Vital Pulp Therapy Using Resin-Modified Calcium Silicate for Permanent Teeth with Reversible Pulpitis: A Systematic Review
DOI:
https://doi.org/10.19166/med.v15i3.11626Keywords:
Dental pulp capping, Resin-modified calcium silicate, Reversible pulpitisAbstract
Background:
Resin-modified calcium silicate (RMCS) cements combine the bioactivity of traditional calcium silicates with the superior handling properties of resins. This systematic review and meta-analysis evaluate the clinical and radiographic success of RMCS compared to established capping materials in permanent teeth diagnosed with reversible pulpitis.
Methods:
Following PRISMA 2020 guidelines, comprehensive searches were conducted across PubMed, EMBASE, Scopus, and Web of Science from inception through April 11, 2026. We included randomized controlled trials assessing vital pulp therapy (indirect and direct pulp capping) using RMCS against active comparators (calcium hydroxide, Biodentine) with at least six months of follow-up. Risk ratios were pooled utilizing the inverse variance method with a DerSimonian-Laird random-effects model.
Result:
Six randomized controlled trials met the criteria for quantitative synthesis. Pooled data indicated that RMCS materials demonstrated robust overall clinical and radiographic success rates across diverse vital pulp therapy procedures at 12- to 36-month follow-ups. Subgroup analyses revealed that while RMCS performed equivalently to calcium hydroxide in indirect pulp capping, it exhibited slightly varied success rates when compared to pure calcium silicate cements like Biodentine during direct pulp capping, though statistical heterogeneity was observed across these subsets.
Conclusions:
RMCS serves as a highly effective and clinically pragmatic biomaterial for vital pulp therapy in teeth with reversible pulpitis. While providing excellent outcomes for indirect treatments, clinicians should weigh subtle performance differences against pure calcium silicates when managing direct pulp exposures.
References
1. Brizuela M, Bordoni B. Anatomy, Head and Neck, Dental Pulp. StatPearls, Treasure Island (FL): StatPearls Publishing; 2026.
2. Xie Z, Shen Z, Zhan P, et al. Functional Dental Pulp Regeneration: Basic Research and Clinical Translation. Int J Mol Sci 2021;22:8991. https://doi.org/10.3390/ijms22168991.
3. Bjørndal L, Simon S, Tomson PL, et al. Management of deep caries and the exposed pulp. Int Endod J 2019;52:949–73. https://doi.org/10.1111/iej.13128.
4. Song M, Yu B, Kim S, et al. Clinical and Molecular Perspectives of Reparative Dentin Formation: Lessons Learned from Pulp-Capping Materials and the Emerging Roles of Calcium. Dent Clin North Am 2017;61:93–110. https://doi.org/10.1016/j.cden.2016.08.008.
5. Yalcin M, Arslan U, Dundar A. Evaluation of antibacterial effects of pulp capping agents with direct contact test method. Eur J Dent 2014;8:95–9. https://doi.org/10.4103/1305-7456.126256.
6. Aminozarbian M-G, Barati M, Salehi I, et al. Biocompatibility of mineral trioxide aggregate and three new endodontic cements: An animal study. Dent Res J (Isfahan) 2012;9:54–9. https://doi.org/10.4103/1735-3327.92944.
7. Cervino G, Laino L, D’Amico C, et al. Mineral Trioxide Aggregate Applications in Endodontics: A Review. Eur J Dent 2020;14:683–91. https://doi.org/10.1055/s-0040-1713073.
8. Rodríguez-Lozano FJ, Pérez-Guzmán N, García-Rios P, et al. In Vitro Evaluation of Novel Resin-Modified Calcium Silicate Cements for Minimally Invasive Vital Pulp Therapy. Int Dent J 2026;76:109299. https://doi.org/10.1016/j.identj.2025.109299.
9. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021:n71. https://doi.org/10.1136/bmj.n71.
10. Deshmukh SN, Shenoy VU, Margasahayam SV, et al. Comparative Evaluation of Efficacy of Resin-modified Glass Ionomer Cement and Light-curable Tricalcium Silicate Cement as Indirect Pulp Capping Materials: A Randomized Clinical Trial. The Journal of Contemporary Dental Practice 2024;25:1141–7. https://doi.org/10.5005/jp-journals-10024-3797.
