Clinical and Radiographic Outcomes Following Pulpotomy Using Biodentine in Carious Exposed Mature Permanent Teeth: A Systematic Review and Meta-analysis.

AIM: Vital pulp therapy is increasingly used in managing mature permanent teeth exposed to caries. Biodentine, a tricalcium silicate-based material, has emerged as a potential alternative to mineral trioxide aggregate (MTA) in pulpotomy procedures due to its favorable properties of handling and biocompatibility. The aim was to systematically evaluate and compare the clinical and radiographic outcomes of biodentine and MTA as pulpotomy agents in mature permanent teeth exposed to caries.

MATERIALS AND

METHODS

This systematic review and meta-analysis was registered with International Prospective Register of Systematic Reviews (CRD4202457708) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive search of MEDLINE, Scopus, EBSCOhost, OpenGrey, and relevant journals was conducted up to August 31, 2024, to identify randomized controlled trials (RCTs). Studies comparing biodentine and MTA in mature permanent teeth with carious pulp exposure were included. The risk of bias was assessed using the Joanna Briggs Institute checklist, and statistical analysis was conducted using RevMan 5.4. The certainty of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

RESULTS

Seven RCTs were included in the systematic review, of which three were eligible for meta-analysis. The pooled results showed no significant difference between biodentine and MTA regarding clinical and radiographic success (odds ratio = 0.77; 95% confidence interval: 0.24-2.49; P = 0.66). Heterogeneity was low (I 2 = 0%), and no significant publication bias was detected. However, the GRADE assessment rated the certainty of evidence as low due to imprecision and potential risk of bias.

CONCLUSION

Both biodentine and MTA demonstrate comparable clinical and radiographic success as pulpotomy agents in mature permanent teeth exposed to caries pulp. Given its advantageous handling and lower discoloration potential, biodentine may serve as a suitable alternative to MTA. Further high-quality trials are warranted to strengthen the current evidence base.