Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions.

Background and aim: A new concept of antibiotic sterilization has come into existence which can be used to sterilize the demineralized portion of the teeth with minimal or ultraconservative excavation of caries in deep dentinal carious lesions as an alternative for indirect pulp therapy (IPT) and pulpotomy to avoid further complications. This study was undertaken to compare the success rates of antibiotic sterilization, indirect pulp treatment, and pulpotomy in the management of primary teeth with deep carious lesion. Materials and methods: Ninety teeth involving deep carious lesions approaching pulp in primary molars were selected and randomly divided into three groups containing 30 teeth. Group I was treated with antibiotic sterilization using 3Mix-MP paste, group II was treated with indirect pulp treatment using calcium hydroxide, and group III was treated with conventional pulpotomy using 15.5% ferric sulfate (FS) solution. Clinical and radiographic analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-squared test and McNemar test were used for statistical analysis. Results: At the end of the 12-month follow-up period, the overall clinical and radiographic success was determined to be 96.3% for group I, 100% for group II, and 96.4% for group III. There were no statistically significant differences observed between the success of three groups, suggesting that either of the procedures can be adopted for the management of deep carious lesions approaching pulp in primary teeth. Conclusion: Antibiotic sterilization can be introduced as a newer modality in the management of deep carious lesions approaching pulp in primary teeth which is ultraconservative in nature and reduces the risk of pulp exposure in comparison with indirect pulp treatment and pulpotomy procedures. How to cite this article: Saxena D, Garg N, Pathivada L, et al. Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions. Int J Clin Pediatr Dent 2024;17(3):237-242.

Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study.

AIM: This investigation aimed to observe the effects of Dycal, mineral trioxide aggregate (MTA), and TheraCal LC, as indirect pulp-capping materials in primary molars. MATERIALS AND METHODS: About 75 children with lower primary molars aged between 4 and 7 years suggested for IPC were selected and randomly allocated into: Group I - Dycal, group II - MTA, and group III - TheraCal LC. An immediate postoperative radiograph was taken after the procedure. Recall examination was done after 3 and 6 months for clinical and radiographic assessment. The radiographs were digitized, and the amount of thickness of dentin was assessed using Corel Draw software. The values were tabulated and subjected to paired t-tests and independent t-tests for intra and intergroup analysis, respectively. The p-value < 0.05 was considered statistically significant. RESULTS: There was a statistically significant increase in dentin thickness in the first 3 months compared to the 6-month follow-up. At the end of the research phase, TheraCal LC had more tertiary dentin deposited than MTA, followed by Dycal. CONCLUSION: TheraCal LC can be a reliable indirect pulp-capping agent in primary teeth. CLINICAL SIGNIFICANCE: Indirect pulp capping (IPC) is a very extensively employed treatment regimen to manage extensive caries. For many decades, calcium hydroxide has been regarded as the benchmark of pulp capping materials. With several advancements in materials for restoration, TheraCal LC a resin-modified, light-cured calcium silicate-filled liner serves as a pulp-capping agent and dentin protector, promoting pulp healing and preserving vitality as an obstacle cum protector of the dental pulp complex. How to cite this article: Thomas NA, Jobe J, Thimmaiah C, et al. Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study. J Contemp Dent Pract 2024;25(4):365-371.

Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review.

OBJECTIVES: To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). MATERIAL AND METHODS: Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. RESULTS: For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). CONCLUSION: Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. CLINICAL RELEVANCE: Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.

Effectiveness of silver diamine fluoride in indirect pulp capping in primary molars: A systematic review and meta-analysis.

