AzTrials
AzTrials

Deep CariesNCT04265833

Evaluation of Three Different Pulp Capping Materials in Indirect Pulp Treatment of Primary Teeth

A study testing Biodentine, TheraCal LC and Calcium hydroxide in people with Deep Caries, run by Izmir Katip Celebi University.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The aim of this randomized, controlled, three-arm parallel-group, double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth. Read more about this study

Who is it for?
Ages 5 to 9 yearsHealthy volunteers can take part
Conditions the study is for
Deep Caries
What is being tested?
Biodentine, TheraCal LC and Calcium hydroxide
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
109 participants
Where
No sites listed yet
Study dates
8 Feb 2015to 7 Jul 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 5 to 9 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Previously untreated, vital and asymptomatic lower primary molars with deep caries lesions considered likely to result in pulp exposure if they were treated by a single and terminal excavation
  • Positive pulp sensibility tested by an electric pulp tester and cold stimulation,
  • Mild discomfort from chemical and thermal stimuli,
  • Cooperative children and parents willing to follow the instructions and report for follow-up.

Who cannot join

  • Signs of irreversible pulpitis (spontaneous pain, prolonged pain response etc.)
  • The presence of percussion or palpation sensitivity, pathological mobility, or infection symptoms like fistula or abscess or discoloration in the clinical examination,
  • Absence of normal lamina dura and periodontal range, presence of lesion, internal or external resorption or calcification in or around the root in the radiological examination,
  • Children with special health care needs.

About this study

Official title: Clinical, Radiographic and Histological Evaluation of Three Different Pulp Capping Materials in Indirect Pulp Treatment of Primary Teeth: A Randomized Clinical Trial

The aim of this randomized, controlled, three-arm parallel-group, double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth.

The study included a total of 109 patients aged 5-9 years who had primary teeth with deep carious lesions with or symptoms of irreversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) Calcium hydroxide (Ca[OH]2) (control group) (n=36), (II) bioactive tricalcium silicate (Biodentine) (n=37), and (III) resin-based tricalcium silicate (TheraCal LC) (n=36). All the teeth were evaluated clinically and radiographically at postoperative months 6, 12, 18, and 24. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24-40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation and the quality of the dentin formed, severity of pulpitis, and other pulpal changes.

Read the detailed description

Following the clinical and radiographic examinations, pulp vitality was assessed with cold thermal test (Chloraethyl; Wehr, Baden, Germany) and electrical pulp test. After local anesthesia injection, rubber-dam isolation was performed. In the first step of the IPC procedure, cavity preparation was performed and the caries were removed using a high-speed dental handpiece with a diamond bur. In the second step, the carious peripheral dentin was removed at the enamel-dentin junction using a high-speed tungsten-carbide bur and the infected and necrotic soft dentin layer in the center was carefully removed to prevent pulp exposure. Cavity excavation was stopped when the residual dentin over the pulp tissue showed increased resistance to manual instrumentation, and the demineralized dentin (affected dentin) was left at the floor of the cavity.

After this stage, the teeth were randomly divided into 3 groups:

Ca(OH)2 Group (Control): The residual demineralized dentin was covered with a thin layer of Ca(OH)2 (Dycal; Dentsply/Caulk, Dentsply International Inc. Milford, DE, USA) in accordance with the recommendations of the manufacturer.

Biodentine Group: A thin layer of tricalcium silicate-containing pulp-capping material (Biodentine, Septodont, France) consisting of powder and liquid was applied to the demineralized dentin tissue and a 12-min setting time was allowed for hardening, in accordance with the recommendations of the manufacturer.

TheraCal LC Group: Flowable form of resin-reinforced tricalcium silicate-containing material (TheraCal LC, Bisco Inc, IL, ABD) was applied directly onto the demineralized dentin at a maximum thickness of 1 mm and was polymerized for 20 sec (Valo LED, Ultradent Products Inc., South Jordan, USA), in accordance with the recommendations of the manufacturer.

