Search Results (38)

Ex vivo human tooth culture models preserve the native dentine–pulp complex and offer a translational platform to study pulp-capping biomaterials. This systematic review aimed to synthesize the evidence on histological pulp tissue responses to calcium silicate-based cement (CSCs) used for direct pulp capping in human tooth culture models. The review followed PRISMA 2020 guidance. Eligible studies were ex vivo whole human tooth culture models with direct pulp exposure treated with commercial or experimental CSCs and reporting histological outcomes. Risk of bias was assessed using the QUIN tool. Thirteen studies were included. Most used immature human third molars (from 15- to 19-year-old patients) and culture periods up to 28 days, with a minority extending observation to 45–90 days. Across hydraulic CSCs, Biodentine was the most frequently evaluated material, followed by ProRoot MTA and several experimental hydraulic and resin-modified formulations. Overall, hydraulic CSCs were consistently associated with biocompatible pulp responses and a pro-mineralization pattern characterized by periexposure mineralized foci/osteodentin-like tissue; where assessed, immunohistochemistry supported odontoblast-like differentiation. In contrast, the resin-modified CSC TheraCal LC and other experimental resin-modified CSCs showed more heterogeneous findings, with reports of absent, delayed, or less prominent mineralization compared with reference hydraulic CSCs. In intact human tooth culture models, hydraulic CSCs show reproducible biocompatibility and early mineralization features consistent with reparative dentinogenesis, whereas resin-modified CSCs demonstrate more variable histological performance. Full article

Metformin is a promising small molecule for dentin regeneration, but an effective local delivery system for pulp applications has been underexplored. This study encapsulated metformin in poly(lactic-co-glycolic acid) (PLGA) microspheres and incorporated them into calcium phosphate–chitosan cement (CPCC) as a direct pulp-capping material (DPC). Metformin-PLGA microspheres were prepared by double emulsion and mixed with CPCC at a concentration of 0% to 20% by weight. Microsphere morphology, encapsulation efficiency, chemical composition, and physico-mechanical properties were characterized, and compatibility with human dental pulp stem cells (hDPSCs) was evaluated by live/dead assay and SEM. The microspheres were spherical (5.43 ± 0.17 µm) with (51 ± 3.69%) encapsulation efficiency, and FTIR confirmed metformin incorporation. The 15% Met-PLGA-CPCC group showed flexural strength (15.22 ± 1.98 MPa), elastic modulus (4.60 ± 0.73 GPa), and work of fracture (104.96 ± 12.48 J/m²) comparable to or higher than CPCC and MTA, while all Met-PLGA-CPCC groups had shorter setting times ranging from 18 min to 27 min than CPCC (39.15 ± 2.10 min) and MTA (123 ± 4.2 min). Metformin release increased proportionally with Met-PLGA content. hDPSCs exhibited good attachment and high viability on all materials over the evaluated period. In conclusion, Met-PLGA-CPCC provides fast-setting and favorable physico-mechanical properties, sustained metformin delivery, and excellent hDPSC compatibility. These properties support its potential as a bioactive direct pulp-capping material and as a versatile platform for regenerative applications. Full article

Vital pulp therapy (VPT) is increasingly recognised as a biologically driven alternative to root canal treatment in teeth with deep caries and a vital pulp diagnosis. Resin-modified calcium silicate-based materials (RM-CSMs) were introduced to combine the bioactivity of traditional cements with improved handling and immediate light-curing, but their biological performance remains debated. Objectives: This systematic review and meta-analysis aimed to evaluate the clinical and radiographic outcomes of VPT performed with RM-CSMs compared with conventional non-resin-modified calcium silicate-based materials (NRM-CSMs) Methods: PRISMA Guidelines were followed to carry out this systematic review. Electronic databases (Medline, Embase, Scopus, and Web of Science) were searched up to October 2025 for randomised clinical trials evaluating indirect pulp capping, direct pulp capping, or pulpotomy. Nine trials met the inclusion criteria. Meta-analyses were performed for TheraCal LC, the only RM-CSM with sufficient clinical evidence. The risk of bias was assessed using the RoB 2 Tool. The certainty of evidence was assessed using GRADE. Results: Pooled results showed no significant differences in overall clinical–radiographic success between RM-CSMs and NRM-CSMs at 90 or 180 days. At 360 days, a trend favouring NRM-CSMs emerged, though not statistically significant. Dentine bridge formation at 360 days was significantly lower with TheraCal LC. Conclusions: Current RM-CSMs demonstrate comparable short-term success to conventional materials but still present biological limitations, particularly regarding long-term reparative outcomes. NRM-CSMs remain the preferred option when maximal bioactivity and predictable dentinogenesis are required Full article

