4-Year Pulp Survival in a Randomized Trial on Direct Pulp Capping.

Area of Science:

• Endodontics
• Restorative Dentistry
• Dental Materials

Background:

• Assessing pulp survival in adult posterior teeth with carious pulp exposure undergoing direct pulp capping.
• Evaluating the efficacy of pulp lavage solutions in conjunction with mineral trioxide aggregate (MTA) direct pulp capping.

Purpose of the Study:

• To compare the pulp survival rates and treatment outcomes of direct pulp capping using mineral trioxide aggregate (MTA) following lavage with either physiological saline or 2.5% sodium hypochlorite (NaOCl).

Main Methods:

• Randomized controlled trial involving 96 patients with nonpainful posterior teeth and carious pulp exposure.
• Complete caries excavation, direct pulp capping with MTA, and immediate composite resin restoration.
• Pulp lavage with physiological saline or 2.5% NaOCl.
• Assessment of matrix metalloproteinase-9 (MMP-9) and total protein in pulpal fluid.
• Clinical and radiographic evaluation at 1 and 3 years post-intervention.

Main Results:

• Pulp survival at 1500 days was significantly higher with 2.5% NaOCl lavage (55%) compared to saline (7%).
• NaOCl lavage substantially reduced painful treatment failures (33% vs. 62% in the saline group).
• High MMP-9/total protein values indicated early, painful failures but did not predict later failures.

Conclusions:

• The study challenges the high success rates expected from direct pulp capping in cases of deep caries.
• Sodium hypochlorite (NaOCl) lavage significantly enhances pulp survival and reduces painful failures in direct pulp capping procedures.
• MMP-9 assessment is not a reliable predictor of treatment failures beyond the early stages.