Cone-Beam Computed Tomography Evaluation of Mineralized Tissue Formation Following Direct Pulp Capping With Calcium...

This study aimed to evaluate the efficacy of two calcium silicate biomaterials, mineral trioxide aggregate (MTA) and Biodentine (BD), as direct pulp capping (DPC) agents by assessing reparative mineralized tissue formation using cone-beam computed tomography (CBCT).

This randomized controlled, split-mouth clinical trial involved 44 permanent premolars in patients aged 18-25 requiring orthodontic extraction. Teeth were randomly assigned for evaluation at 9-12 weeks and 13-16 weeks following DPC with either MTA or BD. Radiographic parameters, including dentin bridge thickness, continuity, and periapical status (CBCT periapical index [CBCT-PAI]), were assessed in three dimensions. Bonferroni-adjusted significance thresholds for multiple comparisons were p  < 0.0125 (dimensional) and p  < 0.025 (categorical).

All 44 teeth (100%) remained vital and asymptomatic, with no radiographic evidence of periapical lesions (CBCT-PAI score 1), pulp necrosis, or inflammation. The BD group achieved a 100% incidence of dentin bridge formation at both follow-up intervals, whereas the MTA group showed lower rates (63.6% at 9-12 weeks; 54.5% at 13-16 weeks). Even under strict Bonferroni correction, BD demonstrated significantly superior performance in dentin bridge thickness at 9-12 weeks (p  < 0.0125) and notably in both continuity and thickness at 13-16 weeks (p  < 0.025).

Both MTA and BD are highly effective in maintaining clinical pulp vitality. However, BD exhibits significantly superior performance in promoting the consistent formation of thicker, more homogeneous, and continuous dentin bridges. CBCT was confirmed as an effective and precise modality for the early, detailed 3D assessment of mineralized tissue formation.