatibility of Protooth when used for the apexification of an avulsed immature permanent incisor . Further, Protooth exhibited a successful and comparable outcome to ProRoot MTA in direct pulp capping of human primary molars after one year follow‐up .…”

Outcomes of direct pulp capping in vital primary teeth with cariously and non‐cariously exposed pulp: A systematic review

“…For instance, mineral trioxide aggregate (MTA), which was clinically and histologically tested in four studies, exhibited high success rates, ranging from 90% to 100%. These data reveal that MTA can be a recommendable DPC material for primary teeth due to its stimulation capacity for the healing of pulp and bone/periodontal tissues, and its adequate sealing ability . This material has, however, several drawbacks: it is much more expensive than other pulp dressers; it is difficult to manipulate; it involves a very long setting time (more than 2 hours) and entertains the potential of tooth discoloration .…”

“…These data reveal that MTA can be a recommendable DPC material for primary teeth due to its stimulation capacity for the healing of pulp and bone/periodontal tissues, and its adequate sealing ability. 31,32,36,37 This material has, however, several drawbacks: it is much more expensive than other pulp dressers; it is difficult to manipulate; it involves a very long setting time (more than 2 hours) and entertains the potential of tooth discoloration. 38 Other relevant materials included a calcium-enriched mixture, 8 with a reported success rate of between 85% and 100%; this is considered an excellent alternative to calcium hydroxide and MTA, due to its multiple advantages, such as hard-tissue/hydroxyapatite formation, antibacterial activity, sealing ability, and quick setting time.…”

“…Follow-up times ranged from 6 months to 2 years, and dropout rates were <20%. The DPC agents tested and compared in these studies were calcium hydroxide (Dycal), 14,23,28 formocresol, 10 MTA (mineral trioxide aggregate), calcium-enriched mixture, 18 simvastatin, 29 3Mix (a combination of metronidazole, minocycline, and ciprofloxacin), 3Mixtatin (3Mix plus simvastatin), 6 calcium sulphate hemihydrate (Dentogen), 30 enamel matrix derivative (Emdogain), 14 etch adhesive (Prime&Bond NT), nonrinse conditioner plus Prime&Bond NT, 36% phosphoric acid plus Prime&Bond NT, a self-adhesive system (Xeno III), 28 calcium silicate cement (Protooth), 31 resin-modified calcium silicate (TheraCal LC), 32 and an extract from aloe vera (acemannan). 22 In general, treated teeth were finally restored with amalgam, glass-ionomer, or preformed stainless-steel crowns.…”