RCT of Pulp Capping Over Carious Exposure in Adults

NCT ID: NCT01224925

Last Updated: 2019-03-18

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-10-18

Study Completion Date

2015-12-10

Brief Summary

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This multicentre study was a randomized, controlled, parallel, patient-blinded, two-arm superiority trial with a 1:1 allocation ratio that followed the CONSORT guidelines.The aim of this study was to investigate whether MTA is more effective than a conventional calcium hydroxide liner (Dycal®) as a direct pulp capping material in mature molar teeth with a carious pulpal exposure.

Detailed Description

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Calcium hydroxide (CH) is considered the standard material for pulp capping with good results in cases with pulpal exposure as a result of dental trauma both in animal and clinical studies. However, in carious exposures, follow-up studies of direct pulp capping performed with CH based materials have shown increasing failure rates and the outcome has been considered uncertain. Direct capping of carious exposures still remains a controversial treatment for mature teeth.

A new material, mineral trioxide aggregate (MTA) was introduced for root end filling material almost two decades ago. It is also suggested for pulp capping. MTA cement has showed good sealing ability and bio-compatibility in animal studies. Results from studies in humans corroborate the results from animal studies.

Although the overall results of pulp capping in human studies using MTA are very positive, well designed and controlled clinical studies, especially involving carious exposures on adult teeth are lacking.At the time the present study was launched, there were no RCTs comparing MTA and CH as DPC materials and the histological evaluations have primarily been based on healthy teeth, thus undermining the generalizability of the results to adult patients with carious exposures.

Conditions

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Carious Exposure Human Permanent First and Second Molars Mature Teeth Proximal Caries Healthy Pulp Reversible Pulpitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multicenter study a randomized, controlled, parallel, patient-blinded, two-arm superiority trial with a 1:1 allocation ratio
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Patient -blinded

Study Groups

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Capping over carious exposure with Dycal

Total caries removal. In case of pulp exposure Direct Pulp capping with (Dycal®, Dentsply DeTrey GmbH, Konstanz, Germany)

Group Type ACTIVE_COMPARATOR

Direct pulp capping with Dycal

Intervention Type PROCEDURE

Capping over carious exposure with Dycal. Dycal: covered with Fuji IX. After one week, part of the temporary filling was left under the permanent filling

Capping over carious exposure with WMTA

Total caries removal. In case of pulp exposure Direct Pulp capping with Mineral Trioxide Aggregate White ProRoot® (WMTA) (DENTSPLY, Tulsa Dental, Tulsa, OK, USA)

Group Type EXPERIMENTAL

Direct pulp capping

Intervention Type PROCEDURE

WMTA capping over exposed pulp, wet pellet, Fuji IX. After one week, the entire temporary filling was removed,the cavity was permanently restored with a composite resin material used at the study clinic.

Interventions

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Direct pulp capping with Dycal

Capping over carious exposure with Dycal. Dycal: covered with Fuji IX. After one week, part of the temporary filling was left under the permanent filling

Intervention Type PROCEDURE

Direct pulp capping

WMTA capping over exposed pulp, wet pellet, Fuji IX. After one week, the entire temporary filling was removed,the cavity was permanently restored with a composite resin material used at the study clinic.

Intervention Type PROCEDURE

Other Intervention Names

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(Dycal®, Dentsply DeTrey GmbH, Konstanz, Germany WMTA - White Mineral Trioxide Aggregate

Eligibility Criteria

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Inclusion Criteria

* Age 18-55 years
* 1st and 2nd permanent molars
* Proximal caries to inner 1/3 of dentin (bite-wing)
* Apex closed, no periapical changes (apical radiograph)
* No periodontal pockets deeper than 4mm
* Medical history non-contributory (incl.pregnancy)
* No medication (no antibiotics during last month)
* No signs or symptoms more severe than reversible pulpitis
* Positive response to electrical pulp test(EPT) or cold test
* Written consent Inclusion requires compliance with all the criteria listed

