Direct Pulp Capping: What is the Most Effective Therapy?-Systematic Review and Meta-Analysis

Anabela B Paula; Mafalda Laranjo; Carlos-Miguel Marto; Siri Paulo; Ana M Abrantes; João Casalta-Lopes; Manuel Marques-Ferreira; Maria Filomena Botelho; Eunice Carrilho

doi:10.1016/j.jebdp.2018.02.002

Direct Pulp Capping: What is the Most Effective Therapy?-Systematic Review and Meta-Analysis

J Evid Based Dent Pract. 2018 Dec;18(4):298-314. doi: 10.1016/j.jebdp.2018.02.002. Epub 2018 Feb 15.

Authors

Anabela B Paula¹, Mafalda Laranjo², Carlos-Miguel Marto³, Siri Paulo⁴, Ana M Abrantes², João Casalta-Lopes⁵, Manuel Marques-Ferreira⁶, Maria Filomena Botelho⁶, Eunice Carrilho⁶

Affiliations

¹ Dentistry 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. Electronic address: anabelabppaula@sapo.pt.
² 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.
³ Dentistry 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; Experimental Pathology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁴ Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal.
⁵ 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; Radiation Oncology Department, Coimbra University Hospital Center, Coimbra, Portugal.
⁶ Dentistry 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.

PMID: 30514444
DOI: 10.1016/j.jebdp.2018.02.002

Abstract

Introduction: Direct pulp capping therapies use biomaterials to protect exposed tissues, inducing repair through the production of a mineralized barrier. The purpose of this study was to compare the effectiveness of biomaterials and techniques by means of a systematic review and meta-analysis.

Methods: The PubMed, Cochrane, and Embase databases were used to search the literature published from January 1, 1980 until August 31, 2017. Studies that met inclusion criteria were screened by 2 authors individually. The meta-analysis was performed on mineral trioxide aggregate (MTA) cement vs calcium hydroxide cement, tricalcium silicate cement vs MTA cement, and adhesive systems vs CaOH cement and evaluated the success rate, inflammatory response, and dentin bridge formation.

Results: Forty-six studies were included in the systematic review, while 22 studies were included in the meta-analysis. There was no significant heterogeneity between the studies. MTA cements showed a significantly higher success rate, in all parameters, compared with calcium hydroxide cements (odds ratio = 2.72; 95% confidence interval [CI] = 1.90-3.90; P = 0.000). However, when compared with the tricalcium silicate cements, there were no statistically significant differences (odds ratio = 1.18; 95% CI = 0.53-2.65; P = 0.672). Adhesive systems showed a significantly lower success rate, in all parameters, compared with calcium hydroxide cements (odds ratio = 0.062; 95% CI = 0.024-0.157; P = 0.000).

Conclusions: MTA cements have a higher success rate, with a lower inflammatory response and a more predictable hard dentin barrier formation than calcium hydroxide cements. However, there were no differences, in these parameters, when MTA cement was compared with tricalcium silicate cements. Dental adhesives systems showed the lowest success rates.

Keywords: Biomaterials; Capping; Dentinogenesis; Pulp; Reparative.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Dental Cements*
Dental Pulp Capping*
Humans
Root Canal Therapy

Substances

Dental Cements