Emmanuel J. N. L. Silva, Karem P. Pinto, Fernanda N. S. J. Riche, Maristela G. H. Carestiato, Jorge N. R. Martins, Henry F. Duncan, Marco A. Versiani, Gustavo De-Deus
First published: 23 February 2025 https://doi.org/10.1111/iej.14210
Another reminder of the fruitless search for the scientific truth. At least with this one there is a refreshing honesty.
It is a question I have posed to myself. For many years we would use calcium hydroxide (Dycal) in cases of pulp exposure when hard tissue bridge formation is required to keep a pulp healthy. And it worked well. Not always. But well enough to provide some predictability.
Time moves on though, and with all the hype of bioactive materials, these are now the trendy and much more expensive replacement for the humble calcium hydroxide. But what of the science? You wouldn’t want to look like a dinosaur using ancient and proven materials when the endodontic gods are all endorsing the next best thing.
This paper has gone looking for research on comparative dentine bridging following the use of MTA-like materials and calcium silicate-based cements versus calcium hydroxide in pulp exposures and pulpotomies. It has always been a dodgy set of samples for this type of comparison. Think about it, how can you analyse something like this clinically?
26 human studies were found in which exposures were carried out on teeth to be extracted mostly for orthodontic of wisdom teeth reasons and then subsequently histologically analysed. Your eye is immediately drawn to the column in the summary table describing the state of the pulp before the pulps were exposed – healthy. How many healthy pulps are we going to be doing direct pulp caps and pulpotomies on?
Clearly, there is a substantial bias, and the results obtained are therefore highly questionable.
The summary of the meta-analysis was that using ProRoot MTA resulted in a significantly higher frequency of complete hard tissue bridge formation compared with using other calcium-silicate cements and calcium hydroxide. Subgroup analyses indicated that using ProRoot MTA led to higher complete bridge formation compared with Biodentine. However – THE CERTAINTY OF EVIDENCE IS LOW.
What do we learn? Once again, evidence-based dentistry is an unrealistic goal when it comes to dental research. As Barry Norman always said ‘you pays your money, you take your chances’.
