Comparing the success of indirect pulp capping of permanent molars using Protooth fast-setting calcium silicate cement and calcium hydroxide cement: a randomized clinical trial with 12-month follow-up

Abstract

Introduction: One of the most important challenges in pediatric dentistry is the restoration of permanent molar with deep caries. Traditional caries removal by removing all infected and affected dentin increases the risk of pulp exposure. For many years, calcium hydroxide has been mentioned as a standard material in indirect and direct pulp caping treatment, but this material is soluble in water and has poor mechanical properties. Recently, novel fast-setting calcium silicate cement containing fluoride has been introduced. This new silicate cement consists of the same components as MTA (including tricalcium silicate, dicalcium silicate, tricalcium aluminate, and calcium sulfate), plus fluoride, nanosilica, and radiocontrast agents. Considering the importance of choosing the right material in the method of selective excavation and its role in the final success of the treatment, and taking into account the good and successful features of the novel CSC (protooth), In this study, we aimed to compare the clinical success of fast CSC cement versus traditional calcium-hydroxide-based material in the treatment of deep caries lesions using the selective excavation technique after 12 months. Materials and methods: A total of 102 teeth in 66 patients were included in the study. Enamel and dentin caries were removed peripherally. Pulpo-axial carious dentin was removed using a hand excavator until leathery consistency, slightly moist and reasonably soft dentin remains. In the test group, fast CSC powder (Ultrafast Protooth, Aarhus University, Denmark) and in the control group, a thin layer of calcium hydroxide-based material (Hydro-C, Dentsply, York, PA, USA) was placed over the soft lethargy dentin in pulpal floor. Finally, the cavity was restored with Bulk fill resin composite restorative material and followed up in 6 and 12 months in terms of the success rate of the treatment. Success of the treatment was defined as a clinically non-symptomatic vital tooth without pathological findings in the periapical radiographs in follow-ups. Result: After 6 months, one treatment failure was observed in each group, with no further failures recorded at the 12-month follow-up. The treatment success rates were statistically similar between the two groups at both the 6-month and 12-month intervals (P > 0.05), indicating no significant difference in outcomes based on the material used. Conclusion: The finding of this study illustrated that the success rate of selective caries removal using one-layer ultra-fast-setting CSC (Protooth) had comparable results with two-layer calcium hydroxide-based material covered with glass ionomer, as a gold standard material.