Exclusion Criteria

* During the treatment there will be no pulpal exposure
* The bleeding of the exposed pulp cannot be controled in 10 minutes
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Norwegian Public dental health service

UNKNOWN

Sponsor Role collaborator

University of Tromso

OTHER

Sponsor Role lead

Responsible Party

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Rita Kundzina

DDS,PhD (Associate professor (endodontics)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Rita Kundzina, DDS, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Tromso,Faculty of Health Sciences, Institute of Clinical Dentistry

Locations

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Avimeda Dental Clinic

Klaipėda, , Lithuania

Site Status

Alta Dental Clinic

Alta, , Norway

Site Status

Sandessjoen Dental Clinic

Sandnessjøen, , Norway

Site Status

Tromso University Dental Clinic

Tromsø, , Norway

Site Status

Countries

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Lithuania Norway

References

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Zander HA. Reaction of the pulp to calcium hydroxide. J Dent Res 1939;18:373-9

Reference Type BACKGROUND

Hørsted-Bindslev P, Bergenholtz G. Vital pulp therapies. In: Bergenholtz G,Hørsted-Bindslev P, Reit C. Textbook of endodontology. Blackwell Munksgaard,Oxford;2003:66-91

Reference Type BACKGROUND

Baume LJ, Holz J. Long term clinical assessment of direct pulp capping. Int Dent J. 1981 Dec;31(4):251-60.

Reference Type BACKGROUND
PMID: 7030965 (View on PubMed)

Tronstad L. Reaction of the exposed pulp to Dycal treatment. Oral Surg Oral Med Oral Pathol. 1974 Dec;38(6):945-53. doi: 10.1016/0030-4220(74)90348-x. No abstract available.

Reference Type BACKGROUND
PMID: 4216870 (View on PubMed)

Horsted P, Sandergaard B, Thylstrup A, El Attar K, Fejerskov O. A retrospective study of direct pulp capping with calcium hydroxide compounds. Endod Dent Traumatol. 1985 Feb;1(1):29-34. doi: 10.1111/j.1600-9657.1985.tb00555.x. No abstract available.

Reference Type BACKGROUND
PMID: 3858095 (View on PubMed)

Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. J Endod. 2000 Sep;26(9):525-8. doi: 10.1097/00004770-200009000-00010.

Reference Type BACKGROUND
PMID: 11199794 (View on PubMed)

Ward J. Vital pulp therapy in cariously exposed permanent teeth and its limitations. Aust Endod J. 2002 Apr;28(1):29-37. doi: 10.1111/j.1747-4477.2002.tb00364.x.

Reference Type BACKGROUND
PMID: 12360679 (View on PubMed)

Stanley HR. Criteria for standardizing and increasing credibility of direct pulp capping studies. Am J Dent. 1998 Jan;11 Spec No:S17-34.

Reference Type BACKGROUND
PMID: 9760878 (View on PubMed)

Torabinejad M, Watson TF, Pitt Ford TR. Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod. 1993 Dec;19(12):591-5. doi: 10.1016/S0099-2399(06)80271-2.

Reference Type BACKGROUND
PMID: 8151252 (View on PubMed)

Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996 Oct;127(10):1491-4. doi: 10.14219/jada.archive.1996.0058.

Reference Type BACKGROUND
PMID: 8908918 (View on PubMed)

Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF, Dezan Junior E. Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer. J Endod. 1999 Nov;25(11):728-30. doi: 10.1016/s0099-2399(99)80118-6.

Reference Type BACKGROUND
PMID: 10726538 (View on PubMed)

Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimitriou S. The dentinogenic effect of mineral trioxide aggregate (MTA) in short-term capping experiments. Int Endod J. 2002 Mar;35(3):245-54. doi: 10.1046/j.1365-2591.2002.00471.x.

Reference Type BACKGROUND
PMID: 11985676 (View on PubMed)

Asgary S, Parirokh M, Eghbal MJ, Ghoddusi J, Eskandarizadeh A. SEM evaluation of neodentinal bridging after direct pulp protection with mineral trioxide aggregate. Aust Endod J. 2006 Apr;32(1):26-30. doi: 10.1111/j.1747-4477.2006.00004.x.

