Clinical and Radiographic Outcomes of Calcium-Silicate-Based Materials in Primary-Tooth Pulpotomy: An Umbrella Review

Background/Objectives: Calcium-silicate-based materials, many of which are commonly classified as bioceramics, are increasingly used for pulpotomy in vital primary teeth. This umbrella review synthesized systematic reviews and meta-analyses evaluating their clinical and radiographic outcomes. Methods: Eligible reports were systematic reviews of human primary-tooth pulpotomy involving calcium-silicate-based materials and reporting clinical and/or radiographic outcomes. MEDLINE/PubMed, Embase, and Scopus were searched from inception through June 2026. Methodological quality was appraised using AMSTAR-2, overlap was quantified using the Corrected Covered Area (CCA), and certainty was assessed using a GRADE-informed approach. Findings were integrated through structured narrative synthesis and review-level functional meta-synthesis. The protocol was registered in PROSPERO (CRD420261338396). Results: Eleven systematic reviews were included, comprising 78 unique primary-study reports and 180 study occurrences; aggregate participant totals were not calculated because of primary-study overlap. AMSTAR-2 confidence ranged from critically low to moderate, and overlap was high (CCA 13.1%). MTA and Biodentine showed broadly comparable clinical and radiographic outcomes through 24 months. Evidence for Biodentine versus formocresol was less consistent: one meta-analysis reported more favorable radiographic outcomes with Biodentine; whereas, another found no substantial difference; clinical superiority was not consistently demonstrated. Comparisons with ferric sulfate were generally inconclusive, and evidence for newer calcium-silicate-based formulations remained limited. No material demonstrated sustained long-term superiority. Certainty was predominantly low, with very low certainty for several sparsely studied comparisons. Conclusions: Contemporary calcium-silicate-based materials show high clinical and radiographic success in vital primary-tooth pulpotomy, but comparative conclusions remain constrained by methodological limitations, high overlap, and limited certainty.