Pulpotomy in primary teeth: BiodentineTM versus calcium hydroxide. A systematic review and meta-analysis

Introduction: Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial. Objectives: To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months. Materials and methods: An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023). Results: Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001). Conclusion: BD showed significantly higher clinical and radiographic success than CH in pulpotomy.