Abstract

Objectives: Our objective was to evaluate the effectiveness of techniques and pulp-capping materials used to maintain pulp vitality in extensively carious lesions. Materials and Methods: We conducted an electronic search to collate studies published from 2009 to 2019 that showed clinical and radiological success of pulp-capping materials after removal of deep carious lesions. We performed meta-analysis to compare two calcium silicate-based cements (CSC) for pulp protection and hard tissue barrier formation after vital pulp therapy. Results: Sixteen clinical trials were included in the systematic review. The mean follow-up duration was 26.88 months. The majority of the clinical trials included in this review used complete caries removal technique (CCRT), whereas four studies utilized incomplete caries removal technique (ICRT). ICRT reported lower risk of pulp exposure than CCRT. One-step ICRT with absence of pulpal inflammation enhanced the results. Direct pulp-capped teeth with opened apex, minute exposure with no pulpal inflammation, and well-sealed restoration showed higher success in pulp healing. The risk of bias widely differed between studies. Meta-analysis reported no significant difference between both materials in different pulp therapies. Conclusions: ICRT had a significantly higher success rate than CCRT. The clinical observation, extent and depth of caries, location and size of pulp exposure, pulpal bleeding, and patient age were predictive factors used to assess the success rate of deep caries removal techniques. There is no significant difference in clinical performance between different CSC. Clinical Relevance: Incomplete CRT seems suitable to treat deep carious lesions. No specific CSC can be recommended.