How does the pulpal response to Biodentine and ProRoot mineral trioxide aggregate compare in the laboratory and clinic?

Introduction Vital-pulp-treatment (VPT) procedures are biologically-based therapies aimed at preserving pulp-vitality. Historically, calcium-hydroxide was the 'gold-standard' VPT-material, however, recently a tricalcium-silicate material, ProRoot-mineral-trioxide-aggregate (MTA) has emerged as the material of choice for pulpal-application in permanent teeth. ProRoot-MTA also has drawbacks, including long-setting time, handling-difficulties and post-application crown-discolouration. Relatively recently, another tricalcium-silicate material, Biodentine, has been indicated for VPT. Objectives The aim of this review was to compare from relevant laboratory, biological and clinical-studies whether Biodentine is a better material than ProRoot-MTA for use in pulpal applications in permanent teeth. Methods A comprehensive MEDLINE search was used to identify manuscripts, which directly compared the materials in relation to dental-pulp applications. Results Literature analysis demonstrated that most of the comparative research is in vitro cell-culture studies demonstrating a wide range of methodologies and conflicting findings. In contrast there is a paucity of clinical studies comparing the pulpal response to the materials in permanent teeth. Histological evidence suggests similar pulpal responses, while clinical outcome studies, although preliminary, show equally high material efficacy. Other physical characteristics diverge with Biodentine setting quicker and staining less than ProRoot-MTA, however, the radiopacity of Biodentine is below testing standards making identification difficult. Conclusions Biodentine does present an evidence-based biologically-based alternative VPT material to ProRoot-MTA. Future research should be directed at long-term clinical outcome studies and the interaction of Biodentine with the dentine matrix.