MTA and ferric sulfate in pulpotomy outcomes of primary molars: a systematic review and meta-analysis

Abstract

Objective: Methods of systematic review and meta analysis were employed to compare the success rate of pulpotomy of primary molars using mineral trioxide aggregate (MTA) and ferric sulfate (FS) as two regenerative and preservative agents, respectively.

Study design: After raising a PICO question (In pulpotomy of vital carious-exposed primary molars, how does MTA compare to FS in terms of clinical and radiographic outcomes?) and determining the search strategy, MeSH-matching keywords were searched in four electronic databases and retrieved papers were examined in titles, and if necessary abstracts and full texts, to be relevant. Randomized clinical trials (RCTs) evaluating pulpotomy of vital primary molars after carious/traumatic exposure conducted with either FS or MTA, with at least a 6-month recall, tooth restorability, and those considering clinical and radiographic signs/symptoms, were included. The nonrandomized allocation and absence of comparison between the treatment groups caused the exclusion of the article. The quality of the RCTs and also their risk of bias (low, moderate, high), were assessed using a modification of van Tulder list; for meta-analysis of the matching studies, the extracted data were analyzed by Mantel Hanszel analysis.

Results: A total number of 620 articles were found. After exclusion of the common titles and application of the eligibility criteria, 4 RCTs [12-month follow-up: n=3, 24-month follow-up: n=4, in total: 264 teeth) comparing MTA and FS, were selected. It was showed that the 12-month outcome of both materials were similar [RR= 0.642 (CI 95%: 0.225-1.833, P=0.407)], while the two-year follow-up results revealed significant differences in treatment outcome, in favor of MTA [RR was 0.300 (CI 95%: 0.132-0.683, P=0.004)].

Conclusion: MTA demonstrated superior long-term treatment outcomes in pulpotomy of primary molars than FS.

Keywords: MTA; ferric sulfate/sulphate; meta-analysis; mineral trioxide aggregate; primary molar; pulpotomy; vital pulp therapy.