ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Mineral Trioxide Aggregate As Direct Pulp Capping Cement Is More Effective In Calcified Bridge Formation And Reduction Of Pulp Inflammation Than Dycal and Ca(OH)2
Clinical Question Is Mineral Trioxide Aggregate (MTA) material more effective in dentin bridge formation and reducing pulpal inflammation compared to other pulp capping agents in patients with pulp exposure?
Clinical Bottom Line Initial bridge-formation may be better with MTA with less pulpal inflammatory response.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17586038Roberts/2008Patients with endodontic treatmentNarrative Review
Key resultsBased on the electronic search of scientific papers, MTA material has a great potential as a pulp-capping agent in endodontic use due to its biocompatibility. However, because of lack of long-term follow-up studies, insufficient randomized, double-blind clinical studies involving MTA, further clinical studies are needed in these areas.
#2) 18833854Accorinte/2008Patients with pulp exposureComparative study
Key resultsAfter 30 days, only calcium hydroxide cement formed a hard dentin bridge (P>0.05). However, after 60 days, calcium hydroxide and MTA showed similar response. In terms of inflammation, MTA showed lower inflammation response by the pulp than calcium hydroxide.
#3) 22144801Eskandarizadeh/2011Patients with exposed pulp due to trauma or cariesRandomized clinical trial
Key resultsThe author reported a study that included 90 randomly intact maxillary and mandibular first and second premolars. The teeth were assigned into groups of 3, which included 30 each, and analyzed after 30, 60, and 90 days. Calcified dentin bridge in teeth formed using both types of MTA (GMTA and WMTA) were significantly thicker than Dycal at 30and 60 days (P=0.015 and P=0.002, respectively for the gray type) and at 90 days (P=0.02 for the white type). Also, significant inflammation reduction was noted using both WMTA and GMTA when compared to Dycal at day 90. Thus, both WMTA and GMTA are the material of choice for direct pulp capping procedure instead of Dycal.
Evidence Search (("mineral trioxide aggregate" [Supplementary Concept]) AND "Endodontics"[Mesh]) AND "Dental Pulp"[Mesh]
Comments on
The Evidence
Roberts’s article searched 156 citations from scientific, peer-review of dental literature. Authors reported that MTA has a potential to be used in endodontics. However, this report lacked randomized, double-blind clinical studies of long-term follow up to confirm its validity. No meta-analysis was done.Accorinte’s article compared response of tooth pulp when directly capped with MTA vs Ca(OH)2 powder. MTA is found to be better than Ca(OH)2 as a pulp capping agent in the long term use. Eskandarizadeh’s article compared tooth pulp response when capped with WMTA, GMTA, and Dycal to determine the best treatment choice to maintain the pulp after trauma or caries. This recent study strongly shows that MTA is a better pulp capping material of choice over Dycal for teeth exposed to caries or trauma.
Applicability Further clinical studies are still needed in this area. Iatrogenic pulp exposures have traditionally been treated with Dycal with guarded results. MTA may prove to be a better pulp-capping agent due to its biocompatibility nature and lower inflammatory response. More clinical research needs to be done to determine this.
Specialty/Discipline (Restorative Dentistry)
Keywords Mineral Trioxide Aggregate, Dycal, calcium hydroxide, direct pulp capping.
ID# 2232
Date of submission: 04/14/2012spacer
E-mail ELKWEIFI@livemail.uthscsa.edu
Author Sonia El-Kweifi
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Rita Renee Parma, DDS
Faculty mentor/Co-author e-mail PARMA@UTHSCSA.EDU
Basic Science Rationale
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