Outcomes of Direct Pulp Capping After Carious Excavation of Deep Caries on Permanent Mature Teeth: An Ancillary Study Derived From A Randomised Clinical Trial

Objective: To evaluate the clinical efficacy of direct pulp capping (DPC) using Biodentine, a calcium silicate-based cement, in cases of carious pulp exposure, focusing on pulp survival and treatment success.
Methods: This study retrospectively included all patients with pulp exposure who participated in the randomised clinical trial. Follow-up was performed at 1, 2 and 3 years after treatment. The primary outcome was pulp survival. The secondary outcomes were patient satisfaction, marginal integrity of the restoration, and overall survival (defined as both pulp survival and marginal integrity success combined). To account for censoring, pulp survival, marginal integrity success, and overall survival were analysed using the actuarial survival methods.
Results: Of the 36 patients included, the pulp survival, marginal integrity success, and overall survival rates at one year (95% confidence interval (CI)) were 0.912 (0.816-1.000), 0.971 (0.914-1.000) and, 0.882 (0.774-0.991), respectively. At two years, the conditional pulp survival and overall survival rates were both 0.926 (0.827-1.000) and the marginal integrity rate was 1 (1-1). After three years, the conditional pulp survival rate, marginal integrity rate and overall survival rate were 0.953 (0.864-1.000), 0.907 (0.784-1.000) and 0.86 (0.714-1.000), respectively. From the patients’ view, the restorations were considered clinically satisfactory, with only one patient expressing concerns after two years.
Conclusions: Despite the potential for attrition bias, our results are promising and consistent with the existing literature. This study supports DPC as a reliable therapeutic approach for managing pulp exposure following carious excavation.