Clinical and Radiographic Evaluation of Biodentine for Apexogenesis in Young Permanent Mandibular Molars: A Systematic Review and Meta-Analysis.

Abstract

Apexogenesis, a vital pulp therapy, is a crucial treatment option for preserving the vitality of immature permanent teeth affected by caries or trauma. The goal of apexogenesis is to promote the continued development of the root and apex, allowing for a more favorable prognosis. This systematic review and meta-analysis aimed to evaluate the clinical and radiographic outcomes of Biodentine (Septodont, Saint-Maur-des-Fossés, France) for apexogenesis in young permanent mandibular molars. The protocol of the present article was registered in the PROSPERO database and allocated the identification number CRD42024589204. A comprehensive search of PubMed, Scopus, and EMBASE was conducted using a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) keywords to retrieve relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The formulated population, intervention, comparison, and outcome (PICO) question was "What are the clinical and radiographic outcomes for apexogenesis in young permanent mandibular molars?" Six trials were considered for inclusion, with the studies demonstrating that Biodentine could be used in stepwise root canal retreatment with/without coronal seal and indirect pulp treatment. However, the studies also highlighted the importance of individual clinical circumstances and preference in choosing the treatment material. The meta-analysis revealed that Biodentine tends to present slightly higher clinical success rates compared to other calcium compounds, although the difference was not statistically significant. The heterogeneity test revealed moderate variability between studies. Regarding radiographic success rates, the analysis showed that Biodentine tends to have similar radiographic success rates compared to mineral trioxide aggregate (MTA) at six-month and one-year follow-up periods. The overall summary estimate revealed no significant difference between Biodentine and MTA. The heterogeneity test did not detect significant variability between studies at both follow-up periods. Our systematic review suggests that Biodentine has similar clinical and radiographic success rates compared to other calcium compounds and MTA for apexogenesis in young permanent mandibular molars. However, the results should be interpreted with caution due to the moderate heterogeneity and the limited number of studies included.