Critical Appraisal. Comparative Performance of Mineral Trioxide Aggregate Versus Calcium Hydroxide as a Direct Pulp Capping Agent.

Vital pulp therapy is the general concept involved in the "regenerative" restorative treatment of the reversibly injured dental pulp with the intention of maintaining its vitality in a restored, functioning tooth. While this procedure has been attempted with various materials and techniques over a period of several centuries, the advent of hard-setting calcium hydroxide materials in the late 1950s made the procedure of direct pulp capping a more routine and relatively predictable procedure. More recently, in the mid 1990s, a new type of water-based, "hydraulic-type," calcium silicate-based cement, mineral trioxide aggregate (MTA), was introduced to dentistry as a possible alternative to the established standard of hard-setting calcium hydroxide. Over the last two decades, a slowly growing body of pre-clinical and human clinical studies evaluating and comparing these two materials has developed. Most recently, a number of well-designed, randomized controlled studies and resultant systematic reviews have been completed and published regarding the comparative efficacy of calcium hydroxide versus MTA for direct pulp capping. This Critical Appraisal considers and reviews some of the more recently published reports which provide a more definitive answer to this clinical research question.