Reference Type BACKGROUND
PMID: 16603042 (View on PubMed)

Salako N, Joseph B, Ritwik P, Salonen J, John P, Junaid TA. Comparison of bioactive glass, mineral trioxide aggregate, ferric sulfate, and formocresol as pulpotomy agents in rat molar. Dent Traumatol. 2003 Dec;19(6):314-20. doi: 10.1046/j.1600-9657.2003.00204.x.

Reference Type BACKGROUND
PMID: 15022999 (View on PubMed)

Farsi N, Alamoudi N, Balto K, Al Mushayt A. Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. J Clin Pediatr Dent. 2006 Winter;31(2):72-6. doi: 10.17796/jcpd.31.2.n462281458372u64.

Reference Type BACKGROUND
PMID: 17315797 (View on PubMed)

Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J. 2003 Mar;36(3):225-31. doi: 10.1046/j.1365-2591.2003.00652.x.

Reference Type BACKGROUND
PMID: 12657149 (View on PubMed)

Caicedo R, Abbott PV, Alongi DJ, Alarcon MY. Clinical, radiographic and histological analysis of the effects of mineral trioxide aggregate used in direct pulp capping and pulpotomies of primary teeth. Aust Dent J. 2006 Dec;51(4):297-305. doi: 10.1111/j.1834-7819.2006.tb00447.x.

Reference Type BACKGROUND
PMID: 17256303 (View on PubMed)

Chacko V, Kurikose S. Human pulpal response to mineral trioxide aggregate (MTA): a histologic study. J Clin Pediatr Dent. 2006 Spring;30(3):203-9. doi: 10.17796/jcpd.30.3.38h13g5p84651652.

Reference Type BACKGROUND
PMID: 16683667 (View on PubMed)

Iwamoto CE, Adachi E, Pameijer CH, Barnes D, Romberg EE, Jefferies S. Clinical and histological evaluation of white ProRoot MTA in direct pulp capping. Am J Dent. 2006 Apr;19(2):85-90.

Reference Type BACKGROUND
PMID: 16764130 (View on PubMed)

Nair PN, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J. 2008 Feb;41(2):128-50. doi: 10.1111/j.1365-2591.2007.01329.x. Epub 2007 Oct 23.

Reference Type BACKGROUND
PMID: 17956562 (View on PubMed)

Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008 Mar;139(3):305-15; quiz 305-15. doi: 10.14219/jada.archive.2008.0160.

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Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater. 2008 Feb;24(2):149-64. doi: 10.1016/j.dental.2007.04.007. Epub 2007 Jun 21.

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PMID: 17586038 (View on PubMed)

Miyashita H, Worthington HV, Qualtrough A, Plasschaert A. Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004484. doi: 10.1002/14651858.CD004484.pub2.

Reference Type BACKGROUND
PMID: 17443547 (View on PubMed)

Eriksen HM, Bergdahl M, Byrkjeflot LI, Crossner CG, Widstrom E, Tillberg A. Evaluation of a dental outreach teaching programme. Eur J Dent Educ. 2011 Feb;15(1):3-7. doi: 10.1111/j.1600-0579.2010.00636.x.

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Bjorndal L. Stepwise excavation may enhance pulp preservation in permanent teeth affected by dental caries. J Evid Based Dent Pract. 2011 Dec;11(4):175-7. doi: 10.1016/j.jebdp.2011.09.005.

Reference Type BACKGROUND
PMID: 22078824 (View on PubMed)

Kundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E. Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J. 2017 Oct;50(10):924-932. doi: 10.1111/iej.12719. Epub 2016 Nov 28.

Reference Type DERIVED
PMID: 27891629 (View on PubMed)

Other Identifiers

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UiT-IKO-MTA-001

Identifier Type: -

Identifier Source: org_study_id

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