Direct Pulp Capping of Carious Primary Molars. A Specialty Practice Based Study

Abstract

Objective: Recommendations against direct pulp capping (DPC) for carious primary teeth are based on old, low level evidence. This study investigates the medium to long term clinical and radiographic outcomes of such treatment. Study design: Each of 62 3-9 year old children with any deep, primary molar cavity was included if a pulp exposure occurred during caries excavation. Exclusion criteria were irreversible pulp damage / uncontrolled hemorrhage. Using rubber-dam, fast setting calcium hydroxide (CH) and tooth restoration were placed. Patients were followed up for signs/symptoms. Survival analysis, the Kaplan-Meier method and the Mantel-Cox test were used for statistically analyzing the data. Results: Seven patients (11.3%) dropped out. Controlled hemorrhage occurred in 25 exposures. Fourteen exposures were large and 46 were pin point. Out of 60 primary molars with DPC (in 55 patients), 7 failed by clinical and/or radiographic criteria. The remaining 53/60 (88.3%) teeth survived for 21.0 (±9.0) months. The 4 year cumulative survival rate by Kaplan-Meier analysis was 80%. All restorations remained in place with 3 needing replacement without affecting pulp survival. Conclusion: The CH success rate of carious primary molar DPC justifies further research based on careful initial diagnosis of pulp inflammation reversibility.