A Prospective Clinical Study With One Year Follow Up of Deep Caries Management Using a Novel Biomaterial

A Prospective Clinical Study With One Year Follow Up of Deep Caries Management Using a Novel Biomaterial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Prospective Clinical Study With One Year Follow Up of Deep Caries Management Using a Novel Biomaterial M Roma, Ravi Gupta, Shreya Hegde This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1338557/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Objectives: The objectives of this study was to check the outcome of the direct and indirect pulp capping procedure using MTA (Mineral Trioxide Aggregate) by comparing the pre – and post – operative pain by using VAS scale, associating the pre- and post- operative changes in intraoral periapical radiograph and clinical symptoms. Materials and Methods: In this prospective clinical study 10 cases (5 for direct and 5 for indirect) with deep carious lesions (symptomatic) with no periapical changes were selected for the trial. The participants were subjected to deep caries management procedure under rubber dam where MTA is placed as pulp capping material followed by immediate restoration with sandwich technique using composite resin. The participants were followed up at recall visits of 1 month, 3 months, 6 months and 1 year intervals for clinical and radiographic evaluation. Results: The results of the study, analyzing the VAS, clinical symptoms and radiographic changes did not show any signs of pain, clinical and radiographic symptoms at 1 month, 3 months, 6 months and 1 year intervals. Conclusions: It was concluded that MTA can be used for deep caries management as a pulp capping material which being equivalent to calcium hydroxide. Mineral trioxide aggregate Portland cement Pulp Capping Deep caries management Figures Figure 1 Figure 2 Introduction Dental caries is one of the greatest challenges faced to the integrity of the tooth. Caries progression affects the dental pulp and bring about irreversible damage. The dentist needs to acquire deeper understanding of the factors involved with caries management. To provide patients with best caries therapy and, risk assessment strategies, the, caries should be detection detected of caries at the earliest by using various advanced methods and techniques like, non-cavitated lesion management and conservative treatment modalities of management specific to defects, conservative caries removal and appropriate material selection. The basis for the current approach for caries removal in deep caries management is to understanding the changes that occur in tooth ultrastructure with the method and the rate of caries process progression. is the basis for the current biological approach for caries removal especially in case deep caries management. Traditional treatment for carious exposed pulps has been root canal treatment. To overcome this myth, deep caries management plays a significant role in persevering the vitality of the dental pulp. The main motto of operative therapy of deep carious lesions is the conservation of pulpal vitality of such teeth, which presents real task for dental clinicians. The complete caries excavation procedure is generally accepted by the clinicians over the stepwise excavation process for the treatment of deep caries management protocol [ 1 , 2 , 3 ]. In this treatment aspect, when the remaining dentinal thickness is less than 0.5mm, the pulp is protected with a pulp protecting base. At present, there is substantial research done in dental materials focal point designed for the recognition of the dental materials which aid in production formation of strong dentinal bridge, other than long standing basic calcium hydroxide which is considered as gold standard material for pulp capping [ 4 ]. This is done basically to avoid uncontrolled necrotic zone created by calcium hydroxide [ 5 , 6 ]. Calcium hydroxide is bound to have other disadvantages like disintegration in the oral fluids, [ 7 ] formation of tunnel defects in dentinal bridges which lead to destruction over a period of time [6,33,6,7]. Numerous materials such as hydroxyapatite, zinc oxide eugenol, tricalcium phosphate, bioceramics, propolis, dentin adhesives have been tried on pulp [ 8 ]. Recently introduced Mineral Trioxide Aggregate (MTA) is one of the successful materials for the therapeutic treatment of deep caries lesions. Mineral Trioxide Aggregate, better known as MTA was introduced by Mahmoud Torabinejad in 1993. ProRoot® MTA (Dentsply Maillefer) a tricalcium based cement, has accentuated its usage in dentistry over the years in a successful way. Dentinal bridge formed with MTA when compared to that of calcium hydroxide, created effective hermetic seal which can unify with the dentin walls [ 9 ]. Literature search about MTA has shown various advantages like biocompatibility, [ 10 ] good sealing ability, [ 11 ] and being insoluble in oral fluids. [ 12 ] These beneficial effects have made it possible as a pulp capping agent for the treatment of deep caries management. A lot of comparative studies has been conducted previously on treatment aspect of deep carious lesions, [ 13 ] nevertheless only a handful of them have studied the comparative effects of calcium hydroxide and MTA in the management of deep carious lesions. [ 14 ] Only few studies have studied the beneficial effects of MTA. This in vivo study discusses