Avaliação clínica e radiográfica de pulpotomias em dentes decíduos com hidróxido de cálcio associado a diferentes veículos: estudo clínico randomizado

Abstract

With the search for biocompatible capping materials for the maintenance of pulp vitality, different materials have been investigated, including calcium hydroxide (CH) and mineral trioxide aggregate (MTA). CH is a material widely used material in pulp therapy for permanent teeth, although many studies diverge from its use in pulpotomy of primary teeth. MTA is a capping material with excellent biological properties and scientifically proven clinical, radiographic and histologic success rates. The aim of this in vivo study was to evaluate the response of the dentin-pulp complex of human primary molars after pulpotomy with Calcium Hydroxide (CH) associated with different vehicles and compare them with MTA. Forty-five primary molars in children between 5 and 9 years old were randomly assigned to 3 groups: MTA, CH+ saline and CH + Calen. After coronal pulp removal and hemostasis, remaining pulp tissue was covered by the capping material according to the groups MTA, CH+ saline or CH + Calen®. All teeth were restored with resin modified glass-ionomer cement (Vitremer ®). Clinical and radiographic follow up evaluations were performed at 3, 6 and 9 months. Teeth presenting with spontaneous pain, abscess/fistula and pathological mobility were considered as clinical failures. Radiographic failures were considered in teeth presenting with internal root resorption, furcation/periapical radiolucency. In the CH + saline and CH + Calen ® groups, 33.3 % and 72.7 % of the teeth presented clinical and radiographic success at 9 months, respectively. In the MTA group, 100 % of the teeth presented clinical and radiographic success in all of the follow up appointments. Internal resorption was a frequent radiographic finding in the CH + saline groups and less frequent in the CH + Calen ® group. MTA was superior to CH + saline group but without statistically significant difference from the CH + Calen® group. Although the radiographic failures were less frequent in the CH + Calen® group, further studies are needed to elucidate whether it is possible to find a vehicle that can be associated with CH in order to obtain an effective capping material for pulpotomy of primary teeth, since there was no statistically significant difference between the groups presenting CH in its composition.