Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. Reparative hard tissue formation following calcium hydroxide application after partial pulpotomy in cariously exposed pulps of permanent teeth. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars Postoperative Pain following Pulpotomy of Primary Molars with Two Biomaterials: A Randomized Split Mouth Clinical Trial Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. Calcium Hydroxide vs. Mineral Trioxide Aggregates for Partial Pulpotomy of Permanent Molars with Deep Caries Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. Response of human dental pulp capped with biodentine and mineral trioxide aggregate. Histological evaluation of mineral trioxide aggregate and calcium hydroxide in direct pulp capping of human immature permanent teeth. Two-year outcomes of primary molar ferric sulfate pulpotomy and root canal therapy. Evaluation and comparison of mineral trioxide aggregate and biodentine in primary tooth pulpotomy: Clinical and radiographic study Comparison of CaOH with MTA for Direct Pulp Capping Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial. The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth Effects of diode laser on direct pulp capping treatment Partial pulpotomy on caries-free teeth using enamel matrix derivative or calcium hydroxide: a randomized controlled trial. Clinical, Radiographic and Histological Evaluation of Primary Teeth Pulpotomy Using MTA And Ferric Sulfate. Direct Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate, and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial A comparative study on dental pulp response to calcium hydroxide, white and grey mineral trioxide aggregate as pulp capping agents A randomized controlled study of the use of ProRoot mineral trioxide aggregate and Endocem as direct pulp capping materials.
PURPOSE This manuscript presents evidence -based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children . A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence -based recommendations on three vital pulp therapies : indirect pulp treatment ( IPT ; also known as indirect pulp cap ) , direct pulp cap ( DPC ) , and pulpotomy . METHODS The basis of the guideline 's recommendations was evidence from " Primary Tooth Vital Pulp Therapy : A Systematic Review and Meta- Analysis . " ( Pediatr Dent 2017;15;39[1]:16 - 23 . ) A systematic search was conducted in PubMed ® / MEDLINE , Embase ® , Cochrane Central Register of Controlled Trials , and trial data bases to identify r and omized controlled trials and systematic review s addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost . Quality of the evidence was assessed through the Grading of Recommendations Assessment , Development , and Evaluation approach ; the evidence -to-decision framework was used to formulate a recommendation . RESULTS The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions . The panel recommends use of  mineral trioxide aggregate ( MTA ) and formocresol in pulpotomy treatments ; these are recommendations based on moderate- quality evidence at 24 months . The panel made weak recommendations regarding choice of medicament in both IPT ( moderate- quality evidence [ 24 months ] , low quality evidence [ 48 months ] ) and DPC ( very-low quality evidence [ 24 months ] ) . Success of both treatments was independent of type of medicament used . The panel also recommends use of ferric sulfate  ( low- quality evidence ) , lasers ( low- quality evidence ) ,  sodium hypochlorite  ( very low- quality evidence ) , and  tricalcium silicate  ( very low- quality evidence ) in pulpotomies ; these are weak recommendations based on low- quality evidence . The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions . Conclusions and practical implication s : The guideline intends to inform the clinical practice s with evidence -based recommendations on vital pulp therapies in primary teeth with deep caries lesions . These recommendations are based upon the best available evidence to- date In a prospect i ve study , partial pulpotomy was performed on six permanent molars with deep carious lesions and pulpal involvement . The bleeding pulp was irrigated with normal tap water until bleeding had stopped and the exposed pulp was covered with calcium hydroxide followed by zinc oxide eugenol , and finally covered with a semipermanent restoration . All teeth showed hard tissue barrier formation , both clinical ly and radiographically , within three months and were free from subjective and objective symptoms through the observation period ( average observation period was 26 