Review Article
Volume 19 Issue 7 - 2020
Overview of Different Options for Dental Pulp Therapy: A Systematic Review
Hatem Faisal Bajnaid1*, Rayif Jazaa Alanazi2, Nouf Saad Suliman3, Saad Saleh Alamri4, Eman Ali Alhabib4, Nouf Naif Alquthami5, Ranad Abdulkareem Alghamdi6, Duaa Hamed Alrajhi6, Naif Awdhah Alzahrani7, Nujud Awadh Alharbi8 and Fatimah Mohammad Alamri9
1Department of Endodontics, King Fahad Hospital, Jeddah, Saudi Arabia
2Department Dentistry, Ajmal Dental Polylinic, Hail, Saudi Arabia
3College of Dentistry, King Khalid University, Abha, Saudi Arabia
4General Dentist, Ministry of Health, Hail, Saudi Arabia
5College of Dentistry, Alfarabi Colleges, Jeddah, Saudi Arabia
6General Dentist, Andalusia Dental Center, Jeddah, Saudi Arabia
7General Dentist, Albaha University Medical Center, Albaha, Saudi Arabia
8College of Dentistry, King Saud University, Riyadh, Saudi Arabia
9College of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
*Corresponding Author: Hatem Faisal Bajnaid, Department of Endodontics, King Fahad Hospital, Jeddah, Saudi Arabia.
Received:June 16, 2020; Published: June 29, 2020


The dental pulp has many functions that include nutritive, protective, initiative, and reparative ones. Nevertheless, it has a low threshold of damage, for being enclosed in hard tissue. This could, by time, lead to a loss of the pulp and fragile teeth with low quality of life. To avoid tooth extraction and all of the root canal treatment, the proper pulp capping or regeneration therapy of the pulp should be directly carried out. For that, this systematic review will focus on the different options of dental pulp therapy. A systematic electronic database search was conducted for relevant studies published from inception and till 13th May 2020 in seven databases. We included the most appropriate published studies that reported different techniques of dental pulp therapy, after excluding irrelevant ones and those with poor quality. Therapies for dental pulp include two main categories: direct pulp capping and vital pulp amputation. In this study, we have reviewed current and future dental pulp therapies. Most of the current procedures cause an irreversible sacrifice of tissues, leaving vulnerable teeth. Shortly, new regenerative therapies and DCP agents, thanks to the great ongoing studies, are expected to re-shape the current practice and improve patients’ quality of life.

Keywords: Dental Pulp Therapy; Endodontics; Pulpotomy


  1. Avery James K and Daniel J Chiego. “Essentials of Oral Histology and Embryology: A Clinical Approach”. St. Louis, Mo.: Mosby Elsevier (2006).
  2. Hargreaves Kenneth M., et al. “Seltzer and Bender's Dental Pulp”. Quintessence Chicago (2012).
  3. Bergenholtz Gunnar., et al. “Textbook of Endodontology”. John Wiley and Sons (2013).
  4. Heyeraas KJ and I Kvinnsland. "Tissue Pressure and Blood Flow in Pulpal Inflammation”. Proceedings of the Finnish Dental Society 1 (1992): 393-401.
  5. Ng YL., et al. "Outcome of Secondary Root Canal Treatment: A Systematic Review of the Literature”. International Endodontic Journal 12 (2008): 1026-1046.
  6. Health, National Institutes of. "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies”. National Heart, Lung, and Blood Institute (2014).
  7. Komabayashi T., et al. "Current Status of Direct Pulp-Capping Materials for Permanent Teeth”. Dental Materials Journal 1 (2016): 1-12.
  8. Morotomi Takahiko., et al. "Current and Future Options for Dental Pulp Therapy”. The Japanese Dental Science Review1 (2019): 5-11.
  9. Hilton Thomas J. "Keys to Clinical Success with Pulp Capping: A Review of the Literature”. Operative Dentistry5 (2009): 615-625.
  10. Chen L., et al. "Bioactive Dental Restorative Materials: A Review”. American Journal of Dentistry 4 (2013): 219-227.
  11. Poggio C., et al. "In Vitro Cytotoxicity Evaluation of Different Pulp Capping Materials: A Comparative Study”. Archives of Industrial Hygiene and Toxicology 3 (2015): 181-188.
  12. Reston EG and CA De Souza Costa. "Scanning Electron Microscopy Evaluation of the Hard Tissue Barrier after Pulp Capping with Calcium Hydroxide, Mineral Trioxide Aggregate (Mta) or Proroot Mta”. Australian Endodontic Journal 2 (2009): 78-84.
  13. De Lourdes Rodrigues Accorinte, M., et al. "Influence of Rubber Dam Isolation on Human Pulp Responses after Capping with Calcium Hydroxide and an Adhesive System”. Quintessence International 37.3 (2006): 205-212.
  14. De Souza Costa CA., et al. "Response of Human Pulps Capped with a Self-Etching Adhesive System”. Dental Materials 3 (2001): 230-240.
  15. Accorinte ML., et al. "Response of Human Pulps Capped with Different Self-Etch Adhesive Systems”. Clinical Oral Investigations 2 (2008): 119-127.