11. Foscarini AV, Barros LS, Turssi CP, et al. Flexural Strength of Conventional or Bulk-fill Resin Composite Repaired with High- or Low-viscosity Restorative Materials. Oper Dent 2023;48:677–88. https://doi.org/10.2341/22-125-L.
12. Peskersoy C, Lukarcanin J, Turkun M. Efficacy of different calcium silicate materials as pulp-capping agents: Randomized clinical trial. Journal of Dental Sciences 2021;16:723–31. https://doi.org/10.1016/j.jds.2020.08.016.
13. Rahman B, Goswami M. Comparative Evaluation of Indirect Pulp Therapy in Young Permanent Teeth using Biodentine and Theracal: A Randomized Clinical Trial. The Journal of Clinical Pediatric Dentistry 2021;45:158–64. https://doi.org/10.17796/1053-4625-45.3.3.
14. Yavuz Y, Kotanli S, Dogan MS, et al. Examination of 6 and 12 month follow-up of calcium hydroxide and calcium silicate materials used in direct and indirect pulp capping. Advances in Clinical and Experimental Medicine 2025;34:1289–98. https://doi.org/10.17219/acem/194504.
15. Zhang L, Yin L, Wu J, et al. Clinical influencing factors of vital pulp therapy on pulpitis permanent teeth with 2 calcium silicate-based materials: A randomized clinical trial. Medicine 2024;103:e38015. https://doi.org/10.1097/MD.0000000000038015.
16. Goldberg M, Njeh A, Uzunoglu E. Is Pulp Inflammation a Prerequisite for Pulp Healing and Regeneration? Mediators Inflamm 2015;2015:347649. https://doi.org/10.1155/2015/347649.
17. Pohl S, Akamp T, Smeda M, et al. Understanding dental pulp inflammation: from signaling to structure. Front Immunol 2024;15:1474466. https://doi.org/10.3389/fimmu.2024.1474466.
18. Kunert M, Piwonski I, Hardan L, et al. Dentine Remineralisation Induced by “Bioactive” Materials through Mineral Deposition: An In Vitro Study. Nanomaterials (Basel) 2024;14:274. https://doi.org/10.3390/nano14030274.
19. Pedano MS, Li X, Yoshihara K, et al. Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents towards Human Tooth-Pulp Cells: A Systematic Review of In-Vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials. Materials (Basel) 2020;13:2670. https://doi.org/10.3390/ma13122670.
20. Marashdeh M, Lévesque C, Friedman S, et al. Interfacial Biomaterial–Dentin Bacterial Biofilm Proliferation and Viability Is Affected by the Material, Aging Media and Period. Dentistry Journal 2022;10:33. https://doi.org/10.3390/dj10030033.
21. Palczewska-Komsa MP, Gapiński B, Nowicka A. The Influence of New Bioactive Materials on Pulp-Dentin Complex Regeneration in the Assessment of Cone Bone Computed Tomography (CBCT) and Computed Micro-Tomography (Micro-CT) from a Present and Future Perspective-A Systematic Review. J Clin Med 2022;11:3091. https://doi.org/10.3390/jcm11113091.
22. Sari C, Bala O, Akgul S, et al. Effect of using different materials and restorative techniques on cuspal deflection and microleakage in endodontically treated teeth. BMC Oral Health 2025;25:302. https://doi.org/10.1186/s12903-025-05693-0.
23. Eraković M, Duka M, Bekić M, et al. Anti-inflammatory and immunomodulatory effects of Biodentine on human periapical lesion cells in culture. Int Endod J 2020;53:1398–412. https://doi.org/10.1111/iej.13351.
24. Hanna SN, Perez Alfayate R, Prichard J. Vital Pulp Therapy an Insight Over the Available Literature and Future Expectations. Eur Endod J 2020;5:46–53. https://doi.org/10.14744/eej.2019.44154.
25. Asgary S, Roghanizadeh L, Eghbal MJ, et al. Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years. Sci Rep 2024;14:2063. https://doi.org/10.1038/s41598-024-52654-8.
26. Khijmatgar S, Bellucci G, Creminelli L, et al. Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights. Int J Mol Sci 2024;25:1357. https://doi.org/10.3390/ijms25021357.
27. Gillen BM, Looney SW, Gu L-S, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod 2011;37:895–902. https://doi.org/10.1016/j.joen.2011.04.002.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Vikri Sandya Dhika, Veriantara Satya Dhika
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website). The final published PDF should be used and bibliographic details that credit the publication in this journal should be included.
