Effect of Liners on Pulpal Outcome and Restoration Survival After Partial Caries Excavation
Condition: Reversible Pulpitis
MeSH terms: Pulpitis
Study type: Interventional

Summary: 
      Aim of the study was to determine the effectiveness of cavity liners regarding survival of
      restoration beneath composite restoration after partial caries removal in permanent teeth
      with deep caries and to evaluate and compare the pulp vitality outcome both clinically and
      radiologically with and without liners.

      Study was conducted in Post Graduate Institute of Dental Sciences, Rohtak in department of
      Conservative Dentistry & Endodontics. Mature permanent mandibular molars with deep dentinal
      caries and without any signs of irreversible pulpitis were included in the study. After
      partial excavation of caries, patients were randomly allocated into three groups- RMGIC, CH
      and DIRECT COMPOSITE group and were restored according to standard protocol.
    

Detailed description: 
      AIM AND OBJECTIVES The present study aims to

        1. Evaluate the success of partial caries excavation in mandibular molar teeth.

        2. Evaluate and compare the clinical and radiographic success with RMGIC, calcium hydroxide
           and without liners after partial caries excavation.

        3. Evaluate and compare the effect of liners on restoration survival after partial caries
           excavation.

      MATERIALS AND METHODS Study subjects were recruited from OPD of Department of conservative
      dentistry and endodontics, PGIDS, Rohtak.

      METHODOLOGY Prior to treatment, a thorough clinical and radiological examination was carried
      out and a thorough history was taken.

      Clinical procedure:

      Mature mandibular permanent molars exhibiting deep caries involving more than half or two
      thirds of dentin 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; teeth determined to have
      reversible pulpitis were included and with irreversible pulpitis were excluded.

      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.

      After administration of local anesthesia, rubber dam isolation of the involved tooth was done
      and tooth was swabbed with betadiene. Carious tissue from lateral walls and dentino enamel
      junction was removed completely while a layer of soft carious dentin was left adjacent to
      pulpal or axial wall followed by cleaning with distilled water and drying with sterile filter
      paper. Then the teeth were randomised into three groups using a computer generated sheet.

      GROUP I CH GROUP- The pulpal or axial wall was lined by a layer of dycal as per manufacturer
      directions and restored with composite restoration using incremental technique.

      GROUP II RMGIC GROUP - A layer of resin modified GIC was placed adjacent to pulpal or axial
      wall and tooth restored as above.

      GROUP III DIRECT COMPOSITE GROUP- Tooth was restored with composite restorations as above
      without placing any liner.

      FOLLOW UP- The patients were recalled periodically at 1 month, 3 months, 6 months and 12
      months after the procedure for clinical (post operative sensitivity, pain, tenderness,
      vitality) and radiographic (widening of periodontal ligament space and periapical
      radiolucency) evaluation. Also, the restoration survival was assessed using modified Hickel
      criteria where marginal staining, marginal adaptation, fractures and retention, secondary
      caries and post operative sensitivity were evaluated.

      CRITERIA FOR SUCCESSFUL PULPAL 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.
    

Intervention name(s): PCR with calcium hydroxide; PCR with RMGIC; PCR with direct composite
Intervention type(s): Procedure; Procedure; Procedure
Other intervention name(s): indirect pulp capping with dycal; indirect pulp capping with RMGIC; indirect pulp capping with adhesive restorations
Intervention MeSH terms: Calcium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment