Potential factors affecting the success rate of indirect pulp therapy in primary molars with deep caries: a retrospective study

Indirect pulp therapy (IPT) is a common conservative treatment for deep dental caries. However, the potential risk factors for the prognosis of IPT have not been well studied. This study retrospectively investigated the success rate of IPT in treating primary molars with deep caries and the factors potentially affecting the two-year success rate. A total of 303 primary molars in 202 children (106 boys and 96 girls) were included in this study. These primary molars were identified as having deep caries by clinical and radiographic examinations and were treated with IPT. The factors potentially affecting the IPT success rate were analyzed after two years of follow-up. The results indicated that the two-year IPT success rate was 86% (262/303). The success rate of primary molars with and without stainless steel crowns was 96% (120/125) and 80% (142/178), respectively. Primary molars treated with stainless steel crowns showed a significantly lower risk of failure (hazard ratio (HR) = 0.18, 95% confidence interval (CI): (0.10, 0.34), p = 0.01). There were no significant differences in other factors, including gender (male vs. female), age (preschool vs. school age), cooperation level (Frankl 2 vs. 3 or 4 scales), arch type (maxillary vs. mandibular), tooth type (first vs. second primary molar), or pulp capping material (calcium hydroxide vs. glass ionomer cement). IPT is an effective, conservative treatment modality for primary molars with deep caries. Stainless steel crowns could significantly improve the IPT success rate.

Deep caries; Indirect pulp therapy; Primary molar; Potential factors; Stainless steel crown; Success rate

[1] Zou J, Du Q, Ge L, Wang J, Wang X, Li Y, et al. Expert consensus on early childhood caries management. International Journal of Oral Science. 2022; 14: 35.

[2] Opal S, Garg S, Dhindsa A, Taluja T. Minimally invasive clinical approach in indirect pulp therapy and healing of deep carious lesions. Journal of Clinical Pediatric Dentistry. 2014; 38: 185–92.

[3] American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp Therapy subcommittee; American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on pulp therapy for primary and young permanent teeth. Pediatric Dentistry. 2008; 30: 170–174.

[4] Lim ZE, Duncan HF, Moorthy A, McReynolds D. Minimally invasive selective caries removal: a clinical guide. British Dental Journal. 2023; 234: 233–240.

[5] Gizani S, Seremidi K, Stratigaki E, Tong HJ, Duggal M, Kloukos D. Vital pulp therapy in primary teeth with deep caries: an umbrella review. Pediatric Dentistry. 2021; 43: 426–437.

[6] Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatric Dentistry. 2000; 22: 278–286.

[7] Donnermeyer D, Dammaschke T, Lipski M, Schäfer E. Effectiveness of diagnosing pulpitis: a systematic review. International Endodontic Journal. 2023; 56: 296–325.

[8] Al-Ali M, Camilleri J. The scientific management of deep carious lesions in vital teeth using contemporary materials—a narrative review. Frontiers in Dental Medicine. 2022; 3: 1048137.

[9] Igna A, Mircioagă D, Boariu M, Stratul ȘI. A diagnostic insight of dental pulp testing methods in pediatric dentistry. Medicina. 2022; 58: 665.

[10] Duncan HF. Present status and future directions—vital pulp treatment and pulp preservation strategies. International Endodontic Journal. 2022; 55: 497–511.

[11] Sahin N, Saygili S, Akcay M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clinical Oral Investigations. 2021; 25: 3945–3955.

[12] Igna A, Rusu D, Ogodescu E, Dinu Ș, Boariu M, Voicu A, et al. Age-related variation of pulpal oxygen saturation in healthy primary and permanent teeth in children: a clinical study. Journal of Clinical Medicine. 2022; 12: 170.

[13] Stratigaki E, Tong HJ, Seremidi K, Kloukos D, Duggal M, Gizani S. Contemporary management of deep caries in primary teeth: a systematic review and meta-analysis. European Archives of Paediatric Dentistry. 2022; 23: 695–725.

[14] Jakovljevic A, Jaćimović J, Aminoshariae A, Fransson H. Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: a systematic review. International Endodontic Journal. 2023; 56: 340–354.

[15] Duggal M, Gizani S, Albadri S, Krämer N, Stratigaki E, Tong HJ, et al. Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. European Archives of Paediatric Dentistry. 2022; 23: 659–666.

