Comparative Clinical Effectiveness of Calcium-Silicate Cements and Calcium Hydroxide in Vital Therapy of Permanent Teeth Pulp

BACKGROUND: Preservation of pulp viability allows to preserve the integrity of tooth structures, the correct relationship with other elements of the dental system, therefore, the improvement of materials aimed at preventing endodontic treatment with preservation of the entire pulp is of great clinical importance. AIM: Comparison of clinical effectiveness of various materials in the vital therapy of permanent tooth pulp. MATERIALS AND METHODS: The study involved 30 patients (20 male and 10 female patients aged 11 to 25 years) divided into 3 groups. Vital pulp therapy of permanent molars and premolars with formed and unformed roots diagnosed as reversible pulpitis was carried out by direct and indirect coating with calcium hydroxide in group 1 (9 patients/18 teeth) (Calasept, with Dycal-isolated surface), with ProRootMTA in group 2 (10 patients/15 teeth) and with Biodentine in group 3 (11 patients/15 teeth). IRM (methyl methacrylate-reinforced zink-oxide-eugenol cement) was used as temporary filling. The research data were processed using nonparametric statistics. RESULTS: After 4 years of follow-up: After the first stage of observation, not in a single of 14 remaining teeth in group 1 (4 teeth were subjected to endodontic treatment), clinical and radiological signs of pulp pathology were found; in 3 teeth (21.4%), pronounced narrowing of the pulp chamber and obliteration of the pulp of canal orifice were noted, which did not require endodontic intervention. In group 2, of 13 teeth (2 teeth previously received endodontic treatment), 1 tooth (7.6%) was diagnosed with irreversible symptomatic pulpitis and 2 teeth (16.6%) — with pronounced narrowing of the pulp chamber, obliteration of the root pulp, 3 teeth (25%) — with denticles in the pulp chamber. In group 3, 2 teeth (13.3% of cases) were subjected to endodontic treatment for irreversible symptomatic pulpitis in 1.5 year after the beginning of the observation, and in 1 tooth (6.6%), the formation of multiple denticles in the pulp chamber was noted. CONCLUSION: Thus, the clinical and radiological effectiveness of use of calcium hydroxide in vital pulp therapy of permanent teeth after 12 months was 77.7% (14 of 18 teeth), of ProRootMTA — 86.6% (13 of 15 teeth) and of Biodentine — 100%, which absolutely correlates with the data of modern literature sources. In direct pulp coating (pulpcap) in permanent teeth, 100% excellent treatment results within 1 year were achieved only with Biodentine.