DOI: https://doi.org/10.

53350/pjmhs22167172
ORIGINAL ARTICLE

To Compare the Effectiveness of Biodentine versus Mineral Trioxide

aggregate as Direct Pulp Capping agent in carious exposed permanent
tooth
MAHRUKH ANWAR1, MUHAMMED BADER MUNIR2, NIGHAT SHAFI3, SADIA JAVED4, MARYUM VIRDA5, SANA AKRAM6
1
Assistant Professor, Department of Operative Dentistry, Rashid Latif Dental College, Lahore.
2
Associate Professor, Operative Dentistry, deMontmorency College of Dentistry, Lahore.
3
Assistant Professor, Department of Operative Dentistry, Avicenna dental college, Lahore
4
Assistant Professor, Department of Operative Dentistry, Shahida Islam Dental College, Lodhran
5
Assistant Professor, Department of Operative Dentistry, University College of Medicine and Dentistry, Lahore
6
Assistant Professor, Department of Operative Dentistry, Faryal Dental College, Lahore
Correspondence to Dr.Mahrukh Anwar, Email ID: [email protected], Phone number: 03332407517

ABSTRACT
Aim: To compare the effectiveness of Biodentine versus mineral trioxide aggregate as direct pulp capping agent in carious
exposed permanent tooth
Study Design: Randomized controlled trial
Placeand duration: Operative Dentistry, Department of de’Montmorency College of Dentistry / Punjab Dental Hospital, Lahore
From 29-07-16 to 30-01-17
Methods: Sample size of 75 in each group (using non-probability) calculated using 80 percent power, 5% level of significance
with expected percentage of effectiveness (lack of periapical radiolucency) among groups i.e. 92.68%19 in Biodentine group vs.
78%20 in mineral trioxide group aggregate as direct pulp capping agent. Data was entered and analyzed with IBM SPSS 20.
Level of significance was kept at p-value ≤ 0.05.
Results: Total 150 patients, 82 are male and 68 are female. The age of patients was 18-45 years. The Mean and SD of age of
patients is 30±7.916. In group I, 57(75%) showed efficacy and 18(25%) showed failure of efficacy while in group II 72 (95%)
showed efficacy and 3 (5%) showed failure of efficacy after 3 months. Comparison of efficacy shows that group II Biodentinehas
better efficacy as compared to group I.
Conclusion: It is concluded that Biodentine is more effective than MTA.It can be used as bulk fill, simplify the pulp capping
procedure.
Keywords: direct pulp capping, vital pulp therapy, efficacy of newer pulp capping materials, MTA and Biodentine.

