Direct Pulp Capping with Flowable Mineral Trioxide Aggregate and Composite Resin: A Case Series Report

<p> Purpose: Preservation of pulpal vitality is important in the treatment of deep caries. Mineral trioxide aggregate (MTA) has been applied to vital pulp therapy as a pulp capping material with good sealing properties, antibacterial properties, biocompatibility, and ability to induce the formation of calcified tissue. The most common direct pulp capping procedure with MTA is to place a temporary restoration after the initial curing of the paste-type MTA in the first visit. However, this procedure needs to place the final restoration in the second visit. Furthermore, this procedure has problems such as difficulty of paste-type MTA placement, microleakage from temporary material, and invasion in the second visit. This report describes a direct capping procedure using flowable MTA and composite resin without second treatment.</p><p> Case 1: A 34-year-old male patient was found with deep caries in the left maxillary first molar that was diagnosed with reversible pulpitis. Visible pulp exposure was observed after complete caries removal. The exposed pulp surface was protected from bonding and a composite resin wall was made around the exposed pulp surface. After chemical treatment, the exposed pulp surface was filled with flowable MTA. The composite resin wall was filled by composite resin after silane treatment. After three months, the pulp responded normally and permanent restoration was performed with inlay.</p><p> Case 2: A 22-year-old male patient was found with deep caries in the left maxillary first molar that was diagnosed with reversible pulpitis. Approximately 1 mm pulp exposure was observed. Direct pulp capping was performed applying the same procedure as in case 1. Permanent restoration with composite resin was performed on the same day.</p><p> Case 3: A 28-year-old female patient was found with deep caries in the right mandibular second molar that was diagnosed with reversible pulpitis. Approximately 1 mm pulp exposure and subgingival perforation were observed. Direct pulp capping and repair of perforation were performed applying flowable MTA. Permanent restoration with composite resin was performed on the same day.</p><p> Conclusion: A successful prognosis was obtained in three cases, by applying a direct capping procedure using flowable MTA and composite resin. Flowable MTA improves the complexity of the direct capping procedure using original paste-type MTA, and the well-sealed restoration with composite resin will prevent microleakage and eliminate re-entry treatment. It may improve the success rate of direct pulp capping. However, further clinical research is needed to verify the clinical effectiveness of direct pulp capping using this procedure.</p>