Iranian Endodontic Journal

Abstract

Introduction: To systematically evaluate and compare the in vitro cytotoxic effects of three calcium silicate-based cements [Mineral Trioxide Aggregate (MTA), Biodentine, and Calcium Enriched Mixture (CEM) Cement], focusing on their biocompatibility with human dental pulp cells in vital pulp therapy (VPT). Materials and Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane, ProQuest, Wiley, and Ovid (including Embase) for in vitro studies published up to February 2023. Studies evaluating cytotoxicity via cell viability assays (e.g., MTT) were included. Results: Among 8,004 screened records, 32 studies met the inclusion criteria, with 11 included in the meta-analysis. Overall, no significant differences in cytotoxicity were identified among Mineral Trioxide Aggregate (MTA), Biodentine, and Calcium-Enriched Mixture (CEM) cement. Nevertheless, undiluted MTA and Biodentine at a 1:4 dilution were associated with a statistically significant reduction in cell viability at 48 hours (P<0.05). No other concentrations or exposure durations showed significant cytotoxic effects. CEM cement consistently demonstrated favorable biocompatibility across the included studies. Conclusion: These findings indicate that MTA, Biodentine, and CEM cement generally exhibit acceptable in vitro biocompatibility for vital pulp therapy.  Their biological responses may be influenced by material concentration and exposure duration, emphasizing the importance of careful and controlled clinical application.