Objectives <p>Premixed calcium silicate-based cements (PCSCs) offer practical advantages over mineral trioxide aggregate (MTA) and calcium hydroxide (CH), including easier handling, ready-to-use formulation, and rapid setting. This systematic review assessed patient- and clinician-related outcomes of PCSCs compared to MTA and CH for pulpotomies.</p> Methods <p>A comprehensive search of five databases and grey literature identified 14 clinical trials (eight in permanent and six in deciduous teeth). Risk of bias was evaluated using RoB 2.0, and evidence certainty with GRADE. Meta-analyses of success rates were performed using random-effects models.</p> Results <p>Success rates ranged from 76.6 to 97.1%, with no significant differences between PCSCs and comparators. MTA showed higher tooth discoloration in permanent teeth. Eight studies were rated as having low risk of bias. Evidence certainty was low for permanent teeth and moderate for deciduous teeth. Further well-designed trials with larger samples and longer follow-ups are needed to strengthen the evidence base.</p> Conclusion <p>PCSCs are efficient as pulpotomy materials in both permanent and deciduous teeth, with comparable or similar success rates and less tooth discoloration compared to MTA in up to 12 months of follow-up.</p> Clinical relevance <p>PCSCs offer similar pulpotomy success rates to MTA and CH, with easier handling and less tooth discoloration, supporting their clinical use in both pediatric and adult dental care.</p>