A systematic review and meta-analysis evaluating the success of different protective liners after performing selective caries removal

TL;DR

This study compares different protective liners used after removing tooth decay and finds no significant difference in their effectiveness in preserving pulp health.

Contribution

The study provides a meta-analysis comparing various protective liners after selective caries removal, revealing no significant differences in clinical outcomes.

Findings

No significant difference in pulp vitality preservation between RMGIC and calcium hydroxide.

Biodentine, Theracal, and MTA showed similar effectiveness to calcium hydroxide.

Evidence quality ranged from very low to moderate across the studies included.

Abstract

This systematic review appraised clinical trials that evaluated the efficacy of various protective liners on preserving pulp vitality after selective caries removal.

This systematic review adhered to the Preferred Reporting Items for Systematic Review and Meta-analysis principles. The Population, Intervention, Comparison, Outcome and Study Design (PICOS)strategy was intended to encompass individuals with deep carious lesions in permanent teeth. Studies comparing the efficacy of calcium hydroxide with glass ionomer cement (GIC) or resin-modified glass ionomer (RMGIC) or mineral trioxide aggregate (MTA) or Biodentine or Theracal on pulp vitality after selective caries removal having 1 year of follow-up were included.

After full-text analysis, eight studies (n = 8 trials, 678 teeth) were included. The results of meta-analysis of seven studies indicated that there was no statistically significant difference between RMGIC and calcium hydroxide (risk ratio [RR] = 0.98; 95% Confidence limits (CL) = 0.92 to 1.06; P = 0.68), Biodentine and calcium hydroxide (RR = 1.05; 95% CL = 0.94 to 1.18; P = 0.40), Theracal and calcium hydroxide (RR = 1.02 ; 95% CL = 0.97 to 1.07; P = 0.48) and MTA and calcium hydroxide (RR = 1.13; 95% CL = 0.95 to 1.34; P = 0.17). Sensitivity analysis also showed no significant difference between Theracal and calcium hydroxide. Heterogeneity was moderate for comparison between MTA and calcium hydroxide (I² = 54%). Two studies were with low risk of bias, and six studies were classified as having some concerns. Evidence ranged from very low to moderate.

There were no differences in clinical outcomes between RMGIC and calcium hydroxide, Biodentine and calcium hydroxide, Theracal and calcium hydroxide and MTA and calcium hydroxide. Thus, the findings suggest that treatment success is not significantly influenced by the type of protective liner employed.

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