Efficacy of Mineral Trioxide Aggregate Versus Biodentine as a Direct Pulp Capping Material in Carious Human Mature Permanent Teeth: A Systematic Review.

The present systematic review and meta-analysis aimed to evaluate and compare the clinical efficacy of Mineral Trioxide Aggregate (MTA) and Biodentine (BD) as direct pulp capping materials in cariously exposed mature permanent teeth, focusing on outcomes such as pulp vitality preservation, dentin bridge formation, and complication rates, including tooth discoloration. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and other dental databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in PROSPERO (CRD42023463513). Eligible studies included randomized controlled trials and retrospective studies reporting clinical and radiographic success. Risk of bias was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Eleven studies involving 373 treated teeth were included. Meta-analysis revealed a pooled risk ratio (RR) for success of 0.98 (95% CI: 0.94-1.03), slightly favoring MTA but without statistical significance. BD showed a lower failure rate (RR = 1.94; 95% CI: 0.48-7.94) and marginally better outcomes in calcific bridge formation (RR = 0.90; 95% CI: 0.75-1.08), though these differences were also not statistically significant. Biodentine demonstrated superior handling, a shorter setting time (about 12 minutes), and no risk of discoloration, which is an issue noted with MTA. Both materials are clinically effective, but BD may be preferable due to its practical and aesthetic advantages. Further long-term, standardized studies are recommended.