Trial suggests that two types of mineral trioxide aggregate both out perform calcium hydroxide for primary molar pulpotomy


The aim of this study was to evaluate and compare two different white MTA cements as pulpotomy medicaments in human primary teeth, Pro-Root MTA and MTA Angelus.

Child patients with deep occlusal carious lesion, which presented potential risk of pulp exposure during complete removal of carious dentin, as determined by clinical and radiographic assessment were included patients with spontaneous pain, sensitivity to percussion, pathologic mobility, carious pulp exposure, presence of swelling or fistulae, proximal caries, internal/external resorption, inter-radicular bone destruction, calcific metamorphosis, and uneven/pathologic root resorption were excluded.

Eligible primary maxillary and mandibular first and second molars were randomly assigned to one of the following treatment groups, Pro-Root MTA; MTA Angelus or calcium hydroxide (CaOH).  Treatment was provided under rubber dam to a standard protocol with follow up at 1,3,6,12,18 & 24 months.  Clinical and radiographic success was determined by absence of: –

  1. spontaneous pain and/ or sensitivity to palpation/percussion;
  2. fistula, swelling, and/or abnormal mobility;
  3. radiolucencies at the inter-radicular and/or periapical regions, as determined by conventional periapical radiographs taken at all control appointments;
  4. pulp canal obliteration (fully obliterated canals); and
  5. internal or external (pathologic) resorption that was not compatible with a normal exfoliation process.

Restorations were assessed using the United States Public Health Service (USPHS) clinical rating system.

  • 139 teeth (in 75 children) were randomised (Pro-Root MTA =46; MTA Angelus=45; CaOH = 48 )
  • There were (3 Pro-Root MTA, 1 MTA Angelus, and 1 CaOH) dropouts at 24 months
  • 24-month cumulative clinical survival probabilities of the Pro-Root MTA, MTA Angelus, and calcium hydroxide groups were 0.973, 0.953, and 0.752, respectively.
  • Clinical survival probabilities of Pro-Root MTA and MTA Angelus were similar (P>.62), and were significantly greater than that of the calcium hydroxide group (P=.008 and P=.004, respectively).
  • 24-month cumulative radiographic survival probabilities of the Pro-Root MTA, MTA Angelus, and calcium hydroxide groups were 0.974, 0.908, and 0.446, respectively.   Both MTA groups were similar and significantly greater than that of the calcium hydroxide group
  • Clinical evaluations using the USPHS criteria showed that approximately two per- cent of the teeth in the Pro-Root MTA group, two per- cent in the MTA Angelus group and four percent in the calcium hydroxide group had amalgam restorations with ditched margins and had at least one sign of radiographic failure.

The authors concluded

Pro-Root MTA and MTA Angelus showed similar and favorable success rates as pulpotomy materials in primary molars.


Recently we highlighted a new network meta-analysis (Dental Elf 27th Feb 2014) that indicated that MTA had better clinical and radiographic outcomes than other materials at 9-12 months although interestingly  at 18-24 months in addition  MTA both formocresol and ferric sulphate outperformed calcium hydroxide.  This study was not included in that review.


Celik B, Ataç AS, Cehreli ZC, Uysal S. A randomized trial of mineral trioxide  aggregate cements in primary tooth pulpotomies. J Dent Child (Chic). 2013 Sep-Dec;80(3):126-32. PubMed PMID: 24351693.

 Dental Elf – 27th Feb 2014 – Review suggests that mineral trioxide aggregate had best clinical and radiographic outcomes at 9-12 months for primary molar pulpotomy


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