cases of clinical management of deep carious lesions using MTA in the institutional set up with a follow up over one year. Materials And Methods This preliminary prospective longitudinal study was formulated and conducted on patients who attended the Department of Conservative dentistry and Endodontics. The methodology was accepted by the Institutional Ethical Committee (17061) of the University. Written informed consent was procured from all the patients who were involved in the study. Confidentiality pertaining to the information obtained during the course of the study was maintained at every stage of the study. This clinical trial was pre- registered in a Clinical Trials Registry (India) under the reference number REF/2019/05/025827. Selection of patients Ten patients, aged 18-50 years were incorporated in this study. Symptomatic teeth with deep carious lesion having mild pain, mild tenderness and sensitivity to cold beverages and without any radiolucency or periapical changes in the intraoral periapical radiograph were included. Symptomatic cases with severe pain, swelling/extraoral swelling, intraoral sinus, with presence of periapical changes in radiograph and medical history such as diabetes mellitus, immune-deficient conditions were prohibited excluded from the study. An elaborate case history and a thorough clinical examination was carried out. Pre-operative IOPA radiograph in paralleling technique was taken for every case. The participants were introduced to deep caries management procedure under rubber dam. The case selection for direct pulp capping was done if there was exposure during excavation and if not, indirect pulp capping procedure was performed. Treatment Protocol Direct Pulp Capping procedure: The infected soft caries was excavated using sterile sharp spoon excavator. Bleeding was controlled with 2.5% NaOCl (Vishal Dentocare Pvt Ltd.) soaked sterile cotton plug. The disinfection of the cavity was done with 2% Chlorhexidine gluconate solution. MTA (MTA ANGELUS®) was mixed as per manufacturer’s instructions and was applied as pulp capping material followed by the placement of moist cotton and temporization was done. The patient was recalled after 24hrs to remove the cotton pellet from the cavity and restored with glass ionomer (GC Glass Ionomer Universal Restorative) restoration. Indirect Pulp Capping Procedure: The infected soft caries was excavated using a sterile sharp spoon excavator leaving behind a layer of affected dentin. The disinfection of the cavity was done with 2% chlorehexidine gluconate (Vishal Dentocare Pvt Ltd.) solution. The disinfection of the cavity was carried out. MTA was applied as pulp capping material followed by the placement of moist cotton and temporization done. The patient was recalled after 24hrs to remove the cotton pellet from the cavity and restored with glass ionomer restoration and composite. The participants involved in the study was followed up at 1month, 3months, 6months and one year intervals (Figure 1 and 2). Visual Analogue Scale (VAS) was used for the assessment of the degree of pain in the scale of 0 -10. Patients were assessed after a week. The cases were subjected to clinical examination to evaluate symptoms and post- operative IOPA radiographs at every interval for the radiographic changes. Radiographs was taken with paralleling technique and did not reveal any periapical changes. Statistical analysis Data was analyzed using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc, Chicago IL). Descriptive statistics were tabulated. Chi square tests were applied. Results This clinical trial consisted of 10 adult symptomatic permanent teeth with no periapical changes and rendered vital with pulp sensibility tests. All the 10 samples were subjected deep caries management procedure under proper isolation. The treated teeth did not have failures and the patients did not complain of any continuous pain or swelling. All the patients were recalled at follow‑up periods at 1month, 3months, 6months and 12 months. All recall visits included both clinical and radiographic examinations. Clinically, there was total absenteeism of signs and symptoms and the teeth responded positively to pulp sensitivity tests, and radiographically, there was absence of periapical changes. The final treatment success rate was observed to be 100% (10 of 10) and the failure rate was 0.0% as shown in Table 1 . Table 1 Success Outcome of Deep caries management with MTA Teeth Analyzed (n = 10) Direct Pulp capping with MTA (n = 5) Indirect Pulp capping with MTA (n = 5) Total SUCCESS 5 5 10 FAILURE 0 0 0 P VALUE ≥ 0.05 ≥ 0.05 ≥ 0.05 Discussion One of the biggest dilemmas in the treatment of deep caries lesions whether to restore it conservatively or to perform root canal treatment. In regard with this, there are two doctrine laid down which debated with the management of deep caries lesions. One doctrine debated that root canal treatment should be performed regardless of the pulpal status of the tooth. The second doctrine stated that the tooth can be treated conservatively with vital pulp therapy which helps in preservation of pulp. [ 15 ] Vital pulp is the key factor for vital pulp therapy procedure. Pulp sensibility tests do not accurately dictate the vital status of the pulp. Hence, the treatment success of deep caries management depends on preservation of the vital component of the pulp while removing the diseased