Comparison of Hyaluronic Acid, TheraCal, and Mineral Trioxide Aggregate as Pulpotomy Agents in Primary Molars

NCT ID: NCT07168811

Last Updated: 2025-09-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

66 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-01

Study Completion Date

2026-11-01

Brief Summary

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This randomized clinical trial aims to evaluation the clinical and radiographic outcomes of hyaluronic acid, TheraCal, and Mineral Trioxide Aggregate (MTA) when used as pulpotomy agents in primary molars.

The main question it aims to answer is:

In children with restorable mandibular second primary molars requiring pulpotomy, does the use of hyaluronic acid or TheraCal LC, compared to MTA, result in improved clinical and radiographic success rates over a 12-month follow-up period?

Detailed Description

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Premature loss of primary teeth can affect occlusion development and lead to complications such as space loss and malalignment of permanent teeth. To prevent this, effective pulpotomy treatment is essential. Therefore, identifying the most suitable pulpotomy agent is crucial to retain primary teeth until their natural exfoliation.

According to MTA research, it has a high success rate as a pulpotomy agent and favors tissue regeneration while also having a good long-term prognosis, good biocompatibility, and strong sealing capacity . Among its many applications are direct pulp capping, pulpotomy, root end filling, apexification, apexogenesis, and root perforation . Low compressive strength, high pH (approximately 10.2 after setting which take 3 hours, pH increase to 12,5), high cost, short shelf life, manipulation challenges, lengthy setting time, and discoloration are some disadvantages.

TheraCal LC (Bisco, Schaumburg, IL, USA) is a novel calcium silicate-based resin-modified material designed as a liner under restorative materials to protect and stimulate the pulp in both direct and indirect pulp capping. It contains polyethylene-glycol dimethacrylate monomers, barium zirconate, and tri-calcium silicate particles. According to earlier research, the TheraCal LC material stimulated the production of secondary dentin and apatite by releasing calcium.

TheraCal provides a number of advantages over other silicate-based materials, including low solubility, easy application, good mechanical properties, setting time, adequate bonding ability, and prevention of microleakage. Commercially available as a syringe, TheraCal is user-friendly. TheraCal is a good option for kids who can't handle long visits and might eventually stop cooperating because of all these benefits.

Hyaluronic Acid (HA) is made up of polyanionic disaccharide units of N-acetyl glucosamine and glucuronic acid joined by alternating β-(1ــــ3) and β-(1ــــ4) linkages. It is a naturally occurring non-sulfated glycosaminoglycan with a high molecular weight of 4000-20,000,000 Da. It is a linear polysaccharide found in the extracellular matrix of skin, vitreous humor, embryonic mesenchyme, connective tissue, synovial fluid, and several other human tissues and organs . It is an appealing material for use in several dental operations due to its biocompatibility, regenerative qualities, and antibacterial properties .

It is used in dentistry to treat alveolar osteitis, peri-implantitis, chronic periodontitis, and gingivitis; manage wound healing following free gingival graft; control symptoms like pain, swelling, and trismus that may arise following tooth extraction; heal recurrent oral ulcers; and to manage teething symptoms. Additionally, HA is employed in research utilizing human dental pulp stem cells (hDPSCs) in an effort to offer a novel method of regenerative endodontic therapy.

So the present study will be conducted for evaluation of Hyaluronic Acid, TheraCal, and Mineral Trioxide Aggregate as Pulpotomy Agents in Primary Molars.

Conditions

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Pulpotomies Primary Teeth Pulp Disease, Dental

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1. Group I: Hyaluronic acid (0,5% gengigel teething). (Study group).
2. Group II: theraCal LC. (Study group).
3. Group III: MTA (Control group).
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Operator Blinding: The operator performing the procedure will not be blinded due to the differences in handling and appearance of the materials.

Patient and Parent Blinding: Participants and their parents/legal guardians will be blinded to the type of pulpotomy agent used. All materials will be applied under rubber dam isolation, and the clinical procedure will be standardized to avoid revealing the material identity.

Outcome Assessor Blinding: The clinical and radiographic evaluations will be performed by a blinded, calibrated examiner who is unaware of the group assignments. The radiographs will be coded and assessed using standardized criteria to prevent bias.

Study Groups

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Hyaluronic acid

• After achieving complete hemostasis: Mix HA (0,5% gengigel teething) with ZO powder until a mixture, then apply it on pulp stumps.

all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India).

