Bioactive Materials in Vital Pulp Therapy Supporting Natural Tooth Repair

Thailand Dental News: Understanding Dental Pulp Inflammation and Repair
Dental health experts from Huazhong University of Science and Technology, China, have been exploring new ways to heal damaged teeth without resorting to invasive treatments like root canals. The latest research highlights how bioactive materials can support vital pulp therapy (VPT), a modern approach that helps the body repair dental pulp naturally instead of removing it.


Bioactive Materials in Vital Pulp Therapy Supporting Natural Tooth Repair

In the past, severe tooth decay or injury often led to irreversible pulp damage, requiring extraction or root canal treatment. However, this Thailand Dental News report shows that mild to moderate inflammation can actually trigger repair and healing, rather than destruction. By understanding how inflammation works in the pulp, researchers hope to enhance the effectiveness of bioactive materials, which are now widely used in VPT.
 
The Role of Bioactive Materials in Healing Pulp Tissue
Vital pulp therapy involves treating injured dental pulp with special materials that promote healing and regeneration. Researchers have focused on materials like mineral trioxide aggregate (MTA), Biodentine, and iRoot BP Plus, which have been found to interact with pulp tissue to encourage natural healing. These materials contain bioactive compounds, such as calcium and silicon, which stimulate the cells inside the pulp to form new dentin—the hard tissue protecting the pulp.
 
One key discovery is that bioactive materials do more than just cover exposed pulp. They actively regulate inflammation, ensuring it stays at a level that supports healing instead of causing further damage. Inflammation is a natural response to injury, but if it becomes excessive, it can destroy pulp tissue. The study found that bioactive materials help maintain the right balance, reducing harmful inflammation while allowing beneficial repair processes to take place.
 
How Bioactive Materials Control Inflammation
The study examined how bioactive materials interact with pulp cells and influence inflammatory responses. When dental pulp is damaged, the body releases signaling molecules called cytokines, which control inflammation. Some cytokines trigger inflammation, while others reduce it. Bioactive materials help regulate this process, ensuring that inflammation does not get out of control.
 
MTA, one of the most widely used materials in VPT, was found to temporarily increase inflammation before gradually reducing it, which is essential for initiating healing. Similarly, Biodentine was shown to influence the immune response, first triggering mild inflammation and later encouraging tissue repair. iRoot BP Plus, another bioactive material, demonstrated anti-inflammatory properties, helping the pulp heal more efficiently.
 
Another important finding was how these materials interact with immune cells like macrophages. These cells play a crucial role in the healing process by clearing damaged tissue and signaling fo r repair. Bioactive materials were found to encourage macrophages to shift from an inflammatory state to a healing state, further promoting tissue regeneration.
 
Bioactive Compounds Used in Pulp Therapy
-MTA: A calcium silicate-based material widely used in endodontics due to its excellent sealing ability, biocompatibility, and ability to induce dentin formation. It interacts with pulp cells through multiple signaling pathways, influencing inflammation and promoting healing.

-Biodentine: A tricalcium silicate-based material with properties similar to MTA but with a shorter setting time and reduced risk of tooth discoloration. It stimulates the odontogenic differentiation of pulp cells while modulating the inflammatory response.
 
-Bioaggregate: A bioceramic material composed mainly of calcium silicates, calcium phosphates, and hydroxyapatite. It has shown promising results in pulp repair by enhancing mineralization and reducing inflammatory cytokines.
 
-iRoot BP Plus: A bioceramic material containing tricalcium silicate and zirconium oxide, known for its bioactivity and potential to regulate pulp inflammation, reduce cytokine secretion, and enhance cellular differentiation.
 
-Bioactive Ions (Lithium, Zinc, Strontium, Magnesium, Silver): These ions play essential roles in cellular signaling and pulp regeneration. Lithium enhances Wnt signaling, promoting dentin formation. Zinc supports odontogenic differentiation and angiogenesis through integrin and NF-κB pathways. Strontium influences dentin formation via Ca-sensing receptors, while magnesium enhances mineralization through ERK/BMP signaling. Silver ions contribute to antibacterial activity and inflammation regulation by modulating the NF-κB pathway.
 
These compounds contribute to pulp therapy by balancing inflammation and repair, ensuring successful tissue regeneration and preservation of tooth vitality.
 
The Science Behind Pulp Regeneration
Researchers also investigated how bioactive materials activate cellular pathways responsible for pulp healing. One of the key pathways is the NF-κB pathway, which plays a role in regulating inflammation. The study found that while some materials like MTA initially activate this pathway, they later suppress it to control excessive inflammation. Other pathways, such as the MAPK and Wnt signaling pathways, were also influenced by these materials, helping pulp cells multiply and form new dentin.
 
Autophagy, a process where cells break down and recycle damaged components, was another critical factor in pulp healing. The study found that MTA and iRoot BP Plus could enhance autophagy, which helps pulp cells survive and repair themselves more effectively. This means that bioactive materials not only protect the pulp from damage but also activate mechanisms that support long-term tooth health.
 
Future Implications for Dental Treatments
The findings of this study are significant for the future of dentistry. Traditional root canal treatments remove the pulp completely, which can weaken the tooth over time. However, by using bioactive materials in VPT, dentists can help patients retain their natural pulp, reducing the need for more invasive procedures. This research suggests that refining these materials and better understanding their effects could lead to even more effective treatments that preserve natural teeth for longer.
 
While bioactive materials are already used in clinical practice, this study highlights the need for continued research to optimize their formulation and application. Researchers hope that by fine-tuning these materials, they can further improve their ability to regulate inflammation and promote natural repair processes in dental pulp.
 
The study findings were published in the peer-reviewed journal: Biomolecules.
https://www.mdpi.com/2218-273X/15/2/258
 
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