one. [ 16 ] One more criterion for successful preservation of vital pulp is the placement of lining material. Over a decade, calcium hydroxide has been contemplated as the “gold standard” material for deep caries management procedure but due to certain disadvantages like tunnel defects, dissolution of material in oral fluids, etc. As an alternative to calcium hydroxide, the use of Mineral Trioxide Aggregate is in vogue. MTA being bioactive in nature incites the dental pulp cell proliferation, osteoblastic differentiation to form hard tissue in a shorter period of time and the dentinal interface had similar composition to hydroxyapatite. [ 17 ] MTA has been successfully used in various areas of endodontics as root end repair material, perforation repair, apexification etc. [ 18 ] MTA is used in vital pulp therapy procedures and its outcome have shown tremendous successful results in direct and indirect pulp capping procedures thereby helping in dentinal regeneration and maintaining the pulpal vitality. [ 9 ] Khaled Wagih Al–Saudi et al. histologically studied the pulpal repair after direct pulp capping procedure with MTA and concluded the formation of complete dentinal bridge formation without any inflammatory pulpal response.[ 19 ] This is in accordance with the present clinical study which supports the fact that MTA is well used as pulp capping material. The cases selected in this study were vital tooth without any history of spontaneous pain and periapical changes which played an important role for the success of the treatment Therefore, the condition of the pulp is very important for the conservative treatment modality. The degree of pulpal exposure and the pulpal bleeding highlights the severity of the pulpal inflammation. [ 20 ] For the direct pulp capping, various literature search has shown that “the amount of time to arrest the bleeding” should be between 5-10min, and this point is taken into consideration to differentiate between reversible and irreversible pulpitis. [ 21 ] However, in this study the time to arrest the bleeding was within the confined time, which indicated vital pulp. Optimum clinical conditions like a) vital pulp, b) biomimetic pulp capping material like MTA, c) final restorative material play a very important role in the success of the treatment outcome. The success with this clinical study is mainly due to the nontoxic effect of Mineral Trioxide Aggregate on pulp and dentinal regeneration which will help in maintain the pulpal vitality and seals against all the microbes and the bacteria. In future, the clinical trial can be done with a larger study group. Conclusions Mineral Trioxide Aggregate has proven to be a successful material in preservation of pulpal vitality in management of deep carious lesions. Biomimetic mineralization produced by MTA helps in formation of dentinal matrix has revolutionized its usage in the treatment of carious affected teeth in the field of dentistry. Limitation Finally, the small number of patients included in this preliminary study meant that the analysis was underpowered. We recommend that future studies include a sufficiently large sample size to achieve adequate statistical power for analysis. Abbreviations MTA - Mineral Trioxide Aggregate IOPA- Intraoral Periapical Declarations Acknowledgements Not applicable Authors’ Contributions RM, SH and RG: Conceptualization, Methodology and Investigation RM and SH: Conceptualization and Data Curation. RM, SH and RG: Writing - Review and Editing and Supervision. RM and RG: Writing - Original Draft and Writing - Review and Editing. SH and RG: Writing - Original Draft and Project Administration. RM and SH: Resources and Writing - Review and Editing. All authors read and approved the final manuscript. Funding Not applicable Availability of data and materials The data used to support the findings of this study can be made available upon request to the corresponding author. Ethics approval and consent to participate The present study was approved by the Ethics Committee of Manipal College of Dental Sciences, Mangalore (approval number:17061), and only individuals who provided written informed consent were included in the study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interest References Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. Journal of public health dentistry. 2011 Sep;71(4):265-70. Reeves R, Stanley HR. The relationship of bacterial penetration and pulpal pathosis in carious teeth. Oral Surgery, Oral Medicine, Oral Pathology. 1966 Jul 1;22(1):59-65. Padavala S, Aarthy MG. MTA-An Elixir for Root Perforations-A Short Review. Research Journal of Pharmacy and Technology. 2017;10(5):1577-9. Sivakumar P, Naseem I. Biosmart materials the future of dentistry: A review. Research Journal of Pharmacy and Technology. 2016;9(10):1737-42. Divya S, Sujatha S. An insight on the success of various pulpotomy medicaments in pediatric dentistry-A review of literature. Research Journal of Pharmacy and Technology. 2018;11(6):2647-55. Cox CF, Sübay RK, Ostro E, Suzuki S, Suzuki SH. Tunnel defects in dentin bridges: their formation following direct pulp capping. Operative dentistry. 1996 Jan 1;21(1):4-11. Abiraamasri BL, Gurunathan D. Comparison of ferric sulphate and calcium hydroxide as a pulpotomy agent. Research Journal of Pharmacy and Technology. 