Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes. deciduous or young permanent teeth with immature roots affected by caries and without evidence of radicular pathology [7,8]. Nowadays, treatment options of VPT are represented by indirect pulp treatment (namely indirect pulp capping), direct pulp capping and pulpotomy [7]. Although clinically successful in primary molars, direct capping is mainly recommended in the VPT of permanent young teeth [9,10] and indirect capping seems to possess a relative effectiveness when compared to pulpotomy procedures [11]. The latter provides favorable clinical survival rates over time and allows the vitality of primary teeth until their natural exfoliation, avoiding pulpectomy procedures [2]. Pulpotomy consists of elimination of the bacterial infection by the removal of the pulp in the pulp chamber; then, the decontaminated tooth is filled with a medicament [11]. The most frequently used agents are mineral trioxide aggregate (MTA), Biodentine (BD), formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH). When compared, FC, FS and MTA seemed to provide significantly better clinical and radiographic results as pulpotomy agents than CH after two years of follow-up; moreover, MTA showed the best performance in respect to FC and FS over time [12]. Accordingly, Stringhini et al. [13] reported that MTA yielded superior clinical and radiographical results in comparison to FC. On the other hand, electrosurgery and FS showed similar success to FC, whereas CH did not show positive evidence as medicament in pulpotomies of primary teeth [13]. In the same way, Asgary et al. [14] further stressed that MTA demonstrated better long-term outcomes in pulpotomy of primary molars when com...