The intra- and intercellular signaling molecule nitric oxide (NO) is produced in endothelial cells by the activity of endothelial NO synthase (eNOS). Upon formation, NO diffuses into the underlying vascular smooth muscle cells, where it activates NO-sensitive guanylyl cyclase (NO-GC) resulting in the production of cyclic guanosine 3′,5′-monophosphate (cGMP) from guanosine 5′-triphosphate (GTP). Inducing vasodilatation, inhibiting platelet aggregation and leukocyte adhesion, and inhibiting the proliferation and migration of vascular smooth muscle cells, the NO-cGMP signaling leads to a number of anti-inflammatory processes. Inflammation-dependent elevated concentrations of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in blood vessels of inflamed dental pulp induce an uncoupling of eNOS and oxidized NO-GC, leading to a disruption of NO-cGMP signaling. Endothelial dysfunction in inflamed dental pulp alters cell–cell and cell–matrix interactions, reducing the regenerative and reparative potential of the dentin–pulp complex in response to carious lesions. In the therapeutic management of caries, it is essential to consider the presence of endothelial dysfunction in the inflamed dental pulp. The utilization of NO-GC stimulators and activators in indirect and direct pulp capping materials may enhance the regeneration and repair potential of inflamed dental pulp. Full article

Preserving dental pulp vitality is a key goal in minimally invasive dentistry. Conventional materials such as calcium hydroxide and mineral trioxide aggregate (MTA) are effective but limited in bioactivity and mechanical strength. This systematic review evaluated the biological efficacy of chitosan-based nanoparticles and biomaterials for pulp capping and regeneration. Following PRISMA 2020 guidelines, electronic searches were conducted across five databases up to April 2025. Controlled in vitro and animal studies using chitosan-based nanoparticles, hydrogels, or composite scaffolds were included. Risk of bias was assessed using SYRCLE (animal) and ToxRTool (in vitro), and certainty of evidence was rated via the GRADE-Preclinical framework. Due to methodological heterogeneity, data were synthesized using direction-of-effect coding and visualized through Albatross and heatmap plots. Sixteen studies met the criteria, consistently demonstrating enhanced cell viability, mineralization, and upregulation of odontogenic and angiogenic markers (BMP-2, TGF-β₁, VEGF, DSPP) compared with MTA or calcium hydroxide. Animal models confirmed improved angiogenesis, reparative dentin formation, and pulp vitality preservation. Despite uniformly positive biological outcomes, the overall certainty was rated Low to Very Low owing to small samples and unclear randomization. Chitosan-based biomaterials show promising regenerative potential, warranting well-designed preclinical and clinical studies for translational validation. Full article

Introduction: Direct pulp capping (DPC) aims to preserve the vitality of the dental pulp by placing a protective biocompatible material over the exposed pulp tissue to facilitate healing. There are several calcium-silicate materials that have been designed to promote mineralization and the regulation of inflammation. These have strong potential for the repair and regeneration of dental pulp. Among them, Biodentine (BD) and EndoSequence RRM Putty (ES) have been found to promote in vitro and in vivo mineralization while minimizing some of the limitations of the first-generation calcium-silicate-based materials. Theracal-LC (TLC), a light-cured, resin-modified calcium-silicate material, is a newer product with potential to improve the clinical outcomes of DPC, but existing studies have reported conflicting findings regarding its biocompatibility and ability to support pulpal healing in direct contact with the pulp. A comprehensive assessment of the biocompatibility and pulpal protection provided by these three capping materials has not yet been performed. Aim: We aimed to quantify the inflammatory response, dentin bridge formation, and material adaptation following DPC using three calcium-silicate materials: ES, BD, and TLC. Materials and Methods: DPC was performed on the maxillary first molar of C57BL/6 female mice. Maxilla were collected and processed at 1 and 21 days post-DPC. The early inflammatory response was measured 24 h post-procedure using confocal imaging of anti-Lys6G6C, which indicates the extent of neutrophil and monocyte infiltration. Reparative mineralized bridge formation was assessed at 21 days post-procedure using high-resolution micro-computed tomography (micro-CT) and histology. Lastly, the homogeneity of the capping materials was evaluated by quantifying voids in calcium-silicate restorations using micro-CT. Results: DPC using TLC induced less infiltration of Lys6G6C⁺ cells at 24 h than BD or ES. BD promoted higher volumes of tertiary dentin than TLC, but TLC and ES showed no significant differences in volume. No differences were observed in material adaptation and void spaces among the three capping materials. Conclusions: All three materials under investigation supported pulp healing and maintained marginal integrity. However, TLC induced a lower inflammatory response on day 1 and induced similar levels of tertiary dentin to ES. These observations challenge the common perception that resin-based capping materials are not suitable for direct pulp capping. Our findings underscore the need to balance biological responses with physical properties when selecting pulp capping materials to improve long-term clinical success. Full article