months ) . The patients also experienced the therapy positively . These findings and those of others have helped gain more recognition for partial pulpotomy as a strong possible alternative therapy when pulps are exposed by deep carious lesions and a bleeding pulp is exposed during the excavation process . The rationale for this therapy is to remove the infected and /or inflamed pulpal areas beneath the carious lesion and disintegrated tissue . A rapid and simplified procedure would allow the general practitioner to perform this procedure when necessary at dental clinics , without specialist facilities under conditions that avoid unnecessary contamination of the pulp Less invasive excavation methods have been suggested for deep caries lesions . We tested the effects of stepwise vs. direct complete excavation , 1 yr after the procedure had been carried out , in 314 adults ( from six centres ) who had received treatment of a tooth with deep caries . The teeth had caries lesions involving 75 % or more of the dentin and were central ly r and omized to stepwise or direct complete excavation . Stepwise excavation result ed in fewer pulp exposures compared with direct complete excavation [ difference : 11.4 % , 95 % confidence interval ( CI ) ( 1.2 ; 21.3 ) ] . At 1 yr of follow-up , there was a statistically significantly higher success rate with stepwise excavation , with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [ difference : 11.7 % , 95 % CI ( 0.5 ; 22.5 ) ] . In a subsequent nested trial , 58 patients with exposed pulps were r and omized to direct capping or partial pulpotomy . We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [ 31.8 % and 34.5 % ; difference : 2.7 % , 95 % CI ( -22.7 ; 26.6 ) ] . In conclusion , stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation . In view of the poor prognosis of vital pulp treatment , a stepwise excavation approach for managing deep caries lesions is recommended BACKGROUND Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth .  Formocresol ( FC ) is considered the gold st and ard dressing agent for pulpotomy , but concerns have been raised over the years about its safety . Other alternative pulpotomy agents have been investigated and suggested . OBJECTIVE The objective was to evaluate and compare the clinical and radiographic response of FC and white mineral trioxide aggregate ( MTA ) as pulpotomy material s on primary molars . MATERIAL S AND METHODS Fifty primary molars , with deep carious lesion that exposed a vital but asymptomatic pulp , in 37 children aged 4 - 7 years were treated with conventional pulpotomy procedure .  The teeth were divided r and omly into two groups . Group I ( FC ) and group II ( MTA ) . The treated teeth were evaluated clinical ly and radiographically and were followed-up for 12 months . RESULTS At the end of the 12 months follow-up , the clinical success rates for FC and MTA were 81 % and 100 % , respectively . There was a statistically significant difference ( P = 0.04 ) between the clinical success rates of FC and MTA . While the radiographic success rates for FC and MTA were 81 % and 96 % , respectively , there was no statistically significant difference between the radiographic success of MTA and FC . CONCLUSION White MTA showed a higher clinical and radiographic success rate when compared to FC as a pulpotomy agent in vital primary molars , and it has a potential to become a replacement for FC in primary molars OBJECTIVE To compare clinical and radiographic outcomes of pulpotomy treatment using calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) in carious-exposed vital immature permanent first molars . DESIGN Fifty-one immature molars with clinical carious exposure with symptomatic/asymptomatic pulpitis met the inclusion criteria and r and omly assigned to one of the treatment groups ( CEM [ 26 teeth ; 59 roots ] , MTA [ 25 teeth ; 59 roots ] ) . After performing pulpotomy and covering the radicular pulps with the bio material s , all teeth were permanently restored . Blinded clinical and radiographic evaluations were performed at 6 and 12 months after operation for signs of success or failure . Radiographs were evaluated for complete/partial apical closure . The data were analysed using chi-square test and generalized estimating equation ( GEE ) model . RESULTS There was no significant difference at the baseline between the two experimental groups . All available cases ( 49 teeth ) showed pulp survival and signs of continuous root development after 12 months . Overall , complete apical closure ( apexogenesis ) occurred in 76.8 % and 73.8 % of