Recent approaches to managing deep carious lesions focus on preserving pulp vitality. The present study selected the single-step IPC technique [30]. In this approach, infected dentin was removed, leaving the affected dentin, which can undergo remineralization and allow the odontoblasts to generate reactionary dentin [16].
Mineral trioxide aggregate, the current gold standard for IPC in permanent teeth, was chosen for the control group [10]. However, owing to the previously mentioned drawbacks of MTA, more studies were needed to search for an ideal pulp capping agent. SDF was chosen as the intervention since it is nowadays used to arrest caries lesions in primary teeth. Nevertheless, according to the AAPD, 2023, more research is needed on using SDF to arrest carious lesions in permanent teeth [11]. Also, limited data was available in the literature regarding using SDF in IPC in permanent teeth.
In the current research, complete blinding of the operator was not feasible due to the apparent difference in the capping materials used. This problem was approached by semi-blinding the operator, i.e., not knowing the capping material until finishing the cavity preparation (the most crucial step in IPC). The treatment of both groups was standardized using objective outcomes as applicable and an independent radiographic outcome assessor [31].
The present study included 13 boys and 17 girls, and there was no statistically significant difference between both groups regarding gender. A systematic review stated that female children were 1.14 times more likely to have poor oral health than male children [32].
No single failure report was evident regarding both groups’ overall clinical success rate after 12 months of follow-up. For GROUP 1, this is comparable to the results of a similar study by Baraka et al. [17] who reported a 97.2% success rate for SDF in IPC after 12 months. For GROUP 2, this is similar to previous studies, which reported high success rates for MTA in IPC [33, 34]. The high success rate of SDF can be explained by its antibacterial action, remineralizing potential and desensitizing effect [13]. The high success rate of MTA can be linked to its good sealing ability and bioactivity [10]. Also, the IPC approach for deep caries management has a high success rate and is based on some other factors rather than the type of material used, among which is the good coronal seal and correct case selection [5].
Considering the spontaneous post-operative pain, this was assessed by a telephone call one week after the treatment to avoid repeated school absences. Two patients reported post-operative pain, one in each group, in the form of sensitivity. The guardians were then instructed to bring the children to the hospital if the pain recurred. However, the sensitivity subsided during later follow-up visits. This sensitivity may be attributed to the inherent acidity of glass ionomer, particularly the acid conditioning of the cavities, as explained by El-Bialy et al. [23].
Considering the pain on percussion, all cases in both groups showed no pain on percussion, which agrees with the results of previous studies [16, 35]. This was also evident regarding the absence of swelling, sinus or fistula in the current research, which is similar to the findings of Sinha et al. [16].
Regarding the response to the sensibility test, during the 12-month follow-up period, there was no statistically significant difference among each group or between both groups, which is close to the results of previous studies [17, 36]. Meanwhile, one patient in GROUP 1 failed to respond to the sensibility test since the baseline and during the 12-month follow-up. The patient reported clinical and radiographic success in all other examined parameters. This can be explained by the fact that some children could be less reliable in responding to the sensibility test, as mentioned in previous literature [37].
The radiographic success rate in the current study was 100% in both groups, which correlates with previous studies [16, 38]. Also, periodontal membrane space widening, bone resorption, and pulp stones were not evident in the current research findings, which agrees with the results of a previous study [38]. The calculated Cohen’s Kappa coefficient was 1, indicating perfect agreement between the radiographic assessors.
Regarding dentin bridge thickening, there was a statistically significant increase in dentin bridge thickness in both groups after the 12-month follow-up period with 0.30 (±0.13) mm and 0.20 (±0.15) mm increase, respectively. This was unlike the results reported by a previous study [29]. This disagreement may be attributed to the use of different IPC materials. However, the current study’s results of dentin bridge thickening came in accordance with the measurements of previous research [19].
For the intergroup comparison, there was no statistically significant difference between both groups regarding dentin bridge formation after 12 months. This can be attributed to the remineralizing potential of SDF and the bioactive potential of MTA, as explained in previous literature [10, 16]. This finding was compared to a recent study that reported no variations among the groups regarding the quality and quantity of tertiary dentin formation following IPC by SDF compared to glass ionomer cement (using CBCT) [38].
The comparison between the two groups revealed no statistically significant difference in the clinical and radiographic parameters assessed; therefore, the current study failed to reject the null hypothesis.
A limitation faced during the current study was the radiographic stent. Although it is recommended in the literature, the precise reproducibility of intraoral periapical radiographs using the stent represented a challenge due to the ongoing growth and dynamic nature of the teeth during the mixed dentition stage. Also, the sensibility test was less reliable in children, with some probability of having a false negative or false positive response. Additionally, the patients were followed up for one year only.
