Clinical applications and classification of calcium silicate-based cements based on their history and evolution: a narrative review.

Abstract

Objectives: The objective of this narrative review was to analyze the evolution of the calcium silicate-based cement (CSC) products since 1993 and classify them to better understand their appropriate use in clinical practice and foster innovation in dental material development.

Materials and methods: A narrative review of the relevant literature was conducted, collecting findings from computerized databases (PubMed, Science Direct, SCOPUS, and Web of Science) to provide historical background, classification, and modifications of CSCs published between 1993 and 2024.

Results: We classified CSCs into six distinct generations based on previous literature. This classification revealed that the improvement in CSC's drawbacks, especially in physio-chemical properties, have led to the development of novel CSCs products. It also exhibited little to no variation in the bioactivity of CSCs across different generations and raised concerns regarding the biocompatibility of resin-modified CSC.

Conclusions: No CSC has yet emerged as a potential gold-standard material for endodontic treatments. Therefore, clinical applications tailored to the characteristics of each generation of CSCs are essential. Future advancements are anticipated to enable CSCs to induce the regeneration of tissues such as dentin, cementum, periodontal ligament, and dental pulp by incorporating regulatory signals.

Clinical relevance: This comprehensive classification system would assist clinicians in choosing the appropriate CSCs for various clinical situations by considering critical factors. This systematic approach enables clinicians to rely on evidence-based material selection rather than marketing claims. Furthermore, the insights into their evolution, classification, and clinical applications would fill a knowledge gap for clinicians and researchers.