INTRODUCTION MATERIALS AND METHODS

Dental Pulp is highly sensitive vascular tissue protected by The study was conducted on outpatient operative department of de
dentine, both work together as functional and formative complex. ’Montmorency college of dentistry / Punjab dental hospital from
The response of tissueagainst differentphysiologicalforces, 29thjuly 2016 to 30thjan 2017 following approval from the
pathologic stimuli or developmental anomalies depends upon institution’s Ethical Committee. One hundred fifty teeth were
theseverity. Thedental pulp has ability to form reparative dentin selected in patients ranging from 18 to 45 years, Maxillary and
continuously throughout life. This maintains pulp vitality and helps Mandibular permanent teeth. All teeth exhibited deep caries with
to compensate the enamel or dentin loss2,6. no prior restoration clinically .Each tooth was clinically and
Pulp capping in carious exposure was questionable in the radiographically examined. Detailed history, Periapical
past. Recent studies show that carious exposed pulp in a vital radiographic assessment, periodontal status, percussion testing
permanent tooth can be successfully treated with vital pulp and vitality of teeth through electrical pulp testing was completed.
therapy(VPT)3,24. Direct pulp capping is one of the procedure of An informed consent was obtained from patient. No ethical issue or
VPT, observed 1 year: 87.5%, 2 years 95.4%, 3 years 87.7 % and risk was involved.
more than 3 years 72.9%3. Treatment protocol was carried out in two visits. Patients
The objective of pulp capping in a permanent tooth with were randomly divided (seventy five each) into two groups I and II
deep carious exposure is vital, asymptomatic without radiographic .After anesthesia, the tooth was isolated with rubber dam,
evidence of periradicular lesion5. disinfected by 0.2% chlorhexidine mouthwash,14 removed all the
Factors affecting the success of direct pulp capping include carious lesion with a sterile round bur then carefully examined the
sustained blood supply, intensity of inflammation, adequate exposure size (<1mm) with no persistent bleeding. Used
hemostasis, disinfection of the exposure site, 5.25%NaOCl soaked cotton pellet to achieve hemostasis within 5
antimicrobial/biocompatible property of the pulp capping agent, minutes in all cases.
adequate seal, and skill of the clinician to use the The area was then dried with cotton. In Group-I mix MTA
material.6Adequate vascularization with vital pulp is essential factor according to manufacturer instructions and placed2 mm thick layer
for the success of direct pulp capping.6, 7 of cement on the exposed site. Damp cotton placed on tooth was
The gold standard and premier material for direct pulp initially restored using temporary material (CAVIT, 3M ESPE)
capping is Calcium hydroxide7. MTA was introduced in 1998, followed by amalgam replacement after initial setting (24 hrs).
clinically indicated as perforation repair, root end filling material, In Group-II tooth pulp capped with Biodentine (Septodont,
apical barrier for immatureapices, pulp vitality procedures in France) accordingly manufacturer so' instruction. The Biodentine
primary and permanent teeth. It has good sealing ability9,10, capsule triturated with its liquid in amalgamator for 30 sec then
biocompatible, bioactive, noncytotoxic, Hydraulic cement (ideal in placed to a mixing pad then applied using an amalgam carrier to
wet climate)5,9. the cavity preparation. The whole cavity filled with Biodentine after
2 weeks restored by composite.
----------------------------------------------------------------------------------------- Data Analysis Procedure: Statistical analysis was performed with
Received on 14-12-2021 SPSS version 18.0. Standard deviation and mean calculated for
Accepted on 07-06-2022 quantitative variables like age, height, weight and BMI of patient.
Frequency and percentage were calculated for qualitative variables

172 P J M H S Vol. 16, No. 07, July 2022

 M. Anwar, M. B. Munir, N. Shafi et al

like gender of patient and efficacy of material in terms of lack of Vital pulp therapy is a procedure toretain the vitality of dental
development of Periapical Radiolucency (PR) on radiograph. Effect pulp as well as to stimulate the remaining pulp tissue to function
modifiers such asgender and age of patient are controlled through adequately. The VPT includes number of procedure:indirect and
post stratification. Post stratification test (chi square test) used for direct pulp capping, pulpotomyin young permanent dentition4.
p value 0.05. In this study 150 patients fulfillsthe inclusion criteria The foremost objective ofVPT is

are included. 82 are male (54%) and 68 are female (45%). To sustain thevascularity of pulp