Introduction: Recently, clinical trials have assessed the effectiveness of Silver Diamine Fluoride (SDF) as an indirect pulp capping material (IPC) in primary teeth. This systematic review aimed to assess the evidence presented in these trials. Data sources: A comprehensive search identified relevant studies through five electronic databases (PubMed, Scopus, ClinicalTrials.gov, ScienceDirect, and Cochrane). Search strategies were designed using the PICO model to identify all studies that investigated SDF as an IPC compared to calcium hydroxide (CaOH) or mineral trioxide aggregate (MTA). Quality assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to assess the level of evidence. Study selection: Four clinical trials were found to be suitable for inclusion in the qualitative synthesis and three studies were included in the quantitative analysis. Three studies compared SDF with CaOH and only one study compared SDF, CaOH, and MTA. Only one randomized controlled trial (RCT) had a low risk of bias, and the non-RCT study had a moderate risk of bias. The level of evidence based on the GRADE was low. Three out of four studies showed higher clinical and radiographic outcomes with SDF than with CaOH. One non-RCT study showed that SDF resulted in the least reparative dentin at the 6-months follow-up. The meta-analysis showed a non-significant difference between the SDF and CaOH groups (P = 0.36). Conclusion: There is little evidence showing a higher clinical and radiographic outcome of SDF compared to CaOH as an IPC material in primary molars. Clinical significance: This systematic review updates pediatric dentists regarding the effectiveness of using SDF as indirect pulp caping in primary teeth.

Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial.

Selecting an appropriate vital pulp therapy (VPT) for primary teeth with reversible pulpitis can sometimes be confusing for clinicians. Encouragingly, continuous developments in capping materials with bioactive properties help the selection of less-invasive treatments. This non-randomized clinical trial aimed to assess the clinical and radiographic success rates of indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP) and pulpotomy in primary molars utilizing TheraCal PT over a 12-month period. Different inclusion criteria were assigned for each treatment to assess the eligibility of each treatment type for specific clinical scenarios. Additionally, the association of tooth survival with some variables was assessed. The trial was registered at clinicaltrials.gov (NCT04167943) on 19 November 2019. Primary molars (n = 216) with caries extending into the inner dentin third or quarter were included. Selective caries removal was employed in IPT. Non-selective caries removal was employed in other groups, and treatment was decided according to pulp exposure characteristics, whereby the most conservative treatment was selected for the least clinically detectable pulp inflammation. Cox regression was performed to assess the effects of different variables on tooth survival using p ˂ 0.05 for detecting statistical significance. The 12-month combined clinical and radiographic success rates for IPT, DPC, PP and pulpotomy were 93.87%, 80.4%, 42.6% and 96.15%, respectively. Proximal surface involvement, provoked pain and first primary molars were associated with increased odds of treatment failure. According to the specified inclusion criteria, IPT, DPC and pulpotomy using TheraCal PT demonstrated acceptable results, while PP was associated with poor treatment outcomes. The odds of failure increased with proximal surface involvement, provoked pain and first primary molars. These results provide insights into different scenarios when managing deep carious lesions in primary teeth. The effects of clinical predictors on treatment outcomes may guide clinicians in case selection.

A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial.

Background: Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years. Materials and Methods: In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4-6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05. Results: Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I - P ≤ 0.001, Group II - P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups. Conclusion: Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial.

OBJECTIVES: The purpose of this randomized controlled trial was to compare the 24-month success rates of indirect pulp treatment (IPT) and iRoot BP Plus pulpotomy of primary molars with extremely deep caries. MATERIALS AND METHODS: Generally healthy children aged 3-7 years requiring general anesthesia for treating primary molars with extremely deep caries or reversible pulpitis were recruited. Patients with systemic disease, mental health problems, or manifestations of irreversible pulpitis were excluded. In total, 175 molars were randomized and blinded for either IPT (n = 87) or iRoot BP Plus pulpotomy (n = 88). All teeth were restored with stainless steel crowns and evaluated after 6, 12, 18, and 24 months by two blinded calibrated investigators. Kaplan-Meier survival curves were used to compare the survival rates between the groups. The correlations between success rate and patient characteristics were explored with the Cox proportional hazards model. RESULTS: A total of 168 primary molars in 67 patients (average age: 3.83 years) were evaluated. The cumulative survival probability at 24 months was not significantly different between the IPT (93.8%) and pulpotomy (97.7%) groups (P = 0.238). IPT treatment success was significantly associated with age (odds ratio = 2.347; 95% CI: 1.068-5.156; P = 0.034) and preoperative sensitivity (odds ratio = 9.742; 95% CI: 1.079-87.970; P = 0.043). CONCLUSIONS: The 24-month success rates of IPT and iRoot BP Plus pulpotomy performed in primary molars with extremely deep caries were not significantly different. Increasing age and preoperative sensitivity were found to be associated with the cumulative survival probability in IPT-treated primary molars with extremely deep caries. Primary teeth with extremely deep carious lesions without signs of irreversible pulpitis can be treated successfully by either indirect pulp capping or iRoot BP Plus pulpotomy. TRIAL REGISTRATION: ChiCTR2000032462.

