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Bakland LK, Andreasen JO. Dent Traumatol 2012; 28: 25–32

In the field of medicine, particularly psychiatry, prescribing patterns are influenced by many factors, some of which are cyclical and even idiosyncratic. Are there parallels here with the use of dental medicaments? Calcium hydroxide was popularised in the 1920s and subsequently became almost a panacea for the treatment of dento-pulpal perturbations. Nevertheless calcium hydroxide 1) is tardy at inducing hard tissues (2-3 months for pulp capping), 2) the quality of the 'bridge' is sub-optimal allowing subsequent bacterial leakage and, 3) calcium hydroxide weakens residual dentine leading 'rather frequently to cervical root fractures'. During the past 20 years, MTA has taken over from calcium hydroxide. However, MTA may also weaken dentine and in addition has a 'staining effect' on it. Its true efficacy can only be established by carrying out RCTs.