radiographically interpreted roots in CEM cement and MTA groups , respectively . There was no statistical difference in terms of radiographic outcomes between two groups . CONCLUSIONS Calcium-enriched mixture cement and MTA showed similar performance in pulpotomy of immature caries-exposed permanent molars Purpose The aim of this study was to compare the effect of white mineral trioxide aggregate ( MTA ) to that of formocresol ( FC ) as pulp dressing agents in pulpotomised primary molars . Methods In this clinical trial study , 60 lower second primary molars of 46 children were treated by a conventional pulpotomy technique . The teeth were r and omly assigned to the MTA ( experimental ) and FC ( control ) groups by r and om numbered table . Following removal of the coronal pulp and haemostasis , the pulp stumps were covered with an MTA paste in the experimental group . In the control group , FC was placed with a cotton pellet over the pulp stumps . The teeth of both groups were restored with stainless steel crowns . Children arrived for clinical and radiographic follow-up evaluation after 6 , 12 and 24 months . Results The treated teeth in FC group ( n = 18 ) were clinical ly and radiographically successful after 24 months . The radiographic follow-up evaluation revealed one failure ( furcation involvement ) in 18 molars treated with MTA after 24 months . The treated teeth in MTA group were clinical ly successful 24 months postoperatively . Pulp canal obliteration was observed in one of the teeth treated with MTA and four of the teeth treated with FC . Conclusion MTA could be used as a safe medicament for pulpotomy in cariously exposed primary molars and could be a substitute for FC Introduction : The aim of this r and omized clinical trial split-mouth study was to compare the postoperative pain following use of mineral trioxide aggregate ( MTA ) and calcium-enriched mixture ( CEM ) cement as pulpotomy agents in carious primary molars . Methods and Material s : Forty-seven children aged between 6 - 10 years old were enrolled in this study . Each child had two cariously involved primary molar in need of pulpotomy . After caries removal and preparing access cavity in one of the carious teeth , either MTA or CEM cement was r and omly used as the pulpotomy agent , while the other cariously involved primary molar tooth was capped with the other material in a separate visit . After covering the radicular pulp with one of the capping material s the teeth were permanently restored with stainless steel crown ( SSC ) .  Postoperative pain was recorded by using Wong-Baker faces pain rating scale ( Wong-Baker FPRS ) up to seven days following the treatment . Data was analyzed using the Wilcoxon , McNemar , and chi square tests . Results : Forty-five patients fulfilled the treatment procedure and returned the Wong-Baker FPRS forms . Overall 65.6 % of the patients reported pain irrespective of the pulpotomy agents used . There was no significant difference in postoperative pain between the teeth that received either MTA or CEM cement as pulpotomy agents in the first , second and the third day ( P=0.805 , P=0.942 , P=0.705 , respectively ) following the procedure . The trend of the pain scores showed decreasing manner during the study period for the teeth in either groups of MTA or CEM cement . There was no significant difference between the two groups in the number of analgesics used following the treatment ( P>0.05 ) . Conclusion : The findings of the present study showed that a majority of the children felt pain following pulpotomy and SSC placement ; however , there was no significant difference in pain reported when either MTA or CEM cement was used as pulpotomy agents UNLABELLED Carious pulp exposure in permanent molars of children is a common incident . Mineral trioxide aggregate is a new material that possesses numerous exciting possibilities for pulp therapy . AIM The purpose of this study was to evaluate the efficiency of MTA as a direct pulp capping agent in young permanent teeth . METHODS Thirty asymptomatic permanent molars with pulp exposures were treated by pulp capping using MTA . At each recall ( 6 12 , 18 and 24 months ) , the teeth were assessed clinical ly , through pulpal sensitivity tests , as well as radiographically to evaluate periapical healing . RESULTS None of the cases reported spontaneous pain at the six months follow up and the pulp showed signs of vitality and absence of periapical radiolucency . At 24 months , the clinical and radiographic success rate was 93 % with evidence of continued root growth . CONCLUSION Pulp capping with MTA is