Comparative evaluation of calcium-enriched mixture and mineral trioxide aggregate in vital pulp therapy of molars: A systematic review

Vital pulp therapy (VPT) promotes pulp healing and prevents bacterial contamination. Mineral trioxide aggregate (MTA) improves outcomes but has drawbacks such as difficult handling, long setting time, discoloration, and cost. Calcium enriched mixture (CEM) cement, introduced as an alternative, offers easier handling, faster setting, and comparable biological properties. This systematic review evaluated the effectiveness of CEM versus MTA in VPT of primary and permanent molars. The review protocol was registered in the PROSPERO database (Registration Number: CRD420251030455). A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library was performed for randomized controlled trials (RCTs) published between January 2005 and December 2024. Eligible studies compared CEM with MTA or calcium hydroxide in VPT. Of 522 studies screened, 8 RCTs met the inclusion criteria. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 tool. Clinical outcomes were evaluated by postoperative pain (Visual Analog Scale and Numeric Rating Scale), and radiographic outcomes by periapical index. Both CEM and MTA significantly reduced postoperative pain and showed high success rates in direct pulp capping, pulpotomy, and pulpectomy. No significant difference was observed between the two biomaterials. CEM and MTA both demonstrated favorable results in preserving pulp vitality and achieving long term success. While MTA remains widely used due to its proven biocompatibility, CEM offers comparable efficacy with advantages such as easier handling, faster setting, and reduced discoloration. Further long term multicenter RCTs are needed to establish standardized protocols.