Clinical Comparison of Resin-modified and Conventional Calcium Hydroxide Pulp Capping Agents in Deep Carious Lesions: A Randomized Trial

Introduction: This study was conducted to compare the clinical success and restoration survival of a resin-based pulp capping material (Apacal ART) with a conventional chemical-cure calcium hydroxide liner (Dycal) in deep carious teeth over a ۱۲-month period. Methods: This randomized clinical trial was conducted on ۱۲۰ permanent posterior teeth with deep caries requiring direct pulp capping. Teeth with positive cold test responses and controllable pulpal bleeding were randomly assigned to two groups: Group I (Dycal) and Group II (Apacal ART). Following pulp capping, a glass ionomer liner and composite restoration were placed. Postoperative evaluations were performed at ۲۴ hours, ۴۸ hours, and ۱۲ months. Data were analyzed using the Chi-square test and Kaplan–Meier survival analysis. Results: Post-operative sensitivity at ۴۸ hours was reported by ۱۷ patients in the Dycal group and ۹ patients in the Apacal ART group, with no statistically significant difference between the groups (P=۰.۰۶). After ۱۲ months, ۴ teeth in the Apacal ART group and ۵ teeth in the Dycal group met the criteria for failure outcomes. The Apacal ART group demonstrated superior restoration survival, with a statistically significant difference between groups (P=۰.۰۰۹). Conclusion: Both Dycal and Apacal ART showed satisfactory clinical performance as direct pulp capping materials. However, Apacal ART exhibited higher restoration survival over ۱۲ months, likely due to its resin-modified composition that enhances bonding, mechanical strength, and marginal adaptation. Resin-based materials such as Apacal ART appear to be promising alternatives for direct pulp capping procedures.