Group Type EXPERIMENTAL

Hyaluronic Acid (HA)

Intervention Type PROCEDURE

• After achieving complete hemostasis:

1. Mix HA (0,5% gengigel teething) with ZO powder until a mixture, then apply it on pulp stumps.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

TheraCal

• After achieving complete hemostasis: TheraCal L.C will be applied directly to the radicular pulp by a disposable syringe tip and light cure will be done for 20 seconds.

all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India).

Group Type EXPERIMENTAL

TheraCal

Intervention Type PROCEDURE

• After achieving complete hemostasis:

1. TheraCal L.C will be applied directly to the radicular pulp by a disposable syringe tip and light cure will be done for 20 seconds.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

Mineral Trioxide Aggregate

• After achieving complete hemostasis: mix MTA with sterile saline and put on pulp stumps. A moist cotton pellet was placed for initial setting.

all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India).

Group Type ACTIVE_COMPARATOR

Mineral Trioxide Aggregate

Intervention Type PROCEDURE

• After achieving complete hemostasis:

1. mix MTA with sterile saline and put on pulp stumps. A moist cotton pellet was placed for initial setting.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

Interventions

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Hyaluronic Acid (HA)

• After achieving complete hemostasis:

1. Mix HA (0,5% gengigel teething) with ZO powder until a mixture, then apply it on pulp stumps.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

Intervention Type PROCEDURE

TheraCal

• After achieving complete hemostasis:

1. TheraCal L.C will be applied directly to the radicular pulp by a disposable syringe tip and light cure will be done for 20 seconds.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

Intervention Type PROCEDURE

Mineral Trioxide Aggregate

• After achieving complete hemostasis:

1. mix MTA with sterile saline and put on pulp stumps. A moist cotton pellet was placed for initial setting.
2. all teeth will be restored with glass ionomer (Prevest Denpro Micron Superior Limited, India),then a stainless steel crown (3M, ESPE, USA) to ensure proper coronal seal and long-term success, which was cemented by glass ionomer cement(Prevest Denpro Micron Luting Limited, India)

Intervention Type PROCEDURE

Other Intervention Names

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HA Pulpotomy TheraCal LC Pulpotomy MTA Pulpotomy

Eligibility Criteria

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Inclusion Criteria

* Age 4-8 years,
* Co-operative patient
* At least one restorable mandibular second primary molars with deep carious lesions requiring pulpotomy.
* Absence of gingival swelling or sinus tract.
* Absence of spontaneous pain.
* Absence of pain on percussion.
* Controlled bleeding.
* First treatment the tooth.
* Possibility of restoring the tooth with a stainless steel crown.
* No Radiographic evidence of changes associated with pulp degeneration, such as widening of PDL space, internal root resorption, external root resorption, inter-radicular or periapical bone destruction (radiolucency).

Exclusion Criteria

* Swelling, sinus tract, or fistula.
* Spontaneous pain.
* Necrotic pulp, pathological mobility.
* Cases require for general anesthesia.
* A history of repeated need for analgesics.
* Patients with any systemic diseases.
* Uncontrolled bleeding.
* Selected deciduous teeth without a permanent successor
Minimum Eligible Age

4 Years

Maximum Eligible Age

8 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Al-Azhar University

OTHER

Sponsor Role lead

Responsible Party

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Omaima Salah Ahmed Mohamed Elbeltagy

Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Al-Azhar University

Cairo, , Egypt

Site Status

Countries

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Egypt

Central Contacts

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Omaima Salah Elbeltagy

Role: CONTACT

00201159514617

Dr. Adel Fathy Hussein, Professor

Role: CONTACT

References

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Cameron, Angus C., and Richard P. Widmer, eds. Handbook of Pediatric Dentistry E-Book: Handbook of Pediatric Dentistry E-Book. 5th ed. Elsevier Health Sciences, 2021. P. 131.

Reference Type BACKGROUND

Khatab, Arafa, and Elsayed Mohamed Deraz. "Clinical, radiographical and histopathological evaluation of Biodentine versus formocresol in primary teeth pulpotomy." Egyptian Dental Journal 65.4-October (Orthodontics, Pediatric & Preventive Dentistry) (2019): 3199-3212

Reference Type BACKGROUND

Amrollahi N, Karimi R, Shariati F. Clinical and radiographic success of TheraCal versus Formocresol in primary teeth pulpotomy: A systematic review and meta-analysis. Saudi Dent J. 2024 Aug;36(8):1058-1065. doi: 10.1016/j.sdentj.2024.06.008. Epub 2024 Jun 6.

