Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, 11566 Cairo, Egypt.
J Clin Pediatr Dent. 2023 Mar;47(2):10-22. doi: 10.22514/jocpd.2023.004. Epub 2023 Mar 3.
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 ˂ 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.
选择合适的活髓保存治疗（VPT）对于可逆性牙髓炎的年轻恒牙有时会令临床医生感到困惑。令人鼓舞的是，具有生物活性的盖髓材料的不断发展有助于选择微创治疗方法。本非随机临床试验旨在评估 12 个月内使用 TheraCal PT 对年轻恒牙进行间接盖髓治疗（IPT）、直接盖髓（DPC）、部分活髓切断术（PP）和活髓切断术的临床和放射成功率。为了评估每种治疗类型在特定临床情况下的适宜性，为每种治疗方法分配了不同的纳入标准。此外，还评估了牙齿存活率与某些变量的关系。该试验于 2019 年 11 月 19 日在 clinicaltrials.gov（NCT04167943）注册。纳入有龋病扩展至牙本质内层或 1/4 的年轻恒牙（n=216）。IPT 采用选择性去腐。其他组采用非选择性去腐，根据牙髓暴露特征决定治疗方法，即对于最不易察觉的牙髓炎症，选择最保守的治疗方法。使用 Cox 回归分析不同变量对牙齿存活率的影响，以 P 值＜0.05 为统计学意义。IPT、DPC、PP 和活髓切断术的 12 个月联合临床和放射成功率分别为 93.87%、80.4%、42.6%和 96.15%。近中面受累、激发痛和第一恒磨牙与治疗失败的可能性增加相关。根据指定的纳入标准，使用 TheraCal PT 的 IPT、DPC 和活髓切断术显示出可接受的结果，而 PP 与较差的治疗结果相关。近中面受累、激发痛和第一恒磨牙的存在增加了失败的可能性。这些结果提供了在管理年轻恒牙深龋病时不同情况下的见解。临床预测因素对治疗结果的影响可能有助于临床医生进行病例选择。