recommended for teeth with carious pulp exposures specially immature teeth with high potential for healing Aim : To prospect ively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide ( CH ) and mineral trioxide aggregates ( MTA ) as pulp dressing agents . Methods : Restorable permanent first molars ( 64 ) with carious pulp exposures were r and omly assigned to two groups ; CH and MTA . A st and ardized operative procedure was followed in both groups . Following isolation and caries removal , the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2–4 mm . Bleeding was controlled and pulp dressed with either a paste of non- setting Ca(OH)2 followed by a setting layer of Ca(OH)2 , or with grey MTA . The dressing material s in both groups were then covered with a layer of light cured glass ionomer cement . The teeth were either restored using amalgam , or where grossly carious with preformed metal crowns . Patients were scheduled for follow-up at 3 , 6 , 12 months and annually thereafter . Results : There were 34 patients ( 17 males and 17 females ) with 51 teeth available for evaluation . The age of patients at the time of restoration ranged between 6.8 to 13.3 years ( mean of 10.3 ±1.8 years ) . The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 ± 4.4 months . There was no statistically significant difference in the success rate of teeth treated with CH ( 91 % ) in comparison to teeth treated with MTA ( 93 % ) . Radiographically , a hard tissue barrier under CH was noticed in 12 ( 55 % ) teeth compared with 18 ( 64 % ) teeth under MTA ( p=0.4 ) . Conclusions : MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious AIM To compare the treatment outcomes of calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) as pulp dressing bio material s in vital pulpotomy of carious primary molars . STUDY DESIGN split-mouth r and omised clinical trial . MATERIAL S AND METHODS Forty children aged 4 - 8 years with 2 carious teeth requiring pulpotomy were selected and r and omly assigned to MTA ( n = 40 ) or CEM ( n = 40 ) groups . After coronal pulp removal , the remaining radicular pulp was covered with an appropriate bio material ; the teeth were then permanently restored . Clinical /radiographic success/failures were blindly evaluated at 6- , 12- and 24-month follow-ups . STATISTICS the recorded data were analyzed with McNemar test and GEE . RESULTS A total of 36 , 33 and 35 patients were available for 6- , 12- and 24-month follow-ups , respectively . At the 12-month follow-up only one and three teeth in the CEM and MTA groups had pathologic external root resorption , respectively . The resorbed teeth were then missed due to extraction /exfoliation at the 24-month follow-up ; all other treated teeth were sign/symptom-free . Overall , clinical and radiographic outcomes in both MTA/CEM groups were comparable at the three follow-ups without significant differences . Time had no significant effect on the success . CONCLUSION MTA and CEM demonstrated favourable treatment outcomes for pulpotomy of carious primary molars ; CEM may be an effective pulp dressing bio material INTRODUCTION Biodentine is a new bioactive cement that is similar to the widely used mineral trioxide aggregate ( MTA ) . It has dentin-like mechanical properties , which may be considered a suitable material for clinical indications of dentin-pulp complex regeneration such as direct pulp capping . The purpose of the present study was to compare the response of the pulp-dentin complex in human teeth after direct capping with this new tricalcium silicate-based cement with that of MTA . METHODS Pulps in 28 caries-free maxillary and m and ibular permanent intact human molars scheduled for extraction for orthodontic reasons were mechanically exposed and assigned to 1 of 2 experimental groups , Biodentine or MTA , and 1 control group . Assay of periapical response and clinical examination were performed . After 6 weeks , the teeth were extracted , stained with hematoxylin-eosin , and categorized by using a histologic scoring system . RESULTS The majority of specimens showed complete dentinal bridge formation and an absence of inflammatory pulp response . Layers of well-arranged odontoblast and odontoblast-like cells were found to form tubular dentin under the osteodentin . Statistical analysis showed no significant differences between the Biodentine and MTA experimental groups during the observation period . CONCLUSIONS Within the limitations of this study , Biodentine had a similar efficacy in the clinical setting and may be considered an interesting alternative to MTA in pulp-capping