Bioactivity of Pulp Capping Materials in Pulp Regeneration: Mineralization Mechanisms and Clinical Evaluation

Abstract

Vital pulp therapy is a minimally invasive approach that aims to maintain pulp vitality and support the formation of reparative dentin. The effectiveness of this treatment largely depends on the properties of the biomaterials applied. A range of bioactive materials—including calcium hydroxide, mineral trioxide aggregate (MTA), Biodentine, TheraCal LC, bioactive glass, and calcium-enriched mixture (CEM) cement—have been developed to improve biological responses and promote healing. These materials exert their effects through mechanisms such as ion release, pH alteration, and the activation of signaling pathways that drive odontoblastic differentiation and dentinogenesis. Exposure to these materials leads to increased expression of key molecular markers, such as dentin matrix protein-1 (DMP-1) and dentin sialophosphoprotein (DSPP), indicating their regenerative potential. Furthermore, growth factors like TGF-β1, BMP-2, and VEGF contribute to tissue repair, angiogenesis, and neural regeneration. The integration of dental stem cells and scaffold systems has also enhanced the potential for pulp–dentin complex regeneration. Clinically, calcium silicate-based materials demonstrate superior outcomes compared to traditional agents. Various studies have found that that calcium silicates induce higher tissue-repair efficacy as compared to calcium hydroxide. Calcium silicate based materials have a higher success rate in dentin regeneration, and more likely to form a homogenous dentinal bridge. In addition, non-invasive imaging methods like micro-computed tomography (micro-CT) offer precise evaluation of mineralized tissue formation. Overall, bioactive pulp capping materials are essential in promoting tissue regeneration through their interaction with cellular and molecular mechanisms. Advancements in biomaterials, stem cell technology, and imaging are paving the way for improved strategies in regenerative endodontics. 

Keywords: pulp capping, biomaterial, regeneration, pulp therapy, mineralization, growth factor