Direct pulp capping: short-term success rate for new material

Direct pulp capping, where a medicament is placed over exposed dental pulp in order to maintain pulp vitality has success rates reported of between 13-95%. Calcium Hydroxide and mineral trioxide aggregate (MTA) have both been used. MTA is increasingly being seen as the material of choice. Endocem is an MTA-derived pozzolan cement that was approved by the US Food and Drugs administration in 2012. It is faster setting and has good manipulation properties.

The aim of this study was to compare MTA and Endocem for permanent teeth requiring direct pulp capping.

Methods

Patients over 19 yrs of age with a tooth eligible for direct pulp capping were randomised to receive direct pulp capping with either MTS or Endocem. Teeth were treated under local anaesthetic and rubber dam and pulp capping agents were placed as per manufacturers instructions. Teeth in the MTA group were restored provisionally and teeth later restored with a resin-modified glass ionomer (RMGI). Teeth in the Endocem group were restored with RMGI at the same treatment session.

Teeth were examined clinically and radiographically at 1,2,4, and 12 weeks by examiners blind to the interventions. Teeth responding to vitality testing and free of clinical or radiographic signs of irreversible pulpitis and pulp necrosis were considered a success.

Results

35 patients (46 teeth) were randomised
1 patient from the MTA group and 2 from the Endocem group failed to return for follow up leaving 32 patients (43 teeth) available at 12-week recall.
22 teeth were treated with MTA, 21 with Endocem.
There were 2 failures in the Endocem group and 1 in the MTA group giving success rates of 90.5% and 95.5% respectively.

Conclusions

The authors concluded

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 favourable short-term outcome success rate of 93% indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth.

Commentary

While this study does suggest that there are similar outcomes with both agents, as the authors point out it is both small and short-term. Consequently the results should be interpreted with caution. Larger well-conducted longer-term studies are necessary to properly establish the clinical utility of this new material.