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Title Dentin Bonding Agents Can Be Used to Reduce the Amount of Tooth Discoloration From a MTA Pulpotomy
Clinical Question In patients with teeth requiring a MTA pulpotomy, does the use of a dentin bonding agent (DBA) help reduce the amount of tooth discoloration compared to not using a dentin bonding agent?
Clinical Bottom Line In patients with teeth requiring a MTA pulpotomy, it has been observed that the use of a dentin bonding agent can help reduce the amount of tooth discoloration during a MTA pulpotomy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 29090391Shokouhinejad/201896 extracted bovine incisors Laboratory study
Key results96 bovine incisors were randomly divided into two groups – one group receiving DBA (dentin bonding agent), while the other group did not. The mean values for the color changes were measured for both groups. This study showed that sealing the dentinal walls with dentin bonding agent significantly decreased coronal discoloration (p < 0.001). All specimens did display a clinically noticeable amount of discoloration though, with ΔE ≥ 3.3 (ΔE is defined as the measure of change in visual perception of two given colors).
#2) 22114601Akbari/201250 extracted human maxillary incisorsLaboratory study
Key results50 extracted human maxillary incisors were randomly divided into five groups – white MTA (WMTA), grey MTA (GMTA), DBA + WMTA, DBA + GMTA, and the control group (no DBA or MTA). The results were analyzed by t-test, with significance level of α = 0.05. The mean tooth discoloration in WMTA group was signficantly more than the DBA + WMTA group and the control group. The teeth in GMTA group also showed significantly more discoloration than the DBA + GMTA group and control group. There was no signficant difference observed between control (no DBA or MTA) and DBA + GMTA groups.
Evidence Search ("dentin"[MeSH Terms] OR "dentin"[All Fields]) AND ("object attachment"[MeSH Terms] OR ("object"[All Fields] AND "attachment"[All Fields]) OR "object attachment"[All Fields] OR "bonding"[All Fields]) AND agent[All Fields] AND discoloration[All Fields] AND MTA[All Fields]
Comments on
The Evidence
Validity: Since both of these studies are considered laboratory studies, they provide a low level of evidence on this topic. In the Shokouhinejad study, the bovine teeth were randomly divided into two groups. Both groups were treated similarly throughout the lab study. In the Akbari study, the fifty extracted human maxillary anterior teeth were all made sure to be free from any caries, calcifications, or restorations. These teeth were also randomly distributed into five different testing groups. Perspective: While both laboratory studies show that dentin bonding agent can be used to reduce the amount of discoloration caused by MTA, there is only so much an in vitro study can replicate of the oral environment. It would be preferable to have higher levels of evidence on this topic before a more definitive conclusion can be made.
Applicability Mineral trioxide aggregate (MTA) has become very commonly used in endodontics, especially in the pediatric population. It serves many purposes, including pulp capping agent, medicament during a pulpotomy, as well as treatment of teeth with an open apex. One of the reasons why MTA is not used as frequently during treatment of anterior teeth is due to the MTA-related tooth discoloration that can occur. The two studies above have shown that the application of dentin bonding agent to the dentinal walls of the pulp chamber can seal the dentinal tubules, lessening the amount of discoloration. Further research could be performed on extracted primary teeth, to see if dentin bonding agent has the same effect on MTA pulpotomies performed in the pediatric population.
Specialty/Discipline (Endodontics) (Pediatric Dentistry)
Keywords MTA, mineral trioxide aggregate, dentin bonding agent, discoloration
ID# 3329
Date of submission: 09/05/2018spacer
E-mail Misaqi@livemail.uthscsa.edu
Author Badi Misaqi, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Dr. Jungyi Alexis Liu, DDS, MS
Faculty mentor/Co-author e-mail LiuJA@uthscsa.edu
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