{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:16:11Z","timestamp":1779916571214,"version":"3.53.1"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Indirect pulp treatment (IPT) is a conservative approach aimed at preserving pulp vitality in teeth with deep carious lesions. In adult patients, however, evidence comparing different liner materials remains limited. Objectives: To assess the 12-month clinical and radiographic outcomes of IPT performed with Biodentine and resin-modified glass ionomer cement (RMGIC) in mature permanent teeth. Methods: A split-mouth clinical study was conducted in adult patients presenting with deep carious lesions in vital permanent teeth. Following selective caries removal, IPT was completed using Biodentine or RMGIC under a standardized operative protocol. Clinical and radiographic evaluations were performed at baseline and after 12 months. Outcomes included pulp vitality, postoperative pain, and radiographic changes. Results: At 12 months, pulp vitality was preserved in over 90% of treated teeth in both groups, with no statistically significant differences between materials. Teeth treated with Biodentine showed lower postoperative pain scores at 24 h compared with those treated with RMGIC, although this difference resolved within the first postoperative week. Radiographic outcomes were comparable between groups, with a low incidence of periapical changes. Conclusions: Within the limits of this interim analysis, IPT performed with either Biodentine or RMGIC resulted in similar clinical and radiographic outcomes in mature permanent teeth. These findings indicate that pulp vitality preservation can be achieved using different liner materials when minimally invasive principles and effective coronal sealing are applied. Extended follow-up is required to evaluate long-term durability.<\/jats:p>","DOI":"10.3390\/dj14040200","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:08:34Z","timestamp":1775030914000},"page":"200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Indirect Pulp Treatment for Deep Carious Lesions in Mature Permanent Teeth: A Preventive, Minimally Invasive Clinical Approach"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-1894","authenticated-orcid":false,"given":"Liana","family":"Beresescu","sequence":"first","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1665-3239","authenticated-orcid":false,"given":"Alexandra Mihaela","family":"Stoica","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csinszka Andrea","family":"Kovacs-Ivacson","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-3870","authenticated-orcid":false,"given":"Timea","family":"Dak\u00f3","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3883-0547","authenticated-orcid":false,"given":"Alexandru","family":"Vlasa","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csilla","family":"Benedek","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1019-864X","authenticated-orcid":false,"given":"Gabriela Felicia","family":"Beresescu","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7147-5623","authenticated-orcid":false,"given":"Andrea","family":"Bors","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Medicine and Pharmacy, Science, and Technology George Emil Palade, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022). Global Oral Health Status Report, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/iej.13080","article-title":"European Society of Endodontology position statement: Management of deep caries and the exposed pulp","volume":"52","author":"Duncan","year":"2019","journal-title":"Int. Endod. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.adaj.2018.09.023","article-title":"Oral health, academic performance, and school absenteeism in children and adolescents: A systematic review and meta-analysis","volume":"150","author":"Ruff","year":"2019","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"615","DOI":"10.2341\/09-132-0","article-title":"Keys to clinical success with pulp capping: A review of the literature","volume":"34","author":"Hilton","year":"2009","journal-title":"Oper. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2147\/CCIDE.S141381","article-title":"Calcium hydroxide liners: A literature review","volume":"9","author":"Arandi","year":"2017","journal-title":"Clin. Cosmet. Investig. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1177\/0022034515602879","article-title":"Global economic impact of dental diseases","volume":"94","author":"Listl","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1365-2591.2012.02101.x","article-title":"Tertiary dentinogenesis with calcium hydroxide: A review of proposed mechanisms","volume":"46","author":"Sangwan","year":"2013","journal-title":"Int. Endod. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/j.joen.2015.03.014","article-title":"Color Stability of Teeth Restored with Biodentine: A 6-month In Vitro Study","volume":"41","author":"Roig","year":"2015","journal-title":"J. Endod."},{"key":"ref_9","first-page":"e39374","article-title":"Evaluation of Direct and Indirect Pulp Capping with Biodentine in Vital Permanent Teeth with Deep Caries Lesions","volume":"15","author":"Drouri","year":"2023","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"158","DOI":"10.17796\/1053-4625-45.3.3","article-title":"Comparative Evaluation of Indirect Pulp Therapy in Young Permanent Teeth using Biodentine and Theracal: A Randomized Clinical Trial","volume":"45","author":"Rahman","year":"2021","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s40368-014-0114-3","article-title":"Biodentine\u2122 material characteristics and clinical applications: A review of the literature","volume":"15","author":"Rajasekharan","year":"2014","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00784-012-0701-9","article-title":"Clinical evaluation of the performance and safety of a new dentine substitute, Biodentine, in the restoration of posterior teeth\u2014A prospective study","volume":"17","author":"Koubi","year":"2013","journal-title":"Clin. Oral Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/0022034516639271","article-title":"Managing carious lesions: Consensus recommendations on carious tissue removal","volume":"28","author":"Schwendicke","year":"2016","journal-title":"Adv. Dent. Res."