Pulp Capping Success Linked to Material Choice, Patient Age, and Adhesive Systems: New Study Reveals

The study, published in the Journal of Clinical Medicine, revealed that the success of preserving pulp vitality following indirect pulp capping treatments is influenced by the type of adhesive system employed, with the total-etch system demonstrating superior performance compared to the self-etch system.

"When performing direct pulp-capping treatments, it is crucial to carefully consider the type of pulp-capping material, the patient’s age, and the extent of pulp exposure before the procedure," the researchers wrote.

The research highlights that direct and indirect pulp capping procedures are pivotal in maintaining dental pulp health when faced with exposure or deep carious lesions. Mario Alovisi, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy, and colleagues sought to evaluate the long-term reactions of dental pulp tissue to direct and indirect pulp capping treatments after a 10-year follow-up period.

For this purpose, the researchers evaluated 276 permanent teeth with deep carious lesions, categorizing them into five distinct groups: Group 1 received direct pulp capping using Mineral Trioxide Aggregate cement; Group 2 was treated with direct pulp capping using a resin-based glass ionomer; Group 3 involved direct pulp capping with TheraCal; Group 4 underwent indirect pulp capping with a three-step total-etch adhesive system; and Group 5 was treated with indirect pulp capping using a two-step self-etch adhesive system.

The following were the key findings of the study:

• A 72.5% success rate was achieved overall.
• There was a statistically significant difference when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively.
• For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis, while bleeding after exposure appeared independent.
• Patient age was significantly related to the maintenance of pulp vitality.
• A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered.
• For the indirect pulp-capping treatments, a significant correlation between patient age and the adhesive system with pulp necrosis was described.

This retrospective study highlighted the importance of carefully selecting the pulp-capping material for direct capping procedures. It also revealed that factors such as patient age and the extent of pulp exposure significantly impact the preservation of pulp vitality.

"Furthermore, the study found that the success of indirect pulp-capping treatments in maintaining pulp vitality is influenced by the adhesive system used, with the total-etch system proving more effective than the self-etch system," the researchers concluded.

Reference:

Alovisi, M., Baldi, A., Comba, A., Gamerro, R., Paolone, G., Mandurino, M., Dioguardi, M., Roggia, A., & Scotti, N. (2023). Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study. Journal of Clinical Medicine, 13(13), 3962. https://doi.org/10.3390/jcm13133962