Table 1.
Summary of the benefits and drawbacks of several pulp-capping agents
| Pulp-capping agents | Benefits | Drawbacks |
|---|---|---|
| CH: Hermann, 1930[7] | Gold standard of DPC agent Excellent antimicrobial properties (bacteriostatic after being initially bactericidal) Low acid pH neutralization Minimal cytotoxicity Mineralization stimulation Low price and not difficult to use[8,68,69] |
Nonadhesive nature High solubility Disintegration over time Deterioration following acid etching Tunnels found in reparative dentin Excessive dentin growth entirely obliterates the pulp chamber Leakage at margin upon amalgam condensation[8,68,69] |
| MTA: Torabinejad, 1993[24] | Antibacterial property Good cytocompatibility Cells adhere and growth regulation Bioactive dentin matrix protein solubilization Limited inflammatory pulpal response and higher dentinal bridge formation compared to CH No mutagenicity and toxicity Radiopacity[29,68,69] |
Difficult to manipulate clinically Setting time is too long Grey MTA results in postprocedural tooth discoloration Two-step process More expensive than CH[29,68,69] |
| BD: Septodont, Saint-Maur-des-fossés Cedex, France | Excellent cytocompatibility Good antimicrobial activity Compared to MTA, limited inflammatory pulpal response and higher dentinal bridge formation Stronger mechanically compared to CH Less setting time and better handling capabilities compared to MTA[37,68,69] |
Need long-term clinical studies for a definitive evaluation Higher cost than CH[37,68,69] |
| NMP: Avalon Biomed Inc., Bradenton, Florida, USA | Fine powder provides faster setting time than MTA Gel enhances the handling qualities and washout resistance Greater Ca2+and OH−ions release and lesser porosity than traditional MTA Higher dentinal bridge formation compared to traditional MTA No postprocedural tooth discoloration[49,68,69] |
Early set material’s high solubility creates gaps[49,68,69] |
| Quick-Set2 (Primus Consulting, Bradenton, Florida, USA) | Quick setting time Ultimate pH Tubule penetration Acid and washout resistance No postprocedural tooth discoloration High ability for mineralogenic stimulation[54,55,68,69] |
Low bridge quality compared to NMP[48,54,55,68,69] |
| iRoot SP (Innovative BioCeramix, Inc., Vancouver, Canada) | Premixed putty Good antibacterial property Less cytotoxic compared to MTA[60,61,68,69] | Small particle size for better hydration, and Ca2+and OH−ions release Crystalline structure production resembles tooth hydroxyapatite by moisture absorption in the dentinal tubules Higher dentinal bridge formation compared to NMP[60,61,68,69] |
| Glass ionomer (1995) | Excellent sealing ability Similar to dentin in terms of coefficient of thermal expansion, and modulus of elasticity Inherent adhesive nature to enamel and dentin Good pulp tissue cytocompatibility[67,68,69] |
Chronic inflammation over time Lack of development of dentin bridges Poor pulp tissue cytocompatibility Unfavorable physical characteristics, an elevated solubility, and a sluggish setting time RMGIC is greater cytotoxic than traditional GIC[67,68,69] |
CH: Calcium hydroxide, MTA: Mineral trioxide aggregate, BD: Biodentine, NMP: NeoMTA Plus, GIC: Glass ionomer cement, RMGIC: Resin-modified GIC, DPC: Direct pulp capping