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

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

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

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

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

MTA and CEM performed comparably for clinical and radiographic success (2 RCTs, 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
  CEM vs MTA was investigated in 2 RCTs (Asgary 2017; Nosrat 2013) for the primary outcome; not pooled owing to heterogeneity. The per-trial forest plots (Figure 8) indicated MTA performed comparably to CEM. Weak evidence.
  2 studies
  GRADE not reported

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

Evidence on dentin bridge formation for calcium hydroxide versus MTA is weak and imprecise, with no material shown superior (4 RCTs, 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
  Four RCTs compared CH with MTA for dentin bridge formation (all used partial pulpotomy; all at low risk of bias except Qudeimat 2007). Apart from Wei 2010, trials yielded implausibly large ORs with very wide 95% CIs;…
  4 studies
  GRADE not reported

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

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).

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

  ≥6 months; follow-up range 1-2 years · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure · Root maturation: immature
  OR 2.22 [0.13, 36.67]
  2 studies · 106 participants
  Very low

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

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).

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

  ≥6 months; follow-up range 1-3 years · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure · Treatment performed: DPC
  OR 3.10 [1.66, 5.79]
  4 studies · 559 participants
  Moderate

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

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).

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

  ≥6 months; follow-up range 1-2 years · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure · Root maturation: mixed
  OR 1.11 [0.17, 7.11]
  3 studies · 257 participants
  Very low

Biodentine vs Mineral trioxide aggregate (MTA)

More tooth discoloration was observed with MTA than with Biodentine, but odds ratios were implausibly large and not pooled (3 RCTs; 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
  Tooth discoloration was recorded in 4 trials; the 3 Biodentine-vs-MTA trials consistently showed more discoloration with MTA (Awawdeh 2018: 27/35 MTA vs 0/34 BD; Parinyaprom 2018: 11/31 MTA vs 0/29 BD; Uesrichai 2019:…
  3 studies
  GRADE not reported

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

The effect of MTA versus CH in immature teeth is very uncertain (very 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 vital pulp therapy · Immature teeth
  OR 2.22 [0.13, 36.67]
  2 studies · 106 participants
  Very low

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

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).

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

  ≥6 months; follow-up range 1-2 years · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure · Treatment performed: pulpotomy (FP/PP)
  OR 2.36 [0.47, 11.75]
  6 studies · 341 participants
  Low

Calcium hydroxide (CH) vs Biodentine

Biodentine appeared to perform better than calcium hydroxide for success, but the evidence was not pooled (2 RCTs; 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
  CH vs Biodentine was investigated in 2 RCTs for the primary outcome; not pooled. Biodentine appeared to perform better than CH (and than Theracal) in the per-trial forest plots (Figure 8). Weak evidence.
  2 studies
  GRADE not reported

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

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).

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

  ≥6 months; follow-up range 1-3 years · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure · Root maturation: mature
  OR 3.34 [1.81, 6.17]
  5 studies · 537 participants
  Moderate

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

MTA increases clinical and radiographic success versus CH after direct pulp capping (moderate certainty).

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

  1 to 3 years · Success after direct pulp capping · Direct pulp capping
  OR 3.10 [1.66, 5.79]
  4 studies · 559 participants
  Moderate

Inhaled corticosteroids vs placebo

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 10316 participants
  Moderate

Inhaled corticosteroids vs placebo

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 2507 participants
  Moderate