| Mineral trioxide aggregate(MTA)is a new kind of pith capping material.Its main component is silicate.MTA has good sealing ability,small cytotoxicity,good antibacterial and bacteriostasis effect,and strong bacterial penetration resistance,which is beneficial to reduce microleakage and induce pulp formation to repair dentin bridge.Due to its good biocompatibility and excellent clinical treatment effect,it has been favored by clinicians.More and more MTA has been applied to dental pulp treatment,especially in direct pulp capping.Objective: In this study,a scientific and systematic review and evaluation of high-quality literatures related to the comparison of the application effect of MTA and calcium hydroxide(CH)in clinical direct pulp capping was conducted.Then doing a further Meta-analysis,which was performed to compare the effects of MTA and CH in direct pulp capping.It wants to explore the clinical evidence of MTA in direct pulp capping,thus providing a scientific basis for clinicians to select the best materials and drugs in daily direct pulp capping operations.Methods: This research is based on certain retrieval strategies.Pub Med and WOS were used as electronic databases.The retrieval period is 2010.1-2018.12.It used the following keywords to preliminary search:(mineral trioxide aggregate),(calcium hydroxide),and(direct pulp capping).Restrictions on use is English.In accordance with strict inclusion and exclusion criteria,references related to the literature of "randomized controlled trials of MTA and CH in the clinical application of direct pulp capping" were comprehensively screened.Two researchers independently read the retrieved and research-related literature.They retrieved titles and abstracts of documents,independently evaluated the qualification of relevant literature,though bring into inclusion and exclusion criteria,then preliminary eliminated the articles that did not meet the criteria.Then according to the inclusion and exclusion criteria,the remaining literatures were carefully read to select that met the inclusion criteria.Using the Cochrane bias risk assessment tool to evaluate the quality of these final included studies.Outcome measures were clinical success,inflammatory response,and dentin bridge formation.This research was using the Rev Man5.3 software provided by the Cochrane collaboration to perform Meta-analyses.Result: From Jan.2010 to Dec.2018,12 eligible studies(9 RCTS and 3 RNT)from 169 potentially relevant studies were included in this study according to the inclusion and exclusion criteria.Comparing the effectiveness of MTA and CH,the studies was applied to the final Meta-analysis.The results showed that the success rate was 2.66,95% CI(1.96,3.63),in the MTA group(609 teeth)compared with that in the CH group(511 teeth).The power difference between the two components was statistically significant(P<0.00001).The success rate of the MTA treatment group was significantly higher than that of the CH group.In terms of inflammatory response,compared with CH,MTA showed less inflammatory response(OR = 6.64;95% CI,2.98,14.79;P<0.00001).The formation ratio of calcified dentin bridge in MTA group was higher than that in CH group(OR = 4.35;95%,95% CI,1.95,9.72;P=0.0003).Conclusion: Current evidence shows that,as a new type of pulp capping material,MTA is significantly superior to CH in direct pulp capping compared with traditional CH.However,literature on randomized controlled trials to study long-term outcomes of MTA is limited.Therefore,the long-term effect of MTA is still uncertain.And the quantitative and qualitative limitations of the included studies,Therefore,it is necessary to design more scientifically rigorous,comprehensive and high-quality randomized controlled trials to support the long-term effects of MTA in pulp treatment,So as to provide a scientific basis for clinicians to use MTA. |
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