  16. Sübay RK and M Demirci. "Pulp Tissue Reactions to a Dentin Bonding Agent as a Direct Capping Agent”. Journal of Endodontics 3 (2005): 201-204.
  17. Accorinte Mde L., et al. "Adverse Effects of Human Pulps after Direct Pulp Capping with the Different Components from a Total-Etch, Three-Step Adhesive System”. Dental Materials 7 (2005): 599-607.
  18. Fernandes AM., et al. "Direct Capping of Human Pulps with a Dentin Bonding System and Calcium Hydroxide: An Immunohistochemical Analysis”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 3 (2008): 385-390.
  19. Hörsted-Bindslev P., et al. "Direct Capping of Human Pulps with a Dentin Bonding System or with Calcium Hydroxide Cement”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 5 (2003): 591-600.
  20. Jitaru S., et al. "The Use of Bioceramics in Endodontics - Literature Review”. Clujul Medical 4 (2016): 470-473.
  21. Camilleri J. "The Chemical Composition of Mineral Trioxide Aggregate”. Journal of Conservative Dentistry 4 (2008): 141-143.
  22. Bogen G., et al. "Direct Pulp Capping with Mineral Trioxide Aggregate: An Observational Study”. Journal of the American Dental Association3 (2008): 305-315.
  23. Mente, J., et al. "Treatment Outcome of Mineral Trioxide Aggregate or Calcium Hydroxide Direct Pulp Capping: Long-Term Results”. Journal of Endodontics 11 (2014): 1746-1751.
  24. Hilton TJ., et al. "Comparison of Caoh with Mta for Direct Pulp Capping: A Pbrn Randomized Clinical Trial”. Journal of Dental Research 7(2013): 16s-22s.
  25. Al-Hiyasat AS., et al. "The Radiographic Outcomes of Direct Pulp-Capping Procedures Performed by Dental Students: A Retrospective Study”. Journal of the American Dental Association12 (2006): 1699-1705.
  26. Torabinejad M., et al. "Physical and Chemical Properties of a New Root-End Filling Material”. Journal of Endodontics 7 (1995): 349-353.
  27. Monteiro Bramante C., et al. "Presence of Arsenic in Different Types of Mta and White and Gray Portland Cement”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 6 (2008): 909-913.
  28. Camilleri J. "Characterization and Chemical Activity of Portland Cement and Two Experimental Cements with Potential for Use in Dentistry”. International Endodontic Journal 9 (2008): 791-799.
  29. Accorinte Mde L., et al. "Evaluation of Mineral Trioxide Aggregate and Calcium Hydroxide Cement as Pulp-Capping Agents in Human Teeth”. Journal of Endodontics 1 (2008): 1-6.
  30. Tuna D and A Olmez. "Clinical Long-Term Evaluation of Mta as a Direct Pulp Capping Material in Primary Teeth”. International Endodontic Journal 4 (2008): 273-278.
  31. Aeinehchi M., et al. "Mineral Trioxide Aggregate (Mta) and Calcium Hydroxide as Pulp-Capping Agents in Human Teeth: A Preliminary Report”. International Endodontic Journal 3 (2003): 225-231.
  32. Iwamoto CE., et al. "Clinical and Histological Evaluation of White Proroot Mta in Direct Pulp Capping”. American Journal of Dentistry 2 (2006): 85-90.
  33. Min KS., et al. "Effect of Mineral Trioxide Aggregate on Dentin Bridge Formation and Expression of Dentin Sialoprotein and Heme Oxygenase-1 in Human Dental Pulp”. Journal of Endodontics 6 (2008): 666-670.
  34. Qudeimat MA., et al. "Calcium Hydroxide Vs Mineral Trioxide Aggregates for Partial Pulpotomy of Permanent Molars with Deep Caries”. European Archives of Paediatric Dentistry 2 (2007): 99-104.
  35. Percinoto C., et al. "Clinical and Radiographic Evaluation of Pulpotomies Employing Calcium Hydroxide and Trioxide Mineral Aggregate”. General Dentistry 4 (2006): 258-261.
  36. Nair PN., et al. "Histological, Ultrastructural and Quantitative Investigations on the Response of Healthy Human Pulps to Experimental Capping with Mineral Trioxide Aggregate: A Randomized Controlled Trial”. International Endodontic Journal 2 (2008): 128-150.
  37. Chacko V and S Kurikose. "Human Pulpal Response to Mineral Trioxide Aggregate (Mta): A Histologic Study”. The Journal of Clinical Pediatric Dentistry 3 (2006): 203-209.
  38. Formosa LM., et al. "The Effect of Curing Conditions on the Physical Properties of Tricalcium Silicate Cement for Use as a Dental Biomaterial”. International Endodontic Journal 4 (2012): 326-336.
  39. Bortoluzzi EA., et al. "The Influence of Calcium Chloride on the Setting Time, Solubility, Disintegration, and Ph of Mineral Trioxide Aggregate and White Portland Cement with a Radiopacifier”. Journal of Endodontics 4 (2009): 550-554.
