Clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with 1.25% sodium hypochlorite: 2-year results

Abstract

Purpose: To evaluate, prospectively, the clinical and radiological response of primary molars, pulp-capped with calcium hydroxide and different adhesive systems after hemorrhage control with 1.25% sodium hypochlorite (NaOCl).

Methods: 100 primary molar teeth were pulp-capped in 67 children who met inclusion criteria. Hemorrhage at the exposure site was controlled with 60 seconds application of 1.25% NaOCl. Teeth were randomly assigned into five groups (n=20 each) with respect to the material/technique used for capping: (1) calcium hydroxide cement (Dycal); (2) acetone-based total-etch adhesive (Prime&Bond NT); (3) a non-rinse conditioner (NRC) and Prime&Bond NT; (4) total-etching with 36% phosphoric acid followed by Prime&Bond NT; and (5) a self-etch adhesive system (Xeno III). Teeth in Group 1 were restored with amalgam and Groups 2-5 with polyacid-modified resin-based composite (Dyract AP). The teeth were evaluated clinically and radiographically for 24 months. Marginal integrity of the restorations was also recorded at recall periods using modified USPHS/Ryge criteria.

Results: After 2 years, the overall success rate of direct pulp capping was approximately 93% (78/84 teeth, excluding exfoliations). The Dycal and Prime&Bond NT groups did not exhibit any clinical or radiographic failure. A majority of failures were observed in teeth that received NRC and phosphoric acid pretreatments (Groups 3 and 4). Clinical symptoms were seldom associated with failed teeth. Only one tooth failed in the Xeno III group. Marginal integrity scores were not compatible with the clinical/ radiographic outcome.