Comparative Evaluation of Success of Biodentine and Mineral Trioxide Aggregate with Formocresol as Pulpotomy Medicaments in Primary Molars: An In Vivo Study

Comparative efficacy of medicaments or techniques for pulpotomy of primary molars: a network meta-analysis

OBJECTIVES

We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide (CH), mineral trioxide aggregate (MTA), biodentine, and laser for pulpotomy of molar teeth.

MATERIALS AND METHODS

An updated search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before October 30, 2022, after screening previous meta-analyses. The Cochrane risk of bias assessment tool was used to appraise the methodological quality of included studies. Clinical and radiographic success rates were assessed as outcomes. Random network meta-analysis was performed by using STATA software (version 14.0) with "network" command.

RESULTS

A total of 43 RCTs were included. Network meta-analysis indicated that CH was inferior to other medicaments and techniques in all outcomes, and MTA and biodentine was better than FC, FS, and NaOCl in terms of clinical and radiographic success rates. Results of ranking probabilities suggested that MTA ranked first in all outcomes except for clinical success at both 6 months.

CONCLUSIONS

Our results suggested that MTA was associated with significant improvement in both clinical and radiographic success than other pulpotomy medicaments and techniques, with the highest probability of being the optimal option.

CLINICAL RELEVANCE

The current network meta-analysis determined the comparative efficacy and safety of 7 common pulpotomy medicaments in molar pulpotomy, including FC, FS, NaOCl, CH, MTA, biodentine, and laser, and the pooled results revealed comparable efficacy in clinical and radiographic success rates at 6 and 12 months between FC, FS, and NaOCl in primary molars pulpotomies. However, MTA, biodentine and laser may have more advantages than other pulpotomy medicaments for clinical and radiographic success. Therefore, in clinical practice, practitioners should select MTA, biodentine, or laser as pulpotomy medicaments in molar pulpotomy.

Clinical and radiographic comparison of Biodentine and Formocresol: an updated meta-analysis with trial sequential analysis

PURPOSE

This meta-analysis aimed to compare the clinical and radiographic success rate of Biodentine as an alternative to Formocresol to provide a critical appraisal of the available literature and evidence-based conclusion as well as update the previous systematic review.

METHODS

MEDLINE, CENTRAL, Web of Science, Scopus, and Google Scholar databases were searched up to 20 October 2021 to identify RCTs evaluating pulpotomy with Biodentine/Formocresol in carious primary molars among children ≤ 10 years old. The risk of bias was assessed using the Cochrane RoB-2 tool. RRs and corresponding 95% CIs were calculated to pool results that RR ˃ 1 indicated a higher success rate in the Biodentine group and RR < 1 indicated a higher success rate in the Formocresol group. Heterogeneity was calculated using the I² and τ² statistics. In addition, trial sequential analysis was performed to adjust results for type I and type II errors and evaluate power of the meta-analysis.

RESULTS

Nine RCTs were identified and eight RCTs were included in the meta-analysis and trial sequential analysis. The obtained evidence showed no significant difference between Biodentine and Formocresol in terms of clinical efficacy. However, considering the radiographic success rate the results of the meta-analysis and trial sequential analysis significantly favoured Biodentine.

CONCLUSION

Within the limitations of the present review and based on the retrieved findings it has been clearly shown that Biodentine is superior compared to Formocresol in terms of radiographic success rate with firm evidence in this regard. Although the performed meta-analysis showed no significant clinical difference between Biodentine and Formocresol, however, trial sequential analysis revealed a lack of firm evidence in this regard.