Mineral trioxide aggregate (MTA) has been put to a range of dental uses, direct pulp capping root-end filling, apexogenesis and apexification in immature teeth, filling root canals an treatment of root fractures. The aim of this review was to evaluate whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars.
Only the Medline database was searched and only human outcome studies included. Articles were assessed and graded by two authors. The assessment scheme was a weighted criteria based system.
- 22 studies were included, 17 studies compared MTA with formocresol, 4 studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM), and one study compared white MTA with grey MTA.
The authors concluded
Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament
While this review used a detailed weighted criteria based assessment system to assess study quality,this type of approach is not recommended by the Cochrane Collaboration. The search strategy used for the review only included a single database and restricted the language to English. This means that some studies are likely to have missed. The authors provide a detailed discussion of the included studies highlighting many inconsistencies and quality issues with the identified studies. They also noted the three earlier ‘systematic reviews by Simancas-Pallares et al 2012, Ng & Messer 2008, and Peng et al 2006. These reviews all suggest more positive outcomes using MTA. The earlier 2003 Cochrane review by Nadin et al that looked at pulpotomy treatemtn in primary molars noted that:-
Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.
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