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Received Nov 10, 2017; Revised Feb 7, 2018; Accepted Feb 14, 2018
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1. Introduction
The primary objective of restorative dentistry is to preserve pulpal health of vital teeth. Currently, there is no single pulp protection protocol for clinicians to follow [1, 2]. A direct pulp cap is a procedure in which the exposed vital pulp is treated with a therapeutic material, followed by a base and restoration, to promote healing, to maintain pulp vitality, and to protect the pulp from thermal, chemical, and noxious stimuli [1]. Calcium hydroxide has traditionally been used as the pulp capping material of choice for pulpal exposures in permanent teeth [3]. The effect of calcium hydroxide is the result of the chemical injury caused by the hydroxyl ions released during the hydration reaction into the surrounding environment [2]. Calcium hydroxide stimulates the pulp to defend and repair to form a reparative dentin bridge. It has been reported that 89% of 192 dentin bridges formed by calcium hydroxide cement in monkeys contained tunnel defects that might fail to provide a permanent barrier and a long-term biological seal against bacterial infection [4]. However, the major disadvantage of calcium hydroxide is its high solubility which leads to the disappearance of the material and the formation of defects in reparative dentin underneath the capping material, thereby failing to provide a permanent seal against bacterial invasion [5].
Calcium silicate-based materials are bioactive materials capable of forming apatite by using calcium silicates or calcium aluminates. These materials are also biointeractive [6]; they release ions needed to stimulate dentin bridging. Mineral trioxide aggregate (MTA) is a calcium silicate-based material that is used in direct and indirect pulp capping in primary and permanent teeth. MTA has been reported superior to calcium hydroxide for pulp capping of mechanically exposed human teeth [7–9]. However, MTA exhibits many drawbacks as a capping material such as difficult handling, long setting time, induction of tooth discoloration, and incompatibility with other dental materials when layered [10].
New calcium silicate materials have appeared recently, and among them, Biodentine (Septodont, Saint Maur-des-Fosses, France) is a modified...