},{"key":"ref_14","unstructured":"American Association of Endodontists (2025, September 12). Endodontic Diagnosis. Available online: https:\/\/www.aae.org\/specialty\/clinical-resources\/endodontic-diagnosis\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1177\/0022034515571415","article-title":"Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: A randomized controlled clinical trial","volume":"94","author":"Hashem","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_16","first-page":"137","article-title":"Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses","volume":"47","author":"Coll","year":"2025","journal-title":"Pediatr. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"795","DOI":"10.5005\/jp-journals-10005-2073","article-title":"Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review","volume":"14","author":"Saber","year":"2021","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/JISPPD.JISPPD_213_17","article-title":"Comparative evaluation of biodentine, 2% chlorhexidine with RMGIC and calcium hydroxide as indirect pulp capping materials in primary molars: An in vivo study","volume":"37","author":"Boddeda","year":"2019","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1111\/iej.13709","article-title":"Present status and future directions: Hydraulic materials for endodontic use","volume":"55","author":"Camilleri","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_20","first-page":"43","article-title":"Calcium silicate and calcium hydroxide materials for pulp capping: Biointeractivity, porosity, solubility and bioactivity of current formulations","volume":"13","author":"Gandolfi","year":"2015","journal-title":"J. Appl. Biomater. Funct. Mater."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/iej.13128","article-title":"Management of deep caries and the exposed pulp","volume":"52","author":"Simon","year":"2019","journal-title":"Int. Endod. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1111\/j.1365-2591.2011.01924.x","article-title":"Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine","volume":"44","author":"Han","year":"2011","journal-title":"Int. Endod. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.joen.2013.01.005","article-title":"Response of human dental pulp capped with Biodentine and MTA","volume":"39","author":"Nowicka","year":"2013","journal-title":"J. Endod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1177\/0022034512460833","article-title":"Effect of a calcium-silicate-based restorative cement on pulp repair","volume":"91","author":"Tran","year":"2012","journal-title":"J. Dent. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.5005\/jp-journals-10005-2953","article-title":"Comparison of Modified NeoPutty MTA\u00ae, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An In Vivo Clinical Study","volume":"17","author":"Acharya","year":"2024","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.joen.2014.09.012","article-title":"In vitro cytotoxicity of calcium silicate-containing endodontic sealers","volume":"41","author":"Zhou","year":"2015","journal-title":"J. Endod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"205","DOI":"10.4103\/JCDE.JCDE_257_23","article-title":"Outcome of novel pulp capping modalities after full pulpotomy in teeth diagnosed with irreversible pulpitis: A prospective randomized clinical trial","volume":"27","author":"Mishra","year":"2024","journal-title":"J. Conserv. Dent. Endod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e38015","DOI":"10.1097\/MD.0000000000038015","article-title":"Clinical influencing factors of vital pulp therapy on pulpitis permanent teeth with 2 calcium silicate-based materials: A randomized clinical trial","volume":"103","author":"Zhang","year":"2024","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/0022034513477425","article-title":"Incomplete caries removal: A systematic review and meta-analysis","volume":"92","author":"Schwendicke","year":"2013","journal-title":"J. Dent. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17321","DOI":"10.1038\/s41598-024-69367-7","article-title":"Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth: A systematic review and network meta-analysis","volume":"14","author":"Komora","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1177\/0022034514544217","article-title":"Longevity of posterior composite restorations: A systematic review and meta-analysis","volume":"93","author":"Opdam","year":"2014","journal-title":"J. Dent. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1111\/j.1365-2591.2012.02053.x","article-title":"Tooth discoloration induced by endodontic materials: A laboratory study","volume":"45","author":"Lenherr","year":"2012","journal-title":"Int. Endod. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s00784-017-2296-7","article-title":"Factors affecting the outcomes of direct pulp capping using Biodentine\u00ae","volume":"22","author":"Lipski","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1016\/j.joen.2014.07.028","article-title":"Direct pulp capping after a carious exposure versus root canal treatment: A cost-effectiveness analysis","volume":"40","author":"Schwendicke","year":"2014","journal-title":"J. Endod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e083","DOI":"10.1590\/1807-3107bor-2023.vol37.0083","article-title":"Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions","volume":"37","author":"Jardim","year":"2023","journal-title":"Braz. Oral Res."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/4\/200\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:36:47Z","timestamp":1775032607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/4\/200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["dj14040200"],"URL":"https:\/\/doi.org\/10.3390\/dj14040200","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}