treatment during vital pulp therapy PURPOSE To evaluate histological findings in human immature permanent premolars scheduled for extraction for orthodontic reasons , in which mechanical pulp exposures were capped with white ProRoot Mineral Trioxide Aggregate ( WMTA ) or calcium hydroxide ( CH ) . METHODS Forty-eight human immature premolars in 23 patients ( age 10 - 18 years ) were r and omly treated with  WMTA or CH . After rubber dam isolation Cl I cavities were prepared and the pulps exposed . After hemostasis the pulps were capped with either material . The preparations were restored using an acid etch , bonding agent , flowable composite and composite resin technique . The teeth were extracted after 47 to 609 days and processed for routine histological examination , stained with hematoxylin and eosin and Brown and Brenn for recognition of bacteria . Statistical analyses of inflammation , bridge formation and bacterial leakage were performed using a Chi-square test and ANOVA . RESULTS Forty-four of 48 teeth were suitable for microscopic evaluation , 30 with WMTA , 14 with CH . Of the WMTA group , 29 teeth were vital , 28 had formed a bridge , and one specimen had failed . Twelve of 14 teeth with CH were vital , while three teeth failed to form a bridge . No statistically significant differences between WMTA and CH were found , except for superficial and deep inflammatory cell response ( P < or = 0.05 ) . Pulp capping of intentionally exposed human immature premolars performed slightly better when using MTA PURPOSE The objective of this outcome study was to compare ferric sulfate pulpotomy ( FS ) and primary tooth root canal therapy ( RCT ) on cariously exposed vital pulps of primary molars . METHODS A total of 291 molars were treated in 130 children--182 molars received FS and 109 received RCT by r and om selection . RESULTS At 2-year re assessment , 116 molars ( 73 FS , 43 RCT ) were available for clinical and radiographic examination . There was no clinical evidence of pathosis in 96 % of FS and 98 % of RCT molars . Two independent pediatric dentists evaluated periapical radiographs of the treated molars . Molars were classified into 1 of 4 outcomes : ( 1 ) N -- normal treated molar , ( 2 ) H -- nonpathologic radiographic change present , ( 3 ) P(O)--pathologic change present , follow-up in 6 months , and ( 4 ) P(X)--pathologic change present , extract immediately . Survival analysis was applied . A good level of agreement between raters was found for molars with outcome P(X ) ( kappa=0.745 ) . Intrarater reliability was good for molars with outcome P(X ) ( kappa=0.710 ) . Significantly greater numbers of FS than RCT molars were rated P(X ) at the 2-year recall ( chi2=5.8 ; P=.02 ) . No significant difference in survival between the 2 types of vital pulp treatments was detected in log rank tests ( P=.22 ) . CONCLUSIONS Outcomes for FS were poorer than RCT outcomes at 2 years ; however , at 2 years , the survival rates were not statistically different Objectives : Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth . For many years , research ers have search ed for an ideal material that allows regeneration of the residual pulp . The purpose of this study was to evaluate the efficacy of mineral trioxide aggregate ( MTA ) , Biodentine as a pulpotomy medicament in primary teeth , both clinical ly and radiographically . Material s and Methods : A total of 25 children ( 50 human primary molar teeth ) aged between 5 and 9 years were selected in this r and omized clinical study . The patients were r and omly assigned to receive the pulpotomy medicaments in either [ Group 1 ] : MTA or [ Group 2 ] : Biodentine . All pulpotomized teeth were restored with stainless steel crowns and evaluated clinical ly and radiologically at 1 , 3 , 6 and 12 months . Statistical analysis using Mann – Whitney U test and Fisher 's exact test , and chi-square test was performed to determine the significant differences between the groups . Results : Clinical and radiological success rates were 96 and 80 % in Group 1 and 96 and 60 % in Group 2 , respectively . There were no significant differences between the groups ( P > 0.05 ) . The radiographic success rates decreased in the controls , but there were no significant differences . Conclusion : Biodentine showed similar clinical and radiographic results as MTA in the 12-month evaluation and can be safely used as a pulpotomy medicament This practice -based , r and omized clinical trial evaluated and compared the success of direct pulp capping in permanent teeth with MTA ( mineral trioxide aggregate ) or CaOH ( calcium hydroxide ) .  