Published: 2017-04-29

Histological evaluation of human pulp capped with light-cured calcium based cements: a randomized controlled clinical trial

G. Jeya Gopika, Sathyanarayanan Ramarao, Carounanidy Usha, Bindu Meera John, N. Vezhavendhan


Background: Calcium hydroxide has traditionally been used as the pulp capping material for pulpal exposures in permanent teeth. The tunnel defects in the barrier and the tendency for dissolution, however, fails to provide permanent protection to the pulp. Light curable resin based cements have been introduced to enable a better marginal seal and lesser dissolution. The purpose of this study was to compare and evaluate the response of human pulp following direct pulp capping with the new resin based Calcium silicate (TheraCal LC) and Calcium hydroxide with hydroxyapatite (Septocal LC) cements compared with calcium hydroxide (Dycal).

Methods: 72 intact human premolars scheduled for orthodontic extractions were exposed to direct pulp capping procedures using three different pulp capping agents. Teeth were randomly divided into 3 groups, Group A: Dycal, Group B: TheraCal LC, Group C: Septocal LC. The teeth were extracted at the end of 15 and 40 days’ and were evaluated histologically. They were scored for reparative dentin formation and inflammatory response. Inferential statistics was done using Chi square test.

Results: Majority of the specimens in all three groups at the end of 15 days’ showed partial to lateral deposition of hard tissue. There was continuous deposition of hard tissue and severe inflammatory response at the end of 40 days’ in Dycal. There was partial deposition of hard tissue and reduced inflammatory response at the end of 40 days’ in TheraCal LC and Septocal LC. However, the results were not statistically significant between the three groups at two different time periods.

Conclusions: Light cured, Calcium silicate (TheraCal LC) and Calcium hydroxide with hydroxyapatite (Septocal LC) cements were as effective as calcium hydroxide (Dycal) in inducing the formation of reparative dentin and evoking inflammatory response.


Pulp capping, Calcium hydroxide, TheraCal LC, Septocal, Pulp therapy

Full Text:



Torabinejad WM. Principles and practice of endodontics. 1st edition. Philadelphia, PA: Saunders; 2002.

Willershausen B, Willershausen I, Ross A, Velikonja S, Kasaj A, Blettner M. Retrospective study on direct pulp capping with calcium hydroxide. Quintessence Int. 2011;42(2):165-71.

Horsted P, Sandergaard B, Thylstrup A, El Attar K, Fejerskov O. A retrospective study of direct pulp capping with calcium hydroxide compounds. Endod Dent Traumatol. 1985;1(1):29-34.

Cox CF, Subay RK, Ostro E, Suzuki S, Suzuki SH. Tunnel defects in dentin bridges: Their formation following direct pulp capping. Oper Dent. 1996;21:4-11.

Accorinte M, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E, et al. Evaluation of Mineral Trioxide Aggregate and Calcium Hydroxide Cement as Pulp-capping Agents in Human Teeth. J Endod. 2008;34(1):1–6.

Gandolfi MG, Siboni F, Botero T, Bossù M, Riccitiello F, Prati C. Calcium silicate and calcium hydroxide materials for pulp capping: biointeractivity, porosity, solubility and bioactivity of current formulations. J Appl Biomater Funct Mater. 2015;13(1):43-60.

Chenxi Zhu, Bin Ju, Rong Ni. Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis. Int J Clin Exp Med. 2015;8(10):17055–60.

Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012;45(6):571-9.

Woodard JR, Hilldore AJ, Lan SK, Park CJ, Morgan AW, Eurell JA, Clark SG, Wheeler MB, Jamison RD, Wagoner Johnson AJ. The mechanical properties and osteoconductivity of hydroxyapatite bone scaffolds with multi-scale porosity. Biomaterials. 2007;28(1):45-54.

Iwamoto CE, Adachi E, Pameijer CH, Barnes D, Romberg EE, Jefferies S. Clinical and histological evaluation of white ProRoot MTA in direct pulp capping. Am J Dent. 2006;19:85–90.

Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur Arch Paediatr Dent. 2007;8:99–104.

Horsted P, Sandergaard B, Thylstrup A, El Attar K, Fejerskov O. A retrospective study of direct pulp capping with calcium hydroxide compounds. Endod Dent Traumatol. 1985;1(1):29-34.

Parolia A, Kundabala M, Rao NN, Acharya SR, Agrawal P, Mohan M, et al. A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J. 2010;55(1):59-64.

Eskandarizadeh A, Shahpasandzadeh MH, Shahpasandzadeh M, Torabi M, Parirokh M. A comparative study on dental pulp response to calcium hydroxide, white and grey mineral trioxide aggregate as pulp capping agents. J Conserv Dent. 2011:14(4):351–5.

Nair PNR, Duncan HF, Pitt Ford TR, Lunder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral tri-oxide aggregate: a randomized controlled trial. Int Endod J. 2008;41:128–50.

Silva GAB, Lanza LD, Lopes-Júnior N, Moreira A, Alves JB. Direct Pulp Capping with a Dentin Bonding System in Human Teeth: A Clinical and Histological Evaluation. Oper Dent. 2006;31(3):297–307.

Komabayashi T, Qiang ZHU, Robert E, Yohji IMA. Current status of direct pulp-capping materials for permanent teeth. Dental Materials J. 2016;35(1):1–12.

Accorinte MLR, Loguercio AD, Reis A, Bauer JRO, Grande RHM, Murata SS. Evaluation of two mineral trioxide aggregate compounds as pulp-capping agents in human teeth. Int Endod J. 2009;42(2):122–8.

Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Mineral tri- oxide aggregate (MTA) and calcium hydroxide as pulp capping agents in human teeth: a preliminary report. Int Endod J. 2003;36:225–31.

Accorinte Mde L, Loguercio AD, Reis A, Muench A, de Araujo VC. Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system. Dent Mater. 2005;21:599-607.

Modena KC, Casas-Apayco LC, Atta MT, Costa CA, Hebling J, Sipert CR, et al. Cytotoxicity and biocompatibility of direct and indirect pulp capping materials. J Appl Oral Sci. 2009;17(6):544-54.

Cannon M, Gerodias N, Viera A, Percinoto C, Jurado R. Primate pulpal healing after exposure and TheraCal application. J Clin Pediatr Dent. 2014;38(4):333-7.

Chaudhari WA, Jain RJ, Jadhav SK, Hegde VS, Dixit MV. Calcium ion release from four different light-cured calcium hydroxide cements. Endodontology 2016;28:114-8.

Estrella C, Holland R. Calcium hydroxide: study based on Scientific evidences. J Appl Oral Sci. 2003;11(4):269-82

Dawood AE, Parashos P, Wong RH, Reynolds EC, Manton DJ. Calcium silicate-based cements: composition, properties, and clinical applications. J Investig Clin Dent. 2015.

Gangwal A. A Comparative Evaluation of Antimicrobial Effectiveness of Pulp-capping Agents. J Dent Sci Oral Rehab. 2015;6(2):51-3.

Sübay RK, Aşci S. Human pulpal response to hydroxyapatite and a calcium hydroxide material as direct capping agents. Oral Surg Oral Med Oral Pathol. 1993;76(4):485-92.

Hayashi Y, Imai M, Yanagiguchi K, Viloria IL, Ikeda T. Hydroxyapatite applied as direct pulp capping medicine substitutes for osteodentin. J Endod. 1999;25(4):225-9.