Direct pulp capping (DPC) where medicaments are placed over the exposed dental pulp to maintain vitality have reported success rates of between 13-95%. Both Calcium hydroxide (CH) and mineral trioxide aggregate (MTA) have been used for permanent teeth. The aim of this review was to compare the effectiveness of MTA and CH on direct pulp capping in humans in terms of success rate, inflammatory response, and dentin bridge formation.

Methods

Searches were conducted in PubMed, the Cochrane Library, Embase, and the Web of Knowledge. Randomised controlled trials (RCTs) or retrospective non-randomised trials (RNTs) carried out DPC in human permanent teeth the compared MTA and CH were considered. Two reviewers independently extracted data from the included studies with study quality being assessed. The Cochrane risk of bias tool was used for RCTs.

Results

• 13 studies (10 RCTs and 3 RNTs) were included
• The MTA treatment groups showed a significantly higher success rate compared with the CH-capped groups
  • RCT (2 studies – 405 teeth): OR = 2.26; (95% CI, 1.33–3.85; P = .003)
  • RNT (3 studies – 526 teeth): OR = 2.88; (95% CI, 1.86–4.44; P < .00001)
• 9 studies (325 teeth) compared the inflammatory response with MTA showing a significantly less inflammation compared with CH samples (OR = 4.56; 95% CI, 2.65–7.83; P < .00001)
• 9 studies (325 teeth) compared dentine bridge formation with a higher percentage of calcified dentin bridge formation in the MTA than CH-capped groups (OR = 3.56; 95% CI, 1.89–6.70; P < .0001)

Conclusions

The authors concluded:

MTA has a higher success rate and results in less pulpal inflammatory response and more predictable hard dentin bridge formation than CH. MTA appears to be a suitable replacement of CH used for direct pulp capping which looked more broadly att pulp management in permanent teeth

Comments

This review included 13 studies the majority of which have been published since the 2007 Cochrane review by Miyashita et al. The 2007 review only included 4 trials none of which examined MTA. So this new review is helpful. However, as the authors note the included studies are generally small and suffer with methodological problems so the results of the meta-analysis should be treated with caution as larger higher quality RCTs may have an important impact of direction of the findings.

Links

Li Z, Cao L, Fan M, Xu Q. Direct Pulp Capping with Calcium Hydroxide or Mineral Trioxide Aggregate: A Meta-analysis. J Endod. 2015 May 16. pii: S0099-2399(15)00381-7. doi: 10.1016/j.joen.2015.04.012. [Epub ahead of print] Review. PubMed PMID: 25990198.

Dental Elf -12^th Nov 2014 – Direct pulp capping: trial finds good short-term outcome success rate for new material in permanent teeth

Dental Elf -22^nd May 2013 – Practice-based trial find better outcomes with MTA for direct pulp-capping in permanent teeth

Miyashita H, Worthington HV, Qualtrough A, Plasschaert A. Pulp management for caries in adults: maintaining pulp vitality. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004484. DOI: 10.1002/14651858.CD004484.pub2.