2018;11(5):1881-3. Witherspoon DE, Small JC, Harris G (2006). Mineral trioxide aggregate pulpotomies. A case series outcomes assessment. JADA ;137:610-8. Bergenholtz G, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tranæus S. Treatment of pulps in teeth affected by deep caries–A systematic review of the literature. Singapore Dental Journal. 2013 Dec 1;34(1):1-2. Shahi S, Rahimi S, Yavari HR, Mokhtari H, Roshangar L, Abasi MM, Sattari S, Abdolrahimi M. Effect of mineral trioxide aggregates and Portland cements on inflammatory cells. Journal of endodontics. 2010 May 1;36(5):899-903. Tabrizizade M, Asadi Y, Sooratgar A, Moradi S, Sooratgar H, Ayatollahi F. Sealing ability of mineral trioxide aggregate and calcium-enriched mixture cement as apical barriers with different obturation techniques. Iranian endodontic journal. 2014;9(4):261. Petrou MA, Alhamoui FA, Welk A, Altarabulsi MB, Alkilzy M, H Splieth C. A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment. Clinical oral investigations. 2014 Jun;18(5):1383-9. de Souza Costa CA, Ribeiro AP, Giro EM, Randall RC, Hebling J. Pulp response after application of two resin modified glass ionomer cements (RMGICs) in deep cavities of prepared human teeth. Dental Materials. 2011 Jul 1;27(7):e158-70. Benoist FL, Ndiaye FG, Kane AW, Benoist HM, Farge P. Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal®) in the formation of a dentine bridge: a randomised controlled trial. International dental journal. 2012 Feb 1;62(1):33-9. Kusumvalli S, Diwan A, Pasha S, Devale MR, Chowdhary CD, Saikia P. Clinical evaluation of biodentine: Its efficacy in the management of deep dental caries. Indian Journal of Dental Research. 2019 Mar 1;30(2):191. Duda S, Dammaschke T. Measures for maintaining pulp vitality. Are there alternatives to calcium hydroxide in direct pulp capping. Quintessenz. 2008;59:1327-34. Olsson H, Petersson K, Rohlin M. Formation of a hard tissue barrier after pulp cappings in humans. A systematic review. International endodontic journal. 2006 Jun;39(6):429-42. Prasad BK, Naik CT. Mineral trioxide aggregate in endodontics. Int J Appl Dent Sci. 2017;2017(3):71-5. Al–Saudi KW, Nabih SM, Farghaly AM, AboHager EA. Pulpal repair after direct pulp capping with new bioceramic materials: A comparative histological study. The Saudi Dental Journal. 2019 Oct 1;31(4):469-75. Matsuo T, Nakanishi T, Shimizu H, Ebisu S. A clinical study of direct pulp capping applied to carious-exposed pulps. Journal of endodontics. 1996 Oct 1;22(10):551-6. Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. The Journal of the American Dental Association. 2008 Mar 1;139(3):305-15. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Minor revision 04 Apr, 2022 Reviews received at journal 28 Mar, 2022 Reviewers invited by journal 07 Mar, 2022 First submitted to journal 10 Feb, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1338557","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":88967369,"identity":"db43accd-fbf0-4923-84c0-560c77118440","order_by":0,"name":"M Roma","email":"","orcid":"","institution":"Manipal Academy of Higher Education","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"M","middleName":"","lastName":"Roma","suffix":""},{"id":88967370,"identity":"23a85225-7f6d-4373-b88c-ac3aaaf5ea78","order_by":1,"name":"Ravi Gupta","email":"","orcid":"","institution":"Manipal Academy of Higher Education","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ravi","middleName":"","lastName":"Gupta","suffix":""},{"id":88967371,"identity":"43d1ee45-c080-41fa-8a7d-d9ad9c0b1daf","order_by":2,"name":"Shreya Hegde","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-0730-0914","institution":"Manipal Academy of Higher Education","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shreya","middleName":"","lastName":"Hegde","suffix":""}],"badges":[],"createdAt":"2022-02-08 10:58:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1338557/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1338557/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19091252,"identity":"a478096a-93c1-434b-aec9-7260291a3729","added_by":"auto","created_at":"2022-03-10 19:13:22","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86135,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical Procedure of MTA with respect to 26.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1338557/v1/f90efe7d5c8caeeeab1c31d4.jpg"},{"id":19091253,"identity":"f287e510-3f49-4e06-8b80-41eb8fe6d70f","added_by":"auto","created_at":"2022-03-10 19:13:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41068,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiographic outcome of MTA procedure with respect to #22 over a period of one year\u003cspan class=\"ql-cursor\"\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1338557/v1/66a2fb77a7bf15e4eac0ce27.jpg"},{"id":19091254,"identity":"413f84fd-809f-4ee0-be8a-5a7aac6bd1e3","added_by":"auto","created_at":"2022-03-10 19:13:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":382116,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1338557/v1/afc28912-bb34-4870-88b7-516e9aae2b26.