|Year : 2019 | Volume
| Issue : 1 | Page : 1-5
Assessment of Biodentine as an indirect pulp capping material in young permanent molars
Amira F Soliman1, Nahed A Abu-Hamila1, Manal A El-Ebiary2
1 Department of Pediatric Dentistry, Faculty of Dentistry, Tanta University, Tanta, Egypt
2 Department of Dental Biomaterials, Faculty of Dentistry, Tanta University, Tanta, Egypt
|Date of Submission||20-Apr-2018|
|Date of Acceptance||31-May-2018|
|Date of Web Publication||13-Jun-2019|
Amira F Soliman
Department of Pediatric Dentistry, Faculty of Dentistry, Tanta University, Tanta
Source of Support: None, Conflict of Interest: None
Assess Biodentine as an indirect pulp capping material for treatment of young first permanent molars with deep carious lesions and its microleakage (in vitro).
Materials and methods
Indirect pulp capping was performed on 60 young permanent molars in 30 children aged 6–10 years then were randomly divided into two treatment groups of 30 molars for each group. Group I: The pulp was indirectly capped with Biodentine. Group II: The pulp was indirectly capped with Dycal. At the same appointment, the tooth was restored with Medifil as a semipermanent restoration. Clinical evaluation and standardized periapical radiographs were done after 3, 6 and 9 months. Microleakage test was assessed by dye penetration technique and followed up after 24 h, 1 and 3 months.
The two groups were clinically successful as Biodentine showed 100% success rate and Dycal showed 92.6%. There was no statistically significant difference (P > 0.05) between the two groups regarding to their clinical performance. While the radiographic examinations showed that Dycal had lower radiographic success rate (85.2%) in comparison to Biodentine (100%). Biodentine showed superior sealing ability than Dycal, with no statistically significant difference in the microleakage between the two tested materials (P > 0.05).
Biodentine is a promising material as an indirect pulp capping agent and exhibits superior sealing ability than Dycal.
Keywords: Biodentine, dentine bridge, indirect pulp capping, microleakage
|How to cite this article:|
Soliman AF, Abu-Hamila NA, El-Ebiary MA. Assessment of Biodentine as an indirect pulp capping material in young permanent molars. Tanta Dent J 2019;16:1-5
|How to cite this URL:|
Soliman AF, Abu-Hamila NA, El-Ebiary MA. Assessment of Biodentine as an indirect pulp capping material in young permanent molars. Tanta Dent J [serial online] 2019 [cited 2021 Dec 7];16:1-5. Available from: http://www.tmj.eg.net/text.asp?2019/16/1/1/260273
| Introduction|| |
Conservation of deep carious teeth in children is of a major concern to the pedodontist and general practitioners alike. Such a measure would prevent premature extraction, which may lead to loss of space and subsequent problems concerning the development of occlusion in the permanent dentition. An important priority in the treatment of deep carious lesions is to preserve pulp vitality. More conservative pulp management has the potential to reduce the need for a more invasive endodontic treatment.
For many decades, calcium hydroxide has been the 'gold standard' material for maintaining pulp vitality. Both clinically and histologically, it has been found to produce satisfactory results in indirect and direct pulp capping because it is capable of stimulating the formation of tertiary dentine by the pulp and its antimicrobial properties. However, despite its long history, the use of calcium hydroxide in vital pulp therapy remains controversial. Some studies have shown that calcium hydroxide bases disintegrate over time and microleakage takes place through tunnel defects in the tertiary dentine bridge. Some authors generally report that calcium hydroxide disappears with time.
A new bioactive cement, 'Biodentine', was recently provided in the dental market as a dentine substitute. Biodentine restoration of deep or large crown carious lesions provides a very tight seal, without postoperative sensitivity. It is able to promote mineralization as well as a dense dentine bridge. The sealing ability of this biomaterial was also assessed to be equivalent to glass-ionomers, without requiring any specific conditioning of the dentine surface. Leakage resistance and mechanical strength will improve over the first weeks after placement. It handles easily and needs much less time for setting. It is sufficiently stable so that it can be used both for pulp protection and temporary fillings.
| Materials and Methods|| |
Clinical study sample
This study was performed on 60 young lower first permanent molars of 30 healthy children of both sexes, aged from 6 to 10 years with mean age 8 years. Through clinical as well as radiographic examinations, each child had at least two young first permanent molars with deep carious lesions. The molars were divided into two treatment groups of 30 molars for each group. Group I: the pulp was indirectly capped with Biodentine (Septodont, Saint Maur des Fossés, France). Group II: the pulp was indirectly capped with Dycal (Dentsply, York, Pennsylvania, USA).
