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Light-Cured Calcium Silicate–Based Cements as Pulp Therapeutic Agents
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To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?
MATERIALS AND METHODS
The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison.
Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21).
Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries.
This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.
Disclosure statements are available on the authors' profiles:
LIGHT-CURED CALCIUM SILICATE BASED-CEMENTS AS PULP THERAPEUTIC AGENTS: A META-ANALYSIS OF CLINICAL STUDIESJ Evid Based Dent Pract 2022 Dec 01;22(4)101776, LF García-Mota, L Hardan, R Bourgi, JE Zamarripa-Calderón, JA Rivera-Gonzaga, JC Hernández-Cabanillas, CE Cuevas-Suárez
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
When treating extensive caries lesions that either expose the pulp or leave a thin layer of dentin, some sort of capping material is necessary before the main restoration is placed. The gold standard has been the use of calcium hydroxide (Ca(OH)2), but this is highly soluble and non-adhesive; therefore, alternatives have been sought. This review paper compares one such material, a light-cured calcium silicate–based cement, with other candidates.
The results did not show a large advantage for the light-cured calcium silicate–based cement over the existing alternatives. Indeed, for direct pulp capping, the alternatives were slightly better at the 1-year follow-up. On the other hand, the light-cured silicate-based cement was better than Ca(OH)2 for indirect pulp capping at 1 year. The other comparisons showed no significant differences.
The biggest limitation of this review is the inclusion of a small number of studies, which is compounded when looking at particular comparisons. There were nine studies in total, of which three looked at indirect capping, five at direct capping, and one at both. Similar concerns applied to material comparisons, which were not the same in all studies — for example, only one study considered Biodentine. More long-term research is needed before we can say anything definitive about these materials.
The materials available for this sort of restoration all have limitations; therefore, it is important to develop new candidates. This review suggests that no current existing material is clearly superior to the alternatives; therefore, further research and material development must continue. In the meantime, there is no clear difference in the clinical outcomes among these materials; thus, if the light-cured silicate-based cement has superior handling properties, it is a reasonable choice of material for this kind of treatment.