Synthetic Biomaterials in Vital Pulp Therapy: A Narrative Review of Conventional and Emerging Approaches
Keywords:
Vital pulp therapy, Calcium hydroxide, Mineral trioxide aggregate, Biodentine, TheraCal LC,, Bioactive glass, Bioceramics, Synthetic biomaterialsAbstract
Preservation of pulp vitality is a cornerstone of conservative dentistry and endodontics. The success of vital pulp therapy (VPT) depends heavily on the biomaterials employed, which must provide antimicrobial protection, biocompatibility, sealing ability, and stimulation of reparative dentinogenesis. Calcium hydroxide was historically regarded as the gold standard, but its high solubility, poor sealing, and porous dentin bridge formation limit its long-term success. Mineral trioxide aggregate (MTA) revolutionized VPT by offering superior sealing and bioactivity, though its high cost, difficult handling, and risk of tooth discoloration restrict widespread use. Newer calcium silicate-based materials such as Biodentine and TheraCal LC were developed to overcome these drawbacks, combining improved handling with bioactive potential. In parallel, emerging synthetic biomaterials such as bioactive glasses, enamel matrix derivatives, and dentin matrix hydrogels have demonstrated the ability to stimulate true pulp regeneration through biomimetic mechanisms.
This narrative review consolidates current evidence on conventional and emerging synthetic biomaterials in VPT. Comparative insights highlight their strengths, limitations, and translational challenges. While synthetic agents have advanced clinical outcomes, further innovation and validation are required to achieve predictable pulp preservation and regeneration
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References
Cohenca N, Paranjpe A, Berg J. Vital pulp therapy. Dent Clin North Am. 2013;57: 59–73.
Goldberg M. The Dental Pulp: Biology, Pathology, and Regenerative Therapies. Springer; 2014.
Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig. 2016;20: 1121–1132.
Komabayashi T, Zhu Q. Innovative endodontic therapy for anti-inflammatory direct pulp capping of permanent teeth with a mature apex. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109: e75–81.
Ricucci D, Rôças IN, Alves FRF, Cabello PH, Siqueira JF Jr. Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study. J Endod. 2023;49: 45–54.
Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J. 2018;51: 177–205.
Camilleri J. Endodontic Materials in Clinical Practice. John Wiley & Sons; 2021.
Drukteinis S, Camilleri J. Bioceramic Materials in Clinical Endodontics. Springer Nature; 2020.
Chopra V. Bioceramics in Endodontics. John Wiley & Sons; 2024.
Hanada K, Morotomi T, Washio A, Yada N, Matsuo K, Teshima H, et al. In vitro and in vivo effects of a novel bioactive glass-based cement used as a direct pulp capping agent. J Biomed Mater Res B Appl Biomater. 2019;107: 161–168.
Holiel AA, Mahmoud EM, Abdel-Fattah WM, Kawana KY. Histological evaluation of the regenerative potential of a novel treated dentin matrix hydrogel in direct pulp capping. Clin Oral Investig. 2021;25: 2101–2112.
Paryani M, Bhojwani PR, Ikhar A, Reche A, Paul P. Evolution of Biomimetic Approaches for Regenerative and Restorative Dentistry. Cureus. 2023;15: e33936.
Singer L, Fouda A, Bourauel C. Biomimetic approaches and materials in restorative and regenerative dentistry: review article. BMC Oral Health. 2023;23: 105.
Hanin S. M. A, Anjaneyulu, Muralidharan. Antimicrobial efficacy of calcium hydroxide and triple antibiotic paste combination on E. faecalis biofilm- an in vitro study. J Pharm Res Int. 2020; 120–126.
Teja KV, Janani K, Srivastava KC, Shrivastava D, Natoli V, Di Blasio M, et al. Comparative evaluation of antimicrobial efficacy of different combinations of calcium hydroxide against Enterococcus faecalis. BMC Oral Health. 2023;23: 849.