Preoperative periapical film was taken then anesthesia was given. Complete isolation by rubber dam was done, then removal of gross caries by high-speed hand piece using large diamond round bur. Caries removal at the site of risk for pulp exposure was performed with a large round carbide bur at low speed, and the cavity was thoroughly rinsed with saline (pH 7.4). The treatment was completed according to the grouping. At the same appointment, the molars were restored with Medifil (Promedica, Neumünster, Northern Germany) as a semipermanent restoration. Clinical evaluation and standardized periapical radiographs were done after 3, 6 and 9 months.
Approval for this study was obtained from Tanta Faculty of Dentistry, Tanta University Research Ethics Committee. The purpose of the present study was explained to the patients and informed consents were obtained in addition to the ascents from the children above 8 years old according to the guidelines on human research published by the Research Ethics Committee, Faculty of Dentistry, Tanta University.
Laboratory study sample
This study was carried out on 30 sound extracted upper first premolars due to orthodontic requirements, cleaned and polished of soft tissues and debris using scalars and pumice. The specimens were randomly divided into two treatment groups of 15 specimens for each group, treated as done before in the clinical session then were subdivided into three subgroups of five specimens for each group.
Standardized class I cavities of 3 mm in width, 2 mm in length and 1.5 mm depth in dentine were prepared using a high speed hand piece and a 836 diamond fissure bur. The capping materials were used according to the manufacturer's instructions and were allowed to set and the specimens were restored with Medifil as a semipermanent restoration.
The apices of the specimens were sealed with sticky wax and all specimen surfaces were covered with two coats of clear nail polish with exception of 1 mm around the tooth-restoration margins then allowed to air dry. The specimens were placed in separate mesh bags and thermocycled together for 2500 cycles in water between 5 ± 2 and 55 ± 2°C with a dwell time of 1 min in each bath and 15 s of transfer time between the baths. Specimens were immersed in 1% methylene blue dye (pH = 7.4) at 37°C for 24 h (n = 5), 1 (n = 5) and 3 months (n = 5) and kept at 37°C in an incubator. The specimens were sectioned longitudinally in a mesiodistal direction using a low speed diamond blade under constant water lubrication to remove the debris created by cutting.
Surfaces were dried and photographed under standardized conditions using a digital camera attached to a stereomicroscope. The photographs were imported to the AutoCAD software and the drawing measurements were carried out at a magnification, ×4.5. Dye penetration was calculated in millimeters then the mean microleakage was recorded. Microleakage test was done after 24 h, 1 and 3 months.
Approval for this research was obtained from Research Ethics Committee, Faculty of Dentistry, Tanta University. The purpose of the present study was explained to the patients and informed consents were obtained to use their teeth on the research according to the guidelines on human research published by the Research Ethics Committee, Faculty of Dentistry, Tanta University.
| Results|| |
Group I (Biodentine)
During the different follow-up periods, the treated teeth were symptom-free with no evidence of radiographic changes. The clinical and radiographic success rates were (100%). There was no statistically significant difference between the clinical and radiographic findings of Biodentine group at different follow-up periods (P = 1.00) [Table 1].
|Table 1 Clinical and radiographic evaluation of group I during the study periods|
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Group II (Dycal)
During the different follow-up periods, the treated teeth were symptom-free with no pathological signs except at 9 months two teeth (7.4%) showed pain on percussion while the remaining teeth (92.6%) were clinically free. There was statistically significant difference between Dycal group at 3 and 6 months (P = 0.001) with no statistically significant difference at 9 months (P = 0.135; [Table 2]).
Along the different follow-up periods, the treated teeth revealed no evidence of radiographic changes except two teeth (14.8%) showed periapical with inter-radicular bone loss, while the remaining teeth (85.2%) were radiographically free. There was no statistically significant difference between the radiographic findings of Dycal group at different follow-up periods (P = 1.00; [Table 3]).
After 24 h, no microleakage was calculated in both tested materials, while after 1 and 3 months Biodentine showed mean microleakage of 2.18 and 2.47 mm, respectively, compared to Dycal with mean microleakage of 3.47 and 4.82 mm after the same period respectively. Biodentine showed superior sealing ability than Dycal, with no statistically significant difference in the microleakage between the two tested materials [Table 4].
|Table 4 Comparison between the microleakage results of the tested materials at different follow-up periods|
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| Discussion|| |
Vital pulp therapy is defined as a treatment, which aims to preserve and maintain pulp tissue that has been compromised but not destroyed, by caries, trauma, or restorative procedures in a healthy state. It has been recommended that vital pulp therapy should be performed in young patients because of the high healing capacity of pulp tissue compared to older patients.
