Comparison of CaOH with MTA for Direct Pulp Capping: A PBRN Randomized Clinical Trial

By Hilton T, Ferracane J, Mancl L

Date: 01/2013
Journal: JDR

Purpose:

Compare direct pulp capping success in permanent teeth between CaOHvs MTA

Materials/Methods:

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.

Results:

  • 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.

Clinical Significance:

MTA is a superior material to CaOH as a direct pulp capping material.