Survival Evaluation of Restorations in Pulpotomized Primary Teeth with MTA or Biodentine®: A Systematic Review
Abstract
1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Review Question
- (1)
- Population: Primary teeth undergoing pulpotomy with mineral trioxide aggregate (MTA) or Biodentine®;
- (2)
- Intervention: Coronal restoration of the pulpotomized tooth;
- (3)
- Comparators: Various restorative materials used post-pulpotomy;
- (4)
- Outcome: Clinical success of restorative treatment.
2.3. Eligibility Criteria
2.4. Search Strategy
2.5. Selection of Studies
2.6. Data Extraction
2.7. Assessment of Risk of Bias
2.8. Analysis of the GRADE Levels of Evidence
3. Results
3.1. Study Selection
3.2. Analysis of Included Studies
4. Discussion
5. Conclusions
- Regardless of the pulp therapy material used, stainless-steel crowns (SSCs) offer the highest survival rates for pulpotomized primary molars. SSCs should be used to maximize the long-term survival of pulp therapy in children whenever possible;
- According to in vitro studies, Biodentine® may be preferred as a base material in pulpotomized primary teeth, particularly when restoring with composite resins, due to its superior fracture resistance and bonding properties; for pediatric dentists, this indicates that Biodentine® could be the material of choice when high-strength stainless-steel crowns (SSCs) are not used, as it provides sufficient resistance to maintain the integrity until the treated tooth naturally exfoliates;
- Pediatric dental practice is in a state of continuous evolution, not only because of the constant emergence of new materials but also because of the growing esthetic demands of pediatric patients and their caregivers. Replacing stainless-steel crowns with esthetic restorative materials that can offer the same long-term performance in pulpotomized teeth has become a shared goal among patients, dental professionals, and manufacturers alike.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
Studies carried out in the last 15 years | Case reports, case series, reviews, letters, and commentaries |
Those who evaluated immediate restorations with different materials in pulpotomized teeth | Those which did not correspond to the objective of this review |
Papers in English | Pulpotomies performed on permanent teeth or with materials other than MTA or Biodentine® |
Samples of at least 50 teeth |
Author, Year, and Country | Type of Study | Sample Size | Groups | Success (%) | Fracture Resistance | Shear Bond Strength |
---|---|---|---|---|---|---|
Hutcheson et al., 2012 [22], USA | In vivo | 74 teeth | MTA + composite, MTA + SSCs | 72.3% composite, 87.3% SSCs | Not registered | Not registered |
Abdelwahab et al., 2024 [23], Egypt | In vivo | 64 teeth | MTA + RMGICs, MTA + SSCs | 75% RMGICs, 87.5% SSCs | Not registered | Not registered |
Kim et al., 2020 [25], Republic of Korea | In vivo | 347 teeth | MTA + RMGICs, MTA + SSCs | 76.7% RMGICs, 93.1% SSCs | Not registered | Not registered |
Topçuoğlu and Topçuoğlu, 2023 [26], Turkey | In vitro | 75 teeth | MTA + composite, Biodentine® + composite | Not registered | 334.1 N (MTA), 496.3 N (Biodentine®) | Not registered |
Bolukbasi and Kucukyilmaz, 2021 [24], Turkey | In vitro | 240 teeth | Biodentine® + RMGICs, Biodentine® + composite | Not registered | Not registered | 6.70 MPa, 12.60 MPa |
Confounding | Selection of Participants | Classification of Interventions | Deviations from Intended Interventions | Missing Data | Measurement of Outcomes | Selection of Reported Results | Overall | |
---|---|---|---|---|---|---|---|---|
Hutcheson et al. (2012) [22] | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate |
Abdelwahab et al. (2024) [23] | Moderate | Low | Low | High | Moderate | Moderate | Low | Moderate |
Kim et al. (2020) [25] | Low | Low | Low | Moderate | Low | Low | Low | Low |
Topçuoğlu and Topçuoğlu (2023) [26] | Moderate | Moderate | Low | Moderate | High | Moderate | Low | Moderate |
Bolukbasi and Kucukyilmaz (2021) [24] | Moderate | Moderate | Low | Low | Moderate | Low | Low | Low |
