Ca (OH)2 (1960’s) |
Gold standard of direct pulp capping material
Excellent antibacterial properties
Induction of mineralization
Low cytotoxicity
|
Highly soluble in oral fluids
Subject to dissolution over time
Extensive dentin formation obliterating the pulp chamber
Lack of adhesion
Degradation after acid etching
Presence of tunnels in reparative dentin
|
Zinc oxide eugenol cement (1960-70’s) |
|
Lack of calcific bridge formation
Releases eugenol in high concentration which is cytotoxic
Demonstrate interfacial leakage
|
Corticosteroids and antibiotics (1970’s) |
|
|
Polycarboxylate cement (1970’s) |
|
|
Inert materials (1970’s) (Isobutyl cyanoacrylate and Tri calcium phosphate ceramic) |
|
|
Collagen (1980) |
|
|
Bonding agents (1995) 4-META-MMA-TBB adhesives and hybridizing dentin bonding agents |
|
Have cytotoxic effect
Absence of calcific bridge formation
In vivo studies have demonstrated that the application of an adhesive resin directly onto a site of pulp exposure, or to a thin layer of dentin (less than 0.5 mm), causes dilatation and congestion of blood vessels as well as chronic inflammatory pulpal response
|
Calcium phosphate (1900’s) |
|
|
Hydroxyapatite (1995) |
|
|
Lasers (1995-2010) CO2 Nd: YAG |
|
|
Glass ionomer/Resin modified glass ionomer (1995) |
Excellent bacterial seal
Fluoride release, coefficient of thermal expansion and modulus of elasticity similar to dentin
Bond to both enamel and dentin
Good biocompatibility
|
Causes chronic inflammation
Lack of dentin bridge formation
Cytotoxic when in direct cell contact
Poor physical properties, high solubility and slow setting rate
RMGIC is more cytotoxic than conventional GIC, so it should not be applied directly to the pulp tissue
|
Mineral trioxide aggregate (1996-2008) |
|
|
MTYA1-Ca (1999) |
Helps in dentine bridge formation without formation of a necrotic layer
Shear bond strength is higher than conventional GIC and similar to RMGIC
Dentin bridge formation without reduction of pulp space in MTYA1-Ca, but there is reduction of pulp space is seen in dycal.
Better adhesion to dentine
|
|
Growthfactors (1900-2007) Bone Morphogenic Protein (BMP 2,4,7) Recombinant insulin like growth factor-I Other growth factors (1998) Epidermal growth factor Fibroblast growth factor Insulin like growth factor II Platelet-derived growth factor-BB TGF-β 1 |
Formation of osteodentin and tubular dentin
Formation of more homogeneous reparative dentin
Superior to Ca(OH)2 in the mineralization inducing properties
Dentin bridge formation was equal to dycal after 28 days
Only TGF-β1 induced reparative dentin formation
|
Possibility of unexpected side effects and the production
cost can be obstacles for their clinical application
Fail to stimulate reparative dentin in inflamed pulp
Half life is less
High concentration is required
Delivery vechicles used for the molecules show potent effects at the pictogram level and appropriate carriers will be required to facilitate their handling in the clinical situation
Appropriate dose response is required to avoid uncontrolled obliteration of pulp chamber
Possibility of immunological problems due to repeated implantation of active molecules
Other factors does not induced reparative dentin formation
|
Bonesialoprotein (2000) |
|
|
Biodentin (2000) |
Biocompatible
Good antimicrobial activity.
Stimulate tertiary dentin formation
Stronger mechanically, less soluble and produces tighter seals compared to Ca(OH)2
Less setting time, good handling characteristics than MTA
|
|
ENZYMES Heme-Oxygenase-1 (2008) Simvastatin (2009) |
Play a cytoprotective role against pro inflammatory cytokines and nitric oxide in human pulp cells
Prevent H2O2 induced cytotoxicity and oxidative stress in human dental pulp cells.
Anti inflammatory action
Induction of angiogenesis
Improve the function of odontoblasts, thus leading to improved dentin formation
|
Further in vitro and in vivo studies are required
In high concentration causes pulp tissue damage.
Careful evaluation is required before clinical application to determine the suitable concentration when applied indirectly to a cavity or directly to pulp tissue.
|
STEM CELLS (2009) Dental pulp stem cells (DPSCs) Stem cells from human exfoliated deciduous teeth (SHED) |
|
Less economic
Technique sensitive
|
Propolis (2005-2010) |
Antioxidant, antibacterial, antifungal, antiviral and anti-inflammatory properties
Superior bridge formation compared to Dycal, similar results to MTA
Forms dental pulp collagen, reduces both pulp inflammation and degeneration.
Stimulate reparative dentin formation
|
|
Novel endodontic cement (2010) |
Biocompatible
Shorter setting time
Do not cause tooth staining
Good handling characteristics compared to MTA
Induced a thicker dentinal bridge with less pulp inflammation than MTA
|
|
Emdogain (2001-2011) |
Promote odontoblast differentiation and reparative dentin formation
Suppresses the inflammatory cytokine production and create a favourable environment for promoting wound healing in the injured pulp tissues
Amount of hard tissue formed in EMD treated teeth was twice that of the calcium hydroxide
Post operative symptoms were less
MTA produced a better quality reparative hard tissue response with the adjunctive use of Emdogain compared with calcium hydroxide
|
EMD gel (EMD dissolved in propylene glycol alginate gel) when applied on exposed pulps without the adjunctive use of a pulp-capping material was proven to be ineffective in producing a hard tissue barrier because of its poor sealing qualities.
Clinical advantages of using EMD are unproven
|
Odontogenic ameloblast associated protein (2010) |
|
Till now only in vitro study was conducted.
Further studies containing
a larger number of samples and longer follow-up assessments with various studies with higher primates should be followed
|
Endo sequence root repair material (2010-11) |
|
|
Castor oil bean cement (2010-11) |
Good antibacterial property
Less cytotoxic
It showed less inflammatory response in subcutaneous tissue of rats when compared with calcium hydroxide cement.
Facilitates tissue healing
Better sealing ability than MTA & GIC
Good mechanical properties
Low cost
|
|
Theracal (2012) |
Act as protectant of the dental pulpal complex
Bond to deep moist dentin
Used as a replacement for Ca(OH)2, glass ionomer, RMGI, IRM/ZOE and other restorative materials
Have strong physical properties,no solubility, high radiopacity
TheraCal displayed higher calcium releasing ability and lower solubility than either ProRoot MTA or Dycal
|
|