29 April 2020

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Bioactive ceramic VS calcium hydroxide: which is the best material for pulpotomy?

Simona Chirico

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When we have to effort an incisor fracture that involves enamel, dentin and pulp, our goal is to preserve the pulp, when it is possible. To do this, we have different clinical options: direct pulp capping and pulpotomy.
As we can see in scientific literature, direct pulp capping has a success rate between 43% and 85%; instead of pulpotomy which has a success rate between 79% and 100% (**).
Considering only pulpotomy, there are several materials that we can use to do it, such as: calcium hydroxide (CH) and mineral trioxide aggregate (MTA). Calcium hydroxide (CH) has an antimicrobial activity and simulation of hard tissue formation, but it has got high solubility, poor sealing ability and lack of adhesion. Mineral trioxide aggregate (MTA) has good sealing ability and biocompatibility, but it has discoloration, a long setting time, and high costs.

In these last years, another material has proposed to be used: calcium silicate– based bioactive ceramic, which has excellent biological properties, sealing ability, and antibacterial activity and can stimulate the formation of a thick layer of dentin bridge. Unitl now, none discoloration problems has been reported.
So, If we want to compare bioactive ceramic and calcium hydroxide, which is the best pulpotomy material? Rao et al. in their retrospective study, published on Journal of Endodontics, try to answer to this question.

Materials and Methods:
This research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material:
- BC group:  105 incisor treated with iRoot BP Plus (calcium silicate-based bioactive ceramic;
- CH group: 100 incisor treated with calcium hydroxide.
- Clinical and radiographic information was collected during the 12- to 24-month follow-up period.
The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups.

Results
The success rates for pulpotomy treatment were: 99% in bioactive ceramic (BC) group; 93% in calcium hydroxide (CH) group.
Reparative dentin bridges were observed in: 92.4% of the bioactive ceramic (BP) group; 90% of the calcium hydroxide (CH) group.
Pulp canal obliteration was observed in 2% in each group.

Conclusions
As we can see in this retrospective study, bioactive ceramic group obtains better results than the calcium hydroxide group. So bioactive ceramic is a valid alternative to calcium hydroxide as a pulpotomy material.

(**) References: 
Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures-a retrospective study. Dent Traumatol 2017;33:255–60.
Review of the success of pulp exposure treatment of cariously and traumatically exposed pulps in immature permanent incisors and molars. Stomatologija 2012;14:71–80

For additional information: Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study