Table 2 Main characteristics of the included studies

Jamali Zavare, F. 2020 [23]

5% CaCl₂

X

3

MTA

1 day: 281 ± 8

Day 7:318 ± 15

Day 14: 761 ± 34

MTA + 5% CaCl₂

1 day: 268 ± 16

Day 7: 607 ± 8

Day 14: 810 ± 15

The addition of CaCl₂ to MTA and CEM cement decreased their setting time and increased pH and Ca²⁺ ion release

Mokhtari, H. 2018 [24]

2.5% wt. Na2HPO4

X

10

1D

WMTA + liquid

50%: 42.15 ± 1.50

60%: 41.33 ± 2.09

70%: 37.79 ± 1.28

Na₂HPO₄ WMTA + liquid

50%: 41.44 ± 1.77

60%: 43.72 ± 1,78

70%: 37.37 ± 1.62

21 D

WMTA + liquid

50%: 63.25 ± 1.96

60%: 59.51 ± 1.50

70%: 57.27 ± 1.26

Na₂HPO₄ WMTA + liquid

50%: 62.39 ± 1.39

60%: 63.96 ± 1.40

70%: 59.78 ± 1.03

Adding 2.5% wt. Na₂HPO₄ to MTA increased samples CS

Mokhtari, H. 2018 [25]

2.5% wt. Na2HPO4

X

30

Final setting time

WMTA = 182.00 ± 57.86

NAMTA = 67.00 ± 14.42

Adding 2.5% wt. Na₂HPO₄ to MTA reduces ST

Kulan, P. 2018 [26]

5% CaCl₂

2.5% Na2HPO4

MTS

3

CaCl₂ 5%

1 d = 100 ± 10

7 d = 74.4 ± 14

21 d = 81.3 ± 14

Na₂HPO₄ 2.5%

1 d = 91.4 ± 31

7 d = 56.1 ± 10

21 = 40.9 ± 15

DW

1 d = 97.8 ± 2.1

7 d = 73.4 ± 1.1

21 d = 38.7 ± 20

All MTA samples increased the proliferation of DPSCs

Ahmed, H. 2018 [14]

10% CaCl₂

MTS

3

24h

200 mg/ml (full concentration)

DW: 21.8 ± 14.5

Fs: 0

72 h

200 mg/ml

DW: 10.1 ± 1.4

Fs: 0

addition of CaCl₂.2H₂O increases the cytotoxicity but enhances the dentinogenic differentiation potential of MTA on DPSCs

Ahmad, A. 2017 [27]

10% CaCl₂

MTT

3

24h

50mg/ml

Fs = 10 ± 5

DW = 17.5 ± 2.5

72h

50mg/ml

Fs = 2.5 ± 2

DW = 20 ± 7.5

DW = 112 ± 22

Admixture of 10% CaCl₂ with MTA has a favorable biological profile towards HPLFs

Sobhnamayan, F. 2017 [28]

20%, 50% and 100% PG

X

15

mean (median) ± SD

DAY 7

100% PG: 20 (20) ± 4.56

50% PG: 22 (22.3) ± 2.52

20% PG: 18 (19.9) ± 6.31

100% DW: 10 (11) ± 3.20

The appropriate concentration of PG could improve the CS of MTA and CEM cement

Marciano, M. A. 2016 [6]

20% PG

X

X

X

10

MTA + DW

Initial setting time (min): 13.60 ± 1.30

Final setting time: 68.33 ± 1.53

MTA + PG

Initial setting time

17.31 ± 1.40

Final setting time

103.00 ± 3.35

The addition of PG to MTA resulted in a longer final setting time than MTA + DW

For MTA + PG, higher values of pH and Ca release were observed in the final period of 168 h

Kulan, P. 2016 [29]

5%, 10% CaCl₂,

2/5% wt. Na2HPO4

MTS

3

CaCl₂ 10%

1D = 51.6 ± 18.6

3 d = 50.6 ± 8

7 d = 28.5 ± 8

CaCl₂ 5%

1 d = 64.1 ± 9

3 d = 70.1 ± 9.8

7 d = 57.1 ± 4.2

Na₂HPO₄ 2.5%

1 d = 45.3 ± 15

3 d = 54.9 ± 8

7 d = 56.4 ± 3

DW

1 d = 67.2 ± 9

3 d = 70.4 ± 9.8

7 d = 57.1 ± 4.2

The samples of MTA mixed with 5% CaCl₂ and Na₂HPO₄ were statistically more biocompatible than the samples of MTA mixed with 10% CaCl₂

Ghasemi, N. 2016 [10]

20% PG

X

N = 15

Mean (SD)

