Assessing the efficacy of calcium silicate cement (Biodentine™) vs. glass ionomer cement (GIC, control) as indirect pulp-capping materials in patients suffering reversible pulpitis; comparing effectiveness of cone beam computed tomography (CBCT) vs. radiographs in detecting / monitoring peri-radicular lesion change, T0 and T12 months post-operatively.
Methods:
66 restorations (33 Biodentine™, 33 Fuji IX™) were allocated randomly to 53 patients. CBCT / periapical (PA) radiographs were taken at T0 and 12 months. 2 calibrated examiners assessed presence / absence and increase / decrease in size of existing PA radiolucencies under standardised conditions. Kappa coefficient evaluated statistically the effectiveness of CBCT vs. radiographs in detecting PA changes. Chi-square / Mann Whitney tests evaluated associations between PA changes in CBCT with various measures (age, vitality, symptom severity, cavity size, material, p=0.05).
Results:
Success rates for both Biodentine™ and Fuji IX™ were 83.3%. CBCT was significantly more effective at detecting PA radiolucency vs. radiographs (p<0.05). 48.3% / 75% of the teeth were deemed healthy using CBCT / PA radiographs respectively at T12. Healing/healed rates were 20.2% / 3.2% while new/larger radiolucency were 31.4% / 3.3% with CBCT / radiographs respectively. Out of 11 failed teeth, 63.6% / 27.2% showed signs of PA change at T0 using CBCT / PA respectively.The association between increased CBCT PA radiolucency and symptom severity, cavity size, material, and patient age was not significant (p>0.05). Teeth presenting with an initial CBCT PA radiolucency had a failure rate of 64% whereas teeth with no initial radiolucency had a failure rate of 8%.
Conclusion:
No statistical difference was detected in the efficacy of Biodentine™ / Fuji IX™ when used as pulp-capping materials in patients with reversible pulpitis. CBCT may be useful as a diagnostic aid in care planning.