Comparison of Success of Glass Ionomer Cements with Calcium Hydroxide and Tricalcium Silicate Cements in Indirect Pulp Treatments of Molars in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND

Biological materials such as glass ionomer cement (GIC), calcium hydroxide cement (Ca(OH)₂) and tricalcium silicate cement (TCS) have been effective in the indirect pulp treatment (IPT) of advanced carious lesions in molars. GIC has been in use for a long time as a biomimetic material with the added advantage of fluoride release for the treatment of the same.

OBJECTIVES

Our study compared the success of GIC vs Ca(OH)₂ and TCS in IPT of molars in primary and permanent teeth in 4-18-year-old children.

SEARCH

Two researchers, SN and AMJ, independently searched the literature using appropriate keyword combinations, and conflicts were resolved by a third author, LNM. The search was conducted using PubMed and extended to other search engines.

SELECTION CRITERIA

Randomized controlled trials (RCTs) (both split-mouth and parallel-arm), reported in or with full translations available in English, and a follow-up period of at least 6 months were included. Children aged 4-18 years with carious molars (primary and permanent) who had received IPTs with GIC and other cements were included.

DATA COLLECTION AND ANALYSIS

A data extraction sheet was prepared to include all details. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Publication bias was assessed using funnel plot analysis. Meta-analysis were conducted using forest plots. The certainty of evidence was reported using the GRADE method. RevMan 5.4 software was used.

RESULTS

The success of GIC was compared with Ca(OH)₂ and TCS in IPT. Three studies were included in the meta-analysis; the pooled success of GIC vs Ca(OH)₂ [OR (95% CI)] 1.02 (0.29, 3.61) ( < 0.74). Two studies were included in the meta-analysis comparing GIC vs TCS; the pooled success [OR (95% CI)] 0.33 (0.03, 3.29). Results were statistically nonsignificant. Heterogeneity was low (² = 0%); hence, the fixed-effects model (FEM) was used. The success of GIC IPT (from four studies) was [% (95% CI)] 96.09% (92.88, 98.13).

CONCLUSION

The overall success of GIC IPT was 96%. GIC was comparable to Ca(OH)₂ and TCS. The RoB was moderate, and publication bias was unascertained.

HOW TO CITE THIS ARTICLE

Neelkanthan S, Jawdekar AM, Mistry LN. Comparison of Success of Glass Ionomer Cements with Calcium Hydroxide and Tricalcium Silicate Cements in Indirect Pulp Treatments of Molars in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Clin Pediatr Dent 2025;18(4):473-478.