A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment

Clin Oral Investig. 2014;18(5):1383-9. doi: 10.1007/s00784-013-1107-z. Epub 2013 Sep 17.


Objectives: Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin-pulp complex of permanent and primary teeth treated with two-step IPT.

Materials and methods: In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n = 31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment.

Results: The IPT had a high success rate of 90.3 % regardless of the material used (p = 0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p < 0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p = 0.01/Mutans Strep. p = 0.07).

Conclusions: The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement.

Clinical relevance: The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aluminum Compounds*
  • Calcium Compounds*
  • Calcium Hydroxide*
  • Child
  • Child, Preschool
  • Dental Cements*
  • Dental Pulp / drug effects*
  • Drug Combinations
  • Female
  • Humans
  • Male
  • Oxides*
  • Silicates*
  • Young Adult


  • Aluminum Compounds
  • Calcium Compounds
  • Dental Cements
  • Drug Combinations
  • Oxides
  • Silicates
  • mineral trioxide aggregate
  • Calcium Hydroxide