Clinical and Radiographic Assessment of Direct Pulp-Capping Materials: A Comparison of Calcium Silicate-Based and Calcium Hydroxide Based Approaches (A Review)

Abstract

Background: Direct pulp capping is a critical procedure in endodontics aimed at preserving pulp vitality following exposure due to carious lesions or trauma. The choice of pulp-capping materials significantly influences treatment outcomes, with calcium silicate-based materials, such as mineral trioxide aggregate (MTA) and Biodentine, emerging as promising alternatives to traditional calcium hydroxide. This systematic review aims to evaluate the clinical and radiographic effectiveness of these materials, addressing the need for updated evidence to guide clinical practice.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Cochrane Library, from January 2000 to October 2023. Inclusion criteria encompassed randomized controlled trials, cohort studies, and systematic reviews that compared calcium silicate-based materials with calcium hydroxide in direct pulp capping. Exclusion criteria included studies not published in English, animal studies, and those lacking relevant clinical outcomes. Data extraction and analysis were performed following PRISMA guidelines, with a focus on clinical success rates, radiographic outcomes, and biocompatibility.

Results: A total of 25 studies met the inclusion criteria, comprising 15 randomized controlled trials and 10 cohort studies. The review revealed that calcium silicate-based materials demonstrated a significantly higher clinical success rate (average 83.33%) compared to calcium hydroxide (average 72.5%). Radiographic assessments indicated superior dentin bridge formation and reduced inflammation associated with calcium silicate materials. Notably, gaps in long-term follow-up data were identified, highlighting the need for further research in this area.

Conclusion: This systematic review underscores the clinical superiority of calcium silicate-based materials over traditional calcium hydroxide in direct pulp capping procedures. The findings contribute to the growing body of evidence advocating for the adoption of advanced materials in endodontic practice, emphasizing the importance of material selection in enhancing patient outcomes. Future research should focus on long-term efficacy and the integration of advanced imaging techniques to further substantiate these findings.

Keywords:

Direct pulp capping, calcium silicate, mineral trioxide aggregate, calcium hydroxide, clinical outcomes, systematic review

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