Afterwards, in all three groups, capsule glass ionomer cement (Capsule; GC Corporation, Tokyo, Japan, Corporation, Tokyo, Japan) was placed on each capping material. Following the etching and bonding process, permanent restoration was finished with composite resin (Filtek Z250 Universal Restorative System, 3M ESPE Dental products, USA).

Histological examination A total of 23 primary mandibular second molars that were in their regular exfoliation period (in which the underlying permanent tooth germ had completed 2/3 of root formation) (24) and were found to be clinically and radiographically successful following IPC were extracted by the researcher and were processed for histological examination .All the extracted teeth were fixed in 10% formaldehyde solution. Three out of 23 specimens were excluded from the study since they were unsuitable for sectioning.

Conditions
Deep Caries
Being tested
Biodentine, TheraCal LC, Calcium hydroxide
Keywords
deep caries, indirect pulp capping

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BiodentineOther

    Biodentine has been shown to cause increased calcium ion release and this increase has been associated with the presence of pure tricalcium silicate and calcium chloride and the increased Ca(OH)2 formation

  • TheraCal LCOther

    TheraCal LC (Bisco Inc, IL, USA) is a light-cured, resin-modified, calcium silicate-based material designed as a direct/indirect pulp-capping material. This agent has been shown to increase the pH on the pulpal surface thereby stimulating regenerative processes in the pulp, and ultimately contributing to the formation of dentin bridge

  • Calcium hydroxideOther

    Calcium hydroxide (Ca[OH]2) is a successful pulp-capping agent activating the repair mechanism by stimulating the dentin-pulp complex. Ca(OH)2, with its bactericidal effects, protects the complex from bacterial effects and also has a stimulating effect on dentin remineralization

Study groups in NCT04265833
Study groupRoleWhat they receive
calcium hydroxideActive comparatorThirty six primary molar teeth with deep caries lesion were selected to apply indirect pulp therapy with calcium hydroxide. The carious peripheral dentin was removed at the enamel-dentin junction using a high-speed tungsten-carbide bur and the infected and necrotic soft dentin layer in the center was carefully removed to prevent pulp exposure. Cavity excavation was stopped when the residual dentin over the pulp tissue showed increased resistance to manual instrumentation, and the demineralized dentin (affected dentin) was left at the floor of the cavity.The residual demineralized dentin was covered with a thin layer of Ca(OH)2 (approximately 1 mm2) in accordance with the recommendations of the manufacturer. Afterwards capsule glass ionomer cement was placed on each capping material. Following the etching and bonding process, permanent restoration was finished with composite resin.
Receives: Other: Calcium hydroxide
BiodentineExperimentalThirty seven primary molar teeth were selected to apply indirect pulp therapy with Biodentine. The carious peripheral dentin was removed at the enamel-dentin junction using a high-speed tungsten-carbide-bur and the infected and necrotic soft dentin layer in the center was carefully removed. Cavity excavation was stopped when the residual dentin over the pulp tissue showed increased resistance to manual instrumentation, and the demineralized dentin (affected dentin) was left at the floor of the cavity. A thin layer of tricalcium silicate-containing pulp-capping material (Biodentine) (approximately 1 mm2) consisting of powder and liquid was applied to the demineralized dentin tissue and a 12-min setting time was allowed for hardening, in accordance with the recommendations of the manufacturer. Afterwards capsule glass ionomer cement was placed on each capping material. Following the etching and bonding process, permanent restoration was finished with composite resin.
Receives: Other: Biodentine
TheraCal LCExperimentalThirty six primary molar teeth with deep caries lesion were selected to apply indirect pulp therapy with TheraCal LC. The carious peripheral dentin was removed at the enamel-dentin junction using a high-speed tungsten-carbide bur and the infected and necrotic soft dentin layer in the center was carefully removed. Cavity excavation was stopped when the residual dentin over the pulp tissue showed increased resistance to manual instrumentation, and the demineralized dentin (affected dentin) was left at the floor of the cavity. Flowable form of resin-reinforced tricalcium silicate-containing material (TheraCal LC) was applied directly onto the demineralized dentin at a maximum thickness of 1 mm and was polymerized for 20 sec (Valo LED), in accordance with the recommendations of the manufacturer. Afterwards capsule glass ionomer cement was placed on each capping material. Following the etching and bonding process, permanent restoration was finished with composite resin.
Receives: Other: TheraCal LC

