Recent Advances in Calcium Silicate-Based Cements in Endodontic Therapy: A Systematic Review of Their Applications

Abstract

Background: Calcium silicate-based cements (CSCs) are widely used in endodontics because of their favourable physical and biological properties. Their formulations and clinical applications have expanded considerably in recent years. This study systematically reviews the evidence on the use of CSCs in contemporary endodontic applications and summarizes their clinical outcomes.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published from 2016 to 2026. Studies were eligible if they were original primary research directly evaluating CSCs in vital pulp therapy, root-end filling/endodontic microsurgery, or root and furcation perforation repair. Reviews, case reports or series, studies focused exclusively on material characterization, and studies without a relevant endodontic application were excluded. Thirty-seven studies were included in the qualitative synthesis.

Results: The included studies predominantly evaluated CSCs in vital pulp therapy, followed by root-end filling and endodontic microsurgery and root or furcation perforation repair. MTA was the most extensively investigated material, while Biodentine, iRoot BP Plus, TheraCal, and other bioceramic materials were also evaluated. Overall, CSCs demonstrated favorable clinical and biological outcomes across the investigated applications. In comparative studies, several newer materials demonstrated clinical outcomes comparable to MTA, although consistent superiority of any single material was not established. Preclinical studies further demonstrated favorable biocompatibility, mineralized tissue formation, reduced inflammation, and tissue repair associated with several CSC formulations.

Conclusion: The results show that CSCs can be widely used in modern endodontics and give good results in several treatment modalities.More good clinical trials with standardized outcome measures and longer follow-up are needed to determine the comparative effectiveness and long-term performance of newer CSC formulations.