The age range of patients was 18 to 45 years. The standard To encourage and regulate the structure/function of the pulp-
deviation and mean were calculated. The Mean and SD of age of dentin complex.
patients undergoing direct pulp capping was 30±7.916 respectively At microscopic level the dentinal bridge is formed by the
as shown in Table 1. P value of variables age (0.360) was not recruitment of odontoblasts from undifferentiated mesenchymal
significant. cells .The arrangement of fibrodentin followed by remineralization
The patients were equally divided into two groups i.e., group to formreparative dentine.However this biological seal prevents
I and II. MTA group was allocated as group I and Biodentine communication between the pulp and the oralenvironment4.
named as group II each group containd 75 patients. The follow-up Certain contributing factors for efficiency of VPT such as
time was 3 months. Periapical radiograph was used for adequate vascularity of pulp, young patient, hermetic coronal seal,
radiographic evaluation of development of Periapical Radiolucency antibacterial/biocompatible material previous pulpal and
by comparing pre-and post-operative radiographs. periodontal health, technique, infection control of exposure site
Out of 75 patients, 57(75%) showed success and 18(25%) with disinfectant, previous inflammation. An appropriate coronal
showed failure of direct pulp capping with MTA group after 3 restoration significantly affects the prognosis of VPT24.
months. While in the group II, 72 teeth did not show any periapical Inflamed tissue and healing of pulpal tissue are directly
radiolucency while 3 teeth showed signs of periapical radiolucency correlated; the mild inflammatory reaction act as a stimuli to release
on periapical radiograph.in group II, out of 75 patients 72(95%) progenitors to initiate pulpal repair/regeneration25.
showed success and 3(5%) showed failure of direct pulp capping Pulp may be exposed due tocaries, trauma or mechanical
with Biodentine group after 3 months. To compare efficacy of both exposure during aggressive cavity preparation. Pulp capping
groups, Post stratification chi square test is applied. The P-Value promotes pulp healing as well as reparative dentine formation.
was calculated as 0.001. The result was significant at p < 0.05 as Many studies shows the survival of toothafter direct pulp capping if
shown in Table 3 it is mechanically exposed rather than caries.22Microbial invasion at
Chi square test was applied to compare the efficacy of direct the carious site results in pulpal inflammation2. Thus healing
pulp capping agent according to age group. p value p=. 360 was property of pulp is compromised in comparison tomechanical
found to be significant asin Table 2 exposure. In mechanical exposure ofasymptomatic tooth shows
Statistics: Mean and Standard Deviation of Age in Pulp Capping lack of any clinical or radiologic signs of pathology5.
Patients - Table 1 In a review literature, the success rate of direct pulp capping
has been observed 1 year: 87.5%, 2 years 95.4%, 3 years 87.7%
Age (years) and more than 3 years 72.9% .
3
Valid 150
N Control of haemorrhage is compulsory for the prognosis of
Missing 0
Mean 30.50 tooth during pulp capping procedure. A veracious exposure at
Std. Deviation 7.916 carious site is always associated with inflamed pulp. Some studies
Minimum 20 shows thata tiny carious exposure can be associated with the
Maximum 45 signs ofinflammation.The severity of inflammation vary
fromminimal to complete necrosis2.
Table 2: Analysis of age and efficacy Disinfection of the exposure site and biocompatible material
Age (years) * Efficacy Cross tabulation as pulp covering agent are indispensable factors for prognosis.
Count In this study I used silicate materials Biodentin andMineral trioxide
Age in years Efficacy Total
aggregate (MTA) as direct pulp capping agent in a carious
No Yes
20 1 29 30 exposure with clinical and radiographic. MTAwas introduced in
25 4 26 30 1995 at Loma Linda University.U.S. Food and Drug Administration
30 4 26 30 allowedits clinical application.At first time it was used as a root-end
35 7 23 30
40 2 13 15 filling material during endodontic surgery ProRootMTA (Tulsa
45 3 12 15 Dental Products, Tulsa, OK). Recently, MTA Angelus (Angelus
Total 21 129 150 Solucoes Odontologicas, Londrina, Brazil) is used in dentistry
Chi sq =5.482 df=5 p=0. 360
worldwide.MTA is analogous to calcium hydroxide with
Table 3: Analysis of Group and Efficacy antibacterial characteristics. It has alkaline pH, biocompatible
Material Groups * Efficacy Crosstabulation properties radiopaque. MTA alsoshows good healing properties by
Count 2,13
releasing certain bioactive dentin matrix proteins
Material groups Efficacy Total
No Yes In the term of sealing ability it is superior to other materials
Group I 18 57 75 such as Ca (OH)2. Some studies showed its regenerative potential
Group II 3 72 75 in periradicular tissues. Other Remarkable properties of MTA are
Total 21 129 150 13
initial setting during moisture and dimensional stability .
MTA is difficult to use because of poor handling properties, high
DISCUSSION material cost, high alkaline pH (11.5-12), low compressive strength
In contemporary era advance technologies and materials and has discoloration potential.MTA releases heavy toxic metal
introduced in dentistry which grant recommended treatments to the arsenic and ferric.2
patient. This can be accomplished by good clinical practice and Second material, Biodentine is a new tricalcium cement with
correct diagnosis. The principle of restorative treatment is to dentine like mechanical properties based on MTA with
perpetuate pulp vitality and functionality. improvement in properties and handling14,19,21. Compositional
difference between MTA and Biodentine is calcium chloride

P J M H S Vol. 16, No. 07, July 2022 173

Biodentine vs Mineral Trioxide aggregate

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