Hydrogels are hydrophilic biocompatible polymers that can be used as a drug delivery material in different medical branches, including vital pulp therapy. The aim of this study is to characterize the physical and biological properties of the newly developed formula as a candidate direct pulp-capping material. The hydrogel composite was prepared from natural and synthetic origins (polyvinyl alcohol (PVA), hyaluronic acid (HA), and sodium alginate (SA)) with the incorporation of bioactive Moringa. Different formulas of hydrogel containing different concentrations were evaluated for physicochemical (FTIR, XRD, SEM, degradation, and swelling), mechanical (viscosity, folding endurance, film thickness), and biological (antioxidant, antibacterial, and cytotoxicity) properties. FTIR and XRD confirmed successful incorporation and partial cross-linking between moringa and hydrogel compounds. At low concentrations of moringa, the hydrogel formula showed integrity, scavenging activity, and homogeneity. The moringa-loaded films showed concentration-dependent antioxidant and antibacterial properties, especially at higher concentrations, with acceptable cytocompatibility. The low concentration of moringa (0.5%) may be considered a promising candidate as a novel pulp-capping agent supporting tissue healing and regeneration. Full article

Background/Objectives: Deep caries lesions represent an actual concern in preserving tooth vitality and preventing irreversible pulpitis. As presently the non-selective approach is considered an overtreatment, the concept of selective caries removal is highly recommended. The goal of this narrative review is to focus on current trends in carious dentine excavation and adjunctive therapies. Methods: A keyword-based selection of scientific publications issued in the last six years, i.e., 2019–2024, was conducted with the search engine of PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: deep carious lesion; caries removal; indirect pulp capping; adjunctive antimicrobial therapy; adjunctive anti-enzymatic therapy; biomimetic restorative dentistry. Discussions: In deep caries management, the current trends of carious dentine excavation recommend preferentially partial caries removal technique as less risky to pulp exposure and more conservative compared to the stepwise technique (SW). Presently, advanced additional procedures such as antimicrobial photodynamic therapy and an anti-enzymatic approach are also considered for caries arrest. Conclusions: Selective caries removal and adjunctive photodynamic antimicrobial therapy are procedures of choice in preserving pulp vitality. Anti-enzymatic therapies impede decoupling with time of adhesive restorations from the smear layer. Biomimetic restorative dentistry and smart materials introduce the principles of artificial intelligence in the therapeutic approach of deep caries. Full article

(1) Background: The aim of this in vitro study was to evaluate the success of indirect pulp capping (IPC) procedures over a period of 40 years. (2) Methods: The investigation of 1412 dental records included 159 patients with 366 IPC teeth having been treated from 1969 to 1980. The teeth revealed caries within the inner third of dentin, were symptom-free, and showed no pulp exposure. The caries were excavated thoroughly and teeth with accidentally exposed pulp were excluded. Zinc–oxide–eugenol was used for the IPC procedures. The posterior teeth were restored with amalgam, and the anterior teeth received direct resin composite fillings. The gathered parameters with possible influences on survival rates were age, gender, tooth locations/positions, dates of vital therapy, the number of filled surfaces, types of primary restoration material, successional treatments on each tooth, and the last dates of surveillance. Data collection and statistical analysis were performed using Excel sheets and DataTab. Significant differences among groups were computed by cox regression analysis and the significance level was set at p = 0.05. Kaplan–Meier curves were utilized to illustrate the survival rates. (3) Results: Treatment success was measured by the maintenance of vitality beyond 365 days. The loss of vitality within 365 days was determined as treatment failure. Treatment outcomes were assessed after different time periods (1 and 6 months; 1, 2, 5, 10, 20, and 40 years). Pulp vitality dropped from 95% after 3 months to 32% after 40 years. Cavity size had a significant influence on the survival of pulp, but tooth position did not; however, third molars at least initially showed a better outcome. Beyond the 1-year recall, no differences for the evaluated parameters were present. (4) Conclusions: IPC showed excellent long-term success rates, revealing a 1.7% annual failure rate after 40 years of clinical service. Larger defects suffer more pulp damage in the long run. Full article