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eA Prospective Clinical Study With One Year Follow Up of Deep Caries Management Using a Novel Biomaterial\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental caries is one of the greatest challenges faced to the integrity of the tooth. Caries progression affects the dental pulp and bring about irreversible damage. The dentist needs to acquire deeper understanding of the factors involved with caries management. To provide patients with best caries therapy and, risk assessment strategies, the, caries should be detection detected of caries at the earliest by using various advanced methods and techniques like, non-cavitated lesion management and conservative treatment modalities of management specific to defects, conservative caries removal and appropriate material selection. The basis for the current approach for caries removal in deep caries management is to understanding the changes that occur in tooth ultrastructure with the method and the rate of caries process progression. is the basis for the current biological approach for caries removal especially in case deep caries management.\u003c/p\u003e \u003cp\u003eTraditional treatment for carious exposed pulps has been root canal treatment. To overcome this myth, deep caries management plays a significant role in persevering the vitality of the dental pulp. The main motto of operative therapy of deep carious lesions is the conservation of pulpal vitality of such teeth, which presents real task for dental clinicians. The complete caries excavation procedure is generally accepted by the clinicians over the stepwise excavation process for the treatment of deep caries management protocol [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this treatment aspect, when the remaining dentinal thickness is less than 0.5mm, the pulp is protected with a pulp protecting base. At present, there is substantial research done in dental materials focal point designed for the recognition of the dental materials which aid in production formation of strong dentinal bridge, other than long standing basic calcium hydroxide which is considered as gold standard material for pulp capping [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is done basically to avoid uncontrolled necrotic zone created by calcium hydroxide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Calcium hydroxide is bound to have other disadvantages like disintegration in the oral fluids, [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] formation of tunnel defects in dentinal bridges which lead to destruction over a period of time [6,33,6,7]. Numerous materials such as hydroxyapatite, zinc oxide eugenol, tricalcium phosphate, bioceramics, propolis, dentin adhesives have been tried on pulp [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Recently introduced Mineral Trioxide Aggregate (MTA) is one of the successful materials for the therapeutic treatment of deep caries lesions. Mineral Trioxide Aggregate, better known as MTA was introduced by Mahmoud Torabinejad in 1993. ProRoot\u0026reg; MTA (Dentsply Maillefer) a tricalcium based cement, has accentuated its usage in dentistry over the years in a successful way. Dentinal bridge formed with MTA when compared to that of calcium hydroxide, created effective hermetic seal which can unify with the dentin walls [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Literature search about MTA has shown various advantages like biocompatibility, [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] good sealing ability, [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and being insoluble in oral fluids. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] These beneficial effects have made it possible as a pulp capping agent for the treatment of deep caries management.\u003c/p\u003e \u003cp\u003eA lot of comparative studies has been conducted previously on treatment aspect of deep carious lesions, [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] nevertheless only a handful of them have studied the comparative effects of calcium hydroxide and MTA in the management of deep carious lesions. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Only few studies have studied the beneficial effects of MTA. This in vivo study discusses cases of clinical management of deep carious lesions using MTA in the institutional set up with a follow up over one year.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis preliminary prospective longitudinal study was formulated and conducted on patients who attended the Department of Conservative dentistry and Endodontics. The methodology was accepted by the Institutional Ethical Committee (17061) of the University. Written informed consent was procured from all the patients who were involved in the study. Confidentiality pertaining to the information obtained during the course of the study was maintained at every stage of the study. This clinical trial was pre- registered in a Clinical Trials Registry (India) under the reference number REF/2019/05/025827.