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical success rate of indirect pulp treatment

    Treatment is considered a clinical failure if one or more of the following signs are observed: Presence of tenderness to percussion or palpation, spontaneous pain or prolonged pain response, discoloration, infectious symptoms such as fistula or abscess, and pathological mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

    Measured: Change of clinical success from Baseline at 6 month

  2. Clinical success rate of indirect pulp treatment

    Treatment is considered a clinical failure if one or more of the following signs are observed: Presence of tenderness to percussion or palpation, spontaneous pain or prolonged pain response, discoloration, infectious symptoms such as fistula or abscess, and pathological mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

    Measured: Change of clinical success from baseline to 12 month

  3. Clinical success rate of indirect pulp treatment

    Treatment is considered a clinical failure if one or more of the following signs are observed: Presence of tenderness to percussion or palpation, spontaneous pain or prolonged pain response, discoloration, infectious symptoms such as fistula or abscess, and pathological mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

    Measured: Change of clinical success from baseline to 18 month

  4. Clinical success rate of indirect pulp treatment

    Treatment is considered a clinical failure if one or more of the following signs are observed: Presence of tenderness to percussion or palpation, spontaneous pain or prolonged pain response, discoloration, infectious symptoms such as fistula or abscess, and pathological mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

    Measured: Change of clinical success from baseline to 24 month

  5. Radiographic success rate of indirect pulp treatment

    For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: lesions in the furcation or periapical regions, internal or external root resorption, and thickening of the periodontal spaces. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

    Measured: Change of radiographic success from baseline to 6 month

  6. Radiographic success rate of indirect pulp treatment

    For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: lesions in the furcation or periapical regions, internal or external root resorption, and thickening of the periodontal spaces. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

    Measured: Change of radiographic success from baseline to 12 month

  7. Radiographic success rate of indirect pulp treatment

    For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: lesions in the furcation or periapical regions, internal or external root resorption, and thickening of the periodontal spaces. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

    Measured: Change of radiographic success from baseline to 18 month

  8. Radiographic success rate of indirect pulp treatment

    For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: lesions in the furcation or periapical regions, internal or external root resorption, and thickening of the periodontal spaces. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

    Measured: Change of radiographic success from baseline to 24 month

Secondary outcomes (1)
  1. Histological success rate of indirect pulp treatment

    For histologic evaluation, the treatment is rated as a failure when one or more of the following signs are present: absent of the integrity of the odontoblastic layer, absent of tertiary dentin formation, presence of pulpitis, presence of fibrosis and dystrophic calcification. The treatment is regarded successful if histologic evaluation does not indicate any signs of failure.

    Measured: up to 40 months (the teeth were extracted in regular exfoliation period (in which the underlying permanent tooth germ had completed 2/3 of root formation).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Feb 2020
  2. Study start8 Feb 2015
  3. Primary completion15 Sep 2015
  4. Study completion7 Jul 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
randomized, three-arm parallel, two-blinded clinical trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
109 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04265833
Sponsor's protocol ID
2014-1-TEZ-54
Status last verified
Feb 2020
First submitted
26 Dec 2019
Last updated
12 Feb 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Biodentine, TheraCal LC and Calcium hydroxide in people with Deep Caries, run by Izmir Katip Celebi University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical success rate of indirect pulp treatment (time frame: Change of clinical success from Baseline at 6 month). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Feb 2020.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in
Clinical Trial NCT04265833 | AzTrials