Effects of calcium silicate cements on dental pulp cells: A systematic review.

OBJECTIVES: The aim of this study was to evaluate the biocompatibility, odontogenic, angiogenic and inflammatory effects of commercially available calcium silicate cements (CSCs) on dental pulp cells. DATA: In vitro, animal and human in vivo studies reporting on biocompatibility, odontogenic, angiogenic and inflammatory effects of CSCs on dental pulp cells were screened using a systematic review, and a descriptive analysis performed. SOURCES: We searched Medline via PubMed, Google Scholar and Scopus, followed by hand search and cross-referencing. STUDY SELECTION: From 7007 identified studies; 38 were included. At least one MTA-type product was evaluated in each study, with ProRooT MTA being the most frequently assessed, followed by Biodentine and iRoot BP Plus. Nearly all CSCs exhibited a high biocompatibility and induced odontogenic and angiogenic effects. There was great heterogeneity in methodology and findings. In vivo, effects differed between materials; also, differences between human or animal pulp cell effects were noted. In vitro, the dilution of the cement, the period of exposure to the CSC and specific effect measure influenced the outcomes. No CSC was clearly superior to alternatives. CONCLUSIONS: All commercially available CSCs are biocompatible, exhibit comparable and favorable effects on odontogenic differentiation of dental pulp cells in vitro and can efficiently enhance dentin bridge formation of high quality with minimal inflammation. No specific CSC can be recommended. CLINICAL SIGNIFICANCE: Most calcium-silicate-cements are highly biocompatible, promoting pulp healing at minimal pulp inflammation. While the variation in methodology limits comparisons across studies, it seems that nearly all CSCs show favorable effects on dental pulp cell. We are unable to recommend one specific material over the others, though.