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection of patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen patients, aged 18-50 years were incorporated in this study. Symptomatic teeth with deep carious lesion having mild pain, mild tenderness and sensitivity to cold beverages and without any radiolucency or periapical changes in the intraoral periapical radiograph were included. Symptomatic cases with severe pain, swelling/extraoral swelling, intraoral sinus, with presence of periapical changes in radiograph and medical history such as diabetes mellitus, immune-deficient conditions were prohibited excluded from the study. An elaborate case history and a thorough clinical examination was carried out. Pre-operative IOPA radiograph in paralleling technique was taken for every case. The participants were introduced to deep caries management procedure under rubber dam. The case selection for direct pulp capping was done if there was exposure during excavation and if not, indirect pulp capping procedure was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDirect Pulp Capping procedure: The infected soft caries was excavated using sterile sharp spoon excavator. Bleeding was controlled with 2.5% NaOCl (Vishal Dentocare Pvt Ltd.) soaked sterile cotton plug. The disinfection of the cavity was done with 2% Chlorhexidine gluconate solution. MTA (MTA ANGELUS\u0026reg;) was mixed as per manufacturer\u0026rsquo;s instructions and was applied as pulp capping material followed by the placement of moist cotton and temporization was done. The patient was recalled after 24hrs to remove the cotton pellet from the cavity and restored with glass ionomer (GC Glass Ionomer Universal Restorative) restoration.\u003c/p\u003e\n\u003cp\u003eIndirect Pulp Capping Procedure: The infected soft caries was excavated using a sterile sharp spoon excavator leaving behind a layer of affected dentin. The disinfection of the cavity was done with 2% chlorehexidine gluconate (Vishal Dentocare Pvt Ltd.) solution. The disinfection of the cavity was carried out. MTA was applied as pulp capping material followed by the placement of moist cotton and temporization done. The patient was recalled after 24hrs to remove the cotton pellet from the cavity and restored with glass ionomer restoration and composite.\u003c/p\u003e\n\u003cp\u003eThe participants involved in the study was followed up at 1month, 3months, 6months and one year intervals (Figure 1 and 2). Visual Analogue Scale (VAS) was used for the assessment of the degree of pain in the scale of 0 -10. Patients were assessed after a week. The cases were subjected to clinical examination to evaluate symptoms and post- operative IOPA radiographs at every interval for the radiographic changes. Radiographs was taken with paralleling technique and did not reveal any periapical changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was analyzed using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc, Chicago IL). Descriptive statistics were tabulated. Chi square tests were applied.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis clinical trial consisted of 10 adult symptomatic permanent teeth with no periapical changes and rendered vital with pulp sensibility tests. All the 10 samples were subjected deep caries management procedure under proper isolation. The treated teeth did not have failures and the patients did not complain of any continuous pain or swelling. All the patients were recalled at follow‑up periods at 1month, 3months, 6months and 12 months. All recall visits included both clinical and radiographic examinations. Clinically, there was total absenteeism of signs and symptoms and the teeth responded positively to pulp sensitivity tests, and radiographically, there was absence of periapical changes. The final treatment success rate was observed to be 100% (10 of 10) and the failure rate was 0.0% as shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSuccess Outcome of Deep caries management with MTA\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTeeth Analyzed (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDirect Pulp capping with MTA (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndirect Pulp capping with MTA (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSUCCESS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFAILURE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP VALUE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOne of the biggest dilemmas in the treatment of deep caries lesions whether to restore it conservatively or to perform root canal treatment. In regard with this, there are two doctrine laid down which debated with the management of deep caries lesions. One doctrine debated that root canal treatment should be performed regardless of the pulpal status of the tooth. The second doctrine stated that the tooth can be treated conservatively with vital pulp therapy which helps in preservation of pulp. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVital pulp is the key factor for vital pulp therapy procedure. Pulp sensibility tests do not accurately dictate the vital status of the pulp. Hence, the treatment success of deep caries management depends on preservation of the vital component of the pulp while removing the diseased one. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOne more criterion for successful preservation of vital pulp is the placement of lining material. Over a decade, calcium hydroxide has been contemplated as the \u0026ldquo;gold standard\u0026rdquo; material for deep caries management procedure but due to certain disadvantages like tunnel defects, dissolution of material in oral fluids, etc. As an alternative to calcium hydroxide, the use of Mineral Trioxide Aggregate is in vogue. MTA being bioactive in nature incites the dental pulp cell proliferation, osteoblastic differentiation to form hard tissue in a shorter period of time and the dentinal interface had similar composition to hydroxyapatite. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] MTA has been successfully used in various areas of endodontics as root end repair material, perforation repair, apexification etc. