Direct Pulp Capping of Carious Primary Molars. A Specialty Practice Based Study

OBJECTIVE: Recommendations against direct pulp capping (DPC) for carious primary teeth are based on old, low level evidence. This study investigates the medium to long-term clinical and radiographic outcomes of such treatment. STUDY DESIGN: Each of 62 3-9 year old children with any deep, primary molar cavity was included if a pulp exposure occurred during caries excavation. Exclusion criteria were irreversible pulp damage/uncontrolled hemorrhage. Using rubber-dam, fast setting calcium hydroxide (CH) and tooth restoration were placed. Patients were followed up for signs/symptoms. Survival analysis, the Kaplan-Meier method and the Mantel-Cox test were usedfor statistically analyzing the data. RESULTS: Seven patients (11.3%) dropped out. Controlled hemorrhage occurred in 25 exposures. Fourteen exposures were large and 46 were pin point. Out of 60 primary molars with DPC (in 55 patients), 7 failed by clinical and/or radiographic criteria. The remaining 53/60 (88.3%) teeth survived for 21.0 (±9.0) months. The 4 year cumulative survival rate by Kaplan-Meier analysis was 80%. All restorations remained in place with 3 needing replacement without affecting pulp survival. CONCLUSION: The CH success rate of carious primary molar DPC justifies further research based on careful initial diagnosis ofpulp inflammation reversibility.