Advanced dental materials protecting a tooth.

Pulp Capping Materials: Are We Using the Best Ones?

Lena Kashyap in Health & Wellness August 2025 • 4 min read.

"A deep dive into the latest research on long-term clinical effectiveness of pulp-capping materials and what it means for your dental health."

For years, the standard approach when a dental pulp was exposed involved a pulpectomy, which basically meant removing the pulp. The thinking was that once exposed, the pulp couldn't recover. But, in 1989, a groundbreaking report by Stanley revealed the dental pulp has regenerative abilities, suggesting that saving the pulp is possible.

This led to vital pulp therapy, including direct pulp capping (DPC), to preserve pulp tissue when exposure occurred due to cavities, trauma, or accidents during dental procedures. Direct pulp capping involves placing a protective material directly over the exposed pulp to encourage healing and maintain the tooth’s vitality.

Many materials have been used for DPC, but figuring out which one works best has been an ongoing question. To get some clarity, a review was conducted to assess the clinical success of different DPC materials based on reliable studies with long-term follow-up. The goal is to recommend the most effective materials for direct pulp capping, ensuring better outcomes and lasting dental health.

MTA vs. Calcium Hydroxide: Which Pulp Capping Material Offers Better Long-Term Success?

Advanced dental materials protecting a tooth.

When it comes to direct pulp capping, two materials have been studied extensively: mineral trioxide aggregate (MTA) and calcium hydroxide (CH). A recent review analyzed numerous studies to compare their long-term effectiveness.

The review included 15 articles that met specific criteria, covering 1,322 teeth treated with 12 different DPC materials. Of these, 1,136 teeth were evaluated at the final follow-up. Key findings revealed that while the number of studies, treated teeth, and average follow-up periods were similar for both MTA and calcium hydroxide, MTA showed superior success rates.

Calcium Hydroxide (CH): CH has been a staple in dental practice since the 1920s, thanks to its high pH, which helps kill bacteria and promote dentin bridge formation. However, CH has drawbacks: its high pH can irritate the pulp, potentially leading to inflammation and necrosis. It can also cause tunnel defects in the dentin bridge and degrade over time, jeopardizing the long-term seal.
Mineral Trioxide Aggregate (MTA): Developed in 1993, MTA is a calcium silicate-based cement known for reducing pulpal inflammation and promoting predictable hard tissue formation. Studies show it results in less inflammation and more reliable hard tissue formation compared to CH.

Despite MTA’s promising results, it's not without its challenges. MTA can cause tooth discoloration and has a long setting time, which can be inconvenient. Newer materials like Biodentine and Endocem aim to overcome these limitations.

The Future of Pulp Capping: What's Next?

While the review suggests MTA is more effective and predictable than calcium hydroxide, the results are based on studies with a high risk of bias. More high-quality, long-term clinical trials are needed to confirm these findings and explore the potential of newer materials like Biodentine and Endocem. Ultimately, the goal is to provide dental professionals with the best tools for preserving tooth vitality and ensuring optimal patient outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2334/josnusd.18-0125, Alternate LINK

Title: Long-Term Clinical And Radiographic Evaluation Of The Effectiveness Of Direct Pulp-Capping Materials

Subject: General Dentistry

Journal: Journal of Oral Science

Publisher: Nihon University School of Dentistry

Authors: Takashi Matsuura, Viviane K. S. Kawata-Matsuura, Shizuka Yamada

Published: 2019-01-01

Everything You Need To Know

What is direct pulp capping (DPC), and why is it used in dentistry?

Direct pulp capping (DPC) is a vital pulp therapy technique used to preserve pulp tissue when exposure occurs due to cavities, trauma, or dental procedure accidents. It involves placing a protective material directly over the exposed pulp to encourage healing and maintain the tooth’s vitality. This approach became popular following a 1989 report by Stanley, which revealed the regenerative abilities of dental pulp, challenging the traditional approach of pulpectomy (pulp removal) for exposed pulps.

How do mineral trioxide aggregate (MTA) and calcium hydroxide (CH) compare as pulp-capping materials?

Mineral trioxide aggregate (MTA) and calcium hydroxide (CH) are two extensively studied materials for direct pulp capping. Calcium hydroxide (CH) has been used since the 1920s due to its high pH, which helps kill bacteria and promote dentin bridge formation. However, CH can irritate the pulp, potentially leading to inflammation and necrosis. It may also cause tunnel defects in the dentin bridge and degrade over time. Mineral trioxide aggregate (MTA), developed in 1993, is a calcium silicate-based cement known for reducing pulpal inflammation and promoting predictable hard tissue formation. Studies suggest MTA results in less inflammation and more reliable hard tissue formation compared to CH. A recent review suggests MTA shows superior success rates.

What are the limitations of using mineral trioxide aggregate (MTA) in pulp capping, and what alternative materials are being explored?

While mineral trioxide aggregate (MTA) has shown promising results in direct pulp capping, it is not without its challenges. MTA can cause tooth discoloration and has a long setting time, which can be inconvenient for dental procedures. Due to these limitations, newer materials like Biodentine and Endocem are being explored as alternatives. These materials aim to overcome MTA's drawbacks while maintaining or improving its effectiveness in promoting pulp healing and hard tissue formation.

What are the potential drawbacks of using calcium hydroxide (CH) for direct pulp capping, and how might these affect the long-term success of the treatment?

Although calcium hydroxide (CH) has been a long-standing material in dental practice for direct pulp capping due to its antibacterial properties and ability to promote dentin bridge formation, it has several potential drawbacks that can affect the long-term success of the treatment. One major concern is that its high pH can irritate the pulp, potentially leading to inflammation and necrosis. Additionally, CH can cause tunnel defects in the dentin bridge and degrade over time, which may jeopardize the long-term seal and increase the risk of treatment failure. These limitations have prompted the search for alternative materials like MTA.

What future research is needed to determine the best pulp-capping materials for ensuring optimal patient outcomes and preserving tooth vitality?

Future research should focus on conducting more high-quality, long-term clinical trials to confirm the findings that mineral trioxide aggregate (MTA) is more effective than calcium hydroxide (CH). These trials should also explore the potential of newer materials like Biodentine and Endocem. Additionally, research should aim to reduce bias and provide dental professionals with the best tools for preserving tooth vitality and ensuring optimal patient outcomes. Further investigation should explore the mechanisms by which these materials interact with pulp tissue at a cellular and molecular level.