Biodentine versus mineral trioxide aggregate as a direct pulp capping material for human mature permanent teeth – A systematic review

BACKGROUND: Biodentine is comparatively a new biomaterial claimed to have properties comparable to mineral trioxide aggregate (MTA). Biodentine and MTA are effectively used for direct pulp capping (DPC), and they are capable of regenerating relatively damaged pulp and formation of hard dentine bridge. OBJECTIVES: The aim of this systematic review was to test the null hypothesis of no difference between Biodentine and MTA as DPC materials for human permanent mature teeth, against the alternative hypothesis of a difference. DATA SOURCES: Clinical trials were identified by electronic databases searches of Midline, CENTRAL Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scopus, Scientific Electronic Library Online, evidence-based endodontics literature, KoreaMed, and Google Scholar. The literature search was performed from January 2010 to February 2018. Hand searches were also performed for relevant abstracts, books, and reference lists. Titles and abstracts of studies identified using the above-described protocol were independently screened by two authors. Full texts of studies judged by title and abstracts to be relevant were independently evaluated by two authors for stated eligibility criteria. STUDY ELIGIBILITY CRITERIA: The eligibility criteria included randomized clinical trials (RCTs) and non-RCTs. PARTICIPANTS: Patients with permanent mature molars indicated for surgical extraction or molars that have symptomless exposure of vital pulp tissue by caries or trauma. In both cases, the molars were subjected to DPC. INTERVENTIONS: The pulp exposures were directly treated by Biodentine or MTA. STUDY APPRAISAL: To assess article quality, two authors independently used the risk of bias in nonrandomized studies – of interventions. METHODS: Qualitative metasynthesis was used to analyze data across qualitative studies. RESULTS: The initial search identified 8725 unique references through the search process. No additional studies were identified through handsearching. After filtering, 915 references were recorded and screened. After the eligibility criteria were applied, seven unduplicated prospective and retrospective cohort studies were included in the qualitative metasynthesis. LIMITATIONS: Further RCTs with much larger sample size and proper methodology with longer observational time are still in need to adequately address the questions of the present systematic review. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Within the limitations of this review, it may be concluded that Biodentine had a similar effect on dentin bridge formation likely to MTA. However, this conclusion is based on only very few well-conducted prospective and retrospective cohort studies. SYSTEMATIC REVIEW REGISTRATION NUMBER: The review had been registered with PROSPERO (registration number CRD42018089302).