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Direct Pulp Capping: What is the Most Effective Therapy?-Systematic Review and Meta-Analysis
Anabela B Paula1, Mafalda Laranjo2, Carlos-Miguel Marto3
1Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal.
The Journal of Evidence-Based Dental Practice
|December 6, 2018
Summary
Mineral trioxide aggregate (MTA) cements demonstrate superior success rates for direct pulp capping compared to calcium hydroxide. Tricalcium silicate cements show similar outcomes to MTA, while dental adhesives yield the lowest success rates.
Area of Science:
- Dentistry
- Biomaterials Science
- Regenerative Medicine
Background:
- Direct pulp capping is a dental procedure to preserve pulp vitality.
- Biomaterials are used to protect exposed pulp tissue and stimulate a mineralized barrier for repair.
- Effectiveness of different biomaterials and techniques varies, necessitating comparative analysis.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of various biomaterials used in direct pulp capping.
- To compare the success rates, inflammatory responses, and dentin bridge formation of different capping agents.
Main Methods:
- A systematic literature search was conducted on PubMed, Cochrane, and Embase databases (1980-2017).
- Studies were screened for inclusion, and a meta-analysis compared mineral trioxide aggregate (MTA) vs. calcium hydroxide, tricalcium silicate vs. MTA, and adhesive systems vs. calcium hydroxide.
- Outcomes assessed included success rate, inflammatory response, and dentin bridge formation.
Main Results:
- Mineral trioxide aggregate (MTA) cements showed significantly higher success rates than calcium hydroxide cements (OR = 2.72).
- No significant differences were found between tricalcium silicate cements and MTA cements (OR = 1.18).
- Adhesive systems demonstrated significantly lower success rates compared to calcium hydroxide cements (OR = 0.062).
Conclusions:
- MTA cements offer superior outcomes in direct pulp capping compared to calcium hydroxide, evidenced by higher success rates, reduced inflammation, and predictable hard dentin barrier formation.
- Tricalcium silicate cements present comparable efficacy to MTA cements.
- Dental adhesive systems are associated with the lowest success rates for direct pulp capping.
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