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Title The Effectiveness Of MTA vs Calcium Hydroxide As Direct Or Indirect Pulp Capping Agents
Clinical Question In a patient who needs direct or indirect pulp capping, does using MTA induce reparative dentin formation more effectively than using calcium hydroxide?
Clinical Bottom Line Using MTA results in either a significantly thicker calcified bridge or a higher successful rates than using calcium hydroxide during the early stage (within 3 months) of direct or indirect pulp capping.
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) 22251035Bonoist/201260 teeth from patients aged 16-34 years. Randomized Clinical Trial
Key resultsAt 3 months, the clinical success rates of MTA and calcium hydroxide were 93% and 73%, respectively (P = 0.02). At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by 0.136 mm with calcium hydroxide at 3 months. At 6 months, there was an increase of 0.235 mm with MTA and of 0.221 mm with calcium hydroxide.
#2) 22144801Eskandarizadeh/201190 sound intact premolars from 40 patients aged 14-21 yearsRandomized Clinical Trial
Key resultsThe calcified bridge in teeth that were capped with GMTA was significantly thicker than Dycal at 30 and 60 days (P= 0.015 and P=0.002, respectively); whereas WMTA showed significantly thicker calcified bridge than Dycal at 90 days (P=0.02). In addition, GMTA specimens showed significantly less inflammation compared to Dycal samples at 90 days interval (P=0.019). No significant difference was found between GMTA and WMTA in terms of calcified bridge thickness and pulp inflammatory response to the capping materials (P>0.05).
Evidence Search ("mineral trioxide aggregate"[Supplementary Concept] OR "mineral trioxide aggregate"[All Fields]) AND ("calcium hydroxide"[MeSH Terms] OR ("calcium"[All Fields] AND "hydroxide"[All Fields]) OR "calcium hydroxide"[All Fields]) AND ("dental pulp capping"[MeSH Terms] OR ("dental"[All Fields] AND "pulp"[All Fields] AND "capping"[All Fields]) OR "dental pulp capping"[All Fields] OR ("pulp"[All Fields] AND "capping"[All Fields]) OR "pulp capping"[All Fields]) AND ("humans"[MeSH Terms] OR "humans"[All Fields] OR "human"[All Fields]).
Comments on
The Evidence
The first study design is a single-blind randomized clinical trial and the success and effectiveness of indirect pulp capping were based on clinical vitality test and radiographic assessment of the dentine thickness. The sample size was determined according to the literature review and in order to yield statistically significant results for the measurement of the thickness of newly formed dentine in each group. No changes occurred in the outcomes after the trial had commenced. The second study design is also a single-blind randomized clinical, but the calcified bridge formation induced by direct pulp capping was evaluated histologically instead of radiographically. In each of the studies, the pulp capping procedures were done by a single clinician to reduce technical variations.
Applicability In patients who need direct or indirect pulp capping, MTA appears to be a more favorable pulp-capping agent than calcium hydroxide.
Specialty/Discipline (Endodontics) (General Dentistry) (Pediatric Dentistry)
Keywords Mineral Trioxide Aggregate (MTA), Calcium Hydroxide, Direct Pulp Capping, Indirect Pulp Capping
ID# 2248
Date of submission: 04/12/2012spacer
E-mail jo@livemail.uthscsa.edu
Author Chungmi Jo
Co-author(s) e-mail
Faculty mentor/Co-author SongJiang Luo, BDS, MS, PhD, DDS
Faculty mentor/Co-author e-mail luos@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Marcos Trevino, Jonathan Hernandez (SAN ANTONIO, TX) on 11/28/2017
A PubMed search conducted in November 2017 revealed more recent publications in reference to this CAT. Both of the following concluded that there is no statistical significance between MTA and CH being used for pulp capping in regard to mineral gain and successful clinical outcomes: RCT by Mathur et al.2016 (PMID 28169260) and Ozgur et al. 2017(PMID 29070158) Therefore, clinicians will want to review past and present data prior to forming a personal decision on treatment as these results contradicted the original bottom line for this CAT.

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