Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial

Abstract

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

Keywords: cone beam computed tomography; dental caries; dental radiography; glass ionomer cements; periapical disease; pulpitis.

Figure 1.

Flow diagram indicating patient recruitment and follow-up. Adapted from the CONSORT flow diagram. *Failed teeth are ones that developed irreversible pulpitis and underwent root canal treatment.

Figure 2.

Example of healed lesion (a) cone beam computed tomography (CBCT) at T0 revealing lesion in the distal root of 36. (b) CBCT at T12 revealing resolved lesion around the distal root of 36. (c) Periapical (PA) radiograph at T0 revealing healthy periapical tissues around 36. (d) PA radiograph at T12 revealing healthy periapical tissues around 36.

Figure 3.

Example of new lesion (a) cone beam computed tomography (CBCT) at T0 revealing healthy periapical (PA) tissues surrounding the roots of 26. (b) CBCT at T12 revealing lesions around the roots of 26. (c) PA radiograph at T0 revealing healthy periapical tissues around 26. (d) PA radiograph at T12 revealing slight widening of the periodontal ligament around 26.