Comparison of four different pulp capping material used for indirect pulp capping in permanent teeth in private clinic in Benghazi-Libya: An in vivo study.

Abstract

In conservative dentistry maintaining the pulp vitality is important, the vital pulp protects the tooth structure, integrity, and physiological function, the pulp vitality may lose, and exposure happens by long-standing caries left untreated, dental trauma( such as fracture crown or cracks), and mechanical injury. In addition, Deep caries lesions could be challenging to manage, and complete caries removal with the conservative approach. 1, 2 the predictability of vital pulp therapy has improved with the introduction of newer bio ceramic materials. 2 Vital pulp therapy techniques are ways to preserve the vitality of the tooth by placing a specific material that helps to reduce inflammation and aid in pulpal regeneration to maintain vitality and neural innervation of the tooth.2 Vital pulp therapy is divided into two types direct pulp capping, means placing the pulp capping material directly on the exposed pulp, unlike the indirect pulp capping procedure the hard affected dentine can be left in the cavity, 3 and the capping material is placed over it. In both techniques, the main reason for such treatment is to maintain tooth vitality and avoid as much as possible any other invasive treatments.4 Different types and varieties of Pulpal capping materials are used in dental practices, but not all material is the same when it comes to their efficiency in the preservation of vital pulp and resolution of inflammation. Researchers work to find out the most effective and ideal capping materials, investigations are still going with the known materials, such as calcium hydroxide and mineral trioxide aggregate (MTA), calcium hydroxide Ca(OH), zinc phosphate, bio glass, and glass ionomer cement.5 For many years, calcium hydroxide [Ca (OH)2] is used as a capping material, its effectiveness comes from promoting the formation of reactive dentine and induced mineralization and also helps the cells of the dental pulp to continue regeneration, with all the benefits of Ca(OH)2 it still has impairments, such as the formation of defects in dentine and the creation of micro leakage. Newer materials like MTA can replace Ca (OH) 2, effective with fewer unwanted side effects. On the other hand, its widely used and has better properties that can help in repairing and aiding pulp healing, MTA's main components are tri-calcium silicate, di-calcium silicate, and tri-calcium aluminate, in addition to bismuth oxide for radiopacity, the most favorable properties is low solubility inhibition of bacterial growth, formation of reparative dentine, and also can reduce inflammation by stabilizing the proses of tooth repair, MTA presents some disadvantages it considered to be expansive, longer sitting time and in some cases, it may cause discoloration, MTA promotes cells like fibroblast to migration into the exposed pulp in which aid in tissue and wound regeneration, MTA recent studies have high clinical success.6 Bio-C Repair is a new silicate-based hydraulic cement material used as a pulp capping material with a better texture, making it very easy to handle. Do not cause discoloration, but it can help to heal and repair pulpal tissue by creating a barrier against microorganisms and promoting regeneration by releasing calcium ions. Bio-C Repair is considered new material further studies and investigation are needed to fully understand its effect on human pulp regeneration and healing, 7 Aim Aimed to evaluate the success rate of different pulp capping materials: MTA, BIO Ceramic, Thecal and Dycal as pulp capping materials for indirect pulp capping in carious permanent teeth.