Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.
OBJECTIVE
The principles of evidence-based dentistry were used to compare mineral trioxide aggregate (MTA), formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH) as primary molar pulpotomy medicaments.


METHODS
Electronic databases were searched and sieved for relevant papers by examining titles, abstracts and finally full texts. Included were randomized clinical trials (RCTs) and clinical trials (CTs) comparing the clinical and radiographic successes of MTA, FC, FS and CH pulpotomies. Data were extracted and common odds ratios (CORs) were derived by fixed effects meta-analysis (direct or indirect MA). Mean clinical and radiographic success rates from relevant study arms were examined.


RESULTS
Eighteen RCTs and 10 CTs (total 1,260 molars) were identified to compare MTA and FC. Direct MAs found MTA was significantly more successful clinically (COR=3.11; 95%CI=1.09-8.85) and radiographically (COR=4.50; CI=1.78-11.42) than FC, and clinical and radiographic data confirmed this. Fourteen RCTs and 4 CTs (total 959 molars) were identified to compare MTA and FS. Indirect MAs found no statistically significant difference in clinical successes, but a statistically significant difference in the radiographic successes of MTA and FS (COR=4.69; CI=1.70-12.95). Clinical and radiographic data showed MTA was significantly more successful than FS. Nine RCTs and 7 CTs (total 531 molars) were identified to compare MTA and CH. Indirect MAs found statistically significant differences in the clinical (COR=6.48; CI=1.75-24.0) and radiographic (COR=10.47; CI=3.35-32.76) successes of MTA and CH. Clinical and radiographic data confirmed MTA was significantly more successful than CH.


CONCLUSIONS
Currently available evidence suggests MTA compared with FC, FS and CH as a pulpotomy medicament resulted in significantly higher clinical and radiographic successes in all time periods up to exfoliation.
Department of Paediatric Dentistry, School of Dental Science, The University of Melbourne, Melbourne, Australia.
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D017607:Aluminum Compounds / Q000627:therapeutic use*; D017610:Calcium Compounds / Q000627:therapeutic use*; D002126:Calcium Hydroxide / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D019317:Evidence-Based Medicine; D005290:Ferric Compounds / Q000627:therapeutic use; D005566:Formocresols / Q000627:therapeutic use; D006801:Humans; D010087:Oxides / Q000627:therapeutic use*; D011672:Pulpotomy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012388:Root Canal Irrigants / Q000627:therapeutic use*; D017640:Silicates / Q000627:therapeutic use*; D014094:Tooth, Deciduous / Q000473:pathology; D016896:Treatment Outcome
D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D005290:Ferric Compounds; D005566:Formocresols; D010087:Oxides; D012388:Root Canal Irrigants; D017640:Silicates; C086631:mineral trioxide aggregate; C031025:formocresol; C024823:ferric sulfate; D002126:Calcium Hydroxide