Treatment Outcomes of Using Bioceramic Materials in Vital Pulp Therapy of permanent Teeth: A Systematic Review

Abstract

Abstract Introduction: The aims of this systematic review were to 1) summarise and appraise the available published information on the treatment outcomes of using various bioceramic materials in vital pulp therapy (VPT) of permanent teeth, focusing on direct pulp capping, full and partial pulpotomies and 2) outline any prognostic factors identified in the literature that could influence the treatment outcome. Materials and Methods: An electronic search of the relevant literature published in peerreviewed journals from January 2010 up to July 2020 in PubMed and EMBASE, Ovid MEDLINE(R) and Cochrane databases was conducted. The quality of all the included studies was critically appraised using the Downs and Black checklist and the randomised controlled trials risk of bias tool in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Thirteen studies met the inclusion criteria. The majority of the studies identified were randomised controlled trials (n=9). Two were retrospective, and two were prospective studies. Seven studies investigated the outcomes of using bioceramic materials in direct pulp capping of permanent human teeth, two were on partial pulpotomy, and four studies reported on the outcomes of complete pulpotomy. The overall evidence was found to be insufficient to assess whether it is more advantageous to use mineral trioxide aggregate (MTA) based materials, Biodentine or calcium-enriched mixture (CEM) over the other in VPT. Conclusion: Based on our review synthesis, MTA based materials, Biodentine and CEM show positive treatment outcomes when used in VPT. However, there is an insufficient scientific basis to affirm whether it is more advantageous to use one over the other in VPT of permanent teeth. Moreover, no generalised prognostic clinical factors were identified.