Thirty-five practice s in Northwest PRECEDENT were r and omized to perform direct pulp caps with either CaOH ( 16 practice s ) or MTA ( 19 practice s ) . Three hundred seventy-six individuals received a direct pulp cap with CaOH ( n = 181 ) or MTA ( n = 195 ) . They were followed for up to 2 yrs at regular recall appointments , or as dictated by tooth symptoms . The primary outcomes were the need for extraction or root canal therapy . Teeth were also evaluated for pulp vitality , and radiographs were taken at the dentist ’s discretion . The probability of failure at 24 mos was 31.5 % for CaOH vs. 19.7 % for MTA ( permutation log-rank test , p = .046 ) . This large r and omized clinical trial provided confirmatory evidence for a superior performance with MTA as a direct pulp-capping agent as compared with CaOH when evaluated in a practice -based research network for up to 2 yrs ( Clinical Trials.gov NCT00812887 ) BACKGROUND Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp , usually as a means of preserving the vitality and function of the remaining radicular portion . OBJECTIVES The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth . SETTING S AND DESIGN This was a prospect i ve , r and omized clinical trial . MATERIAL S AND METHODS In this r and omized clinical trial , pulpotomies were performed on 70 primary molars in children aged 5 - 10 years . The teeth were treated using either a conventional formocresol ( 35 teeth ) or electrosurgical technique ( 35 teeth ) . Following the pulpotomy procedure , the teeth were evaluated for clinical and radiographic success for three , six and nine months . The teeth were evaluated for the presence of pain , abscess , fistula , mobility , internal and external resorption , and radiolucency . STATISTICAL ANALYSIS The data were assessed with Fishers ' Exact test . RESULTS After nine months of follow-up , the clinical and radiographic success rates were 96 and 84 % respectively in the electrosurgical group and 100 and 96.8 % respectively in the formocresol group . There was no statistically significant difference between the success rates in the two groups ( P > 0.05 ) . CONCLUSIONS Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy . Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results , it is still a preservative technique . Further studies using larger sample s and longer evaluation periods are recommended Objective This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp exposures . Material s and methods This study was conducted with 44 m and ibular primary molars requiring vital pulpotomy . Carious dentin surrounding the exposure site was used as the inclusion criteria for all teeth , which were r and omly divided into two groups according to pulpotomy material [ MTA group ( n = 24 ) , Biodentine group ( n = 20 ) ] . Treatment was followed up clinical ly and radiologically for 24 months . Pulp canal obliteration was not regarded as a failure . Results Clinical and radiographic success rates at the end of 24 months were 100 % for the MTA group and 89.4 % for the Biodentine group . Success rates did not vary significantly between the groups ( p = 0.646 ) . Pulp canal obliteration was observed in two teeth ( 8.3 % ) in the MTA group at 6 months , but the teeth were found to be stabilized by 24 months . Conclusion The long-term clinical and radiographic success rates obtained in this study indicate that both MTA and Biodentine are appropriate options for pulpotomy treatment of primary teeth with carious exposure in patients whose teeth should be retained for long periods of time . Clinical relevance The etiology of exposure determines pulpal response , making it crucial to distinguish between mechanical and carious exposures . The carious exposure is presumed to be accompanied by severe inflammation , which makes the prognosis of treatment unpredictable . Bio material s can be used especially in cases with carious pulp exposures At the present time , evidence -based , best practice s have yet to be established for maintaining the vitality of teeth by managing caries-associated pulp exposure in permanent teeth . In terms of biomechanical and esthetic considerations , pulp capping has proven to be more effective than root-canal therapy . Given the low success rate of conventional methods , new techniques , such as laser-assisted repairs , should be developed . The purpose of this study was to compare the effectiveness of conventional and diode laser-assisted methods  in direct pulp capping of carious teeth . Ten patients ranging in age from 12 to 40 were assigned r and omly to experimental