Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey.
Department of Histology and Embryology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey.
Clin Oral Investig. 2021 Jun;25(6):3945-3955. doi: 10.1007/s00784-020-03724-4. Epub 2021 Jan 6.
The aim of this randomized, controlled, three-arm parallel group, and double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth.
The study included a total of 109 patients aged 5-9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) hard-setting calcium hydroxide (Dycal) (control group) (n = 36), (II) bioactive tricalcium silicate (Biodentine) (n = 37), and (III) resin-based tricalcium silicate (TheraCal LC) (n = 36). All the teeth were evaluated clinically and radiographically at 6, 12, 18, and 24 months postoperatively. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24-40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation quality of the dentin formed, severity of pulpitis, and other pulpal changes. Data were analyzed using Fisher's exact test, Pearson's chi-square test, and McNemar's test (p = 0.05).
At the end of the 24-month follow-up period, the clinical and radiographic success rates for Dycal, Biodentine, and TheraCal LC were 100%, 100%, and 93.3%, respectively, and there was no significant difference among the groups (p > 0.05). However, the TheraCal LC group was statistically unsuccessful when compared to the other groups with regard to the integrity of the odontoblastic layer, severity of pulpitis, and other pulpal changes in histological examination (p < 0.05).
Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC.
Resin-free calcium silicate-based materials appear to be more favorable in the indirect pulp treatment of primary teeth, particularly in young-age groups that require long-term success.
本随机对照、三臂平行组、双盲临床试验旨在评估三种不同盖髓材料在儿童恒牙一次性间接牙髓治疗中的临床、放射学和组织病理学效果。
研究共纳入 109 名 5-9 岁的儿童，这些儿童患有深龋病且有可逆性牙髓炎症状的恒牙。根据盖髓剂将牙齿分为三组：（I）硬固型氢氧化钙（Dycal）（对照组）（n=36），（II）生物活性硅酸三钙（Biodentine）（n=37），和（III）树脂型硅酸三钙（TheraCal LC）（n=36）。所有牙齿在术后 6、12、18 和 24 个月进行临床和放射学评估。共有 23 颗下颌第二磨牙处于常规替换期（24-40 个月），将其在 10%甲醛溶液中固定。通过组织学评估评估牙本质形成质量、牙本质形成的继发性牙本质形成质量、牙髓炎的严重程度和其他牙髓变化来评估标本的完整性。使用 Fisher 确切检验、Pearson χ2 检验和 McNemar 检验（p=0.05）进行数据分析。
在 24 个月的随访结束时，Dycal、Biodentine 和 TheraCal LC 的临床和放射学成功率分别为 100%、100%和 93.3%，各组之间无显著差异（p>0.05）。然而，TheraCal LC 组在牙本质层完整性、牙髓炎严重程度和其他牙髓变化的组织学检查方面与其他组相比统计学上不成功（p<0.05）。
间接盖髓治疗儿童恒牙无论选择何种盖髓剂均具有较高的临床和放射学成功率。然而，组织学检查表明，牙髓状态受所选盖髓材料的影响，尤其是在选择含有树脂的材料如 TheraCal LC 时。
无树脂硅酸钙基材料在儿童恒牙间接牙髓治疗中似乎更为有利，特别是在需要长期成功的年轻年龄组中。
