Application of biomaterials in dentin regeneration and direct pulp capping

Abstract

The paper is a systematic evaluation of the use of biomaterials to regenerate dentin and in the direct pulp capping (DPC) using both a systematic review of the clinical literature combined with original in vitro and in vivo experiments to determine the effectiveness of calcium silicate-based products versus conventional calcium hydroxide (CH). A systematic database search (PubMed, Scopus, Web of Science) between the years 2005 and 2025 revealed major evidence of better performance of Mineral Trioxide Aggregate (MTA), Biodentine, and recent bioceramics (e.g., Neo MTA Plus, Total Fill BC Fast Set Putty) as compared to CH. Randomized trials were meta-analysed with pooled success rates of 90-97% in MTA and 88-96% in Biodentine at a maximum of 36 months compared to a ratio of 65-78% in CH and odds ratio of 2-4 times lower failure rates of silicate cements. The bioactivity and antibacterial actions were found to be superior to CH with in vitro assays using human dental pulp stem cells (hDPSCs) showing excellent biocompatibility (>98% viability), increased proliferation, migration, odontogenic gene expression (DSPP, DMP1, RUNX2; 2.5-4.0-fold increase), mineralization, and apatite formation assays using hDPSCs. Histological and micro-CT assessments of 6 months in a canine in vivo model (n=80 premolars) indicated that with bioceramics, dentin bridges were complete (scores 2.62.8), always continuous, and pulp vitality intact whereas with CH controls, bridges were incomplete and inflammation was greater. These findings validate that calcium silicate-based biomaterials cause superior reparative dentin due to prolonged ion release, deposition of apatite, and stimulation of stem cells that shift vital pulp therapy paradigm to bioactive cements to enhance pulp preservation and decrease invasiveness. New putty composites have convenient benefits of working and appearance. Its limitations are animal-human translation and the requirement of the prolonged human testing. Altogether, bioactive calcium silicates are the optimal selection of DPC, which improves clinical results in the field of conservative endodontics.