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Randomized Controlled Trial
. 2023 Aug;8(4):253-261.
doi: 10.14744/eej.2023.83007.

Efficacy of Calcium Enriched Mixture Cement, Mineral Trioxide Aggregate and Calcium Hydroxide Used as Direct Pulp Capping Agents in Deep Carious Lesions - A Randomised Clinical Trial

Mridula Parameswaran  1 , Kiran Vanaja Madanan  2 , Ramesh Kumar Maroli  3 , Dhanya Raghunathan  4
Affiliations
Randomized Controlled Trial

Efficacy of Calcium Enriched Mixture Cement, Mineral Trioxide Aggregate and Calcium Hydroxide Used as Direct Pulp Capping Agents in Deep Carious Lesions - A Randomised Clinical Trial

Mridula Parameswaran et al. Eur Endod J. 2023 Aug.

Abstract

Objective: The primary objective of this randomised clinical trial was to evaluate the efficacy of Calcium Enriched Mixture (CEM) cement compared to Mineral Trioxide Aggregate (MTA) and Calcium Hydroxide (CH) in maintaining pulp vitality when used for direct pulp capping (DPC) of deep carious lesions with reversible pulpitis and secondary objective was to assess the overall success of DPC in carious exposures.

Methods: One hundred and fifty patients diagnosed with reversible pulpitis with deep carious lesions were included in this study. Patients were randomly allocated into three groups (n=50), Group C: CEM group, Group M: MTA group, and Group D: CH (Dycal) group. After caries removal by mechanical excavation except for one carious spot, the removal of which resulted in the exposure of the pulp, the final carious spot was removed with a sterile no.2 round carbide bur. After haemostasis, the pulpal wound was dressed by a capping agent, followed immediately by permanent restoration. Patients were assessed for successful outcomes based on positive vitality tests, absence of clinical signs and symptoms, and PAI scores after 1, 3, 6, 12, and 18-month follow-up periods. The ANOVA test was employed to analyse quantitative variables, and the Pearson Chi-square test was used for qualitative variables. A Bonferroni Test was employed as the post hoc test for intergroup comparison. The significance level was set at p≤0.05 within all tests.

Results: The percentage of success in Group C was 86.7%, Group M was 77.3%, and Group D was 57.9%. This study's overall success rate after direct pulp capping of deep carious lesions was 74.8%. A statistically significant difference in PAI score was found between Groups C and D. Pain on percussion and response to vitality tests also showed significant differences among the three groups at the one-month follow-up.

Conclusion: CEM cement had comparable efficacy to MTA and was superior to CH in maintaining pulpal vitality following DPC in teeth with reversible pulpitis. An overall success rate of 74.8% indicated that DPC in deep carious lesions with reversible pulpitis could yield favourable clinical outcomes. (EEJ-2022-11-134).

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Conflict of interest statement

The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram Group C: Calcium enriched mixture Group, Group M: Mineral trioxide aggregate group, Group D: Dycal group, RCT: root canal treatment
Figure 2
Figure 2
Preoperative view after peripheral caries removal
Figure 3
Figure 3
Pulp exposure site after complete caries removal
Figure 4
Figure 4
Direct pulp capping agent applied to the exposure site
Figure 5
Figure 5
Capping agent covered with Glass ionomer liner
Figure 6
Figure 6
Immediate Restoration with direct composite resin
Figure 7
Figure 7
(a) Preoperative radiograph. (b) 1 month follow-up after DPC with CEM. (c) 6 months follow-up after DPC with CEM. (d) 12 months follow-up after DPC with CEM. (e) 18 months review after DPC with CEM DPC: Direct pulp capping, CEM: Calcium Enriched Mixture
Figure 8
Figure 8
Success versus failure at one month p=0.012<0.05=Statistically significant
Figure 9
Figure 9
Success versus failure at three months p=0.001<0.05=Statistically significant
Figure 10
Figure 10
Success versus failure at six months p=0.003<0.05=Statistically significant
Figure 11
Figure 11
Success versus failure at twelve months p=0.010<0.05=Statistically significant
Figure 12
Figure 12
Overall success versus failure within the groups p=0.010<0.05=Statistically significant
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References

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