The resin ionomer Geristore has been used extensively for root perforation repairs. The purpose of this study was to evaluate oral in vitro biocompatibility of the resin ionomer Geristore compared to two other dental perforation repair materials, Ketac-Fil and Immediate Restorative Material (IRM). Growth and morphology of human gingival fibroblasts (HGFs) was determined using scanning electron microscopy (SEM) of HGFs cells grown on test materials as well as cytotoxicity assays using eluates from test materials. SEM analysis showed that HGFs attached and spread well over Geristore with relatively normal morphology. SEM showed that fibroblasts did not attach and spread well over Ketac-Fil or IRM as cells appeared much fewer with rounded and different morphology than fibroblasts grown on Geristore. Cytotoxicity assays indicated that HGFs proliferated in the presence of Geristore eluates and not in the presence of Ketac-Fil or IRM eluates. In vitro interpretation indicates that Geristore is less cytotoxic to gingival fibroblasts.