and control groups in this clinical trial in which the participants ’ teeth were treated with different techniques , i.e. , conventional treatment and diode 808-nm , laser-assisted treatment . For each of these groups , five cases were chosen for treatment with the same method under rubber dam isolation . The data were analyzed by the runs test using SPSS software . The success rate was significantly different between conventional ( 60 % ) and diode 808-nm , laser-assisted ( 100 % ) groups after one year ( P > 0.05 ) . The laser-assisted procedure proved to be more effective than the  conventional technique in enhancing the outcomes of pulp-capping therapy in carious exposures AIM To compare the effect of enamel matrix derivative ( EMD ) and calcium hydroxide [ Ca(OH)(2 ) ] on exposed human pulp . METHODOLOGY Fifteen pairs of human contralateral premolars were intentionally and partially pulpotomized . The exposed pulps were r and omly capped with either EMDgel ( Emdogain ) or a mix of Ca(OH)(2 ) and sterile water . The subjects recorded pain or discomfort during the first 10 days and were also interviewed and examined by a blinded examiner at 1 day , 2 weeks , 3 and 6 months post-operation . Periapical radiographs were taken prior to the operation , and 3 and 6 months post-operation . After 6 months , the teeth were extracted and processed for histological evaluation . The data were described and analysed using McNemar test and Kaplan-Meier survival analysis . RESULTS The EMDgel-treated teeth had significantly less tooth hypersensitivity than the Ca(OH)(2)-treated teeth during the first 2 weeks ( P = 0.031 ) but were not significantly different after 2 weeks ( P = 0.125 ) . No detectable periapical radiographic changes were observed in any teeth and radiographic evidence of dentine bridge formation from both groups were not significantly different during the follow-up periods ( P > 0.05 ) . Histological evaluation demonstrated that the Ca(OH)(2)-treated teeth had less inflammation and more dentine bridge formation than those in the EMDgel-treated teeth . CONCLUSIONS After 6 months , healthy pulps capped with Ca(OH)(2 ) had more favourable results than counterparts capped with EMDgel . However , similar clinical and radiographic results were seen in both groups The aim of this study was to evaluate the clinical , radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate ( MTA ) and 15.5 % ferric sulfate ( FS ) . Thirty-one primary molars were r and omly allocated into MTA or FS groups . Clinical and radiographic evaluations were recorded at 3- , 6- , 12- and 18-month follow-up . Teeth at the regular exfoliation period were extracted and processed for histological analysis . Clinical and radiographic data were tested by statistical analysis ( p≤0.01 ) . Histological outcomes were analyzed descriptively . All of the treated teeth presented clinical success over the experimental periods . Both groups exhibited 100 % of radiographic success at 3 , 6 and 12 months . At the 18-month follow-up , one tooth from FS group presented inter-radicular radiolucency ( p>0.01 ) . Histologically , the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue . Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps . Both MTA and 15.5 % FS  are effective for pulpotomies of primary teeth . Although MTA is considered the first-choice material , FS may be a suitable alternative when treatment cost is an issue Introduction Direct pulp capping treatment is intended to preserve pulp vitality , to avoid or retard root canal treatment , and , in cases with an open apex , to allow continued root development . Historically , calcium hydroxide ( CH ) was the gold st and ard material , but nowadays calcium silicate material s ( CSMs ) are displacing CH because of their high bioactivity , biocompatibility , sealing ability , and mechanical properties . However , more r and omized clinical trials are needed to confirm the appropriateness of CSMs as replacement material s for CH in direct pulp capping procedures . Methods A r and omized clinical trial was conducted that included 169 patients ( mean age , 11.3 years ) from the Maipo district ( Chile ) . The inclusion criterion was patients with 1 carious permanent tooth with pulpal exposure , a c and i date for a direct pulp capping procedure . The patients were r and omly allocated to one of the experimental groups ( CH , Biodentine , or mineral trioxide aggregate [ MTA ] ) . Clinical follow‐up examinations were performed at 1 week , 3 months , 6 months , and 1 year . The Fisher exact test was performed . Results At the follow‐up