Cost efficiency of calcium silicate and glass ionomer cements in pulpotomies of first mandibular primary molars

Background: Calcium silicate cements (CSCs) and glass ionomer cements (GICs) are widely used in pulpotomy procedures because of their favorable biocompatibility, adhesive properties, and mechanical performance. However, limited evidence is available regarding the economic implications of their clinical use. This study evaluated the cost efficiency of CSCs and GICs used in pulpotomies of mandibular primary first molars (MPFMs). Materials and Methods: An in vitro experimental study was conducted using 72 MPFMs with standardized Class I cavities. The teeth were randomly allocated into six groups (n=12), combining two CSCs (mineral trioxide aggregate [MTA Angelus®] and Biodentine®) and three GICs (Vitremer®, Fuji IX® and Ketac Molar®). The cements were assessed according to commercial costs (per kit, per gram, and per dose), treatment-related costs (gross cost: material placed; actual cost: material prepared), and material utilization efficiency, defined as the gross-to-actual cost ratio. Data were analyzed using one-way ANOVA followed by Tukey’s post hoc test (p<0.05). Results: Among the CSCs, Biodentine showed the highest actual cost, whereas MTA Angelus showed the highest gross cost and greater utilization efficiency. Among the GICs, Vitremer presented the highest gross and actual costs, while Fuji IX and Ketac Molar demonstrated the highest utilization efficiency. The highest actual cost was observed for the Biodentine + Vitremer combination (USD 25.0), and the lowest for MTA Angelus + Fuji IX (USD 18.6). The highest efficiency ratios were found for MTA Angelus combined with Ketac Molar (53.36%) and with Vitremer (41.89%), whereas the remaining combinations showed values ≤25.62% (p<0.001). Conclusions: Significant differences in cost efficiency were identified among the materials evaluated. Overall, MTA Angelus combined with Ketac Molar demonstrated the greatest cost efficiency for pulpotomy procedures. Optimization of material presentations and dose sizes may reduce material waste and overall treatment costs.