  40. Nielsen MJ., et al. "Mechanical Properties of New Dental Pulp-Capping Materials”. General Dentistry 1 (2016): 44-48.
  41. Hench LL. "The Story of Bioglass”. Journal of Materials Science: Materials in Medicine 11 (2006): 967-978.
  42. Pereira RDS., et al. "Histomorphometric and Immunohistochemical Assessment of Runx2 and Vegf of Biogran™ and Autogenous Bone Graft in Human Maxillary Sinus Bone Augmentation: A Prospective and Randomized Study”. Clinical Implant Dentistry and Related Research 5 (2017): 867-875.
  43. Washio A., et al. "Physicochemical Properties of Newly Developed Bioactive Glass Cement and Its Effects on Various Cells”. Journal of Biomedical Materials Research Part B: Applied Biomaterials 2 (2015): 373-380.
  44. Hanada K., et al. "In Vitro and in Vivo Effects of a Novel Bioactive Glass-Based Cement Used as a Direct Pulp Capping Agent”. Journal of Biomedical Materials Research Part B: Applied Biomaterials 1 (2019): 161-168.
  45. McKay WF., et al. "A Comprehensive Clinical Review of Recombinant Human Bone Morphogenetic Protein-2 (Infuse Bone Graft)”. International Orthopaedics6 (2007): 729-734.
  46. Qin C., et al. "Dentin Matrix Protein 1 (Dmp1): New and Important Roles for Biomineralization and Phosphate Homeostasis”. Journal of Dental Research 12 (2007): 1134-1141.
  47. Washio A., et al. "Possible Involvement of Smad Signaling Pathways in Induction of Odontoblastic Properties in Kn-3 Cells by Bone Morphogenetic Protein-2: A Growth Factor to Induce Dentin Regeneration”. International Journal of Dentistry (2012): 258469.
  48. Aberg T., et al. "Expression Patterns of Bone Morphogenetic Proteins (Bmps) in the Developing Mouse Tooth Suggest Roles in Morphogenesis and Cell Differentiation”. Developmental Dynamics 4 (1997): 383-396.
  49. Shimabukuro Y., et al. "Fibroblast Growth Factor-2 Regulates the Cell Function of Human Dental Pulp Cells”. Journal of Endodontics 11 (2009): 1529-1535.
  50. Morotomi T., et al. "Continuous Fever-Range Heat Stress Induces Thermotolerance in Odontoblast-Lineage Cells”. Archives of Oral Biology 7 (2014): 741-748.
  51. Lanneau D., et al. "Apoptosis Versus Cell Differentiation: Role of Heat Shock Proteins Hsp 90, Hsp70 and Hsp27”. Prion 1 (2007): 53-60.
  52. Nakayama K., et al. "The Novel Nf-Κb Inhibitor, Mti-Ii Peptide Anti-Inflammatory Drug, Suppresses Inflammatory Responses in Odontoblast-Like Cells”. Journal of Cellular Biochemistry11 (2016): 2552-2558.
  53. Kalyan Ksdr., et al. "Preclinical Evaluation and Clinical Trial of Chlorhexidine Polymer Scaffold for Vital Pulp Therapy”. The Journal of Clinical Pediatric Dentistry 2 (2019): 109-115.
  54. Durmus N., et al. "Effectiveness of the Ozone Application in Two-Visit Indirect Pulp Therapy of Permanent Molars with Deep Carious Lesion: A Randomized Clinical Trial”. Clinical Oral Investigations 10 (2019): 3789-3799.
  55. Discher DE., et al. "Growth Factors, Matrices, and Forces Combine and Control Stem Cells”. Science5935 (2009): 1673-1677.
  56. Nakashima M. "Induction of Dentine in Amputated Pulp of Dogs by Recombinant Human Bone Morphogenetic Proteins-2 and -4 with Collagen Matrix”. Archives of Oral Biology 12 (1994): 1085-1089.
  57. Yeom KH., et al. "Platelet-Rich Plasma Enhances the Differentiation of Dental Pulp Progenitor Cells into Odontoblasts”. International Endodontic Journal 3 (2016): 271-278.
  58. Sheridan MH., et al. "Bioabsorbable Polymer Scaffolds for Tissue Engineering Capable of Sustained Growth Factor Delivery”. Journal of Controlled Release 1-3 (2000): 91-102.
  59. Julovi SM., et al. "Hyaluronan Inhibits Il-1beta-Stimulated Collagenase Production Via Down-Regulation of Phosphorylated P38 in Sw-1353 Human Chondrosarcoma Cells”. Modern Rheumatology 3 (2008): 263-270.
  60. Inuyama Y., et al. "Effects of Hyaluronic Acid Sponge as a Scaffold on Odontoblastic Cell Line and Amputated Dental Pulp”. Journal of Biomedical Materials Research Part B: Applied Biomaterials 1 (2010): 120-128.
Citation: Hatem Faisal Bajnaid., et al. “Overview of Different Options for Dental Pulp Therapy: A Systematic Review”. EC Dental Science 19.7 (2020): 100-109.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for August Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the August issue of respective journals. Submissions are accepted on/before July 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to