Reference Type BACKGROUND
PMID: 39176161 (View on PubMed)

Jha S, Namdev R, Singhal R, Goel N, Singhal P, Rani R. Comparative Evaluation of Effectiveness of TheraCal LC, MTA, and Calcium Hydroxide in Direct Pulp Capping in Primary Molars: Randomized Clinical Study. Int J Clin Pediatr Dent. 2023 Sep;16(Suppl 2):213-219. doi: 10.5005/jp-journals-10005-2642.

Reference Type BACKGROUND
PMID: 38078039 (View on PubMed)

Ildes GC, Sezgin BI, Vieira AR, Mentes A. A randomized clinical trial of hyaluronic acid gel pulpotomy in primary molars with 1 year follow-up. Acta Odontol Scand. 2022 May;80(4):273-280. doi: 10.1080/00016357.2021.1998612. Epub 2021 Nov 9.

Reference Type BACKGROUND
PMID: 34752723 (View on PubMed)

Shaimaa mohamed Mahfouz; asmaa abdallah; shaimaa shaban el-desouky. "Clinical and Radiographic Evaluation of Hyaluronic Acid as a Vital Pulpotomy Medication in Primary Molars", Egyptian Dental Journal, 67, 3, 2021, 1843-1855

Reference Type BACKGROUND

Verma, Bhawna, et al. "Comparative evaluation of success of pulpotomy in primary molars treated with Formocresol, Pulpotec and Biodentine-6 month follow up study." Int J Appl Dent Sci 5 (2019): 77-82.

Reference Type BACKGROUND

Sezgin BI, Ildes Sezgin GC, Koyuncu O, Mentes A. Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study. BMC Oral Health. 2024 Jun 12;24(1):683. doi: 10.1186/s12903-024-04405-4.

Reference Type BACKGROUND
PMID: 38867194 (View on PubMed)

Miglani A, Vishnani R, Reche A, Buldeo J, Wadher B. Hyaluronic Acid: Exploring Its Versatile Applications in Dentistry. Cureus. 2023 Oct 2;15(10):e46349. doi: 10.7759/cureus.46349. eCollection 2023 Oct.

Reference Type BACKGROUND
PMID: 37920632 (View on PubMed)

Casale M, Moffa A, Vella P, Sabatino L, Capuano F, Salvinelli B, Lopez MA, Carinci F, Salvinelli F. Hyaluronic acid: Perspectives in dentistry. A systematic review. Int J Immunopathol Pharmacol. 2016 Dec;29(4):572-582. doi: 10.1177/0394632016652906. Epub 2016 Jun 8.

Reference Type BACKGROUND
PMID: 27280412 (View on PubMed)

Karadas M, Cantekin K, Gumus H, Ates SM, Duymus ZY. Evaluation of the bond strength of different adhesive agents to a resin-modified calcium silicate material (TheraCal LC). Scanning. 2016 Sep;38(5):403-411. doi: 10.1002/sca.21284. Epub 2015 Nov 10.

Reference Type BACKGROUND
PMID: 26553783 (View on PubMed)

Tao W, Tian G, Song Q, Lv Z. Application of mineral trioxide aggregate pulpotomy in the treatment of early pulpitis of primary molars. Am J Transl Res. 2024 Jan 15;16(1):285-294. doi: 10.62347/XVVC1010. eCollection 2024.

Reference Type BACKGROUND
PMID: 38322556 (View on PubMed)

Hamdi, Mona Nagy. "Clinical and radiographic evaluation of MTA based zinc oxide eugenol versus Formocresol pulpotomy in primary molars." Egyptian Dental Journal 69.3 (2023): 1767-1773.

Reference Type BACKGROUND

Sharaan, Marwa El-Sayed, and Mohamed Ibrahim Rabie. "Mineral Trioxide Aggregate VS Calcium Enriched Mixture molar pulpotomy: A systematic review and meta-analysis." Egyptian Dental Journal 64.1-January (Fixed Prosthodontics, Dental Materials, Conservative Dentistry & Endodontics) (2018): 363-371.

Reference Type BACKGROUND

Other Identifiers

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1222/5298

Identifier Type: -

Identifier Source: org_study_id

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