[16] Maqbool M, Noorani TY, Samsudin NA, Awang Nawi MA, Rossi-Fedele G, Karobari MI, Messina P, et al. Association of vital pulp therapy outcomes with tooth type, arch location, treatment type, and number of surfaces destroyed in deciduous teeth: a retrospective study. International Journal of Environmental Research and Public Health. 2021; 18: 7970.

[17] Nair M. Clinical and radiographic outcomes of calcium hydroxide vs other agents in indirect pulp capping of primary teeth: a systematic review. International Journal of Clinical Pediatric Dentistry. 2019; 12: 437–444.

[18] Gurcan A T, Seymen F. Clinical and radiographic evaluation of indirect pulp capping with three different materials: a 2-year follow-up study. European Journal of Paediatric Dentistry. 2019; 20: 105–110.

[19] Lin YY, Zhang P, Cheon K, Jackson JG, Lawson NC. Chemical and physical properties of contemporary pulp capping materials. Pediatric Dentistry. 2022; 44: 207–212.

[20] Wassel M, Hamdy D, Elghazawy R. Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial. Journal of Clinical Pediatric Dentistry. 2023; 47: 10–22.

[21] Gruythuysen R, van Strijp G, Wu M. Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions. Journal of Endodontics. 2010; 36: 1490–1493.

[22] Covaci A, Ciocan LT, Gălbinașu B, Bucur MV, Matei M, Didilescu AC. Dental pulp response to different types of calcium-based materials applied in deep carious lesion treatment—a clinical study. Journal of Functional Biomaterials. 2022: 13: 51.

[23] Shang W, Zhang Z, Zhao X, Dong Q, Schmalz G, Hu S. The understanding of vital pulp therapy in permanent teeth: a new perspective. BioMed Research International. 2022; 2022: 1–11.

[24] Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatric Dentistry. 2003; 25: 29–36.

[25] Zahdan BA, Szabo A, Gonzalez CD, Okunseri EM, Okunseri CE. survival rates of stainless steel crowns and multi-surface composite restorations placed by dental students in a pediatric clinic. Journal of Clinical Pediatric Dentistry. 2018; 42: 167–172.

[26] Rosenberg L, Atar M, Daronch M, Honig A, Chey M, Funny MD, et al. Observational: prospective study of indirect pulp treatment in primary molars using resin-modified glass ionomer and 2% chlorhexidine gluconate: a 12-month follow-up. Pediatric Dentistry. 2013; 35: 13–17.

[27] Liu F, Yang K, Wang P, Wu T, Li J, Guo Q. Trends, characteristics, and success rates of treatment for severe early childhood caries under general anesthesia: a retrospective study in Northwest China. Journal of Clinical Pediatric Dentistry. 2021; 45: 278–283.

[28] Going RE. Microleakage around dental restorations: a summarizing review. The Journal of the American Dental Association. 1972; 84: 1349–1357.

[29] Askar H, Al-Abdi A, Blunck U, Göstemeyer G, Paris S, Schwendicke F. Secondary caries adjacent to bulk or incrementally filled composites placed after selective excavation in vitro. Materials. 2021; 14: 939.

[30] Pinna R, Usai P, Filigheddu E, Garcia-Godoy F, Milia E. The role of adhesive materials and oral biofilm in the failure of adhesive resin restorations. American Journal of Dentistry. 2017; 30: 285–292.

[31] Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. Preformed crowns for decayed primary molar teeth. The Cochrane Database of Systematic Reviews. 2015; 2015: CD005512.

[32] Ayedun O, Oredugba F, Sote E. Comparison of the treatment outcomes of the conventional stainless steel crown restorations and the hall technique in the treatment of carious primary molars. Nigerian Journal of Clinical Practice. 2021; 24: 584.

[33] Dhar V, Marghalani AA, Crystal YO, Kumar A, Ritwik P, Tulunoglu O, et al. Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry. 2017; 39: 146–159.

[34] Falster CA, Araujo FB, Straffon LH, Nör JE. Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatric Dentistry. 2002; 24: 241–248.

[35] Marchi J, de Araujo F, Fröner A, Straffon L, Nör J. Indirect pulp capping in the primary dentition: a 4 year follow-up study. Journal of Clinical Pediatric Dentistry. 2007; 31: 68–71.

[36] Garrocho-Rangel A, Quintana-Guevara K, Vázquez-Viera R, Arvizu-Rivera JM, Flores-Reyes H, Escobar-García DM, et al. Bioactive tricalcium silicate-based dentin substitute as an indirect pulp capping material for primary teeth: a 12-month follow-up. Pediatric Dentistry. 2017; 39: 377–382.