Vital pulp therapy (VPT) preserves dental pulp and its functions, offering a minimally invasive alternative to root canal therapy. However, the impact of patient-related factors on success remains unclear. This study aimed to estimate the sample size for a multivariate model predicting VPT success for assessing capping material, age, sex, and pulp conditions. A prospective cohort study was conducted with the inclusion of twenty-seven adult patients with carious pulp exposure in mature permanent teeth. Treatment comprised direct pulp capping, partial pulpotomy, or complete pulpotomy with Mineral Trioxide Aggregate Plus (MTA+) or Biodentine. Success rates were evaluated at 6 months through clinical and radiographic examinations. Statistical analysis included Pearson’s Chi-square tests and logistic regression. The success rates were 64% in the Biodentine group and 92% in the MTA+ group (OR: 0.15; p = 0.108). Sex and age had no significant effect. Success declined with increasing pulp condition severity and treatment invasiveness. MTA+ had a higher incidence of discoloration, while Biodentine showed none. Sample size calculations suggested 140 participants would be needed to detect a significant effect of pulp condition. Both materials were effective, though MTA+ showed higher success based on the strict success criteria. More severe pulpitis correlated with lower success, but a larger study is needed for predictive models. Full article

Traditional pulp-capping materials like mineral trioxide aggregate (MTA) offer excellent biocompatibility and sealing, but limitations such as prolonged setting time, low bioactivity, and high costs persist. Metformin, with its potential in craniofacial regeneration, could enhance dentin synthesis by targeting pulp cells. This study aimed to: (1) develop a calcium phosphate cement with chitosan (CPCC) with improved physio-mechanical properties; (2) incorporate metformin (CPCC-Met) to assess release; and (3) evaluate human dental pulp stem cells (hDPSCs) response. CPCC was mixed at different powder-to-liquid ratios to evaluate physio-mechanical properties compared to MTA. The optimized CPCC formulation was loaded with 0, 50, 100, and 150 µg of metformin to measure release and assess hDPSCs attachment and proliferation (1, 4, and 7 d) via live/dead imaging and SEM. One-way ANOVA was used for statistical analysis. Results showed CPCC at a 3.25:1 ratio significantly reduced setting time to 41.5 min versus 123 min for MTA (p < 0.05). Metformin release correlated with concentration, and SEM confirmed the presence of a porous, hydroxyapatite-rich surface. Cell viability was consistently high across groups (>93% at 1 d, >95% at 4 d, ≈98% at 7 d), with no significant differences (p > 0.05). These findings suggest that the novel CPCC-Met demonstrates promise as a fast-setting, cost-effective pulp-capping material, offering metformin delivery to enhance dentin repair. Full article

