Comparison of clinical and radiographic success of novel fast setting calcium silicate cement containing fluoride(protooth) versus Mineral Trioxide Aggregrate(MTA) in vital pulp therapy (apexogenesis) of firs permanent molar with open apices

Abstract

Objectives: To compare the success rate of vital pulp therapy following complete pulpotomy in immature first permanent molars, during caries treatment, using novel fast-setting calcium silicate cement (Novel CSC) versus MTA.

Methods: Six- to eight- years old children, who received pulpotomy of first immature permanent molar using one layer novel CSC (Protooth) or two layers slow-setting MTA (MTA Angelus) covered with glass ionomer were recalled for radiographic and clinical evaluation after two years. The effects of cement type, age, gender, jaw, anesthesia type, and restoration type were assessed on the clinical success of pulpotomy and continued root formation (apexogenesis) as the treatment outcome.

Results: Out of 366 included teeth in the study, 316 teeth were available for statistical analysis. The mean observation time was 28.2 ± 2.7 months. Novel CSC showed a statistically higher clinical success rate (93.1%) compared to MTA (84.5%). Restored teeth with stainless steel crowns after pulpotomy and treatments performed under general anesthesia had a statistically significant effect on treatment outcome in contrast to age, gender, and jaw type.

Conclusion: The observations of this retrospective study suggested that the success rate of vital pulp therapy following complete pulpotomy using one layer fast-setting novel CSC was significantly higher than slow-setting MTA covered with glass ionomer. Treatment under general anesthesia and restoration using stainless steel crowns influenced the treatment outcome.

Clinical significance: Novel fast-setting calcium silicate cement is a promising new biomaterial for vital pulp therapy in immature permanent molars that allows complete root formation overtime with apexogenesis. Clinicians must be also aware of the importance of immediate definitive restoration and proper sealing and isolation in vital pulp therapy.