International Endodontic Jttumat(\9&5) 18,274-276
Evaluation of a tactile hardness test in indirect pulp capping
TAYFUN ALA (^ AM Department ofEndodontics, University af Ankara, Ankara, Turkey
Summary. The value of a tactile hardness test in
indirect pulp capping was investigated by compar-
ing hardness values with the biochemical analysis
for phosphorus. Statistically significant differences
were found between the 6-month evaluation
groups recorded as soft or medium and those
recorded as hard. However, there were no differ-
ences between groups evaluated as soft or medium
before or after treatment.
Introduction
A desirable result of indirect pulp capping is
the remineralization of softened residual den-
tine. In indirect pulp capping, a biological
barrier is formed which resists recurrent
caries and protects the pulp from external
irritation (Kato & Fusayama 1970, Sanjo
1971, Aras 1977, Aiafam & Yihnaz 1983).
The rate of success has been evaluated chni-
cally by radiographs, densitometric studies,
colour determination tests, symptoms of
pain, tactile hardness tests and biochemi-
cal methods (Sowden 1956, Klein 1961,
Eidehnan et al. 1965, Kerkhove et at. 1967,
Ehrenreich 1968, Nordstrom et al. 1974, Aras
1977, Alafam & Yilmaz 1983). Evaluation of
the hardness of carious dentine has been used
as the scale of success in some clinical trials
(Nordstrom et al. 1974, Aras 1977). Assessing
the hardness of carious dentine by a tactile
hardness test with dental instruments is open
to question. This method is regarded as being
subjective and may change according to the
clinician. Terashima et al. (1969) stated that
this method is an unreliable guide for the
removal of carious dentine.
This study was undertaken to find out if
there was any relationship between a tactile
hardness test and the results of biochemical
analysis using a technique described by
Eidelman«a/.(1965).
Materials and methods
Carious dentine in 49 mandibular first
Correspondence: Dr T. Alafam, Neyzen Tevfik
sok, 36/4, Maltepe-Ankara, Turkey.
274
permanent molars from 44 healthy patients
whose ages ranged from 17 to 33 years was
tested and re-evaluated after a period of 6
months. The teeth selected had deep carious
lesions with pulps that were clinically
healthy.
Cavities were isolated from saliva using
rubber dam. Deep carious dentine was re-
moved with sharp spoon excavators, leaving
approximately 1 mm of carious dentine on the
pulpal watt. The cavity was then washed with
physiological saline solution and dried with
cotton pellets. The carious dentine remaining
on the pulpat wall was evaluated for hardness
using a probe, and was scored as hard,
medium or soft according to criteria which
were used by Nordstrom et ai. (1974). The
rating was:
soft—dentine had the texture of soft
wood;
medium—dentine had the texture of
hard wood;
hard—the texture of dentine was
normal.
A sample of part of the carious dentine
close to the pulp was then removed and
placed in a microtutje for measurement of
its inorganic phosphorus (P) content hy
biochemical analysis.
A pulp capping agent based on zinc oxide-
eugenol cement was applied to the putpat wall
and the tooth restored with amalgam.
After 6 months, the teeth were reopened
and the same procedure of measuring dentine
hardness was repeated on the remaining half
of carious dentine, which was then removed
for biochemical analysis.
Phosphorus levels were determined using
the same method as that described by
Eidelman et al. (1965). All samples of carious
dentine were dehydrated for 8 hours in an
oven at 105°C. Samples were weighed, and
5 ml of 0 . 1 M perchloric acid were added.
After 6 hours the dissolved mineral phase was
measured spectrophotometricaUy (Fiske &
 Evaluation of a tactile hardness test 275
Table I. The phosphorus content {mg/100 ml) of and soft groups was not significant. However,
samples determined as medium of soft before the difference between the hard and either of
treatment the other groups was significant (P<0.05,
analysis of variance and Duncan's test).
Hardness No. Mean Sundard deviation There was an increase in phosphorus levels
of samples after 6 months' treatment (Table
Medium 23 3.65 III), and this difference was significant
0.35
Soft 26 3.79 0.32 (P < 0.01, paired Mest).

Discussion
Rehardening of residual carious tissue in
indirect pulp capping increases the potential
Table II. The phosphorus content (mg/100 ml) of safety of treatment. The tactile hardnras test
samples 6 months after treatment for evaluating hardness would be of value if it
could be supported with quantitative restilts.
Hardness No. Mean Standard deviation Therefore, in evaluating carious dentine, the
method described by Eidelman et al. (196S)
was used. These workers determined the
Hard 11 5.69 0.30 inorganic phosphorus content in the softened
Medium 28 4.63 0.24 residual dentine before and after the appli-
Soft 10 4.57 0.35
cation of calcium hydroxide, and showed that
the phosphorus content of carious dentine
could be increased considerably.
When the subjective evaluations ofthe tac-
tile hardness test in this study were compared
Table III. The phosphorus content (mg/100 ml) with phosphorus analysis, no statistically
of samples before treatment and after 6 months
significant differences were found tmless
there was wide diversity in hardness. The
No. Mean Standard deviation number of teeth used in this study was small,
and a much larger sample size wotild help
Initial 49 3.72 0.23 demonstrate more conclusively the relation-
After 6 months 49 4.86 0.18 ship between the tactile hardness test and
Difference l.!3 0.28 biochemical analysis.
In evaluating residual carious tissue by the
tactile hardness test with dental instruments,
important variables affecting the results are
Subbarow 1925); the amount of phosphorus the clinician, the number of subjects included
(mg/100 ml) was determined by optieal den- in the study and the thickness of remaining
sity levels and phosphorus calibration curves. softened dentine. Unique analysis of these
The relationship between hardness evalu- samples by means of phosphorus determi-
ations and phosphorus determinations was nations is another questionable aspect of this
examined statisricaliy using Student's f-test, study. Qualitative and quantitative analysis
paired r-test, analysis of variance and of the softened residual dentine can help in
Duncan's test. deciding whether or not to excavate this
tissue after a certain period. From this
Results standpoint, knowledge about this tissue will
The results are presented in Tables I-^III. give a more scientific basis about the future of
The difference in phosphorus content be- indirect pulp capping.
tween the two initial groups evaluated as
medium or soft was nor significant. References
At the 6-month evaluation, the difference AuCAM, T. & YiLMAZ, T. (1983) In vivo
in phosphorus cdhtent between the medium remineralization of carious dentine treated with
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