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMTA is used in vital pulp therapy procedures and its outcome have shown tremendous successful results in direct and indirect pulp capping procedures thereby helping in dentinal regeneration and maintaining the pulpal vitality. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eKhaled Wagih Al\u0026ndash;Saudi et al. histologically studied the pulpal repair after direct pulp capping procedure with MTA and concluded the formation of complete dentinal bridge formation without any inflammatory pulpal response.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] This is in accordance with the present clinical study which supports the fact that MTA is well used as pulp capping material.\u003c/p\u003e \u003cp\u003eThe cases selected in this study were vital tooth without any history of spontaneous pain and periapical changes which played an important role for the success of the treatment Therefore, the condition of the pulp is very important for the conservative treatment modality. The degree of pulpal exposure and the pulpal bleeding highlights the severity of the pulpal inflammation. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] For the direct pulp capping, various literature search has shown that \u0026ldquo;the amount of time to arrest the bleeding\u0026rdquo; should be between 5-10min, and this point is taken into consideration to differentiate between reversible and irreversible pulpitis. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] However, in this study the time to arrest the bleeding was within the confined time, which indicated vital pulp.\u003c/p\u003e \u003cp\u003eOptimum clinical conditions like a) vital pulp, b) biomimetic pulp capping material like MTA, c) final restorative material play a very important role in the success of the treatment outcome. The success with this clinical study is mainly due to the nontoxic effect of Mineral Trioxide Aggregate on pulp and dentinal regeneration which will help in maintain the pulpal vitality and seals against all the microbes and the bacteria. In future, the clinical trial can be done with a larger study group.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eMineral Trioxide Aggregate has proven to be a successful material in preservation of pulpal vitality in management of deep carious lesions. Biomimetic mineralization produced by MTA helps in formation of dentinal matrix has revolutionized its usage in the treatment of carious affected teeth in the field of dentistry.\u003c/p\u003e "},{"header":"Limitation","content":"\u003cp\u003eFinally, the small number of patients included in this preliminary study meant that the analysis was underpowered. We recommend that future studies include a sufficiently large sample size to achieve adequate statistical power for analysis.\u003c/p\u003e"},{"header":"Abbreviations ","content":"\u003cp\u003eMTA - Mineral Trioxide Aggregate\u003c/p\u003e\n\u003cp\u003eIOPA- Intraoral Periapical\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRM, SH and RG: Conceptualization, Methodology and Investigation\u003c/p\u003e\n\u003cp\u003eRM and SH: Conceptualization and Data Curation.\u003c/p\u003e\n\u003cp\u003eRM, SH and RG: Writing - Review and Editing and Supervision.\u003c/p\u003e\n\u003cp\u003eRM and RG: Writing - Original Draft and Writing - Review and Editing.\u003c/p\u003e\n\u003cp\u003eSH and RG: Writing - Original Draft and Project Administration.\u003c/p\u003e\n\u003cp\u003eRM and SH: Resources and Writing - Review and Editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study can be made available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Ethics Committee of Manipal College of Dental Sciences, Mangalore (approval number:17061), and only individuals who provided written informed consent were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWeber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. Journal of public health dentistry. 2011 Sep;71(4):265-70.\u003c/li\u003e\n \u003cli\u003eReeves R, Stanley HR. The relationship of bacterial penetration and pulpal pathosis in carious teeth. Oral Surgery, Oral Medicine, Oral Pathology. 1966 Jul 1;22(1):59-65.\u003c/li\u003e\n \u003cli\u003ePadavala S, Aarthy MG. MTA-An Elixir for Root Perforations-A Short Review. Research Journal of Pharmacy and Technology. 2017;10(5):1577-9.\u003c/li\u003e\n \u003cli\u003eSivakumar P, Naseem I. Biosmart materials the future of dentistry: A review. Research Journal of Pharmacy and Technology. 2016;9(10):1737-42.\u003c/li\u003e\n \u003cli\u003eDivya S, Sujatha S. An insight on the success of various pulpotomy medicaments in pediatric dentistry-A review of literature. Research Journal of Pharmacy and Technology. 2018;11(6):2647-55.\u003c/li\u003e\n \u003cli\u003eCox CF, S\u0026uuml;bay RK, Ostro E, Suzuki S, Suzuki SH. Tunnel defects in dentin bridges: their formation following direct pulp capping. Operative dentistry. 1996 Jan 1;21(1):4-11.\u003c/li\u003e\n \u003cli\u003eAbiraamasri BL, Gurunathan D. Comparison of ferric sulphate and calcium hydroxide as a pulpotomy agent. Research Journal of Pharmacy and Technology. 2018;11(5):1881-3.\u003c/li\u003e\n \u003cli\u003eWitherspoon DE, Small JC, Harris G (2006). Mineral trioxide aggregate pulpotomies. A case series outcomes assessment. \u003cem\u003eJADA\u003c/em\u003e;137:610-8.