Calcium for Teeth: New Hope for Kids' Cavities

clinical-trial PMID: 34192759

Quick Summary: A recent study found that using certain calcium-based materials to treat deep cavities in children's permanent teeth is very effective. Specifically, Theracal LC showed the best results, helping teeth stay healthy for up to two years.

What The Research Found

Researchers compared different materials used to protect the nerve (pulp) in young permanent teeth with deep cavities. They found that Theracal LC, a material containing calcium, worked the best. Almost all teeth treated with Theracal LC remained healthy for two years. Biodentine, another calcium-based material, also performed well. Dycal, a more traditional material, was less successful.

Study Details

Who was studied: 55 healthy children with deep cavities in their permanent molars (back teeth).

How long: The study followed the children for 24 months (2 years).

What they took: The dentists used either Theracal LC, Biodentine, or Dycal to protect the tooth's nerve after removing the decayed part. The materials were then covered with a filling.

What This Means For You

If your child needs a filling for a deep cavity, this research suggests that using Theracal LC or Biodentine might be a good choice. These materials can help keep the tooth healthy and avoid the need for more extensive treatments like root canals. Talk to your dentist about the best options for your child.

Study Limitations

The study involved a relatively small number of children.

The dentists knew which material they were using, which could have influenced the results.

The study only looked at the results for two years. We don't know how these materials will perform over a longer period.

The study focused on materials used in the dental office, not on calcium supplements you take.

Key Findings

This 24-month randomized clinical trial demonstrated significantly higher success rates for Theracal LC (100%) and Biodentine (94.44%) compared to Dycal (77.78%) as indirect pulp capping agents in young permanent molars with deep caries. Theracal's success rate was statistically superior to both Biodentine and Dycal (p=0.03). All materials showed acceptable clinical outcomes, but Theracal achieved perfect retention and absence of symptoms/radiographic pathology in all 18 evaluated teeth at 24 months, while Dycal failed in 4 of 18 cases (primarily due to pulp exposure or symptoms).

Study Design

This was a prospective, randomized clinical trial involving 60 young permanent molars with caries approaching the pulp in 55 systemically healthy children. Teeth were randomly assigned to three groups (n=20 per group): Biodentine, Theracal LC, or Dycal. After caries removal, the pulp-capping material was applied, covered with 2-3mm glass ionomer cement (GIC), and restored with composite. Clinical and radiographic evaluations occurred at 3 weeks, 3, 6, 12, 18, and 24 months. Analysis used chi-square tests (α=0.05), with 54 teeth completing the 24-month follow-up.

Dosage & Administration

No supplemental calcium dosage was administered. The calcium-containing materials were applied as direct pulp-capping liners: Biodentine (tricalcium silicate-based) and Theracal LC (resin-modified calcium hydroxide) were placed as a 1-2mm layer over affected dentin after caries removal. Dycal (calcium hydroxide) served as the control. All were sealed with GIC and composite restoration. Application followed manufacturer protocols without specified quantity measurements.

Results & Efficacy

Theracal achieved 100% success (18/18 teeth) at 24 months, significantly outperforming Dycal (77.78%; 14/18; p=0.03) and showing a non-significant trend over Biodentine (94.44%; 17/18; p>0.05). Biodentine also significantly outperformed Dycal (p<0.05). Success was defined as absence of pain, mobility, sinus tract, periapical radiolucency, and normal pulp vitality on testing. Dycal failures included 3 cases of pulp exposure during treatment and 1 case of irreversible pulpitis.

Limitations

The study had a relatively small sample size (n=60 initially, n=54 at 24 months), limiting statistical power for subgroup analyses. It was a single-center trial with no blinding of clinicians or patients, introducing potential performance and detection bias. The control material (Dycal) is less contemporary than the test materials. Long-term outcomes beyond 24 months remain unknown, and the study did not assess histological pulp responses. Demographic details (e.g., age range, gender distribution) were not provided.

Clinical Relevance

For dental practitioners, Theracal LC and Biodentine offer superior clinical alternatives to traditional Dycal for indirect pulp therapy in caries-affected young permanent molars, with Theracal showing the highest success rate. This supports using modern calcium-silicate or resin-calcium hydroxide materials to preserve pulp vitality and avoid premature tooth loss in pediatric patients. The findings do not relate to dietary calcium supplementation but inform material selection in restorative dentistry for deep caries management. Clinicians should prioritize complete caries removal while preserving pulp integrity, followed by appropriate biocompatible liner selection.