Evaluation Of Bond Strength Of Splinting Material To The Teeth After Thermocycling - An In Vitro Study
Akshayaa L1, Vignesh Ravindran2*, Madhulaxmi M3
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai- 77, India.
2 Senior Lecturer, Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai- 77, India.
3 Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai- 77, India.
*Corresponding Author
Vignesh Ravindran,
Senior Lecturer, Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha
University, Chennai- 77, India.
E-mail: vigneshr.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 22, 2021; Published: September 23, 2021
Citation:Akshayaa L, Vignesh Ravindran, Madhulaxmi M. Choice Of Tricalcium Silicate Cements Among Children For Pulp Capping - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(9):4527-4530. doi: dx.doi.org/10.19070/2377-8075-21000921
Copyright: Vignesh Ravindran©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: The fundamental objective of paediatric dentistry involves the preservation of functional primary teeth
through various pulp therapies. The significant treatment options for the vital pulp therapy includes pulp capping in adults,
partial or complete pulpotomy in children. MTA (Mineral trioxide Aggregate) was the first Tricalcium silicate cement introduced
in dentistry and was considered as the gold standard pulp capping agent. Recently developed Tricalcium silicate cements
are biodentine, calcium-enriched cement, endosequence.
Aim: The aim of the study was to evaluate the choice of Tricalcium silicate cement among children for pulp capping.
Materials and Methods: The present study was conducted under university setting by analysing 5,00,000 case sheets. The
data was collected from case sheets of children who had pulp capping procedures.The collected data were cross verified by another
examiner and the final data was obtained. A total of 172 cases were taken and statistically analysed using SPSS software.
Results: From the data obtained, it was observed that the most common choice of Tricalcium silicate cement was found to
be MTA 69%, when compared to biodentine only about 30% used for pulp capping among the children aged between 3-17
years. Gender comparison showed no significant differences (p-value = 0.9).
Conclusion: Within the limitations of the study, we found that MTA was highly preferred by the dentists as a pulp capping
material. From the results it has been observed that about 68% of the children are mostly treated with the MTA.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Tricalcium Silicate Cements; Pulp Capping; MTA; Biodentine; Novel Study; Innovative Technique.
Introduction
The fundamental objective of paediatric dentistry involves the
preservation of functional primary teeth through various pulp
therapies. The significant treatment options for the vital pulp
therapy includes pulp capping in adults, partial or complete pulpotomy
in children [1]. There are three endodontic treatment approaches
given for primary teeth which incorporate direct pulp
capping, pulpotomy, indirect pulp capping. Direct pulp capping
and pulpotomy is indicated if the pulp has been exposed. Then,
the indirect pulp capping is indicated for the teeth with deep dentinal
caries and reversible pulpitis [2]. The success of the vital pulp
therapy relies on the choice of pulp capping agents.
An ideal prerequisite of pulp capping material should have: a)
ability to stimulate the formation of reparative dentin; b) to maintain
pulp vitality; c) should have effective bactericidal action; d)
with adequate pulp sealing quality [3]. Tricalcium silicate cement
is a type of white ceramic material, composed mainly of calcium
silicate, calcium hydroxide, and hydroxyapatite particles [4]. These
materials are found to have wide applications in endodontic treatment.
It is widely utilised for pulp capping, pulpotomy, resorption
defects, perforation repair, for root apexification and as a root
canal sealant [5].
MTA (Mineral trioxide Aggregate) was the first Tricalcium silicate
cement introduced in dentistry and was considered as the
gold standard pulp capping agent. Recently developed Tricalcium silicate cements are biodentine, calcium-enriched cement, endosequence
etc [6]. The principal benefits of MTA are it is highly
biocompatible with good sealing ability. MTA has shortcomings
also when utilised for direct pulp capping particularly in children,
as it has prolonged setting time, difficult handling properties and
causes discolouration of teeth [7]. Another important biomaterial
which is known to overcome these limitations is tricalcium
silicate cement, a biodentine which was introduced in 2009, to be
a second generation hydraulic calcium silicate cement. Biodentine
material can be used as a dentin substitute and it is also highly
biocompatible. It also reduces the setting time and is significantly
involved in the regeneration of pulpal tissues [8].
Several clinical studies have evaluated the preference of Tricalcium
silicate cements used for pulp capping procedures. It has been
reported that MTA shows 90% success rate when used as the
pulp capping agent in young permanent teeth [9]. A case report
study has elicited that biodentine was clinically preferred over other
pulp capping materials as it takes a shorter time for setting and
is profoundly biocompatible [10]. Our team has extensive knowledge
and research experience that has translated into high quality
publications [11-23, 24-30]. Thus our present study was aimed to
evaluate the choice of Tricalcium silicate cement used for pulp
capping among children aged 3-17 years.
Materials and Methods
A retrospective study was conducted under a university setting.
The study was approved by the institutional ethical committee. A
total of 5,00,000 case sheets viewing the patient history was collected.
Informed consent was obtained from the parents or guardian
regarding usage of the clinical data for research purposes.
Inclusion criteria includes children who underwent pulp capping
using Tricalcium silicate cement. Patients between 6-17 years of
age who had pulp capping were included for the study. And the
patients above 18 years who had pulp capping without Tricalcium
silicate cement were excluded for the study.
