Outcome of direct pulp capping With Premixed Bioceramic Material And Mineral Trioxide Aggregate In Mature Permanent Molars With Pulps Exposed During Carious Tissue Removal: A Randomized Clinical Trial

In our day-to-day clinical practice most of the patients walk into our clinic with deep or extremely deep carious lesions. To ensure a line of treatment which has always been successful, dentists intervene by doing root canal treatment because of its high success rate. However after delivery of root canal treatment the vitality of the pulp is lost. The vitality of the pulp is essential to Preserve the defense mechanism of the pulp Enable dentin formation, Enhancement of the Survival rate- Vital Teeth > Endodontically treated teeth, Avoid root fracture. Because of this, we are mindful in excavating, deep, extremely deep carious lesions, because today there is a concept of selective caries excavation which advices removal of infected dentine and keeping the affected dentine in place and packing it with pulp capping material which is known as Indirect Pulp Capping. However, AAE , very firmly in there position statement have said hard or firm dentin and dentin below white spot enamel lesions is infected by bacteria in both active and arrested lesions. Histobacteriological studies have consistently shown the presence of chronic inflammatory cell infiltrates and subclinical pulp inflammation where carious tissues are retained, thus potentially compromising pulp vitality. Keeping this school of thought in effect, when caries are very deep we may adverently expose the pulp during the removal of caries itself. We have a Position Statement by our very own Indian Endodontic Society published in the year 2022 which states that **Direct Pulp Capping(DPC)**is considered the most conservative and simplest of the VITAL PULP THERAPIES. It involves applying a biomaterial directly onto the exposed pulp before immediately placing a permanent restoration under aseptic conditions. A randomized clinical trial provides the highest level of support for evidence based clinical practice. There have not been many randomized clinical trials conducted for comparing the outcomes of Premixed Bioceramic Material and Mineral Trioxide Aggregate in mature permanent molars with pulps exposed during carious tissue removal. As DPC is mostly a onevisit procedure, conservative, costeffective, preserving pulp vitality, immunological and proprioceptive function of dental pulp while delaying the restorative cycle, and is considered an ideal treatment option for India where the oral disease burden is high. Thus, there is a need for a randomized clinical trial to evaluate and compare the Treatment outcome of Direct Pulp Capping using the new Premixed Bioceramic Material and comparing it with Mineral Trioxide Aggregate which is advocated for direct pulp capping procedures today.