Dental caries is a
multifactorial disease characterized by the demineralization of inorganic
substance of the tooth and the destruction of organic part of the tooth. Enamel
of deciduous tooth is less mineralized, more susceptible to acid dissolution
compared to enamel of permanent teeth.To preserve the integrity
of tooth until their natural exfoliation, restorative procedures have to be
performed. Treating reversible pulpal injuries and maintaining pulp vitality are
the primary objectives of vital pulp therapy. Indirect pulp capping is a procedure where in
small amount of carious dentin is retained in deep areas of cavity to avoid
exposure of pulp, followed by placement of a suitable medicament and
restorative material that seals off the carious dentin and encourages pulp
recovery. Most commonly used materials for indirect pulp capping
are Calcium hydroxide, zinc oxide eugenol cement, MTA. Each of these materials
have their own drawbacks. Nano- hydroxyapatite (NHA) particles have unique properties
such as higher solubility, higher surface energy, and optimal biocompatibility
compared to the typical hydroxyapatite. Synthetic NHA has the
same physicochemical
properties as those of apatite in the enamel. It shows strong affinity to the
tooth and can strongly adsorb on enamel surfaces. Eggshell is a rich source of
calcium. It contains 94% calcium carbonate, 1% calcium phosphate, 1% magnesium
carbonate, and 4% organic matter. Egg Shell contains not only
calcium but also other elements such as fluoride and strontium -despite the low
concentration- and have a positive effect on bone and dental metabolism. In 1992, Egg shell powder was registered as a medicinal and pharmaceutical
agent. However, the effects of Eggshell powder and Nano-
hydroxyapatite powder on reparative and reactionary dentin formation in primary
molars following application as an indirect pulp capping agent in deep carious
lesions has not been documented. This study aims to evaluate the
efficacy of Egg shell powder and Nano-hydroxyapatite powder as indirect pulp
capping agents. METHOD: Study design: Randomized Clinical Trial Sample size: 60 Children (30/Group). Source of study: Department of Paediatric and Preventive Dentistry, VMSDC, Salem. Inclusion Criteria: No history of spontaneous and nocturnal pain No history of swelling or sinus tracts No radiographic signs of pathologic root resorption and furcation radiolucency Dental caries involving more than 2/3rd of the dentin thickness not approaching pulp Exclusion criteria: Signs of irreversible pulpitis Patients who are unwilling to participate in the study Patients with systemic diseases/ physical disabilities Randomization: The randomization is achieved by simple randomization technique using lottery method. Based on the inclusion criteria a total of 60 children in the age group of 5-10 years will be selected for the study, Study participants will be allocated into 2 groups, Following Rubber dam placement, soft caries (infected dentin) removal will be done using a slow speed handpiece and a carbide bur. Group 1 Egg Shell Powder Commercially available Egg shell powder will be
mixed with saline and placed over the cavity floor with the help of cement
carrier followed by restoration with glass ionomer cement. Group 2 Nano-Hydroxyapatite powder will
be mixed with saline and placed over the cavity floor with the help of cement
carrier followed by restoration with glass ionomer cement. Immediate postoperative periapical
radiographs with IOPA grids will be taken with film holders in paralleling
technique to check the correct placement of material which will serve as the
baseline parameter for the further radiographic evaluation.
The patient will be followed up
clinically for evaluation of pain and radiographically for the amount of
reparative dentin thickness formed at the intervals of 2 months and 6 months respectively. Clinical Assessment: The evaluations will be performed at baseline of 2nd and 6th month intervals through a clinical examination according to Zurn and Seale pain rating scale, 2008. Radiographic Assessment: The evaluations will be performed at baseline of 2nd and 6th month intervals through a radiological examination. Radiographic success will be confirmed by the absence of any pathological root resorption, furcal radiolucency. IOPA grids which are made up of copper wire will be used with film holders. Paralleling technique will be used. The IOPA grids when superimposed with film, they show anatomic structures with grid lines. These grid lines are evenly distributed which is 1mm part length wise and width wise. The dentin remineralisation is evaluated by using digital radiographic technique superimposed with radiolucent grid lines.
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