Clinical and Radiographic Evaluation of Indirect Pulp Capping with Mineral Trioxide Aggregate and Calcium Hydroxide in Primary Molars: A Systematic Review and Meta-analysis.

AIMS AND BACKGROUND

An optimal pulp capping material should promote the formation of reparative dentin, preserve pulpal vitality, and create an effective barrier against bacterial infiltration. Due to issues like disintegration and tunnel defects, mineral trioxide aggregate (MTA) has become a preferred recent alternative to calcium hydroxide (Ca(OH)₂) for indirect pulp capping in primary teeth. In the literature, there have been conflicting opinions regarding the selection of materials for indirect pulp capping. Hence, the aim of this systematic review was to evaluate and compare the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in deep carious lesions of primary molars.

METHODS

This review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched included MEDLINE (via PubMed), Google Scholar, and Cochrane. Randomized clinical trials published until January 31, 2024, without year restrictions, were included. The systematic review assessed the effectiveness of MTA and Ca(OH)₂ as indirect pulp capping agents in primary molars.

RESULTS

The search resulted in 412 published studies. Four hundred and five articles that did not meet the inclusion criteria, were duplicates, or were not in English were excluded. A total of seven studies were included in the systematic review to assess clinical and radiographic effectiveness, and five studies were selected for meta-analysis (radiographic effectiveness). MTA showed greater reparative dentin formation as compared to the Ca(OH)₂ group with a standardized mean difference of 0.45; however, the difference between the two groups was not statistically significant.

CONCLUSION

Both MTA and Ca(OH) can be effectively utilized as indirect pulp capping agents in deep carious lesions of primary molars.

CLINICAL SIGNIFICANCE

This systematic review and meta-analysis highlights the effectiveness of MTA and calcium hydroxide [Ca(OH)₂] as indirect pulp capping agents in primary molars with deep carious lesions, providing valuable evidence-based guidance for pediatric dentists in selecting the most suitable pulp capping agent.

HOW TO CITE THIS ARTICLE

CK A, Ninawe NS, Sawant S, . Clinical and Radiographic Evaluation of Indirect Pulp Capping with Mineral Trioxide Aggregate and Calcium Hydroxide in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2025;18(8):1031-1038.