Bioactive Materials in Vital Pulp Therapy of Permanent Teeth

This randomized controlled clinical study was designed to evaluate and compare the clinical performance, radiographic outcomes, postoperative pain, and pulpal healing following direct pulp capping using two calcium silicate-based materials: ProRoot MTA and Biofactor MTA in permanent teeth with vital pulp exposure.

A total of 80 teeth diagnosed with vital pulp requiring direct pulp capping were included in the study. Participants were randomly allocated into two equal groups (n=40) according to the pulp capping material used. All procedures were carried out under standardized clinical conditions.

Caries removal was performed using a sterile round diamond bur under water cooling, followed by excavation with a spoon excavator. Teeth with pulp exposure were included in the study. Hemostasis was achieved. In cases where bleeding could not be controlled within a clinically acceptable time, the tooth was excluded from the study.

In the experimental group, Biofactor MTA was applied directly over the exposed pulp tissue according to the manufacturer's instructions. In the control group, ProRoot MTA was used following the same protocol. After placement of the capping material, a protective base was applied, and the cavity was temporarily restored. Definitive coronal restorations were completed 24 hours after the initial procedure.

Postoperative pain was evaluated using a Numerical Rating Scale (NRS) at 0, 6, 12, 24, and 48 hours following treatment. Patients were instructed to record their pain intensity and the number of analgesic tablets taken during this period.

Patients were recalled for follow-up examinations at 6 and 12 months. Clinical evaluation included assessment of spontaneous pain, sensitivity, swelling, sinus tract formation, tenderness to percussion and palpation, and periodontal probing depths. Radiographic evaluation was performed to assess the presence of periapical pathology.

Treatment success was defined as the absence of clinical symptoms and the absence of radiographic signs of pathology.

Furthermore, the influence of demographic and clinical variables, including age, gender, number and location of pulp exposures, size of exposure, and bleeding control time, on treatment outcomes was analyzed.

Inclusion criteria

• Patients aged between 13 and 65 years
• Patients with adequate patient-clinician communication
• Patients who agree to attend periodic follow-up visits throughout the study
• Patients who provide written informed consent to participate in the study
• Systemically healthy patients
• Teeth with no previous endodontic treatment
• Teeth showing a positive response to cold and electric pulp test
• Permanent teeth
• Posterior teeth
• Teeth that can be restored with direct composite restoration
• Teeth with pulp exposure (pulpal perforation)
• Presence of bleeding from the exposed pulp that can be controlled within 5-10 minutes

Exclusion criteria

• Patients who refuse to participate in the study
• Medically compromised patients (e.g., patients with systemic diseases, immunological disorders, or those using medications)
• Patients with known allergies to materials used during vital pulp therapy
• Pregnant patients
• Non-vital teeth
• Presence of advanced periodontal disease (probing depth > 3 mm)
• Teeth with previous endodontic treatment
• Teeth with insufficient remaining tooth structure that cannot be restored with restorative materials
• Teeth where adequate isolation cannot be achieved
• Teeth requiring post core restoration
• Patients in whom periapical radiographs cannot be obtained
• Patients unable to attend follow-up visits
• Cases in which bleeding from the exposed pulp cannot be controlled within 5-10 minutes