Comparative Biological Properties of Resin-Modified Calcium Silicate Cements on Dental Stem Cells: A Systematic Review of In Vitro Studies

Objectives: This systematic review aimed to qualitatively synthesize the available in vitro evidence on the cytocompatibility and bioactivity of resin-modified calcium silicate ce-ments in contact with human dental stem cells and cells from other sources. Materials and Methods: An electronic search was performed in five databases. In vitro studies evalu-ating the biological properties of resin-modified calcium silicate cements were included. Cytocompatibility outcomes comprised cell viability, cytotoxicity, migration, prolifera-tion, adhesion, and apoptosis. Bioactivity outcomes comprised mineralization potential and the expression of osteo/odontogenic differentiation markers. A qualitative synthesis of the methodology and results of the selected studies was performed, together with an assessment of methodological and reporting quality using a modified CONSORT checklist for in vitro studies on dental materials. Results: Thirteen articles were included in the qualitative synthesis. Overall, the evaluated resin-modified calcium silicate cements showed reduced cytocompatibility compared with control groups, particularly regarding cell viability and migration. However, bioactivity findings were generally favorable, with several materials maintaining mineralization potential and the expression of markers associated with osteo/odontogenic differentiation. Conclusions: Resin-modified calcium silicate cements showed formulation-, concentration-, and time-dependent biological responses. Although some dual-cure materials retained mineralization potential and osteo/odontogenic activity, resin-containing formulations generally exhibited lower cytocompatibility than hydraulic calcium silicate cements. Favorable bioactivity should therefore not be interpreted as evidence of overall biological suitability, particularly when direct interaction with pulp tissue is expected. Clinical Relevance: Resin-modified calcium silicate cements should be used cautiously in vital pulp therapy, especially when direct interaction with pulp cells is expected.