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ORIGINAL ARTICLE
Clinical evaluation of direct pulp capping using a calcium silicate
cement—treatment outcomes over an average period of 2.3 years
Carolin Sabine Harms
1
&Edgar Schäfer
2
&Till Dammaschke
1
Received: 15 August 2018 /Accepted: 4 December 2018 / Published online: 11 December 2018
#Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Objectives This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine)
after caries excavation.
Materials and methods A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were
directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded:
age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold)
and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and
by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were
considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s
exact test, respectively.
Results After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The
treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p<0.05).
All other evaluated factors had no significant influence on the success rate (p>0.05).
Conclusion Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be
successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly
reduces the success of the treatment.
Clinical relevance Direct pulp capping can be done successfully with this type of calcium silicate cement.
Keywords Biodentine .Calcium silicate cement .Direct pulp capping .Treatment outcome
Introduction
Originally, calcium silicate cements like mineral trioxide ag-
gregate (MTA) were developed to seal perforations in the root
canal system. However, it soon became obvious that MTA is
also suited for maintaining the vitality of the dental pulp [1–3].
The advantages of this calcium silicate-based material over the
usually used calcium hydroxide products lie in the higher
mechanical strength, lower solubility and tighter sealing of
the dentine. Three major disadvantages of calcium hydroxide
could thus be avoided when using MTA: dissolution of the
capping material as well as the mechanical instability and
consequent lack of long-term protection against bacterial
microleakage [3]. Despite these advantages, literature is still
inconclusive concerning the superiority of MTA over calcium
hydroxide suspensions. In some reports, MTA produced better
clinical outcomes and showed higher success rates than calci-
um hydroxide in direct capping [4–6]. Thus, in a meta-analy-
sis, it was stated that direct pulp capping with MTA has a
higher success rate, results in a lower pulpal inflammatory
response and a more reliable formation of hard tissue than
calcium hydroxide. MTA appears to be a suitable substitute
for calcium hydroxide in direct capping [7], whereas other
systematic reviews [8,9] and randomised control trials [10]
failed to confirm any superiority of MTA and MTA-like ma-
terials when covering the exposed pulp tissue in vital pulp
therapy.
*Till Dammaschke
tillda@uni-muenster.de
1
Department of Periodontology and Operative Dentistry, Westphalian
Wilhelms-University, Albert-Schweitzer-Campus 1, building W 30,
48149 Münster, Germany
2
Central Interdisciplinary Ambulance in the School of Dentistry,
Albert-Schweitzer-Campus 1, building W 30,
48149 Münster, Germany
Clinical Oral Investigations (2019) 23:3491–3499
https://doi.org/10.1007/s00784-018-2767-5
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