examination at 1 week , the patients showed 100 % clinical success . At 3 months , there was 1 failure in the CH group . At 6 months , there were 4 new failures ( 1 in the CH group and 3 in the MTA group ) . At 1 year , there was another failure in the CH group . There were no statistically significant differences among the experimental groups . Conclusions CSMs appear to be suitable material s to replace CH . Although no significant differences were found among the material s studied , Biodentine and MTA offered some advantages over CH . HighlightsThis trial compared the efficacy of calcium hydroxide , MTA , and Biodentine as pulp capping material s in young permanent molars . MTA and Biodentine are suitable material s to replace calcium hydroxide in pulp capping procedures .Pulp capping in carious teeth is a successful treatment when done under good clinical protocol Context : Vital pulp therapy has been known as one of the treatment options to preserve pulp after being exposed by trauma or caries . Aim : To investigate human pulpal response to white and grey mineral trioxide aggregate ( WMTA , GMTA ) and Dycal ( MTA ) as pulp capping agents . Setting and Design : Human volunteers were participated in this r and omized clinical trial . Material s and Methods : This study was conducted on 90 intact first and second premolars of human maxillary and m and ibular teeth . The teeth were r and omly assigned into three groups of 30 each . Under local anesthesia , teeth were exposed and capped either with GMTA , WMTA , or Dycal . After 30 , 60 , and 90 days 10 teeth of each group were extracted and prepared for histologic observation . Statistical Analysis : Histopathologic data were analyzed by χ2 , Kruskal Wallis and Mann Whitney tests . Results : the calcified bridge in teeth that were capped with GMTA was significantly thicker than Dycal at 30 and 60 days ( P= 0.015 and P=0.002 , respectively ) ; whereas WMTA showed significantly thicker calcified bridge than Dycal at 90 days ( P=0.02 ) . In addition , GMTA specimens showed significantly less inflammation compared to Dycal sample s at 90 days interval ( P=0.019 ) . No significant difference was found between GMTA and WMTA in terms of calcified bridge thickness and pulp inflammatory response to the capping material s ( P>0.05 ) . Conclusions : Based on the result of this study , both types of MTA can be suggested as the material s of choice for direct pulp capping procedure instead of Dycal as hard setting calcium hydroxide cement INTRODUCTION The purpose of the present study was to evaluate and compare the short-term clinical outcomes of direct pulp capping using ProRoot MTA ( Dentsply , Tulsa , OK ) or Endocem ( Maruchi , Wonju , Korea ) as capping material s in a prospect i ve r and omized controlled study . MATERIAL S AND METHODS This study was conducted with subjects who were recruited from the pool of patients from the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between January and May 2013 . Of the 48 teeth confirmed to be eligible for direct pulp capping , a total of 46 teeth were r and omly assigned to either the ProRoot MTA or the Endocem group ( 23 teeth per group ) . Direct pulp capping was performed using these 2 material s , and clinical and radiographic evaluations were performed at 1 , 2 , 4 , and 12 weeks after the treatments . Teeth with no response to pulp vitality test and those exhibiting clinical or radiographic signs and /or symptoms of irreversible pulpitis or pulp necrosis were considered to be failures . RESULTS Thirty-two patients ( 43 teeth ) were examined at the 3-month follow-up ( patient recall rate = 91.4 % ) ; 22 of these teeth were in the ProRoot MTA group , and 21 were in the Endocem group . The overall success rate was 93 % , and the success rates in the ProRoot MTA and Endocem groups were 95.5 % ( 21/22 teeth ) and 90.5 % ( 19/21 teeth ) , respectively . Statistical analyses of these success rates did not reveal any significant difference between the groups ( P = .522 ) . CONCLUSIONS In this r and omized controlled study , no significant difference in the short-term clinical outcomes of direct pulp capping using ProRoot MTA or Endocem as the capping material was found . Furthermore , the favorable short-term outcome success rate of 93 % indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth
Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy .
INTRODUCTION This systematic review aims to illustrate the outcome of vital pulp therapy , namely  direct pulp capping , partial pulpotomy , and full pulpotomy  , in vital permanent teeth with cariously exposed pulp .