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What do systematic reviews say?

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Evidence found and GRADE certainty

175 questions · 246 findings · 11 reviews · Endodontics and dental trauma

No studies found 7 · 2.8%GRADE not reported 216 · 87.8%Very low 8 · 3.3%Low 9 · 3.7%Moderate 5 · 2%High 1 · 0.4%

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

Periapical pathosis incidence · Vital teeth

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

2 findings from 1 review

Eugenol-based temporary cement vs Eugenol-free temporary cement

Pulp necrosis · Vital teeth

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

2 findings from 1 review

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

Biodentine vs Mineral trioxide aggregate (MTA)

Tooth discoloration · Patients with carious pulp exposure in permanent teeth undergoing DPC or pulpotomy

More tooth discoloration was observed with MTA than with Biodentine, but odds ratios were implausibly large and not pooled (3 RCTs; ungraded).

1 finding from 1 review

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

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

The effect of MTA versus CH in immature teeth is very uncertain (very low certainty).

1 finding from 1 review

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

Periapical pathosis · Vital teeth restored with indirect restorations

Periapical pathosis incidence among follow-up >5-10 years was 3.88% (subgroup analysis; not GRADE-rated).

6 findings from 1 review
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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

Polyether impression material vs Polyvinyl siloxane impression material

Pulp necrosis · Vital teeth

The pooled incidence with polyether impression material was 4.02%.

2 findings 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

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

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

MTA increases clinical and radiographic success versus CH after direct pulp capping (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

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

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

The effect of MTA versus CH in teeth with mixed root development is very uncertain (very low certainty).

1 finding from 1 review