What do systematic reviews say?

Mineral trioxide aggregate (MTA) vs Biodentine

MTA and Biodentine have similar pulpotomy success (OR 0.89, not significant; low certainty).

• Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of… 2024 All outcomes

  >=12 months
  OR 0.89 [0.47, 1.69]
  6 studies · 348 participants
  Low

Mineral trioxide aggregate (MTA) vs TotalFill BC

MTA and TotalFill BC had comparable pulpotomy success (ungraded).

• Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of… 2024 All outcomes

  >=12 months
  OR 1.44 [0.65, 3.19]
  2 studies · 248 participants
  GRADE not reported

Platelet-rich fibrin (PRF) graft vs Calcium hydroxide (CH)

Platelet-rich fibrin and calcium hydroxide showed no significant difference in success (ungraded; effect size not reported).

• Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of… 2024 All outcomes

  >=12 months
  OR 1.67 [0.59, 4.72]
  2 studies · 70 participants
  GRADE not reported

Mineral trioxide aggregate (MTA) vs Calcium-enriched mixture (CEM)

MTA and calcium-enriched mixture had comparable pulpotomy success (ungraded).

• Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of… 2024 All outcomes

  >=12 months
  OR 0.78 [0.46, 1.34]
  4 studies · 611 participants
  GRADE not reported

Transbond XT with 1% chitosan and 1% TiO2 nanoparticles vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control

Chitosan and TiO2 adhesive showed no enamel mineral-content difference, with certainty not graded.

• Can Orthodontic Adhesive Systems Inhibit the Formation and Development of White Spot Lesions During Fixed Orthodontic… 2024 All outcomes

  1 day, 2 months, and 6 months after bonding · Fixed orthodontic treatment
  There were no significant differences in enamel mineral content between the experimental group and control group at all time points.
  1 study · 24 participants
  GRADE not reported

Mineral trioxide aggregate (MTA) vs Platelet-rich fibrin (PRF)

MTA and platelet-rich fibrin had comparable pulpotomy success (ungraded).

• Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of… 2024 All outcomes

  >=12 months
  OR 1.02 [0.43, 2.43]
  3 studies · 109 participants
  GRADE not reported

Tooth location

One study reported a 7.1% incidence in mandibular posterior teeth.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Kontakiotis et al. 2015 mandibular posterior
  Proportion 7.1
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Cheung et al. 2005 mandibular anterior
  Proportion 0
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Cheung et al. 2005 mandibular posterior
  Proportion 6.1
  1 study
  GRADE not reported

Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

The effect of MTA versus CH after pulpotomy is uncertain (low certainty).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  1 to 2 years · Success after full or partial pulpotomy · Full or partial pulpotomy
  OR 2.36 [0.47, 11.75]
  6 studies · 341 participants
  Low

Surgery plus radiotherapy vs Chemotherapy (chemoradiotherapy)

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  oral cavity
  Disease-free survival: not reported (Iyer 2015).
  0 studies
  No studies found

Surgery plus radiotherapy vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found

Platelet-rich fibrin (PRF) graft vs Mineral trioxide aggregate (MTA)

The two trials of PRF versus MTA for success gave contradictory results and were not pooled (ungraded).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  ≥6 months follow-up · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure
  PRF vs MTA was investigated in 2 RCTs (Alawwad 2020; Keswani 2014) for the primary outcome; the two trials provided contradictory evidence and differed in risk of bias, so were not pooled. Weak evidence.
  2 studies
  GRADE not reported

Surgery plus radiotherapy vs Radiotherapy alone

It is very uncertain whether surgery plus radiotherapy changes total mortality compared with radiotherapy alone (very low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.24 [0.10, 0.59]
  1 study · 35 participants
  Very low

Elective radical (comprehensive) neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Total mortality: 2 trials reported HR but could not be pooled (different surgical procedures); neither indicated a difference (BHNCSG 1998 HR 1.14, 0.70 to 1.86; Bier 1994 HR 0.87, 0.41 to 1.83); 252 participants (2…
  2 studies · 252 participants
  Very low

Pre-operative bone level < 35% vs Pre-operative bone level ≥ 35%

One study reported a 1.4% incidence with bone level < 35%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level < 35%
  Proportion 1.4
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level ≥ 35%
  Proportion 0
  1 study
  GRADE not reported

Eugenol-based temporary cement vs Eugenol-free temporary cement

The pooled incidence with eugenol-based temporary cement was 3.34%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-based
  Proportion 3.34 [1.66, 5.58]
  7043 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-free
  Proportion 5.77 [3.72, 8.24]
  639 participants
  GRADE not reported

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: Garrel 2020 reported that the number of patients with recurrences in both arms was almost identical; unable to use the data (variable follow-up); 279 participants (1 RCT).
  1 study · 279 participants
  Very low

Surgery plus radiotherapy vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Disease-free survival: not reported.
  0 studies
  No studies found

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

Sentinel node biopsy (neck dissection only if biopsy positive) showed no clear difference in locoregional recurrence compared with elective neck dissection (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 1.04 [0.91, 1.19]
  1 study · 279 participants
  Low

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: outcome not reported in a usable way (Mehanna 2017: nodal recurrence 3 vs 1; distant metastases 21 vs 23).
  1 study
  GRADE not reported

Supraomohyoid neck dissection vs Modified radical neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: reported but not usable (variable follow-up) (Guo 2014).
  1 study
  GRADE not reported