THE SPECIALIST

For Direct Pulp Capping, do you recommend using MTA or Calcium Hydroxide?

By Dr. Barry H. Korzen

Even though Calcium Hydroxide (CH) has historically been the pulp capping agent of choice, in an excellent paper published on the Journal of Endodontics’ website on September 14, 2014 Mente et al addresses this question. Their paper reports on a controlled, historic cohort study project where potential prognostic factors were evaluated.

They followed up on two hundred and five patients (229 teeth) treated between 2001 and 2011 and found that the MTA treated teeth had a success rate of 80.5% compared with 59% success rate when calcium hydroxide was used as the pulp capping material. They also found that teeth that were permanently restored more than two days after the pulp capping procedure had a significantly worse prognosis irrespective of the pulp capping material chosen.

As the authors conclude, the results of their study “indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended.”

The published abstract appears below:

Abstract
Introduction
This controlled, historic cohort study project continues a previously reported trial aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated on the basis of a larger sample size and longer follow-up periods.

Methods
Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between 2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months). Pre-, intra-, and postoperative information was evaluated and statistically analyzed using a logistic regression model as well as generalized estimating equation logit models.

Results
Two hundred five patients (229 teeth) were available for follow-up (74% recall rate). The overall success rates were 80.5% (95% confidence interval [CI], 74.5–86.5) of teeth in the MTA group (137/170) and 59% (95% CI, 46.5–71.5) of teeth in the CH group (35/59). Multivariate analyses (generalized estimating equation logit model) indicated a significantly increased risk of failure for teeth that were directly pulp capped with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36–5.25; P = .001). Teeth that were permanently restored ≥2 days after direct pulp capping had a significantly worse prognosis irrespective of the pulp capping material chosen (odds ratio = 3.18; 95% CI, 1.61–6.3; P = .004).

Conclusions
The results of this study indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended.

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