Clinical, radiographic and cone-beam computed tomography assessment of the efficacy of dentin coagulum: An innovative autologous pulp capping strategy

Objectives: (i) To compare and assess, using radiography and cone-beam computed tomography (CBCT), the dentin bridge formation achieved by autologous demineralized dentin coagulum (ADDC) versus calcium hydroxide in vital pulp therapy. (ii) To compare the ability of both materials in maintaining pulpal vitality over a 12-month period. Methods: A total of 74 patients (aged 18–30 years) with two or more deep carious lesions approximating the pulp in vital molars, and without periradicular pathology, were enrolled. Following clinical and radiographic evaluation, teeth were randomly assigned to: Group A: Calcium hydroxide (control) Group B: Autologous demineralized dentin matrix (test). For Group B, autologous dentin obtained from an indicated extraction or undermined tooth was processed using a dentin grinder, demineralized, and applied over the pulp exposure site before restoration. Patients were reviewed every three months for one year, with vitality testing and radiographic evaluation of dentin bridge formation. Dentin bridge thickness was quantified radiographically and by CBCT at 12 months. Data were analyzed using the Friedman test (p < 0.001 considered significant). Results: Dentin Bridge Formation: Group A: Mean dentin bridge score decreased from 4.00 (baseline) to 3.23 at 12 months (χ 2 = 81.8, p < 0.001) Group B: Mean dentin bridge score decreased from 4.00 (baseline) to 1.82 at 12 months (χ 2 = 221.0, p < 0.001). Dentin Thickness Group A: Mean thickness decreased from 4.00 to 3.08 at 12 months (χ 2 = 92.4, p < 0.001) Group B: Mean thickness decreased from 4.00 to 1.69 at 12 months (χ 2 = 228.9, p < 0.001). Pulp Vitality Group A: 8.1% non-vital teeth Group B: 4.1% non-vital teeth Conclusions: Autologous demineralized dentin coagulum demonstrated superior clinical performance compared with calcium hydroxide, resulting in thicker and more continuous dentin bridge formation and higher rates of pulp vitality preservation. Given its rich content of bioactive molecules, stem cells, and growth factors, ADDC represents a promising biomimetic approach for regenerative vital pulp therapy.