Systematic review and meta analysis of first and second generation bioceramic materials in primary dentition pulpotomies

Calcium silicate-based materials are considered the gold standard in vital pulp therapy due to their ability to induce favorable repair responses. Mineral trioxide aggregate (MTA), a first-generation bioceramic cement, has demonstrated high clinical and radiographic success rates but is associated with disadvantages such as coronal discoloration, difficult handling, and long setting time. To address these issues, second-generation bioceramic cements were developed with improved chemical composition, radiopacifiers, and handling properties. This systematic review followed the PRISMA guidelines and included a comprehensive search of PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS, and TRIP databases from 2011 up to August 2023. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Meta-analysis was performed using a random-effects model to compare the clinical and radiographic success rates of first- and second-generation bioceramics in pulpotomies of primary teeth, with heterogeneity assessed using the I² statistic. A total of 14 studies were included, involving 1128 primary molars from 637 children. The meta-analysis revealed no statistically significant differences in clinical or radiographic success rates between first- and second-generation bioceramics across follow-up periods of up to 24 months. Both first- and second-generation bioceramics demonstrate comparable clinical and radiographic success in pulpotomies of primary teeth. The choice of material should be guided by clinical considerations and practitioner preference, as no significant differences in outcomes were observed.