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Hoefler V, Nagaoka H et al. J Dent 2016;54: 25–32

Failure was defined as loss of pulp vitality or restoration failure. These markers are fraught with errors as identified by the investigators. For example, when considering pulp vitality, two of the five studies (2 RCTs, and 3 observational case-series) included in this systematic review used the absence of pulpal symptoms together with a satisfactory radiographic appearance. The other studies recruited cold testing. Not only could these surrogate markers for pulpal health have led to false outcomes, but some of the candidate teeth may have been allocated erroneously to receive such treatment regimens. Other confounders were 1) a lack of quantification of residual diseased biomass (infected dentine) before sealing, and 2) the potential effects dental materials could have had on pulpal health and the longevity of the restoration. A meta-analysis could not be performed.