Clinical and radiographic outcomes of pulpotomy materials in permanent teeth: a systematic review of calcium hydroxide, MTA, biodentine, and iRoot BP plus

Document Type

Review

Publication Date

12-1-2026

Abstract

Background: Pulpotomy is increasingly considered a viable treatment for permanent teeth with carious or traumatic pulp exposure, particularly when preserving pulp vitality is desired. Materials such as Calcium Hydroxide (CH), Mineral Trioxide Aggregate (MTA), Biodentine, and iRoot BP Plus have distinct properties. Although many studies report favorable outcomes, direct comparisons between these materials in permanent teeth remain limited, and evidence on their relative long-term performance is inconclusive. This systematic review aimed to evaluate and compare the clinical and radiographic outcomes of CH, MTA, Biodentine, and iRoot BP Plus in permanent teeth, providing evidence to guide material selection in clinical practice. Methods: A comprehensive search of Cochrane, PubMed, ScienceDirect, Google Scholar, and Sage Journals was conducted for studies published from 2000 up to mid 2025 using keywords such as Pulpotomy, Vital Pulp Treatment (VPT), Calcium Hydroxide (CH), MTA, Biodentine, and iRoot BP Plus. The review followed PRISMA 2020 guidelines and the PICOS framework. The quality of randomized controlled trials was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, while cohort and case reports were evaluated using the JBI checklist. Results: A total of 1,543 studies were initially identified, and 22 met the inclusion criteria, with follow-up periods ranging from 6 to 45.6 months. Risk of bias assessments indicated sufficient quality for data extraction. MTA demonstrated consistently high success rates (80%–100%), with several studies reporting complete clinical and radiographic success. iRoot BP Plus also showed excellent outcomes (84.6%–100%), with near perfect results in multiple studies. Biodentine achieved success rates from 70.7% to 100%, with most studies above 90%. CH showed more variable performance (37.5%–99.8%), though some trials reported outcomes comparable to MTA. Conclusion: MTA and iRoot BP Plus demonstrated superior clinical and radiographic success, with Biodentine as a strong alternative. Although CH showed lower success rates, its long history of use supports its continued relevance. These findings should be interpreted cautiously due to study heterogeneity, the limited number of high-quality trials, and short follow-up in some cases. Further well-designed randomized controlled trials with long-term follow-up are needed to confirm these results and guide material selection for pulpotomy in permanent teeth.

Keywords

Biodentine, Calcium hydroxide, IRoot BP plus, clinical outcome, success rate, systematic review, MTA, Vital pulp therapy (VPT), pulpotomy

Publication Title

BMC Oral Health

ISSN

1472-6831

DOI

10.1186/s12903-025-07322-2

Volume

26

Issue

1

Publisher

BioMed Central

Link to Full Text

Share

COinS