Different pulp capping agents and their effect on pulp inflammatory response: A narrative review

Several factors can directly damage dental pulp. Pulp healing requires controlled inflammation, which can be directed through specialized medical materials to eliminate infection and promote pulp repair. This review aimed to categorise these materials and identify their histological and molecular effects on pulp tissue or isolated cells in culture. In addition, we sought to identify which of these materials could trigger a favourable inflammatory pathway that could direct the pulpal response toward healing and regeneration. A single database (PubMed) was used, and the search strategy was based on MeSH terms. The search was conducted for articles published in English between January 2010 and December 2023, including those with histological and molecular findings. Only 33 articles met our inclusion criteria. Several conventional pulp capping agents have been shown to induce pulp healing and repair through dentine bridge formation. These materials show varying degrees of inflammation, ranging from moderate to mild, which may diminish over time. Other experimentally developed materials were also studied, either alone or in combination with conventional products; these materials demonstrated promising potential to reduce inflammation and superficial necrosis associated with conventional products. However, they still do not meet all the criteria for ideal pulp-capping materials and need further development for commercialisation. Several inflammatory pathways were also addressed in this review, along with favourable tissue responses to induce pulp regeneration. The immunomodulatory role of M2 phenotype macrophages is currently the most accepted, though the lack of standardised experimental procedures across studies hinder precise decision-making.