ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Long Term Success of Mineral Trioxide Aggregate and Calcium Hydroxide in Direct Pulp Capping
Clinical Question In a patient requiring a direct pulp cap, will mineral trioxide aggregate, as compared to Calcium Hydroxide compounds, lead to a better long-term outcome?
Clinical Bottom Line In the long-term success rate of direct pulp caps, mineral trioxide aggregate seemed to provide a better prognosis than calcium hydroxide.
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) 20416424Mente/2010149 patients requiring direct pulp capping in 167 teethRetrospective Study
Key resultsOf the 69 teeth treated with mineral trioxide aggregate, 54 had a successful outcome (78% success rate). The calcium hydroxide only had 32 successfully treated teeth of the 53 treated (60% success rate).
Evidence Search (("Oxides"[Mesh]) AND "Calcium Hydroxide"[Mesh]) AND "Dental Pulp Capping"[Mesh] AND "Humans"[Mesh]
Comments on
The Evidence
The study had only a 72.5% completion or recall rate. The clinical follow-up was recorded by independent calibrated examiners. There was adequate follow-up (with a median of 27 months) after the placement of the direct pulp caps.
Applicability Vital permanent teeth with large caries involvement or trauma.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Direct pulp capping, mineral trioxide aggregate, calcium hydroxide
ID# 2257
Date of submission: 04/12/2012spacer
E-mail Patela9@livemail.uthscsa.edu
Author Amar Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author E. Penn Jackson, DDS
Faculty mentor/Co-author e-mail JacksonEP@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Emilia Vega (San Antonio, TX) on 12/05/2017
A search was conducted in PubMed in November 2017, and more recent research was located that does not significantly change the answer to this CAT. An RCT by Brizuela in 2017 (PMID: 28917577) found that patients had a 100% success rate at the 1 week follow-up; zero of the 56 MTA caps failed at 3 months, and three failed at 6 months. Overall, they concluded that while there are not "significant differences... among the materials studied... MTA offered some advantages over CH." Rasaratnam's 2016 evidence-based synopsis (PMID: 27767114) stated that MTA is a suitable substitute for CH. Nine studies reviewed showed the inflammatory response to MTA was signifcantly less compared to that of CH (OR = 4.56; 95% CI, 2.65 7.83; P < .00001). Meta-analysis of 13 studies (Li, 2015, PMID: 25990198) found that MTA treatment groups had significantly higher success rates compared to CH-capped groups (p=0.003 for RCT and p<0.0001 for retrospective nonrandomized trials). MTA use resulted in less pulpal inflmmatory response and more predictable hard dentin bridge formation compared to CH.
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