Pulp Capping and Biodentine

Pulp capping is the preservation of tooth vitality by forming a barrier between the pulp and the surrounding environment. A successful formation of this barrier avoids the need for further treatment and helps in the conservation of the pulp-dentin complex.₁

The dentine-pulp complex is a unique mineralised connective tissue that is composed of two integrated constituents: the pulp – an underlying gelatinous soft connective tissue which has a rich vasculature and is well innervated, and dentine – an outer casing of mineralised tissue.₂

The pulp is under threat from three main sources: carious attack, trauma and iatrogenic damage (Bjørndal et al 2019). Prior to providing any definitive restoration for a tooth it is important to determine if there is any disease associated with the pulp based on the patient’s symptoms and clinical examination.₂

Management of exposed pulp can be accomplished by pulp capping procedure. Pulp capping prevents the pulp from external stimuli by forming a seal between the oral environment and the pulp, which in turn prevents the progression of microorganisms.₁

Types of pulp capping

Indirect pulp capping₂:

Application of a biomaterial onto a thin dentine barrier in a one-stage complete carious tissue removal technique generally to hard dentine

Indication

• Asymptomatic carious lesion without pulp exposure where selective caries removal is not indicated
• Reversible pulpitis without pulp exposure

Direct pulp capping₂:

Application of a biomaterial directly onto the exposed pulp, before immediate placement of a permanent restoration

Indication

• Asymptomatic carious lesion with pulp exposure
• Reversible pulpitis with pulp exposure

Direct versus indirect pulp capping₂:

Determining the most favorable treatment strategy for managing pulpitis is multifactorial. Pre-operative clinical and radiographic investigations play a key role, as the diagnosis affects the level of VPT performed. However, intra-operative findings also influence decision-making.

Which material should you use?₃

Ideal Properties of Pulp Capping Materials:

• Stimulate reparative Dentin formation,
• Maintain Pulp Vitality,
• Release Flouride to prevent secondary caries
• Bactericidal or bacteriostatic
• Adhere to dentin
• Adhere to restorative material
• Resist force during restoration placement and during the life of restoration.
• Sterile
• Radioopaque
• Provide bacterial seal

Why is Biodentine a promising material for pulp capping?

Therapeutic properties:

Biodentine^TM is both a restorative material and a pulp therapeutic in one. Made from ultra pure tricalcium silicate using patented Advanced Biosilicate (ABS) Technology^TM, Biodentine^TM is free from the heavy metals and other impurities found in calcium silicate cements like MTA._4,5,6

Dentine remineralization:

As bioactive material, Biodentine^TM promotes dentine remineralisation through the formation of reactionary dentine and dentinal bridges._7,8,9,10,11 The high alkalinity degrades collagen at the dentine interface, creating a very porous surface and a distinct “mineral infiltration zone.”_10,14

High alkaline pH:

Thanks to its very high alkaline pH, Biodentine^TM creates an unhospitable environment for residual bacteria once placed._10,12,13 When compared to MTA and GIC in in vitro studies, Biodentine^TM demonstrates a higher potential to limit bacteria proliferation thanks to its alkaline pH.₁₀

Tight seal:

Biodentine^TM bonds tightly to the dentine wall via micro-mechanical anchorage, depositing mineral tags into the dentinal tubules._10,14

Exceptional strength:

Biodentine^TM’s compressive strength continues to improve after application and gradually reaches the strength of natural dentine within 28 days 13.

With Biodentine™, you can rely on a clinically proven material for indirect or direct pulp capping, supported by extensive scientific and clinical evidence.

Ref:

1. Current key to clinical success in pulp capping: A review https://ijce.in/archive/volume/8/issue/3/article/3733/pdf
2. Vital pulp therapies in permanent teeth: what, when, where, who, why and how? https://doi.org/10.1038/s41415-025-8560-3
3. Biodentine: an effective pulp capping material DOI: 10.36347/sjds.2016.v03i01.005
4. Watson, T.F., Atmeh, A.R., Sajini, S. et al. (2014) ‘Present and future of glass ionomers and calcium-silicate cements as bioactive materials in dentistry: biophotonics-based interfacial analyses in health and disease’, Dental Materials, 30(1), pp. 50–61. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3885799/
5. Camilleri, J. (2011) ‘Characterization and hydration kinetics of tricalcium silicate cement for use as a dental biomaterial’, Dental Materials, 27(8), pp. 836–844. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0109564111001151
6. Camilleri, J. (n.d.) Biodentine™: The dentine in a capsule or more. Septodont Learning. Available at: https://www.septodontlearning.co.uk/sites/default/files/Biodentine-The-dentine in-a-capsule-or-more-by-Josette-Camilleri-compressed.pdf
7. Internal data: Biodentine™ Scientific file (2011). Pages 20-23. Pages 24-28.
8. Hashem, D., Mannocci, F., Patel, S. et al. (2015) ‘Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial’, Journal of Dental Research, 94(4), pp 562-568. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4485218/
9. Nowicka, A., Lipski, M., Parafiniuk, M. et al. (2013) ‘Response of human dental pulp capped with Biodentine and mineral trioxide aggregate’, Journal of Endodontics, 39(6), pp. 743–747. Available at: https://www.jendodon.com/article/S0099 2399(13)00133-7/abstract
10. Kaur, M., Singh, H., Dhillon, J.S. et al. (2017) ‘MTA versus Biodentine™: Review of literature with a comparative analysis’, Journal of Clinical and Diagnostic Research, 11(8), pp. ZG01–ZG05. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5620936/
11. Sajini, S., Atmeh, A., Banerjee, A. et al. (2022) ‘Glass-ionomer and calcium silicate based cements interactions with human dentine in health and disease: Two-photon fluorescence microscopy and Raman spectroscopy analysis’, Dental Materials, 38(11), pp. 1710–1720. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0109564122002536?via%3Dihub
12. About, I. (2022) Biodentine: Properties and Clinical Applications. Switzerland: Springer. URL: https://link.springer.com/book/10.1007/978-3-030-80932-4
13. Lundy, F.T., Giraud, T., El-Karim, I.A. et al. (2022) ‘Biodentine™ in inflammation and pain control’, in About, I. (ed.) Biodentine: Properties and Clinical Applications. Switzerland: Springer, pp. 51–66. URL: https://link.springer.com/book/10.1007/978 3-030-80932-4
14. Atmeh, A.R., Chong, E.Z., Richard, G. et al. (2012) ‘Dentin-cement interfacial interaction: calcium silicates and polyalkenoates’, Journal of Dentistry, 91(5), pp. 454–459. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4077527/