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

Paula et al., 2018 | J Evid Based Dent Pract | Meta Analysis

Citation

Paula Anabela B, Laranjo Mafalda, ... Carrilho Eunice. 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

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.

Key Findings

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

Outcomes Measured

inflammatory markers

Population

Field	Value
Population	See abstract
Sample Size	22
Age Range	See abstract
Condition	See abstract

MeSH Terms

Dental Cements
Dental Pulp Capping
Humans
Root Canal Therapy

Evidence Classification

Level: Meta Analysis
Publication Types: Journal Article, Meta-Analysis, Systematic Review
Vertical: calcium

Provenance

PMID: 30514444
DOI: 10.1016/j.jebdp.2018.02.002
PMCID: Not in PMC
Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09