MTA + DW

4 days: 35.85 (12.34)

21 days: 51.22 (18.92)

MTA + PG

4 days: 4.5 (0.67)

21 days: 16 (6.78)

Addition of 20% PG reduces CS of MTA

Zapf, A. M. 2015 [30]

5% CaCl₂

15% Na2HPO4

Ca(OH)² decomposition enthalpy

3

CaCl₂ accelerated the reaction product formation

Prasad 2015 [13]

10% CaCl₂,

X

X

X

10

Final setting time

MTA + DW = 133.10 ± 7.84

MTA + 10% CaCl_{2 =} 25.40 ± 5.58

MTA + 15% Na₂HPO₄ = 31.06 ± 2.91

pH

24h

MTA + DW = 12.54 ± 0.27

MTA + 10% CaCl_{2 =} 11.22 ± 0.15

MTA + 15% Na₂HPO₄ = 12.77 ± 0.09

CS

1day

MTA + DW = 18.40 ± 0.64

MTA + 10% CaCl_{2 = 10.82} ± 1.08

_MTA + 15% Na₂HPO₄ = 12.76 ± 1.60

3day

MTA + DW = 23.74 ± 1.25

MTA + 10% CaCl₂ = 18.72 ± 0.65

_MTA + 15% Na₂HPO₄ = 24.37 ± 1.06

7day

MTA + DW = 36.24 ± 3.33

MTA + 10% CaCl₂ = 33.37 ± 3.18

_MTA + 15% Na₂HPO₄ = 29.32 ± 1.13

10% CaCl₂ and 15% Na₂HPO₄ significantly reduced the setting time of MTA

By adding 10% CaCl₂ and 15% Na₂HPO₄ the pH maintained at a high value

There was no improvement in the CS of the material

Natu, V. P. 2015 [11]

20%, 50% and 100% PG

X

X

X

5

3

2

W/PG (initial setting time)

100/0 = 18.3 ± 0.3

80/20 = 55.9 ± 0.7

50/50 = 191.0 ± 0.5

pH and Ca²⁺ ion release

The numbers are not reported

addition of PG did not improve the chemical and physical properties of MTA

Lee, B. N. 2014 [31]

10% CaCl₂

MTS

10

48h

Relative cell viability

DW: 114 ± 5

Fs: 115 ± 4

There was no significant difference in cell viability between experimental groups

Oloomi, K. 2013 [32]

5% CaCl₂

2.5% wt. Na2HPO4

X

5

1h

DW: not set

CaCl₂: 15.64 ± 2.05

Na2HPO4: 19.66 ± 1.25

3h (sig)

DW: 17.36 ± 3.11

CaCl₂: 41.20 ± 7.08

Na2HPO4: 38.16 ± 3.85

24h

DW: 44.52 ± 3.52

CaCl₂: 48.02 ± 2.93

Na2HPO4: 46.26 ± 3.56

1week

DW: 62.64 ± 3.28

CaCl₂: 60.08 ± 3.60

Na2HPO4: 58.64 ± 5.42

CS of original and accelerated RMTA was not significantly different after one week

Kang, J. Y 2013 [33]

10% CaCl₂

X

XTT

6

Ca²⁺ ion release in 1day

MTA = 3.781 mg/dl

MTA + 10% CaCl₂ = 331.1

XTT

1D

Fs = 70 ± 8.3

DW = 82.5 ± 6.3

4D

Fs = 60 ± 8.3

DW = 85.5 ± 8.3

7D

Fs = 73 ± 18.7

DW = 93 ± 5.2

MTA mixed with 10% CaCl₂ in all groups showed the lowest cell viability at every time point and released a higher amount of Ca²⁺ ions than the other groups

Duarte, M. A. 2012 [8]

20%, 50%, 80% and 100% PG

X

X

X

10

Initial setting time

100% DW = 15 ± 1.4

80% DW 20% = 45 ± 1.8

50% DW 50% PG = 175 ± 1.8

20% DW 80% PG = 403 ± 24.6

100% PG = not set

Final setting time

100% DW = 30 ± 1.6

80% DW 20% = 85 ± 2.2

50% DW 50% PG = 385 ± 8.4

20% DW 80% PG = 661 ± 10.2

100% PG = not set

pH

100% DW = 7.80 ± 0.37

80% DW 20% = 7.44 ± 0.19

50% DW 50% PG = 7.56 ± 0.05

20% DW 80% PG = 7.61 ± 0.22

100% PG = 7.61 ± 0.27

Control = 6.90 ± 0.25

Ca²⁺ ion release

Mg/l

24h

100% DW = 3.10 ± 0.78

80% DW 20% = 4.89 ± 1.01

50% DW 50% PG = 4.40 ± 0.91

20% DW 80% PG = 4.36 ± 2.47

100% PG = 3.93 ± 1.49

Control = 0

The addition of PG to MTA-Angelus increased ST. Also increased the pH and Ca²⁺ ion release during the initial and post-mixing periods

