Review suggests direct pulp capping with MTA more effective than calcium hydroxide.

Data sourcesPubMed, the Cochrane Library, Embase, and the Web of Knowledge.Study selectionRandomised controlled trials (RCTs) or retrospective non-randomised trials (RNTs) of direct pulp capping in patients comparing mineral trioxide aggregate (MTA) with calcium hydroxide (CH) were considered.Data extraction and synthesisTwo reviewers independently abstracted data. Risk of bias for the RCTs was assessed using the Cochrane risk of bias tool and RNTs were assessed according to the methodological index for non-randomised studies. Different study designs were analysed separately.ResultsThirteen studies were included, ten of which were RCTs. Meta-analysis demonstrated a significantly higher success rate for MTA compared with the CH-capped groups. For RCT studies (2 studies, 405 teeth): OR = 2.26; (95% CI, 1.33-3.85; P = .003) and for RNTs (3 studies - 526 teeth): OR = 2.88; (95% CI, 1.86-4.44; P < .00001). Nine studies (325 teeth) compared the inflammatory response with MTA showing significantly less inflammation compared with CH samples (OR = 4.56; 95% CI, 2.65 7.83; P < .00001). Nine studies (325 teeth) compared dentine bridge formation with a higher percentage of calcified dentin bridge formation in the MTA than CH-capped groups (OR = 3.56; 95% CI, 1.89 6.70; P < .0001).ConclusionsMTA has a higher success rate and results in less pulpal inflammatory response and more predictable hard dentin bridge formation than CH. MTA appears to be a suitable replacement of CH used for direct pulp capping.