Objective: Preserving pulp vitality is essential for clinicians in both primary and permanent dentition to maintain maxillofacial growth, development and function. Propolis, a natural resinous substance collected by honeybees from plant exudates and known for its anti-inflammatory, antimicrobial, and tissue-regenerative properties, has been proposed as a biocompatible pulp preservation material. This meta-analysis sought to examine the efficacy of propolis as a material for vital pulp therapy (VPT), comparing it to the established standards including mineral trioxide aggregate (MTA) in direct pulp cap (DPC) and formocresol in pulpotomy.
Materials and Methods: The literature search was performed on June 7, 2025, across multiple databases including PubMed, Web of Science, Embase, and Scopus. From the 122 studies identified, 14 were included in systematic review and 7 in meta-analysis.
Results: The results indicated no significant difference in the failure rate of teeth undergoing DPC between the MTA and propolis groups at the 3-month follow-up. However, at the 6- and 12-month follow-ups, the propolis group demonstrated higher failure rates compared to the MTA group, with Risk Ratio [RR]s of 2.87 (95% Confidence Interval [CI]: 0.94–8.78), p = 0.66 and 2.59 (95% CI: 0.73–9.21), p = 0.79, respectively. Despite these trends, the differences were not statistically significant. Additionally, no significant difference was found between formocresol and propolis groups regarding the clinical failure rate of pulpotomized teeth (RR = 0.54; 95% Confidence Interval [CI]: 0.05–6.20), p = 0.62.
Conclusion: These meta-analyses suggest no statistically significant difference in failure rates between propolis and MTA at the  3, 6- and 12-month follow-ups. However, the 6- and 12-month data show a non-significant trend favoring MTA. These findings should be interpreted cautiously due to the limited sample size and number of studies.