Comparison of Effectiveness of Biodentine Versus Calcium Hydroxide as Indirect Pulp Capping Material in Mature Permanent Teeth
Comparison of Effectiveness of Biodentine Versus Calcium Hydroxide as Indirect Pulp Capping Material in Mature Permanent Teeth
This study compares the clinical and radiographic effectiveness of Biodentine and Calcium Hydroxide as indirect pulp capping materials in mature permanent teeth with reversible pulpitis. A total of 76 patients were randomly assigned to two groups. Outcomes were assessed over 12 weeks based on pain, periapical radiolucency, and PDL widening. The goal was to determine which material better preserves pulp vitality
Introduction:
Preservation of pulp vitality is critical for the long-term health and functionality of teeth. The pulp can be compromised due to caries, trauma, or iatrogenic factors. One conservative treatment to preserve pulp vitality in teeth with deep carious lesions and reversible pulpitis is indirect pulp capping (IPC).
Traditionally, Calcium Hydroxide (Ca(OH)₂) has been the gold standard material for IPC due to its antibacterial properties and its ability to stimulate the formation of reparative dentin. However, it has several limitations such as poor bonding to dentin, high solubility, and low mechanical strength, which may affect long-term success.
Biodentine, a newer bioactive dentin substitute, has emerged as a potential alternative due to its biocompatibility, bioactivity, antibacterial effect, good sealing ability, and high compressive strength. These properties suggest Biodentine may offer superior clinical outcomes in preserving pulp vitality when used as an indirect pulp capping material.
Objective:
To compare the clinical and radiographic effectiveness of Biodentine versus Calcium Hydroxide as indirect pulp capping agents in mature permanent teeth with reversible pulpitis.
Study Design:
Type: Experimental comparative study
Setting: Department of Operative Dentistry & Endodontics, HITEC-IMS, Taxila
Duration: 1 year (after IRB approval)
Sample Size: 76 patients (38 in each group), calculated using WHO sample size calculator
Sampling Technique: Non-probability consecutive sampling
Inclusion Criteria:
Patients aged 20-45 years
Teeth with occlusal carious lesions with ICDAS radiographic score RC-5
Vital teeth with signs of reversible pulpitis
No signs of root resorption
Exclusion Criteria:
Teeth tender to percussion
Irreversible pulpitis or non-vital pulp
Medically compromised or pregnant patients
Third molars or teeth with pulp exposure during caries excavation
Materials Used:
Group I: Biodentine (Septodont, France)
Group II: Calcium Hydroxide (Dycal)
Base Material: Self-cure Glass Ionomer Cement (Fuji, Japan)
Final Restoration: Light-cure composite resin
Disinfectant: 0.2% Chlorhexidine
Vitality Tests: Cold test and electric pulp test
Caries Removal: Round bur (#BR-45) under copious water spray
Isolation: Rubber dam
Procedure:
Pre-operative Steps:
Informed consent obtained
Patient assessment: history, clinical examination, vitality testing, radiographs
Operative Steps:
Group I (Biodentine):
Caries removed and cavity prepared
Biodentine mixed per manufacturer's instructions and placed
After 1 week, a GIC base applied
Final composite restoration placed
Post-op radiograph taken
Group II (Calcium Hydroxide):
Caries removed and cavity dried
0.5 mm Dycal applied and allowed to set (2-3 min)
GIC base placed immediately afterward
Final composite restoration after 1 week
Post-op radiograph taken
Follow-Up Intervals:
2 weeks
6 weeks
12 weeks
Evaluation Criteria:
Clinical Parameters:
Pain (reversible or persistent)
Tenderness to percussion
Response to pulp vitality tests
Radiographic Parameters:
Presence or absence of periapical radiolucency
Periodontal ligament (PDL) space widening
Data Collection Tool:
Data was recorded using a structured proforma (Annexure-C), documenting all clinical and radiographic parameters at baseline and follow-up intervals.
Statistical Analysis:
Software: SPSS Version 26
Quantitative Variables: Mean ± standard deviation (e.g., age, weight)
Qualitative Variables: Frequency and percentage (e.g., pain, radiographic changes)
Test Used: Chi-square test
Level of Significance: p < 0.05 considered statistically significant
Ethical Considerations:
Approved by Institutional Review Board (IRB) and College Ethical Committee
Written informed consent obtained in both English and Urdu
Patient confidentiality strictly maintained
Participants allowed to withdraw at any time without affecting treatment
Budget and Funding:
Funded by Dental College, HITEC-IMS, Taxila
No financial burden on participants
Estimated duration for study completion: 1 year
Expected Outcome:
The study aims to determine whether Biodentine, with its superior physical and biological properties, provides better clinical and radiographic outcomes in indirect pulp capping procedures compared to Calcium Hydroxide in mature permanent teeth.
Inclusion Criteria:
Participants must meet all of the following criteria to be included in the study:
Exclusion Criteria:
Chronic systemic illness
Immunocompromised status
Pregnancy
-Third molars (due to anatomical and treatment variability)