Clinical Outcomes of Immediate and Delayed Composite Restorations After Pulp Capping with Biodentine: A Systematic Literature Review

Background: Biodentine is widely used in vital pulp therapy due to its bioactivity and biocompatibility. However, treatment success depends not only on the material but also on the restorative approach. Clinically, Biodentine may be used as a temporary bulk restoration before delayed placement of a composite or immediately covered with a definitive composite. Aim: To evaluate clinical outcomes reported for delayed composite placement after temporary Biodentine restoration and immediate composite restoration following Biodentine pulp capping in permanent teeth. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261325248). Searches were performed in multiple databases. Clinical studies on Biodentine pulp capping reporting outcomes for either delayed or immediate composite restoration were included. Study selection, data extraction, and quality assessment were performed by two reviewers using Joanna Briggs Institute tools. Fourteen studies (8 randomized controlled trials and 6 cohort studies) were included. Results: Considerable heterogeneity was observed in study design and clinical protocols. Most included studies evaluated one of the two strategies separately, so the review results could not be interpreted as a direct comparison. In direct pulp capping, success rates ranged from 74–100% (delayed) and 79–100% (immediate). In indirect pulp capping, success rates ranged from 77.8–88% (delayed) and 80–95.2% (immediate). Meta-analysis was not feasible. Conclusion: Based on low certainty of evidence, both strategies show favorable outcomes, but current evidence does not support the superiority of either approach. Further well-designed comparative studies are needed.