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Development of a Direct Pulp-capping Model for the Evaluation of Pulpal Wound Healing and Reparative Dentin Formation in Mice
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Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis.

Falk Schwendicke1, Fredrik Brouwer2, Anja Schwendicke2

  • 1Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. falk.schwendicke@charite.de.

Clinical Oral Investigations
|April 3, 2016
PubMed
Summary

Mineral Trioxide Aggregate (MTA) may reduce failure risk compared to calcium hydroxide (CH) for direct pulp capping in permanent teeth. However, current evidence is insufficient for definitive recommendations on dental capping materials.

Keywords:
DentalDirect cappingEndodonticsEvidence-based dentistryPulpVitality

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Area of Science:

  • Dental materials science
  • Restorative dentistry
  • Evidence-based dentistry

Background:

  • Direct pulp capping is a dental procedure to preserve pulp vitality.
  • Material selection is crucial for successful outcomes.
  • Systematic reviews are needed to evaluate the efficacy of various direct pulp capping agents.

Purpose of the Study:

  • To systematically assess randomized controlled trials (RCTs) comparing different direct pulp capping materials.
  • To evaluate the clinical and radiographic success rates of these materials.
  • To provide evidence-based recommendations for material selection in direct pulp capping.

Main Methods:

  • Systematic review and meta-analysis of RCTs.
  • Inclusion criteria: direct pulp capping materials, minimum 3-month follow-up.
  • Databases searched: Medline, Central, Embase; hand searches performed.
  • Risk of bias assessment, trial sequential analysis, and GRADE approach for strength of evidence.

Main Results:

  • 11 RCTs (1094 teeth) were included, all with high risk of bias.
  • Mineral Trioxide Aggregate (MTA) showed a significantly decreased risk of failure compared to calcium hydroxide (CH) in permanent teeth (RR 0.59 [0.39/0.90]).
  • No significant differences were found for primary teeth or other material comparisons. Trial sequential analysis indicated insufficient firm evidence.

Conclusions:

  • Insufficient data exists to definitively recommend or refute specific direct pulp capping materials.
  • Dentists may consider MTA over CH for direct capping in permanent teeth to potentially reduce failure risk.
  • Further long-term, practice-based studies with real-life exposures are necessary.