Mineral trioxide aggregate (MTA) has been put to a range of dental uses, direct pulp capping root-end filling, apexogenesis and apexification in immature teeth, filling root canals an treatment of root fractures. The aim of this review was to evaluate whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars.

Only the Medline database was searched and only human outcome studies included. Articles were assessed and graded by two authors.  The assessment scheme was a weighted criteria based system.

• 22 studies were included, 17 studies compared MTA with formocresol, 4 studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM), and one study compared white MTA with grey MTA.

The authors concluded

Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament

Comment

While this review used a detailed weighted criteria based assessment system to assess study quality,this type of approach is not recommended by the Cochrane Collaboration. The search strategy used for the review only included a single database and restricted the language to English. This means that some studies are likely to have missed.  The authors provide a detailed discussion of the included studies highlighting many inconsistencies and quality issues with the identified studies. They also noted  the three earlier ‘systematic reviews by  Simancas-Pallares et al 2012, Ng & Messer 2008, and Peng et al 2006. These reviews all suggest more positive outcomes using MTA. The earlier  2003 Cochrane review by Nadin et al  that looked at pulpotomy treatemtn in primary molars noted that:-

Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

Links

Anthonappa RP, King NM, Martens LC. Is there sufficient evidence to support the long-term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth? Int Endod J. 2012 Aug 29. doi: 10.1111/j.1365-2591.2012.02128.x. [Epub ahead of print] PubMed PMID: 23136828.

Simancas-Pallares MA, Díaz-Caballero AJ, Luna-Ricardo LM. Mineral trioxide aggregate in primary teeth pulpotomy. A systematic literature review. Med Oral Patol Oral Cir Bucal. 2010 Nov 1;15(6):e942-6. Review. PubMed PMID: 20526246.

Ng FK, Messer LB. Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment. Eur Arch Paediatr Dent. 2008 Jun;9(2):58-73. Review. PubMed PMID: 18534173.

Peng L, Ye L, Tan H, Zhou X. Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e40-4. Epub 2006 Sep 26. Review. PubMed PMID: 17138165.

Nadin G, Goel BR, Yeung A, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003220. DOI: 10.1002/14651858.CD003220.