Comparative evaluation of biodentine, 2% chlorhexidine with RMGIC and calcium hydroxide as indirect pulp capping materials in primary molars: An in vivo study.

BACKGROUND: Indirect pulp therapy (IPT) is conventional treatment of deep dentinal carious lesions without risk of pulp exposure. Development of new biomaterials with biocompatibility and seal has changed the attitudes toward IPT. AIM/OBJECTIVES: This study was conducted to evaluate and compare the clinical and radiographic success of biodentine, 2% chlorhexidine gluconate with resin-modified glass ionomer cement (RMGIC), and calcium hydroxide as indirect pulp-capping materials in primary molars over an observation period of 12 months. MATERIALS AND METHODS: A total of 54 primary molars within the age group of 3-9 years, which were indicated for IPT were randomized into three groups of 18 samples each; Group I: biodentine, Group II: 2% chlorhexidine gluconate followed by RMGIC, Group III: calcium hydroxide (Dycal). These cases were followed up for evaluation clinically and radiographically at 3, 6, and 12 months. The recorded data were subjected to statistical analysis using Chi-square test. RESULTS: After 12 months, the clinical and radiographic success of biodentine group was 100% (18/18), with 2% chlorhexidine gluconate disinfecting solution followed by RMGIC was 94.4% (17/18) and calcium hydroxide (Dycal) was 94.4% (17/18), failures included one at 3 months with RMGIC and another at 12 months with calcium hydroxide group; but there was no statistically significant difference observed between them with P = 0.361 at 3 months and P = 0.371 at 12 months interval. CONCLUSION: Biodentine can be effectively used as indirect pulp-capping medicament in primary teeth which has similar clinical and radiographic success as 2% chlorhexidine gluconate in conjunction with RMGIC and calcium hydroxide.

In vivo Outcomes of Indirect Pulp Treatment in Primary Posterior Teeth: 6 Months' Follow-up.

BACKGROUND: Indirect pulp treatment (IPT) is a minimally invasive procedure based on the application of a protective liner on the affected dentin, thereby preserving the pulp vitality. AIM: This study aims to evaluate and compare the clinical and radiographic outcomes of IPT when a layer of calcium hydroxide (Dycal), mineral trioxide aggregate (MTA), or Biodentine was placed over the affected dentin in primary molars. MATERIALS AND METHODS: A clinical trial with sample size of 45 primary molars between the age group of 4-9 years, of which 15 teeth were considered, each for Group I (Dycal), Group II (MTA), and Group III (Biodentine). Measurements on digitized radiographs were made at baseline, 3, and 6 months using Corel Draw software. RESULTS: One-way ANOVA and post hoc tests indicated a statistically significant difference in dentin thickness (P < 0.05) in all the groups. Within Group I, the thickness of dentin was 0.066 ± 0.009 mm at 3 months and 0.099 ± 0.011 mm at 6 months. In Group II, 0.081 ± 0.010 mm at 3 months and 0.123 ± 0.016 mm at 6 months. In Group III, 0.102 ± 0.021 mm at 3 months and 0.154 ± 0.022 mm at 6 months. CONCLUSIONS: Clinically, 100% success rate was observed in all the groups whereas radiographically, Biodentine was superior to both the groups.

Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: A randomized clinical trial.

AIM: To clinically and radiographically evaluate the reparative dentin formation in indirect pulp treatment (IPT) using mineral trioxide aggregate (MTA) and light cured calcium silicate (TheraCal) in primary molars over a period of 6 months. MATERIALS AND METHODS: A clinical trial on IPT on 43 primary molars in 21 patients between the age of 4-7 years, divided into two groups: 22 teeth in MTA group and 21 in TheraCal group. Measurement of the variation in dentin thickness was done on the digitalized radiograph at baseline, 3 months and 6 months using CorelDRAW X3 software. RESULTS: Statistical analysis using an independent t-test for intragroup and intergroup comparison showed a significant increase in dentin thickness in both the MTA and TheraCal group (intragroup comparison [P < 0.05]). However, intergroup comparison between MTA and TheraCal showed no statistical difference in reparative dentin formation (P > 0.05). CONCLUSION: Clinically and radiographically, both MTA and TheraCal are good IPT materials. The better handling characteristics and comparable reparative dentin-forming ability of TheraCal make this material an alternative to MTA in pediatric restorative procedures.

Pulp response to high fluoride releasing glass ionomer, silver diamine fluoride, and calcium hydroxide used for indirect pulp treatment: An in-vivo comparative study.

AIMS AND OBJECTIVES: The study aims at determining pulp response of two high fluoride releasing materials silver diamine fluoride (SDF) and Type VII glass ionomer cement (GIC) when used as indirect pulp treatment (IPT) materials. MATERIALS AND METHODS: Deep Class V cavities were made on four first premolars indicated for extraction for orthodontic reasons. SDF, Type VII GIC, and calcium hydroxide base are given in three premolars, and one is kept control. Premolars were extracted 6 weeks after the procedure and subjected to histopathological examination to determine the pulp response. The results were analyzed using Chi-square test. RESULTS: No inflammatory changes were observed in any of the groups. Significantly more number of specimens in SDF and Type VII GIC groups showed tertiary dentin deposition (TDD) when compared to control group. No significant difference was seen in TDD when intergroup comparison was made. Odontoblasts were seen as short cuboidal cells with dense basophilic nucleus in SDF and Type VII GIC group. CONCLUSION: The study demonstrated TDD inducing ability of SDF and Type VII GIC and also established the biocompatibility when used as IPT materials.

Comparative efficacy of photo-activated disinfection and calcium hydroxide for disinfection of remaining carious dentin in deep cavities: a clinical study.

OBJECTIVES: To comparatively evaluate the efficacy of photo-activated disinfection (PAD), calcium hydroxide (CH) and their combination on the treatment outcome of indirect pulp treatment (IPT). MATERIALS AND METHODS: Institutional ethical clearance and informed consent of the patients were taken. The study was also registered with clinical registry of India. Sixty permanent molars exhibiting deep occlusal carious lesion in patients with the age range of 18 - 22 yr were included. Clinical and radiographic evaluation and set inclusion and exclusion criteria's were followed. Gross caries excavation was accomplished. In group I (n = 20) PAD was applied for sixty seconds. In group II (n = 20), CH was applied to the remaining carious dentin, while in group III (n = 20), PAD application was followed by CH placement. The teeth were permanently restored. They were clinically and radiographically followed-up at 45 day, 6 mon and 12 mon. Relative density of the remaining affected dentin was measured by 'Radiovisiography (RVG) densitometric' analysis. RESULTS: Successful outcome with an increase in radiographic grey values were observed in all three groups. However, on inter-group comparison, this change was not significant (p > 0.05). CONCLUSIONS: PAD and CH both have equal disinfection efficacy in the treatment of deep carious dentin. PAD alone is as effective for treatment of deep carious lesion as calcium hydroxide and hence can be used as an alternative to CH. They can be used independently in IPT, since combining both does not offer any additional therapeutic benefits.