Lee, B. N. 2011 [3]

10% CaCl₂

X

X

X

10

Final setting time

MTA + DW = 108.1 ± 1.6

MTA + 10% CaCl_{2 =} 74.0 ± 0.6b

CS

MTA + DW

1 day = 19.86 ± 3.74

3 day = 37.06 ± 5.10

7 day = 39.08 ± 3.12

MTA + 10% CaCl₂

1 day = 10.79 ± 1.88

3 day = 19.31 ± 1.93b

7 day = 35.30 ± 6.67

pH

24h

MTA + DW = 12.9 ± 0.1

MTA + 10% CaCl₂ = 11.5 ± 0.2

Addition of 10% CaCl₂ to MTA decreased ST

Also decreased CS at all time points for 7 days, but there was no difference in the day 7

The pH of the admixture was significantly lower than the control, but maintained in high level but stable at a high level (pH 11–12)

Jafarnia, B. 2009 [34]

5% CaCl₂

MTT

6

Set MTA

1D

DW: 91 ± 2

Saline: 89 ± 3

Fs: 90 ± 4

2D

DW: 85 ± 4

Saline: 83 ± 5

Fs: 81 ± 7

3D

DW: 83 ± 3

Saline: 81 ± 3

Fs: 84 ± 2

The addition of 5% CaCl₂ does not affect the cytotoxicity of MTA

Bortoluzzi, E. A. 2009 [9]

10% CaCl₂

X

X

36

Initial setting time

WMTA = 12 ± 0.34

WMTA + CaCl₂ = 6 ± 0.50

Final setting time

WMTA = 48 ± 0.87

WMTA + CaCl₂ = 31 ± 2.00

pH

Immediate

DW = 9.77 ± 0.18

10% CaCl₂ = 10.06 ± 0.13

24h

DW = 11.07 ± 0.02

10% CaCl₂ = 11.29 ± 0.09

The addition of CaCl₂ to MTA reduced both the initial and final ST and significantly increased the pH of MTA in the immediate period, at 24 h, and at 72 h

Huang, T. H. 2008 [15]

15%, 10% and 5% Na2HPO4

X

X

3

Final setting time

DW = 151 ± 6

5% = 108 ± 5

10% = 89 ± 4

15% = 26 ± 2

pH

After initial mixing = 11.0

20min = 12.0

Steady point = 13.2

The Na₂HPO₄ solution may be an effective setting accelerator for MTA

Ding, S. J. 2008 [35]

15%, 10% and 5% Na₂HPO₄

X

X

XTT

3

Final setting time

5% = 124 ± 12

10% = 100 ± 14

15% = 28 ± 2

DW = 228 ± 12

pH

Freshly mixed = 11.0

2 h = 12.5

6 h after final setting = 13.5

XTT

1D

15% = 89 ± 11

DW = 92 ± 11

7D

15% = 94 ± 12

DW = 100 ± 13

The ST decreased as the concentrations of Na₂HPO₄ increased

The cell survival rate was higher than 90%

Wiltbank, K. B. 2007 [5]

5% CaCl₂

X

X

3

Initial setting time

WMTA

DW = 74.4 ± 26.1

5% CaCl₂ = 35.1 ± 7.2

GMTA

DW = 67.5 ± 9.9

5% CaCl₂ = 33.3 ± 4.5

pH

Adding 5% CaCl₂ reduced the ST but did not change the pH significantly

Antunes Bortoluzzi, E. 2006 [36]

10% CaCl₂

X

X

3

Ca²⁺ ion release

Mg/dl

immediate

DW = 0.086 ± 0.04

10% CaCl₂ = 0.13 ± 0.06

1h

DW = 0.086 ± 0.05

10% CaCl₂ = 0.13 ± 0.05

24h

DW = 1.16 ± 0.76

10% CaCl₂ = 1.85 ± 0.45

pH

Immediate:

DW = 9.33 ± 0.41

CaCl₂ = 10 ± 0.10

1 h

DW = 10.93 ± 0.38

CaCl₂ = 10.73 ± 0.25

24 h

DW = 11.46 ± 0.14

CaCl₂ = 11.46 ± 0.30

The addition of CaCl₂ to MTA significantly increased Ca2⁺ ion release but did not change the pH significantly at 24h