Cross checking of data including digital entry and intraoral photographs
was done by an additional reviewer, and as a measure to
minimise sampling bias, samples for the group were picked by the
simple random sampling method. Digital entry of clinical examination
and intraoral photographs were assessed.
The collected data was tabulated in Excel and was then imported
to SPSS software (version 23). Descriptive statistics were performed
for the obtained results and comparison between groups
were done by using Chi square tests.
Results and Discussion
Out of 5,00,000 case sheets, 172 cases were included four our
present study. We evaluated the choice of Tricalcium silicate cement
used for pulp capping among the children. Among the children
treated with pulp capping, about 53.5% of them were males
and 46.5% of them were females (Figure 1). About 69.2% of
children were treated with MTA, while 30.8% of children were
treated with biodentine material for pulp capping (Figure 2). MTA
was the most commonly used material for both males and females.
This shows that there was no difference in usage of the
material based on gender of the patient. This was not statistically
significant (p value = 0.908) (Figure 3).
From the results obtained in our study, it has been observed that
MTA is a typical choice of Tricalcium silicate cement used for
pulp capping. A previous study with the similar findings has been
reported that MTA showed higher success rate and it was considered
as the most favourable material for pulpotomy in primary
teeth [31]. A previous study done by Noorollahian et al, stated
that formocresol is profoundly effective and a preferred pulp capping
agent than MTA. As it is more expensive and causes longer
duration of clinical procedures [32]. Our study has compared
the choice of Tricalcium silicate cement with the gender of the
children who had pulp capping. A clinical study similar to this
has revealed that MTA showed a preferable clinical impact than
other Tricalcium silicate cements for pulp capping done on primary
teeth [33]. A previous observational study also revealed that correlation between the gender and choice of Tricalcium silicate
cement didn’t appear to be statistically significant [34].
In our study we analysed that MTA was highly preferred about
37% as a pulp capping material, when compared to biodentine,
15% utilised. Like our findings, another clinical study has assessed
that rather than MTA, Calcium hydroxide CaOH is likewise considered
as a better pulp capping agent because of its excellent
antibacterial properties [35]. A retrospective clinical study reported
that 80% of clinicians have preferred formocresol over
other calcium biosilicate cements as a pulpotomy medicaments
for children [36]. Despite the fact that MTA has high clinical success
rates, it may not be favoured because of its high cost and
difficult handling properties. From our study outcome, we found
that MTA was mostly preferred material by the dentist than biodentine
for its enhanced pulp sealing effect and biocompatibility.
A similar clinical study done among 30 asymptomatic molars in
children, have demonstrated that MTA showed a good clinical impact
when it is used for the teeth with extreme carious pulp exposures
[37]. A previous study done by Schwendicke et al, found that
the main reason for which MTA was underused, for its excellent
response with high cost benefit when compared to formocresol
and CaOH [38].
Biodentine material seems to be less used pulp capping material
among the children as it has recently been introduced. Despite
this, it has predominant properties like easier manipulation with
good clinical outcomes. But only a few studies were found to be
related to the biodentine material [39]. Another study, a 6 month
follow-up clinical trial, found that utilization of biodentine is the
most reliable choice in vital pulp therapy in primary teeth [40].
Our present study had its own limitations as it is being done in
a single university, with a smaller sample size and a shorter time
span. Thus the future extent of our study relies on good pulp
therapy, the best choice of Tricalcium silicate cement used by
the dentist for the pulp capping procedures. However, our study
should have a long term follow up for the cases with the goal
which will allow us to know the preference of Tricalcium silicate
cement being used for pulp capping among the children.
Figure 1. The bar graph represents the percentage distribution of the gender of children who had pulp capping procedures. It shows that about 53.5% of them were males and 46.5% of them were females.
Figure 2. This bar graph represents the percentage of Tricalcium silicate cement preferred for pulp capping among the children. It shows that about 69.2% of children were treated with MTA, while 30.8% of children were treated with biodentine material for pulp capping.
Figure 3. Bar graph represents the association between gender of the children and percentage of Tricalcium silicate cement used for pulp capping procedure. The X axis represents the gender of the children. Y axis represents the percentage of two Tricalcium silicate cements used for pulp capping. Here, blue denotes the percentage of children who are treated using biodentine material. Green denotes the percentage of children treated with MTA. MTA was the most commonly used material for both males and females. This shows that there was no difference in usage of the material based on gender of the patient. (Pearson’s chi square test value is 0.13; p value = 0.908 - statistically not significant).
Conclusion
Within the limitations of the study, we found that MTA was highly
preferred by the dentists as a pulp capping material, as biodentine
is less used. From the results it has been observed that about
68% of the children are mostly treated with the MTA. However,
with its clinical benefits, mineral trioxide aggregate shows promising
material for an indirect pulp capping among the children aged
between 3 to 17 years.
Acknowledgement
The authors are thankful to the Department of Pediatric and Preventive
Dentistry,Saveetha Dental College, Saveetha Institute of
Medical and Technical science, Saveetha University for providing
a platform in expressing their knowledge.
Source of Funding
The present project was sponsored by
• Saveetha Dental College,
• Saveetha Institute of Medical and Technical science (SIMATS),
• Saveetha University and
• Lingam stores.
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