Comparative Evaluation of Calcium Silicate-doped Treated Dentin Matrix and Mineral Trioxide Aggregate as Miniature Pulpotomy Biomaterials in Deep Carious Lesions: a Parallel, Double-blind, Randomised Clinical Trial

1 INTRODUCTION The loss of tooth structure significantly affects the quality of life for patients. This loss occurs due to decay and other non-carious causes. The resulting inadequate aesthetics and impaired function affects even the psychological wellbeing of the patient. Conventional root canal therapy alongside a quality coronal restoration is widely regarded as the standard treatment for this issue. Yet, traditional treatment approaches consistently present challenges such as significant periradicular dentin loss and the risk of reinfection resulting from a compromised coronal seal. Ideally reestablishment of the lost tissue to their pre-disease level should be the goal of these treatment strategies. Regeneration of the dentin-pulp complex and revitalization of the tooth as well as replacement of lost dentin by newly formed dentin should be ultimate objectives of these treatment strategies.

Caries is a biofilm mediated disease of the hard tissues of teeth that is caused by bacterial conversion of fermentable carbohydrates into acids resulting in a acidogenic and cariogenic environment which eventually breaks down the dental hard tissues to form a cavity.

Caries of the permanent teeth was reportedly the most common oral condition as per the Global Burden of Disease Study of 2017. Globally, around 2.4 billion people suffer from caries of the permanent teeth and 486 million children suffer from caries of the primary teeth. The overall prevalence for Dental caries in India is about 54.16%. However there is a remarkable variation in dental caries prevalence rates as per age, diagnostic criteria, dentition, and geographical region.

Involvement of the dentin-pulp complex in the carious process is associated with an inflammatory response. The histopathology and the pathophysiology of the diseased pulp have been extensively studied in the literature clearly illustrating that the parts of the pulpal organ under the inflamed pulpal tissue even in so called "irreversible pulpitis" remain vital or if slightly inflamed are often capable of retaining their vitality especially in the radicular portion. Therefore, there is a growing focus on conserving pulp vitality in different types of teeth with pulp involvement.

Vital pulp therapies are a collection of treatment procedures that aim to conserve the vitality of the pulpal tissue that is affected by the carious process. The procedures include removing the microbial irritation and preventing any new bacterial insult to the pulp by placement of a sealing biocompatible material to protect the pulp from external stimuli. VPT is easier and less invasive than conventional root canal treatment. However the technique is still demanding often requiring magnification and expertise.