Performance and Prospects of Bioactive Endodontic Cements: A Comparative Mechanobiological Assessment of Mineral Trioxide Aggregate and Calcium-Enriched Mixture Cement

Abstract

The success of endodontic therapy critically depends on the effective sealing and biocompatibility of root canal filling materials. This has driven a transition from traditional options towards bioactive alternatives, notably Mineral Trioxide Aggregate (MTA) and Calcium-Enriched Mixture (CEM) Cement, which offer enhanced biological interactions. This study provides a narrative review and performance evaluation of MTA and CEM Cement, with focused analysis of their applications in vital pulp therapy (VPT) and root-end filling (REF). An in-depth examination of their chemical, physical, and biological properties was conducted through a systematic synthesis of extant literature, critically appraising sealing ability, biocompatibility, inflammatory response modulation, antimicrobial efficacy, and long-term clinical success. Both MTA and CEM Cement demonstrate superior biocompatibility, excellent sealing capabilities, and the ability to stimulate hard tissue formation compared to traditional materials. MTA is well-established with a proven track record, though it suffers from a prolonged setting time and potential tooth discoloration. CEM Cement exhibits comparable or superior bioactive properties, including rapid setting, optimal flow, and significant hydroxyapatite generation, leading to promising clinical outcomes in VPT. Evidence confirms that bioactive materials significantly outperform traditional options, validating both MTA and CEM Cement as effective choices, with selection dependent on clinical scenarios and material properties.