Compare direct pulp capping success in permanent teeth between CaOHvs MTA
Providers: 35 practices (16 CaOH, 19 MTA) in the Pacific Northwest. 70% in practice > 10 years.
Patients: N = 358 (175 CaOH, 183 MTA). Age 8-90yo; mean age mid 30s for both groups.
Follow up: phone follow up w/in 1 month, clinical/radiographic follow up q6 months up to 2 years.
Mean f/u (months): CaOH = 12, MTA = 15.
Randomization of practice using computer software; each practice completed equal # of cases. All dentists received training in material utilization.
Inclusion criteria: pulp exposure (carious, traumatic, mechanical), exposure site vital, no PARL, no h/o spontaneous or lingering pain. Each pt can only be included once in the study.
Treatment protocol: rinse pulp exposure with water to remove debris à cotton pellet moistened with 5.25% NaOCl placed over exposure for 1-2 mins until bleeding controlled à pulp cap material (CaOH or MTA) àVitrebond RMGI à restorative material (permanent or temporary).
Outcome measures: vital pulp, radiograph to assess pathology (pulpal – resorption, calcification, periradicular – PARL). Failure = extraction or NSRCT.
- Crude failure rates: 25% (43/175) CaOH, 15% (25/183) MTA.
- Probability of failure forecasted for 24 months: 30% CaOH, 20% MTA (ss).
- One CaOH practice had 56% failure rate. If excluded, probabiity of failure: 27% CaOH, 20% MTA (not ss).
- Additional data:
- 85% cases had light bleeding at exposure site.
- Size of pulp exposure:
- CaOH: ≤ 0.5 mm = 50%, 1 mm = 30%, ≥ 1.5 mm = 20%
- MTA: ≤ 0.5 mm = 60%, 1 mm = 25%, ≥ 1.5 mm = 15%
- Location of pulp exposure:
- Rubber dam use: [CaOH] no = 85%, yes = 15%. [MTA] no = 75%, yes = 25%.
- Type of exposure: 90% carious, 10% non carious.
MTA is a superior material to CaOH as a direct pulp capping material.