20 December 2022

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Direct dental pulp capping using calcium hydroxide: a 35-year follow-up

Lara Figini

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Advanced carious lesions are the leading cause of pulp disease. Management of mature teeth with deep carious lesions that have exposed vital pulp includes attempting pulp preservation by pulp capping, or pulpotomy or complete removal of the pulp (pulpectomy) to prevent necrosis, infection, and apical periodontitis. Several variables are suspected to influence the indication and outcome of pulp capping procedures, including patient age, tooth type, bleeding time, size of pulp exposure, and pulp material. 

Materials, methods

In a retrospective study, the authors evaluated the long-term outcome of the direct pulp capping technique in mature teeth with pulp exposure due to advanced caries with diagnosis of reversible pulpitis. The treatments were performed for a period of 15 years by a single operator. Under magnification, the caries was completely removed, the exposed pulp examined and covered with either pure calcium hydroxide or a calcium hydroxide cement. The cavity was restored, and the long-term outcome was evaluated as 1 to >35 years. Asymptomatic teeth that responded to pulp sensitivity tests within normal limits and that showed no radiographic periapical changes were classified as successful. Teeth with no response to pulp tests or with radiographic images of apical periodontitis were classified as failures. The effects of independent variables (gender, age, symptoms, number and size of pulp exposures, bleeding time, capping material used, type of overlay material used, and final coronal restoration) on the outcome were also evaluated.

Results

The authors studied 225 teeth in 148 patients. The success rate of the direct pulp capping procedure was found to be 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-ups, respectively. The main variable that significantly affected the treatment outcome in all follow-up periods was the quality/presence of the coronal restoration (P<0.001). Other variables associated with outcome were size and number of pulp exposures at the 20-year follow-up and exposure size, capping material, and type of restoration at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P < 0.05) and revealed a higher 5-year failure rate when varnish was used as a base.

Conclusions

From the data of this study, the authors noted a high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome is the quality of the coronal restoration.

Clinical implications

With a careful selection of cases by the dentist, the direct pulp capping procedure can be considered a predictable therapy to save the dental pulps exposed to caries.

Domenico Ricucci, Isabela N. Rôças, Flávio R.F. Alves, Pedro H. Cabello, José F. Siqueira, Jr. "Outcome of direct pulp capping using calcium hydroxide: a long-term retrospective study." Journal of Endodontics (2022), doi: https://doi.org/10.1016/j.joen.2022.11.005.