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What do systematic reviews say?

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Evidence found and GRADE certainty

17 questions · 18 findings · 3 reviews · Dental caries

No studies found 1 · 5.6%GRADE not reported 6 · 33.3%Very low 4 · 22.2%Low 5 · 27.8%Moderate 2 · 11.1%High 0 · 0%

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

Dentin bridge formation · Patients with carious pulp exposure in permanent teeth undergoing partial pulpotomy

Evidence on dentin bridge formation for calcium hydroxide versus MTA is weak and imprecise, with no material shown superior (4 RCTs, not pooled; ungraded).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in immature permanent teeth

In immature teeth, the effect of MTA versus calcium hydroxide on success is very uncertain (OR 2.22, 95% CI 0.13-36.67; very low certainty).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth undergoing direct pulp capping

For direct pulp capping, MTA probably achieves higher clinical and radiographic success than calcium hydroxide (OR 3.10, 95% CI 1.66-5.79; moderate certainty).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth of mixed/unspecified root maturation

In mixed-maturation teeth, the effect of MTA versus calcium hydroxide on success is very uncertain (OR 1.11, 95% CI 0.17-7.11; very low certainty).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth undergoing pulpotomy

For pulpotomy, whether MTA improves success over calcium hydroxide is uncertain (OR 2.36, 95% CI 0.47-11.75; low certainty; CI includes no effect).

1 finding from 1 review

Calcium hydroxide (CH) vs Biodentine

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth undergoing DPC or pulpotomy

Biodentine appeared to perform better than calcium hydroxide for success, but the evidence was not pooled (2 RCTs; ungraded).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in mature permanent teeth

In mature teeth, MTA probably achieves higher clinical and radiographic success than calcium hydroxide (OR 3.34, 95% CI 1.81-6.17; moderate certainty).

1 finding from 1 review

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

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth undergoing DPC or pulpotomy

MTA achieved higher clinical and radiographic success than calcium hydroxide overall (OR 2.94, 95% CI 1.96-4.49; low certainty), but this unadjusted estimate pools clinically heterogeneous DPC and pulpotomy studies.

1 finding from 1 review

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

Continued root formation / root development · Patients with carious pulp exposure in permanent teeth (predominantly immature) undergoing DPC or pulpotomy

Evidence on continued root formation for calcium hydroxide versus MTA is weak and inconclusive (3 RCTs, not pooled; ungraded).

1 finding from 1 review

Partial pulpotomy (PP) with calcium hydroxide vs No comparator

Overall success (composite of clinical and radiographic success) · Adults aged 18 years or older with mature permanent teeth and carious pulp exposure

Partial pulpotomy with calcium hydroxide had a pooled success rate of 34.3%.

1 finding from 1 review

Partial pulpotomy (PP) with calcium hydroxide vs Direct pulp capping (DPC) with calcium hydroxide

Overall success (composite of clinical and radiographic success) · Adults (>=18 y) with mature permanent teeth, carious exposure and normal/reversibly inflamed pulp

At 1 year, partial pulpotomy and direct pulp capping (both calcium hydroxide) gave similarly low success in reversibly inflamed pulps (34.5% vs 31.8%; ungraded, single trial).

2 findings from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Restoration longevity · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

Cavity liners may make little or no difference to restoration longevity (high success across groups; low certainty).

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Treatment failure · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

The evidence is very uncertain about the effect of cavity liners on treatment failure; no significant difference between lined and unlined (or differently lined) restorations was found (very low certainty).

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Postoperative hypersensitivity (POH), patient-reported (VAS score) · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

The evidence is very uncertain whether cavity liners reduce postoperative hypersensitivity; no significant difference was found overall (very low certainty).

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Tooth survival · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

Cavity liners may make little or no difference to tooth survival (99.4% survival across groups; low certainty).

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Oral health-related quality of life · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

No included study reported oral health-related quality of life (a planned outcome), so no evidence is available.

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Secondary prevention of caries · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

Cavity liners may make little or no difference to secondary caries prevention (~100% prevention across groups; low certainty).

1 finding from 1 review