Direct Pulp Capping of Primary Molars with Calcium Hydroxide or MTA Following Hemorrhage Control with Different Medicaments: Randomized Clinical Trial.

Purpose: This study aimed to evaluate the effects of different medicaments (sterile saline [SS]; ferric sulfate [FS]; or sodium hypochlorite [SH]) and pulp capping materials (calcium hydroxide [CH] or mineral trioxide aggregate [MTA]) on the success of direct pulp capping (DPC) in primary molars. Methods: The study was conducted with 55 children aged four to eight years. A total of 118 teeth, in which occlusal caries removal resulted in pulp exposure, were treated with DPC across six groups: SS+CH; FS+CH; SH+CH; SS+MTA; FS+MTA; and SH+MTA. Teeth were restored with Class I composite resin. Results: After two years, the overall clinical and radiographical success for DPC were 94.1 percent (111 out of 118 teeth) and 88.9 percent (105 out of 118 teeth), respectively. The clinical and radiographical success, respectively, for hemorrhage control medicaments were 92.1 percent and 89.5 percent for SS, 92.5 percent and 82.5 percent for FS, 97.5 percent, and 95.0 percent for SH (P>0.05). Internal resorption was significantly higher in the FS+CH group when compared to other groups (P<0.05). MTA had significantly higher success than CH for clinical (98.3 percent versus 89.7 percent) and radiographical success (98.3 percent versus 79.3 percent) (P<0.05, each comparison). Conclusions: For primary molars with occlusal caries and less than one-mm exposure sites, these findings suggest that direct pulp capping with MTA following hemorrhage control with the tested solutions offers a more predictable outcome compared to CH. Further, the findings of this study indicate an increased risk for internal resorption when FS and CH are used for DPC.