In this study, the clinical and radiographic success rate of Biodentine was 100% since the treated teeth were clinically free from pain sensation, soft tissue swelling, pain on percussion, tooth mobility and fistula or sinus tract. Radiographically, the treated teeth were free from internal or external resorption, periapical pathology and inter-radicular bone loss.
The high success rate of Biodentine was in coincidence with Tuna and Olmez reporting 100% success rate clinically and radiographically after 24 months follow-up. In addition, Bogen reported success rate of 98% on the basis of radiographic criteria, subjective symptoms and cold testing of pulp vitality in a 4-year follow-up study of indirect pulp capping in young permanent molars. This agreement may be due to Biodentine ability to create a firm anchorage to dentine, its antibacterial properties due to the alkaline pH and its improved mechanical properties, which are similar to dentine.
According to Mathieu et al. the high radiographic success rate of Biodentine may be also due to a release of TGF-β1 growth factor from pulp cells. This factor attracts pulp stem cells to Biodentine application site where it induces their differentiation into odontoblastic cells secreting reparative dentine.
Regarding the success rate of Dycal: clinically, at 9 months two teeth (7.4%) showed pain on percussion while the remaining teeth (92.6%) were clinically free. Radiographically, two teeth (14.8%) showed periapical with inter-radicular bone loss, while the remaining teeth (85.2%) were clinically free.
These results are consistent with Falster et al. in which the majority of their failures were from inter-radicular lesions noted at the 6–24 months' recall. This agreement may be due to the porous nature of the tertiary dentine bridge, which allows the access of bacteria into the pulp tissue, and eventually inflammatory pulpal reaction and necrosis may take place.
The present results agreed with Leksell et al. reporting success rate of 92% of calcium hydroxide on clinical and radiographic basis. In addition, Marchi et al. reported 88.8% success rate after 48 months. This may be attributed to the unstable physical properties of calcium hydroxide and its inability to provide a permanent seal.
However, these results disagreed with Casagrande et al. reporting 73.3% success rate after 60 months follow-up using calcium hydroxide. The difference in the results may be related to the fact that pulp capping was performed using stepwise excavation technique in addition to the longer follow-up period.
In addition, David and Thompson reported 76% success rate clinically and radiographically following application of calcium hydroxide as an indirect pulp capping agent for a 6 months' period. The difference in the results may be due to they included primary and permanent molars in their study.
In this study dye penetration method was used to evaluate the microleakage because methylene blue dye provides an excellent contrast with the surrounding environment and it can easily penetrate microspaces between the various interfaces.
The samples were subjected to 2500 cycles in water between 5 ± 2 and 55 ± 2°C with a dwell time of 1 min in each bath and 15 s of transfer time between the baths to replicate the intraoral environment.
The stereomicroscopic observations were done, which gave a clear in depth image with the help of recent image processors and software. The use of AutoCAD software provided a far more precise measurement of the actual depth of dye penetration measured on magnified apparent images up to 20 times (×20).
After 24 h, no microleakage was calculated in both tested materials. After 1 and 3 months Biodentine showed superior sealing ability with mean microleakage of 2.18 and 2.47 mm, respectively, compared to Dycal with mean microleakage of 3.47 and 4.82 mm after the same period respectively with no statistically significant difference in the mean microleakage between the two tested materials.
The results of this study agree with those of Kokate et al. and Prasanti et al.for no significant differences were found between the sealing abilities of Biodentine and Dycal. This agreement may be attributed to the good marginal integrity of Biodentine, which is likely due to the outstanding ability of the calcium silicate materials to form hydroxyapatite crystals at the surface. Also, the nanostructure of the calcium silicate hydrate may also explain the good sealing qualities of the calcium silicate cement.
The results of this study disagree with those of Pawar and Ravichandra et al., for significant differences were found between the sealing abilities of Biodentine and Dycal. This disagreement may be due to both of them used a sample size of 10 specimens per group, Indian ink, sectioned their specimens transversely and confocal laser scanning microscopy was used to assess the specimens.
| Conclusion|| |
- Biodentine showed high clinical and radiographic success rate compared to Dycal, with no statistical significant difference between the two groups
- Biodentine showed high sealing ability compared to Dycal, with no statistical significant difference between the two groups.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]