A meta-analysis of calcium silicate-based cements and calcium hydroxide as promoters of hard tissue bridge formation

IF 5.4 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal Pub Date : 2025-02-23 DOI:10.1111/iej.14210

Emmanuel J. N. L. Silva, Karem P. Pinto, Fernanda N. S. J. Riche, Maristela G. H. Carestiato, Jorge N. R. Martins, Henry F. Duncan, Marco A. Versiani, Gustavo De-Deus

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引用次数: 0

Abstract

Background

The formation of a reparative hard tissue bridge is a key indicator of defensive pulp response and successful vital pulp treatment (VPT); however, there is a lack of comprehensive information regarding the impact of bioactive materials on hard tissue formation.

Objectives

This systematic review with meta-analyses aimed to evaluate the hard tissue bridge formation in direct pulp capping and pulpotomies in humans, comparing the use of ProRoot MTA with other calcium silicate-based cements (CSCs) and calcium hydroxide.

Methods

The search was conducted in six electronic databases, until May 2024. The selection process followed the PICOS criteria. Clinical trials that evaluated the hard tissue bridge formation in VPTs using ProRoot MTA compared with other CSCs or calcium hydroxide, were included. The quality of the studies was assessed using the RoB-2 tool for randomized clinical trials, and ROBINS-I for nonrandomized trials. Meta-analyses were performed to compare the frequency of complete bridge formation using RevMan software 5.3. The GRADE tool was used to determine the overall certainty of evidence.

Results

Twenty-six studies were included, and the majority showed high risk of bias. Meta-analyses revealed that using ProRoot MTA resulted in significantly higher frequency of complete hard tissue bridge formation compared with using other CSCs and calcium hydroxide. Subgroup analyses indicated that using ProRoot MTA led to higher complete bridge formation compared with Biodentine. The certainty of evidence was low.

Conclusions

The use of ProRoot MTA resulted in significantly higher frequency of complete hard tissue bridge formation, greater hard tissue thickness and better morphology compared with various other CSCs and calcium hydroxide. Almost all studies were performed in premolars extracted due to orthodontic reasons or third molars. This scenario does not represent the clinical setting and therefore results should be interpreted with caution.

Abstract Image

查看原文本刊更多论文

硅酸钙水泥和氢氧化钙作为硬组织桥形成促进剂的荟萃分析。

背景：修复性硬组织桥的形成是牙髓防御反应和牙髓生命治疗（VPT）成功的关键指标；然而，缺乏关于生物活性物质对硬组织形成影响的综合信息。目的：本系统综述与荟萃分析旨在评估人类直接髓盖和髓切开术中硬组织桥的形成，比较prooroot MTA与其他硅酸钙基水泥（CSCs）和氢氧化钙的使用。方法：检索6个电子数据库，检索时间截止到2024年5月。选择过程遵循PICOS标准。与其他CSCs或氢氧化钙相比，使用prooroot MTA评估vpt硬组织桥形成的临床试验被纳入其中。随机临床试验使用robins -2工具，非随机试验使用robins - 1工具评估研究质量。采用RevMan软件5.3进行meta分析，比较全桥形成的频率。GRADE工具用于确定证据的总体确定性。结果：纳入26项研究，大多数显示高偏倚风险。荟萃分析显示，与使用其他CSCs和氢氧化钙相比，使用prooroot MTA可以显著提高完全硬组织桥形成的频率。亚组分析表明，与Biodentine相比，使用prooroot MTA可以获得更高的完整桥形成。证据的确定性很低。结论：与其他CSCs和氢氧化钙相比，使用prooroot MTA可显著提高全硬组织桥的形成频率，增加硬组织厚度，改善形态学。几乎所有的研究都是在因正畸原因拔出的前磨牙或第三磨牙中进行的。这种情况并不代表临床情况，因此结果应谨慎解释。

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来源期刊

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.