Investigating the impact of the final restoration status on the success of direct pulp capping using BioCeramics: a Pilot Study

This study aimed to evaluate the effect of the final restoration quality on the clinical and radiographic success of direct pulp capping (DPC) using a premixed bioceramic material, TotalFill BC-RRM Paste, in mature permanent teeth with deep carious lesions. A single-arm clinical pilot study was conducted on 40 mature premolars with deep or extremely deep carious lesions in 38 healthy patients aged 18–30 years. Teeth diagnosed with reversible pulpitis and meeting strict clinical and radiographic inclusion criteria were selected. After caries removal and pulp exposure, direct pulp capping was performed using BC-RRM Paste. The cavities were restored immediately following the AAE-recommended protocol using adhesive composite restorations. Clinical and radiographic evaluations were performed at 6 and 12 months, and the final restoration quality was assessed based on FDI criteria. The correlation between restoration quality and DPC outcomes was statistically analyzed. The clinical success rate was 92.5% at 6 months and 82.5% at 12 months. A significant correlation was observed between the quality of the final restoration and the overall treatment outcome. Teeth restored with acceptable-quality restorations showed higher clinical and radiographic success rates compared to those with unacceptable restorations at both follow-up intervals. The quality of the final restoration plays a decisive role in the long-term success of direct pulp capping, even when using advanced bioceramic materials such as TotalFill BC-RRM Paste. Proper restoration protocols and optimal sealing are essential to prevent microleakage and ensure favorable clinical outcomes.