Long term retrospective evaluation of vitality preservation in direct and indirect pulp capping

Objectives: In removing deep caries, the exposure of pulp tissue may occur as a result of advanced carious lesion or a traumatic excavation. However, it’s well known that dentin contains proteins able to stimulate reparative responses. Pulp capping materials are based on these properties of dental tissues and they are formulated to induce the formation of reparative dentin. The aim of this long-term retrospective clinical study was to evaluate the vitality preservation after 10 years in direct and indirect pulp capping and analyzed how intra-operative information, patient age and different techniques and materials used influenced the treatment outcome. Methods: Patients who received direct or indirect pulp capping between May 2009 and September 2013 were recalled, visited and divided in 5 groups according to the treatment, the material and the adhesive system employed: Group 1) direct pulp capping with Mineral Trioxide Aggregate cement; Group 2) direct pulp capping with resin-based glass-ionomer; Group 3) direct pulp capping with TheraCal; Group 4) indirect pulp capping with 3-step total-etch adhesive system; Group 5) indirect pulp capping with 2-step self-etch adhesive system. Conclusions: Based on the obtained results, this retrospective study showed that the type of pulp capping material should be taken into consideration when performing a direct capping treatment and that the vitality preservation depends also on the width of exposure area before the procedure and the patient age. At the same way, the vitality preservation in indirect pulp capping depends on the adhesive system used, with the total-etch better performing than the self-etch. Further follow-up controls are necessary to confirm the results.