Critical Outcome | GRADE Rating | Justification |
---|---|---|
Clinical success at 12 months | High | 100% success in both groups; split-mouth design, blinded outcome assessment, consistent and precise results |
Radiographic success at 12 months | High | 100% radiographic success; blinded, calibrated examiners, high precision and applicability |
Restoration integrity and durability | Moderate | The composite showed more degradation; not statistically significant; detection bias and small sample size |
Tooth discoloration (esthetic acceptability) | Moderate | 94% of the composite group showed discoloration; consistent but limited sample; downgraded for imprecision |
Critical Outcome | GRADE Rating | Justification |
---|---|---|
Clinical success at 12 months | Moderate | Robust RCT with good follow-up; high clinical success (>85%), but small sample size and few failures introduce imprecision |
Radiographic success at 12 months | Moderate | No significant difference between groups (~70% success); a small sample and few failures introduce uncertainty |
Restoration-related failure (SSCs vs. GI) | Moderate | GI restoration significantly increased the failure risk; some detection bias and low event count, but consistent with prior research |
Tooth discoloration (esthetic outcome) | Very low | Not directly assessed; theoretical lower risk with BC RRM-F, but no patient data reported |
Critical Outcome | GRADE Rating | Justification |
---|---|---|
Overall survival of pulpotomized molars | Low | Retrospective design, moderate sample size, some bias, and no control group; lacks replication |
Survival by restoration type (SSCs vs. fillings) | Moderate | Large effect size favoring SSCs; observational data with some bias but directly applicable |
Survival by arch type (upper vs. lower molars) | Low | Significant difference, but wide confidence interval and unconfirmed consistency across studies |
Survival by caries extension (above vs. below CEJ) | Moderate | Strong association observed; effect biologically plausible but based on one study without randomization |
Outcome (Study) | GRADE Quality | Brief Justification |
---|---|---|
Bond strength—composite (Bolukbasi, 2021) [24] | Very low | Single in vitro study, small sample size, indirect setting, no clinical data or replication |
Bond strength—glass hybrid (Bolukbasi, 2021) [24] | Very low | Laboratory-only data, no clinical context, no external validation, and low precision |
Fracture resistance (Topçuoğlu, 2023) [26] | Very low | One laboratory study with limited samples, indirect evidence, imprecise results, and no clinical trials |
Fracture pattern (Topçuoğlu, 2023) [26] | Very low | Based on simulation, few events, no replication, and lacks applicability to real-world fracture behavior |
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Biedma-Perea, M.; Moscoso-Sánchez, M.; Barra-Soto, M.J.; Arenas-González, M.; Ribas-Pérez, D.; Caleza-Jiménez, C. Survival Evaluation of Restorations in Pulpotomized Primary Teeth with MTA or Biodentine®: A Systematic Review. J. Clin. Med. 2025, 14, 5501. https://doi.org/10.3390/jcm14155501
Biedma-Perea M, Moscoso-Sánchez M, Barra-Soto MJ, Arenas-González M, Ribas-Pérez D, Caleza-Jiménez C. Survival Evaluation of Restorations in Pulpotomized Primary Teeth with MTA or Biodentine®: A Systematic Review. Journal of Clinical Medicine. 2025; 14(15):5501. https://doi.org/10.3390/jcm14155501
Chicago/Turabian StyleBiedma-Perea, María, María Moscoso-Sánchez, María José Barra-Soto, Marcela Arenas-González, David Ribas-Pérez, and Carolina Caleza-Jiménez. 2025. "Survival Evaluation of Restorations in Pulpotomized Primary Teeth with MTA or Biodentine®: A Systematic Review" Journal of Clinical Medicine 14, no. 15: 5501. https://doi.org/10.3390/jcm14155501
APA StyleBiedma-Perea, M., Moscoso-Sánchez, M., Barra-Soto, M. J., Arenas-González, M., Ribas-Pérez, D., & Caleza-Jiménez, C. (2025). Survival Evaluation of Restorations in Pulpotomized Primary Teeth with MTA or Biodentine®: A Systematic Review. Journal of Clinical Medicine, 14(15), 5501. https://doi.org/10.3390/jcm14155501