Comparison between Calcium silicate, Mineral Trioxide Aggregate and Calcium Hydroxide on the Induction of Reparative Dentin following Pulpotomy

This in-vivo study used calcium silicate, MTA and calcium hydroxide pulpotomy of premolar tooth to investigate the potential for reparative dentin development without causing unfavorable side effects. For cosmetic reasons, a pulpotomy was used to treat a patient's right first premolar tooth. In order to expose the pulp, a round cavity with a diameter of 2 mm was initially created on the occlusal surface using a flat end fissure bur and a high-speed hand piece under adequate cooling conditions. After using sterile cotton pellets to staunch the bleeding, Dycal^®, MTA and Biodentine^TM was applied to the exposed pulp tissue in accordance with the manufacturer's instructions. The tooth was pulled at 4 weeks under local anesthetic, and it was preserved for 24 hours in 4% neutral buffered formaldehyde. After being demineralized, the specimen was imbedded in paraffin. A blind observer used a light microscope fitted with a digital camera and a computer for histometry to examine a series of sections containing pulp tissue that had been longitudinally serially sectioned at a thickness of 6 µm. Lastly, the experimental tooth's amount of newly generated hard tissue was measured. The findings indicated that the exposed pulp tissue is only partially covered by the 0.9 ± 0.2 µm thick layer of reparative dentin development by Dycal^®. The histological sections of Dycal^® showed no inflammation in the entire extension of the root canal and the presence of stenosis and dentin barrier formation. Thickness of reparative dentin formation is 1.2 ± 0.2 µm and completely covers the exposed pulp tissue by MTA. The healing of pulp was satisfactory with without affecting the normal function of the remaining pulp. The thickness of reparative dentin formation by Biodentine^TM was 1.4 ± 0.4 µm that completely covered the exposed pulp tissue. In conclusion, Calcium-silicate based pulpotomy material is capable to induce pulpal wound healing and reparative formation in the exposed teeth without affecting the normal function of the remaining pulp. More study was need for conclusive result.