Effectiveness of TheraCal LC versus MTA in Vital Pulp Therapy of Cariously-Exposed Young Permanent Molars: Five-Year Follow up of a Randomised Clinical Trial

Abstract

Introduction: Carious pulp exposure of young-vital first permanent molars (FPMs) is a widespread unfortunate event. Pulpotomy treatment is a treatment option; however, choosing capping materials is crucial. Objectives: To compare tooth clinical/radiographic (survival) rate after one/five years following pulpotomy of cariously-exposed vital FPMs using TheraCal-LC (TLC) and Mineral-Trioxide-Aggregate (MTA). Methodology: This was Randomised Clinical Trial (RCT), single-blinded, equivalence-framework. Twenty-two FPMs in children aged 6-8.5 years were randomly allocated to TLC/MTA groups. Pulpotomy was performed, followed by capping material and final restoration. Immediately, post-operative periapical radiographs were taken. A preliminary report was published after 1-year, and now this is the 5-years follow-up. Results: Average age of participants was 7.7 years. Using Absolute-risk/Absolute-risk reduction (ARR), Relative-Risk (RR) and their 95% confidence intervals (95% CI), following results were obtained: Clinically, risk of spontaneous pain/swelling was 7-times/5-times, more in TLC group respectively at 1-year and 2.6-times/5-times, more in TLC group respectively after 5-years. Radiographically, risk of periapical radiolucency/root resorption occurrence was 9-times/2-times more in TLC group, respectively, both after 1-year and 5-years. The probability of root maturation was 20% and 10% less in TLC group at 1-year/5-years, respectively. Surprisingly, 90% of teeth show complete apical closure even if pulp necrosis occurred. The final survival rate (clinical and radiographic) MTA was 90.9% /72.72% after 1-year/5-years respectively. The final survival rate (clinical and radiographic) for TLC was 18.18% after both 1-year and 5-year. Conclusion: Within current study's limitations, TLC results were less promising than MTA in pulpotomy of young permanent molars.