Comparison of the success rate of a bioactive dentin substitute with those of other root restoration materials in pulpotomy of primary teeth: Systematic review and meta-analysis.

BACKGROUND: Several root canal restoration materials can be used after pulpotomy in primary teeth; however, it is unclear which is the most successful. The authors' aim in this systematic review and meta-analysis was to compare the radiographic and clinical failure rates of a calcium silicate-based bioactive material (Biodentine, Septodont) with those of other root restoration materials such as mineral trioxide aggregate (MTA), formocresol, and ferric sulfate. TYPES OF STUDIES REVIEWED: On the basis of the determined study strategy, the authors performed a comprehensive search of the MEDLINE, Web of Science, Embase, and Cochrane Central Register of Controlled Trials online databases. The authors considered only randomized controlled trials. In the included studies, the authors compared the clinical and radiographic failure rates at different follow-up times of the pulpotomy of primary teeth with extensive caries treated by using Biodentine and other root restoration materials. RESULTS: All of the included studies had an unknown or high risk of bias. On the basis of the Grading of Recommendations Assessment, Development and Evaluation scale, the quality of evidence for the comparison of MTA and Biodentine was moderate. Biodentine had a statically significantly higher radiographic failure rate than did MTA at 6 and at 9 through 12 months after pulpotomy. The authors found no substantial differences between the clinical failure rates of Biodentine and MTA and the radiographic or clinical failure rates of Biodentine and formocresol or of Biodentine and ferric sulfate. CONCLUSIONS AND PRACTICAL IMPLICATIONS: MTA has a significantly lower radiographic failure rate than does Biodentine but no difference in clinical failure rates. On the basis of this result, the dentist can weigh the advantages and disadvantages of using Biodentine, MTA, ferric sulfate, and formocresol and can make a more informed decision about using the proper root restoration material.