Effectiveness of Biodentine v/s Calcium Hydroxide as Indirect Pulp Capping Materials

Primary outcomes

1. Radiographic assessment by Periapical Index (PAI)

   Time frame: Follow-up Timeline for Each Patient: Patients will be evaluated at the following intervals after the indirect pulp capping procedure: Baseline (Initial Treatment) 2 weeks follow-up 6 weeks follow-up 12 weeks follow-up

   PAI Scoring Criteria:

   Score Radiographic Features Interpretation

   • Normal periapical structures Healthy PDL and periapical tissues
   • Small changes in bone structure (slight PDL widening) Mild changes; potentially reversible
   • Changes in bone structure with mineral loss Moderate periapical inflammation
   • Well-defined radiolucent area Established periapical periodontitis
   • Severe radiolucency with bone destruction Advanced periapical disease

   Application in my Study:

   At each follow-up (2, 6, 12 weeks), periapical radiographs should be:

   Evaluated using the PAI score

   Compared to baseline radiographs

   Scores ≤2 are generally considered favorable outcomes

   Scores ≥3 indicate disease or failure

2. Visual Analog Scale (VAS) for Pain Measurement

   Time frame: Patients pain level can be measured on the scale at: Baseline 2-week 6-week 12-week follow-up visits

   • Pain Assessment

   Type: Spontaneous or provoked

   Tool: Patient history and Visual Analog Scale (VAS) for Pain Measurement

   Classification:

   No pain

   Mild/transient pain (indicative of successful pulp healing)

   Moderate to severe pain (suggestive of pulpal inflammation or failure)

   Interpretation:

   Absence of pain considered a positive outcome.

   Persistent or worsening pain may indicate treatment failure or progression to irreversible pulpitis

   Visual Analog Scale (VAS) for Pain Measurement

   Description:

   A 10 cm horizontal line representing a continuum of pain intensity.

   One end (0 cm) represents "No pain", and the other end (10 cm) represents "Worst possible pain".

   Scoring Criteria:

   VAS Score (cm) Pain Intensity 0 No pain 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain

   Application in my Study: Patients can be asked to mark their pain level on the scale at:

   Baseline

   2-week

   6-week

   12-week follow-up visits

3. Tenderness to Percussion

   Time frame: Patients tenderness to percussion will be checked at: Baseline 2-week 6-week 12-week follow-up visits

   • Tenderness to Percussion

   Tool: Blunt end of dental mirror gently tapped on the occlusal surface

   Response Categories:

   Absent: No discomfort or pain on percussion (favorable response)

   Present: Pain on percussion, indicating potential periapical inflammation or pulp degeneration

   Interpretation:

   Lack of tenderness is a favorable clinical outcome.

   Positive percussion response may suggest underlying periapical involvement or pulpal pathology.

4. Pulp Vitality Testing : Cold test (Endo-Ice or refrigerant spray on cotton pellet) and Electric Pulp Test (EPT)

   Time frame: Patients tooth vitality testing will be done at: Baseline 2-week 6-week 12-week follow-up visit

   Pulp Vitality Testing

   Methods Used:

   Cold test (Endo-Ice or refrigerant spray on cotton pellet)

   Electric Pulp Test (EPT)

   Response Categories:

   Normal response: Short, sharp, non-lingering sensation (indicative of vital pulp)

   Exaggerated or lingering pain: Suggestive of reversible/irreversible pulpitis

   No response: Indicative of non-vital or necrotic pulp

   Interpretation:

   A normal response to cold or EPT at follow-up implies successful preservation of pulp vitality.

   No response or lingering pain may indicate pulp necrosis or treatment failure