A randomized clinical trial on the use of medical Portland cement,MTA and calcium hydroxide in indirect pulp treatment

Objectives

Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin–pulp complex of permanent and primary teeth treated with two-step IPT.

Materials and methods

In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n?=?31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment.

Results

The IPT had a high success rate of 90.3 % regardless of the material used (p?=?0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p?<?0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p?=?0.01/Mutans Strep. p?=?0.07).

Conclusions

The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement.

Clinical relevance

The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.