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However, current guidelines do not favour any specific pulp\u2010capping material, and there is no direct clinical evidence that pulp\u2010capping materials maintain pulp vitality better than placing the restoration directly on dentine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the effectiveness of various biomaterials, including pulp\u2010capping materials and restorative materials applied directly over the remaining dentine, against one another in preserving pulp health in permanent teeth with deep carious lesions without pulp exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>On June 9, 2024, MEDLINE, Embase, Scopus, and Web of Science were searched, supplemented by a screening of clinical trial registries, grey literature, and reference lists. Randomised controlled trials (RCTs) evaluating the effectiveness of indirect pulp capping in permanent teeth affected by deep carious lesions without pulp exposure were included. Risk of bias was assessed using the revised Cochrane risk\u2010of\u2010bias tool for randomised trials (RoB 2). Network meta\u2010analyses and meta\u2010regression were performed using a Bayesian approach and a random\u2010effects model for the primary outcome (loss of pulp vitality), followed by an assessment of confidence in the evidence using the CINeMA framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen RCTs (19 reports; 1039 participants; 1093 teeth; seven biomaterials) were included. Most comparisons involving the dentine bonding agent (DBA; control) were supported by low\u2010confidence evidence and lacked statistical significance; however, they always resulted in RRs favouring the pulp\u2010capping materials. Notably, moderate\u2010confidence evidence indicated that during the second follow\u2010up year Biodentine (RR\u2009=\u20090.00; 95% CI: 0.00\u20130.53) and glass ionomer cement (GIC) (RR\u2009=\u20090.30; 95% CI: 0.00\u20130.99) outperformed the DBA. Moderate\u2010confidence evidence also demonstrated that during the first follow\u2010up year mineral trioxide aggregate (MTA) (RR\u2009=\u20090.30; 95% CI: 0.09\u20130.84) outperformed calcium hydroxide cement. Meta\u2010regression found that neither study\u2010level demographic covariates nor clinical\u2010technique covariates were significantly associated with pulp\u2010vitality outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While most findings in this review were of low confidence, the evidence nevertheless supports the use of pulp\u2010capping materials in permanent teeth with deep carious lesions. Among these materials, Biodentine, MTA, and GIC have the strongest supporting evidence for preserving pulp vitality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO number: CRD42024507641<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70076","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T10:37:08Z","timestamp":1764585428000},"page":"351-371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pulp Response to Materials Used in the Management of Deep Carious Lesions Without Pulp Exposure: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8010-0196","authenticated-orcid":false,"given":"Fahad","family":"BaHammam","sequence":"first","affiliation":[{"name":"College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"King Abdullah International Medical Research Centre  Riyadh Saudi Arabia"},{"name":"Dental Services, King Abdulaziz Medical City, Ministry of National Guard\u2014Health Affairs  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultan","family":"Aldakhil","sequence":"additional","affiliation":[{"name":"College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"King Abdullah International Medical Research Centre  Riyadh Saudi Arabia"},{"name":"Dental Services, King Abdulaziz Medical City, Ministry of National Guard\u2014Health Affairs  Riyadh Saudi Arabia"},{"name":"Adams School of Dentistry University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"Akhil","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry Alasmarya Islamic University  Zliten Libya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Whitworth","sequence":"additional","affiliation":[{"name":"School of Dental Sciences, Faculty of Medical Sciences Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-5712(00)00067-1"},{"key":"e_1_2_14_3_1","first-page":"336","article-title":"Pulpal Inflammatory Responses Following Non\u2010Carious Class V Restorations","volume":"26","author":"About I.","year":"2001","journal-title":"Operative Dentistry"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.33309\/2639-8281.020101"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10005-2979"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2021.07.015"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3484653"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.4317\/jced.59817"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2017.06.025"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2041-1626.2012.00160.x"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-0707.148892"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/iej.13128"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dental.2014.03.012"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2591.2006.01135.x"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-021-02166-3"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2591.1993.tb00769.x"},{"key":"e_1_2_14_17_1","first-page":"e26","article-title":"The Adverse Effect of Self\u2010Etching Adhesive Systems on Dental Pulp After Direct Pulp Capping","volume":"40","author":"Cui C.","year":"2009","journal-title":"Quintessence International"},{"key":"e_1_2_14_18_1","first-page":"5","article-title":"Clinical Conduct of Dentists in the Treatment of Deep Dental Carious Lesions","volume":"21","author":"De Miranda H. 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