Vital pulp therapy with a new bioceramic versus calcium hydroxide for young permanent teeth: a meta-analysis

Background: Vital pulp therapy (VPT) helps to promote the continued physiological development of the apical foramen of young permanent teeth apical foramen. iRoot® BP Plus is a newly developed and might be potential to replace the current materials used in VPT. The aim of this study was to compare the outcomes of iRoot® BP Plus and calcium hydroxide (CH) in VPT for young permanent teeth. Methods: A systematic literature search was conducted in PubMed, Cochrane library, Ovid, Wiley, Chinese National Knowledge Infrastructure, SinoMed and China Science, and Technology Journal Database. Studies that evaluated the effects of VPT on pulp exposed young permanent teeth with iRoot® BP Plus or CH were included in the study. Bias evaluation classified literature into subgroups based on bias risk. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess evidence quality, and a fixed-effects model was used to analyze clinical success. Results: A total of 21 studies met the inclusion criteria. Of these, 10 studies reporting outcomes at both 6th and 12th months post-surgery were included in the quantitative analysis, respectively. The clinical success of iRoot® BP Plus was superior to CH (Relative risk (RR) = 1.11, 95% confidence interval (CI): 1.04–1.18; RR = 1.10, 95% CI: 1.03–1.16). Descriptive analysis of dentin bridge (DB) formation and DB thickness showed high heterogeneity between iRoot® BP Plus and CH. Conclusions: Based on low- and moderate-risk-of-bias studies, clinical success of iRoot® BP Plus was higher than CH at the 6th and 12th months post-surgery in pulpotomy for young permanent teeth with crown fracture-induced pulp exposure. DB formation differed significantly between the two materials, warranting further investigation. The PROSPERO Registration: The protocol was registered in PROSPERO (CRD42021278982).