Direct Pulp Capping With MTA and Calcium Hydroxide.
Condition: Reversible Pulpitis
MeSH terms: Pulpitis
Study type: Interventional

Summary: 
      Aim of the study was to evaluate and compare clinical and radiographic success with MTA and
      calcium hydroxide as direct pulp capping materials in cariously exposed mandibular molars.

      Study was conducted in Post Graduate Institute of Dental Sciences, Rohtak in department of
      Conservative Dentistry & Endodontics. Mature permanent mandibular molars with reversible
      pulpitis exhibiting occlusal pulp exposure from primary dental caries were included in the
      study. After excavation of caries and obtaining pulpal hemostasis, patients were randomly
      allocated into two groups- MTA and Calcium Hydroxide. Pulp was capped with respective
      allocated material and then tooth in both groups were restored according to standard
      protocol.
    

Detailed description: 
      AIM AND OBJECTIVES The present study aims to

        1. Evaluate the success of direct pulp capping in mandibular molar teeth.

        2. Evaluate and compare the clinical and radiographic success with MTA and calcium
           hydroxide as direct pulp capping materials.

        3. To assess the pain intensity before and after the direct pulp capping with visual analog
           scale (VAS).

      MATERIALS AND METHODS Study subjects were recruited from the patients visiting the Department
      of conservative dentistry and endodontics, PGIDS, Rohtak.

      METHODOLOGY Prior to treatment, a thorough clinical and radiological examination was carried
      out.

      A thorough history will be taken from each patient. Prior informed consent was obtained
      either from the patient or guardians after explaining the procedure, risks and benefits.

      Clinical procedure:

      Mature mandibular permanent molars exhibiting deep caries approaching pulp were chosen for
      the study.

      The teeth were evaluated by periapical radiographs, periodontal probing, percussion test, and
      vitality assessment with thermal test and electric pulp test; the teeth determined to have
      reversible pulpitis were included.

      All periapical radiographs were exposed by using constant kVP, mA, and exposure time (70 KVP,
      8 mA, and 0.8 sec.) with a Rinn paralleling device and processed manually.

      After administration of local anesthesia, rubber dam isolation of the involved tooth was
      done.

      The tooth was disinfected by scrubbing with 2% chlorhexidine and 75% isopropyl alcohol.

      Initially caries was removed with round bur under sterile water spray. Then, the remaining
      caries was removed carefully with a spoon excavator. After complete caries excavation,
      disinfection of exposed pulp with 2.5% sodium hypochlorite irrigation and a soaked cotton
      pellet was done.

      Then sodium hypochlorite dressing was placed for 10 minutes to achieve adequate pulpal
      hemostasis.

      Patients were randomly allocated into two groups (Group I - MTA and Group II -Calcium
      hydroxide) using a computer program This study was a double blinded trial i.e. both the
      patient and the investigator were not aware of the group to which the participant belongs.

      GROUP I- CALCIUM HYDROXIDE GROUP Calcium hydroxide powder was mixed according to
      manufacturer's instructions and applied directly onto the exposed pulps.

      The cavities were then restored with resin modified GIC liner followed by composite
      restoration.

      GROUP II - MTA GROUP MTA was mixed according to manufacturer's instructions i.e. 1:3 water/
      powder ratio and applied to exposure site with a sterile carrier.

      Then cotton pellets soaked in normal saline was placed over MTA and cavity was sealed
      temporarily with intermediate restoration material.

      After 24 hours, the patient was recalled and the setting of MTA was confirmed and the cavity
      was restored with resin modified GIC liner followed by composite restoration.

      FOLLOW UP The patients were recalled periodically at 1 week, 3 months, 6 months and 12 months
      after the direct pulp capping procedure for clinical (post operative sensitivity, pain,
      tenderness, vitality) and radiographic (widening of periodontal ligament space and periapical
      radiolucency) evaluation.

      CRITERIA FOR SUCCESSFUL OUTCOME A positive vitality test. No pain on percussion. No widening
      of periodontal ligament on periapical radiograph. No clinical or radiographic signs and/or
      symptoms of irreversible pulpitis and pulp necrosis.

      CRITERIA FOR FAILURE No response to pulp vitality test. Teeth exhibiting clinical or
      radiographic signs and/or symptoms of irreversible pulpitis and pulp necrosis.

      Postoperative pain assessment:

      This was done using Horizontal VAS scale preoperatively, 6, 12, 18 hours, 1, 2, 3, 4, 5, 6,
      and 7 days after the procedure.

      The pain VAS was completed by the patients themselves. The patients were asked to place a
      line perpendicular to the VAS line at the point that represents their pain intensity.

      Patients were also asked to take analgesic (ibuprofen 400 mg/6-8h) according to the intensity
      of pain experienced by them and note down the details of analgesic intake on the proforma
      regarding the number of doses required and timing of the dose.
    

Intervention name(s): Direct Pulp Capping with Ca(OH)2; Direct Pulp Capping With MTA
Intervention type(s): Procedure; Procedure
Intervention description(s): Calcium hydroxide powder was mixed with saline and placed over the exposed pulp tissue. The cavities were then restored with resin modified GIC liner followed by composite restoration.; MTA was mixed using1:3 water/ powder ratio and applied to exposure site. Then cotton pellets soaked in normal saline was placed over MTA and cavity was sealed provisionally with IRM. After 24 hours, the patient was recalled and the cavity was restored with resin modified GIC liner followed by composite restoration.
Other intervention name(s): Vital Pulp Therapy; Vital pulp therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment