Mineral trioxide aggregate (MTA) and Biodentine, introduced in the 1990s and 2010, are routinely used in primary teeth pulpotomy, yet their relative success remains unclear.

This paper aims to compare Biodentine and MTA efficacy in primary teeth pulpotomy over a 6 to 24-month follow-up, assessing clinical, radiographic, and endodontic outcomes.

Randomized controlled trials (RCTs) published from March 2010 to March 2025 comparing the efficacy of Biodentine and MTA in primary teeth pulpotomy with ≥6-month follow-up were included. Their efficacy was determined by clinical and radiographic success rates, as well as 2 endodontic outcomes of root resorption and pulp canal obliteration (PCO). A bivariate and random-effect meta-analysis determined the pooled risk ratios (RRs) of the outcomes.

Eleven RCTs comprising 649 patients and 706 primary teeth were included. Clinical success rates were comparable between Biodentine and MTA at 6 months (RR = 1.00; 95% CI: 0.98-1.02), 12 months (RR = 1.01; 95% CI: 0.97-1.04), 18 months (RR = 0.99; 95% CI: 0.95-1.04), and 24 months (RR = 1.00; 95% CI: 0.94-1.07), with no observed heterogeneity (I² = 0%). Radiographic success rates also showed no significant differences at 6 months (RR = 0.99; 95% CI: 0.97-1.02), 12 months (RR = 1.00; 95% CI: 0.96-1.03), 18 months (RR = 1.01; 95% CI: 0.94-1.09), and 24 months (RR = 1.01; 95% CI: 0.94-1.08). Root resorption and pulp canal obliteration occurred at comparable rates across over 6, 12, and ≥18 months of follow-ups.

Biodentine and MTA exerted comparable success rates in primary teeth pulpotomy at follow-ups of up to 2 years.

Primary teeth pulpotomy

Biodentine

Mineral trioxide aggregate

Clinical outcomes

© 2025 The Author(s). Published by Elsevier Inc.