Tziafas D, Veis A, Alvanou A. Inability of calcium hydroxide to induce reparative dentinogenesis at non-peripheral sites of dog dental pulp. Eur J Oral Sci. 1996;104: 623–626.
Laurent P, Camps J, About I. Biodentine(TM) induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J. 2012;45: 439–448.
Yadav RK, Jasrasaria N, Tiwari R, Verma UP. Outcomes of vital pulp therapy using various pulp capping agents. J Conserv Dent Endod. 2025;28: 138–143.
Torabinejad M. Mineral Trioxide Aggregate: Properties and Clinical Applications. John Wiley & Sons; 2014.
Nair PNR, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with Mineral Trioxide Aggregate: a randomized controlled trial. 2008. Int Endod J. 2009;42: 422–444.
Acharya S, Gurunathan D, Assiry AA, Luke AM, Shetty KP, Karobari MI. Comparison of Modified NeoPutty MTA, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An Clinical Study. Int J Clin Pediatr Dent. 2024;17: 1025–1029.
Baldawa H, Ravindran V, Jeevanandan G, Arthanari A, Teja KV, Spagnuolo G, et al. Histopathological Assessment of Tricalcium Aluminate-free Mineral Trioxide Aggregate and Two Antibacterial Enhanced Mineral Trioxide Aggregates As Pulpotomy Agents in Rat Model. Eur Endod J. 2024;9: 344–351.
Brizuela C, Ormeño A, Cabrera C, Cabezas R, Silva CI, Ramírez V, et al. Direct Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate, and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial. J Endod. 2017;43: 1776–1780.
Uyar DS, Alacam A. Evaluation of partial pulpotomy treatment in cariously exposed immature permanent molars: Randomized controlled trial. Niger J Clin Pract. 2021;24: 1511–1519.
Koc Vural U, Kiremitci A, Gokalp S. Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months. Oper Dent. 2017;42: 470–477.
Shancy Merlin AR, Ravindran V, Jeevanandan G, Eswaramoorthy R, Arthanari A. Comparative Evaluation of Push-Out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, a Modified Mineral Trioxide Aggregate, and Two Novel Antibacterial-Enhanced Mineral Trioxide Aggregates. Cureus. 2024;16: e56320.
Gandolfi MG, Shah SN, Feng R, Prati C, Akintoye SO. Biomimetic calcium-silicate cements support differentiation of human orofacial mesenchymal stem cells. J Endod. 2011;37: 1102–1108.
Mangat P, Goswami K, Solanki M, Rajput N. Comparison between biodentine and light-cured mineral trioxide aggregate as an indirect pulp capping agent - A randomized controlled trial. J Conserv Dent Endod. 2025;28: 78–83.
Kishen A, Cecil A, Chitra S. Fabrication of hydroxyapatite reinforced polymeric hydrogel membrane for regeneration. Saudi Dent J. 2023;35: 678–683.
Gupta S, Panneer Selvam S, Ramadoss R, Sundar S. Alginate-hydroxyapatite scaffolds: A comprehensive characterization study. J Oral Biol Craniofac Res. 2025;15: 555–562.
Rajasekar V, Abdalla MM, Huang M, Neelakantan P, Yiu CKY. Next-Generation Biomaterials for Vital Pulp Therapy: Exploring Biological Properties and Dentin Regeneration Mechanisms. Bioengineering (Basel). 2025;12. doi:10.3390/bioengineering12030248
Alnour A, Almohammad G, Abdo A, Layous K. Evaluation of the pulp response following direct pulp capping with exogenous nitric oxide and Mineral Trioxide Aggregate (MTA) a histologic study. Heliyon. 2023;9: e17458.
Münchow EA, da Silva AF, Piva E, Cuevas-Suárez CE, de Albuquerque MTP, Pinal R, et al. Development of an antibacterial and anti-metalloproteinase dental adhesive for long-lasting resin composite restorations. J Mater Chem B. 2020;8: 10797–10811.
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