Mineral trioxide aggregate versus formocresol pulpotomy: a systematic review and meta-analysis of randomized clinical trials

Abstract

Objectives: This study systematically reviewed randomized clinical trials (RCTs) investigating the effectiveness of primary molar pulpotomies with mineral trioxide aggregate (MTA) and formocresol. The study also aimed to assess the possible association of reported prognostic factors on the success rate and relative risk using meta-regression analysis.

Materials and methods: A comprehensive literature search using Medline, EMBASE, and Cochrane Central databases up to March 2013 was conducted. After scoring and data extraction of qualified trials (n = 19, representing 1,585 patients), meta-analyses were performed using Mantel-Haenszel model and inverse variance-weighted method.

Results: The results revealed that MTA is more effective than formocresol in primary molars pulpotomy, resulting in a lower failure rate with a relative risk of 0.26 (CI, 0.13-0.49), 0.37 (CI, 0.19-0.70), and 0.41 (CI, 0.25-0.68) for 6-, 12-, and 24-month follow-ups (test for statistical heterogeneity: p = 0.99, p = 0.98, and p = 0.23), respectively. Compared to amalgam restoration, success rate was significantly greater with SS crown (P < 0.05); however, no evidence for association between other reported prognostic factors such as selection of first/second molar, upper/lower jaw, gender, and various follow-up times with treatment success was observed.

Conclusions: Based on the quality, homogeneity, and sufficient number of included RCTs, primary molar pulpotomy with MTA can produce a higher success rate in comparison with formocresol.

Clinical relevance: When compared with formocresol, MTA pulpotomy is superior in treating primary molars.