Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis

Schwendicke, Falk; Brouwer, Fredrik; Schwendicke, Anja; Paris, Sebastian

doi:10.1007/s00784-016-1802-7

Cited by 92 publications

(88 citation statements)

References 56 publications

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“…, Schwendicke et al . 2016b), and only few included studies evaluated the long‐term clinical success of deep carious lesions treatment. Thus, long‐term RCT are needed to confirm whether the clinical success achieved with the two materials remains similar over time.…”

Section: Discussionmentioning

confidence: 99%

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

et al. 2018

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The aim of this systematic review and meta‐analysis was to evaluate whether the use of calcium hydroxide (CH) liner improves the clinical success in the treatment of deep caries lesions of primary and permanent teeth. The review was reported in accordance with the PRISMA Statement. Only studies that evaluated deep carious lesions treated with and without a CH liner were included. The required outcomes had to be obtained by clinical, radiographic or laboratory evaluations. Statistical analyses were performed with the RevMan 5.2 program (The Cochrane Collaboration, Copenhagen, Denmark) for randomized clinical trials with at least 12 months of follow‐up, using fixed‐effect models at a significance level of P < 0.05. The literature search was performed in eight databases: PubMed (MEDLINE), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO and The Cochrane Library. A total of 17 studies were included (15 in primary teeth, two in permanent teeth). The overall risk difference for CH versus adhesive system in primary teeth was 0.06 [95% CI −0.01 to 0.13], and the overall risk difference for CH versus GIC was 0.10 [95% CI −0.01 to 0.22], with no significant differences between materials. CH liner did not influence the clinical success of treatment for deep caries lesions of primary or permanent teeth. Although the present analysis demonstrated that use of CH liner in deep caries lesions was unnecessary, the evidence was of moderate to very low quality; thus, further well‐designed, randomized and controlled clinical trials are necessary to provide stronger recommendations.

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Section: Discussionmentioning

confidence: 99%

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

et al. 2018

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“…At present, no high level, scientific‐based recommendation can be made for selecting a ‘gold standard’ capping material (Schwendicke et al . ).…”

Section: Reviewmentioning

confidence: 97%

Management of deep caries and the exposed pulp

et al. 2019

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Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future.

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“…Consequently, the quest to find an ideal pulp capping agent has led to other biomaterials being suggested in the literature, such as mineral trioxide aggregate (MTA), dental bonding agents, formocresol, ferric sulfate, and materials derived from MTA, such as calcium silicate, calcium phosphate and calcium aluminate-based cements. [5][6][7][8][9] An ideal pulp capping material should adhere to tooth substrate; maintain a sufficient seal, be insoluble in tissue fluids; dimensionally stable, non-resorbable, nontoxic, noncarcinogenic, nongenotoxic, radiopaque, and exhibit biocompatibility and bioactivity. 6,10,11 Unfortunately, none of the biomaterials currently available have been able to satisfy all the requirements of an ideal VPT.…”

Section: Introductionmentioning

confidence: 99%

Current trends and future perspectives of dental pulp capping materials: A systematic review

et al. 2017

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To systematically review the literature to analyze the current trends and future perspectives of dental pulp capping materials through an analysis of scientific and technological data. This study is reported in accordance with the PRISMA Statement. Nine databases were screened: PubMed (MedLine), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO, Google Scholar, and The Cochrane Library. Additionally, the following patent applications were searched online in Questel Orbit (Paris, France), USPTO, EPO, JPO, INPI, and Patentscope databases. A total of 716 papers and 83 patents were included. Calcium hydroxide was the main type of material studied, especially for direct pulp capping, followed by MTA. Patents related to adhesives or resins increased from 1998 e 2008, while in the last years, a major increase was observed in bioactive materials (containing bioactive proteins), materials derived from MTA (calcium silicate, calcium phosphate and calcium aluminate-based cements) and MTA. It was possible to obtain a scientific and technological overview of pulp capping materials. MTA has shown favorable results in vital pulp therapy that seem to surpass the disadvantages of calcium hydroxide. Recent advances in bioactive materials and those derived from MTA have shown promising results that could improve biomaterials used in vital pulp treatments. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1358-1368, 2018.

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Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis

Abstract: To reduce risk of failure, dentists might consider using MTA instead of calcium hydroxide (CH) for direct capping. Current evidence is insufficient for definitive recommendations.

Cited by 92 publications

References 56 publications

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

Management of deep caries and the exposed pulp

Current trends and future perspectives of dental pulp capping materials: A systematic review

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