Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex.

PURPOSE The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.