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures. Full article

Direct pulp capping (DPC) is reliable in pulp exposure management. Objective: This study aimed to assess the success rate of DPC materials and different laser protocols. The included procedures were CO₂ laser (n = 1147), Er: YAG laser (n = 69), and 980 nm diode laser (n = 124), on the one hand, and Ca (OH)₂ (n = 376) and bioactive tricalcium silicate paste, on the other (n = 279). Materials and methods: Data from 1995 DPC cases were included. For laser groups, irradiation was used to coagulate the pulp exposure followed by Ca (OH)₂ placement. Data with follow-up at 12, 24, and 36 months post-treatment were included. The irradiation parameters for the CO₂ laser were as follows: energy density per pulse of 141 J/cm², 1 W power, 0.3 mm beam diameter, 100 ms pulse duration, and 1 Hz, and a series of five pulses maximum were delivered during 5 s. For the 980 diode lasers: 1.5 W power, continuous wave (CW), 400 μm fiber diameter, contact mode, 190.98 W/cm² power density, and total delivered energy density of 2387 J/cm². For the Er: YAG laser: 0.5 W output power, 9.95 J/cm² energy density, a beam diameter of 0.8 mm, 300 µsec pulse duration, 10 Hz, non-contact mode, irradiation with air without water spray, and an average irradiation time of 8–10 s. Results: At the 3-year follow-up, the success percentages were as follows: CO₂ (88.01%) > Ca (OH)₂ (75.72%) > diode (70.01%) > Er: YAG (54.55%) > bioactive tricalcium silicate paste (51.1%). The timing of permanent filling (immediate or delayed), patient age, size of pulp exposure, tooth type, and exposure etiology significantly affected the success rate. Patients aged ≤ 35 years presented higher success (70.91%) compared to those ≥ 36 years (61.2%). Immediate permanent fillings increase the success rate (71.41%) compared to delayed permanent fillings (65.93%). Exposure in molars and premolars significantly lowers the success rate (60.3%) compared to canines and incisors (72.1%). Idiopathic pulp exposure presented higher success (72.58%) compared to caries-related causes (63.7%). Conclusion: The highest success rate was in the CO₂ laser group followed by the diode and Ca (OH)₂, Er: YAG, and bioactive tricalcium silicate material (biodentine) groups. The age factor, filling timing, size of exposure, tooth type, and exposure etiology can significantly affect the success rate of DPC. Full article

Calcium silicate-based cements (CSCs) are endodontic materials widely used in vital pulp-capping approaches. Concerning the clinical application, the reduced set time and pre-mixed formulations are relevant characteristics during the operative management of pulpal exposure, aiming to optimise the work time and improve cross-infection/asepsis control. Additionally, clinical success seems to be greatly dependent on the biological performance of the materials that directly contact the living pulp. As such, this work approaches an integrative biological characterisation (i.e., antibacterial, irritation, and cytocompatibility assays) of three fast-setting CSCs—Biodentine^TM, TotalFill^® BC RRM™ Fast Putty, and Theracal LC^®. These cements, after setting for 24 h, presented the expected topography and elemental composition (assessed by scanning electron microscopy, coupled with EDS analysis), in accordance with the information of the manufacturer. The set cements displayed a significant and similar antibiofilm activity against S. mutans, in a direct contact assay. Twenty-four-hour eluates were not irritant in the standardised CAM assay, but elicited distinct dose- and time-dependent cytotoxicity profiles on fibroblastic cells—i.e., Biodentine was devoid of toxicity, TotalFill presented a slight dose-dependent initial toxicity that was easily overcome, and Theracal LC was deleterious at high concentrations. When compared to long-setting ProRoot MTA cement, which highlighted the pursued integrative approach, Biodentine presented a similar profile, but TotalFill and Theracal LC displayed a poorer performance regarding antibiofilm activity/cytocompatibility features, and Theracal LC suggested eventual safety concerns. Full article

Calcium silicate cement (CSC) is widely used as an endodontic material in clinical applications such as direct pulp capping, pulpotomy, or root canal. CSC has good biocompatibility, sealing properties, and the ability to enhance hard tissue regeneration. However, the disadvantage of CSC is the difficulty in handling when placing it into endodontic tissue due to the long setting time. Several attempts have been made to improve handling of CSC; however, these methods were limited by osteogenic properties. To overcome such a disadvantage, this study investigated the use of Pluronic F127 (F127) for the development easy-to-handle novel endodontic CSCs with osteogenic properties. In this case, different concentrations of F127 (5%, 10%, 20%, 30%, and 40%) were implemented to generate CSC specimens H5, H10, H20, H30, and H40, respectively. Calcium ion was continuously released for 28 days. In addition, each group resulted in apatite formation for 28 days corresponding to calcium ion release. The concentration of F127 showed opposite relationships with water solubility and compressive strength. The H20 group showed a high level of osteogenic activity compared to other groups at 14 days. Mineralization of the H20 group was higher than that of the other groups. This study indicates that the novel F127-based hydrogel with CSC can potentially be used as endodontic filler. Full article