European Archives of Paediatric Dentistry (2018) 19:197–203
ORIGINAL SCIENTIFIC ARTICLE
Direct pulp capping in primary molars using a resin-modiﬁed Portland
cement-based material (TheraCal) compared to MTA with 12-month
follow-up: a randomised clinical trial
· P. Iranparvar
· A. Vafaei
Received: 17 March 2017 / Accepted: 17 April 2018 / Published online: 16 May 2018
© European Academy of Paediatric Dentistry 2018
Aim This study was to compare the success of resin-modiﬁed Portland cement-based material (TheraCal) with MTA in
direct pulp capping (DPC) of primary molars.
Methods Symmetrical bilateral primary molars (92) from 46 healthy subjects aged 5–7 years were included in this split-
mouth randomised clinical trial. DPC for small non-contaminated pulp exposures using either TheraCal or MTA were
randomly performed in symmetrical molars. Thereafter, teeth were restored with amalgam. Clinical and radiographic evalua-
tions were performed at 6 and 12 month follow-ups. Data were analysed using Chi square test at a signiﬁcance level of 0.05.
Results At the ﬁnal follow-up session 74 teeth were available. After 12 months, the overall success rates for MTA and Thera-
Cal were 94.5 and 91.8%, respectively. The diﬀerence between outcomes of the two groups was not statistically signiﬁcant
(P > 0.05).
Conclusion Within the limitations of the current study, radiographic and clinical ﬁndings revealed that TheraCal exhibited
a comparable outcome to MTA in DPC of primary molars after 12 months.
Keywords Direct pulp cap · TheraCal · MTA · Primary molar
Direct pulp capping (DPC) is a conservative pulp treatment
in an attempt to preserve pulp vitality, which is optimally
accompanied with new dentine-like bridge formation at
the exposure site using a protective bioactive material. A
successful DPC minimises the need for more invasive pulp
treatments such as pulpotomy or pulpectomy (Dammaschke
2007; Tuna and Ölmez 2008). In order to achieve such a
successful outcome, a proper case selection and appropriate
material placement with an acceptable seal, biocompatibil-
ity, antimicrobial properties, and hard tissue induction are
essential (Asgary et al. 2008).
Different dental materials have been used for DPC.
Although calcium hydroxide is still considered as the mate-
rial of ﬁrst choice, its long-term solubility and gradual dis-
integration leads to formation of dentinal bridges with tun-
nel-like defects, which compromises the long-term bacterial
seal, and eventually leads to failure of DPC treatment (Cox
et al. 1995; Parirokh and Torabinejad 2010a). Alternatively,
mineral trioxide aggregate (MTA) which is a calcium silicate
based cement is successfully indicated for DPC and many
other pulp treatments, to overcome the drawbacks of calcium
hydroxide-based materials and to improve the overall out-
come of DPC (Parirokh and Torabinejad 2010b). Setting of
calcium-silicate based cements such as MTA occurs in the
presence of humidity (Camilleri 2008), while the mechani-
cal properties improve in humid condition (Ranjkesh et al.
2016). Release of calcium in the course of cement hydration
(Camilleri 2008) induces antibacterial properties (Parirokh
and Torabinejad 2010a), dentinogenesis (Parirokh and Tora-
binejad 2010b), and apatite formation in semi-physiologic
solutions (Sarkar et al. 2005).
MTA success in DPC of primary molars has also been
shown (Tuna and Ölmez 2008; Asl Aminabadi et al. 2016),
* A. Vafaei
Department of Pediatric Dentistry, School of Dentistry,
Tabriz University of Medical Sciences, Daneshgah St.,
Department of Pediatric Dentistry, Shahid Beheshti
University of Medical Sciences, Tehran, Iran