\u003c/li\u003e\n \u003cli\u003eBergenholtz G, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tran\u0026aelig;us S. Treatment of pulps in teeth affected by deep caries\u0026ndash;A systematic review of the literature. Singapore Dental Journal. 2013 Dec 1;34(1):1-2.\u003c/li\u003e\n \u003cli\u003eShahi S, Rahimi S, Yavari HR, Mokhtari H, Roshangar L, Abasi MM, Sattari S, Abdolrahimi M. Effect of mineral trioxide aggregates and Portland cements on inflammatory cells. Journal of endodontics. 2010 May 1;36(5):899-903.\u003c/li\u003e\n \u003cli\u003eTabrizizade M, Asadi Y, Sooratgar A, Moradi S, Sooratgar H, Ayatollahi F. Sealing ability of mineral trioxide aggregate and calcium-enriched mixture cement as apical barriers with different obturation techniques. Iranian endodontic journal. 2014;9(4):261.\u003c/li\u003e\n \u003cli\u003ePetrou MA, Alhamoui FA, Welk A, Altarabulsi MB, Alkilzy M, H Splieth C. A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment. Clinical oral investigations. 2014 Jun;18(5):1383-9.\u003c/li\u003e\n \u003cli\u003ede Souza Costa CA, Ribeiro AP, Giro EM, Randall RC, Hebling J. Pulp response after application of two resin modified glass ionomer cements (RMGICs) in deep cavities of prepared human teeth. Dental Materials. 2011 Jul 1;27(7):e158-70.\u003c/li\u003e\n \u003cli\u003eBenoist FL, Ndiaye FG, Kane AW, Benoist HM, Farge P. Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal\u0026reg;) in the formation of a dentine bridge: a randomised controlled trial. International dental journal. 2012 Feb 1;62(1):33-9.\u003c/li\u003e\n \u003cli\u003eKusumvalli S, Diwan A, Pasha S, Devale MR, Chowdhary CD, Saikia P. Clinical evaluation of biodentine: Its efficacy in the management of deep dental caries. Indian Journal of Dental Research. 2019 Mar 1;30(2):191.\u003c/li\u003e\n \u003cli\u003eDuda S, Dammaschke T. Measures for maintaining pulp vitality. Are there alternatives to calcium hydroxide in direct pulp capping. Quintessenz. 2008;59:1327-34.\u003c/li\u003e\n \u003cli\u003eOlsson H, Petersson K, Rohlin M. Formation of a hard tissue barrier after pulp cappings in humans. A systematic review. International endodontic journal. 2006 Jun;39(6):429-42.\u003c/li\u003e\n \u003cli\u003ePrasad BK, Naik CT. Mineral trioxide aggregate in endodontics. Int J Appl Dent Sci. 2017;2017(3):71-5.\u003c/li\u003e\n \u003cli\u003eAl\u0026ndash;Saudi KW, Nabih SM, Farghaly AM, AboHager EA. Pulpal repair after direct pulp capping with new bioceramic materials: A comparative histological study. The Saudi Dental Journal. 2019 Oct 1;31(4):469-75.\u003c/li\u003e\n \u003cli\u003eMatsuo T, Nakanishi T, Shimizu H, Ebisu S. A clinical study of direct pulp capping applied to carious-exposed pulps. Journal of endodontics. 1996 Oct 1;22(10):551-6.\u003c/li\u003e\n \u003cli\u003eBogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. The Journal of the American Dental Association. 2008 Mar 1;139(3):305-15.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mineral trioxide aggregate, Portland cement, Pulp Capping, Deep caries management","lastPublishedDoi":"10.21203/rs.3.rs-1338557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1338557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The objectives of this study was to check the outcome of the direct and indirect pulp capping procedure using MTA (Mineral Trioxide Aggregate) by comparing the pre – and post – operative pain by using VAS scale, associating the pre- and post- operative changes in intraoral periapical radiograph and clinical symptoms. Materials and Methods: In this prospective clinical study 10 cases (5 for direct and 5 for indirect) with deep carious lesions (symptomatic) with no periapical changes were selected for the trial. The participants were subjected to deep caries management procedure under rubber dam where MTA is placed as pulp capping material followed by immediate restoration with sandwich technique using composite resin. The participants were followed up at recall visits of 1 month, 3 months, 6 months and 1 year intervals for clinical and radiographic evaluation. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe results of the study, analyzing the VAS, clinical symptoms and radiographic changes did not show any signs of pain, clinical and radiographic symptoms at 1 month, 3 months, 6 months and 1 year intervals. Conclusions: It was concluded that MTA can be used for deep caries management as a pulp capping material which being equivalent to calcium hydroxide.\u003c/p\u003e","manuscriptTitle":"A Prospective Clinical Study With One Year Follow Up of Deep Caries Management Using a Novel Biomaterial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-10 19:13:20","doi":"10.21203/rs.3.rs-1338557/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2022-04-04T06:12:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-03-28T14:22:01+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-03-07T20:53:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2022-02-10T23:49:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31c4b376-5f9d-4e1b-9424-78b7e4c3b48f","owner":[],"postedDate":"March 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-04-20T13:56:13+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-10 19:13:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1338557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1338557","identity":"rs-1338557","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}