Scaffold-based and calcium-silicate biomaterials in vital pulp therapy: a systematic review of current evidence and translational perspectives

Objective To critically synthesise and appraise the current evidence on scaffold-based regenerative biomaterials and calcium-silicate biomaterials used in vital pulp therapy (VPT), with particular emphasis on the translational challenges associated with achieving biological regeneration of the dentine–pulp complex. Methods This systematic review was conducted in accordance with PRISMA 2020 guidelines. Electronic searches of MEDLINE (via PubMed), Scopus and Web of Science were performed from database inception to March 2025. Studies evaluating scaffold-based regenerative biomaterials or calcium-silicate biomaterials in VPT were included. Human clinical investigations and in vivo animal studies were considered to capture evidence across different stages of translational research. Methodological quality was assessed using study-design-appropriate risk-of-bias tools. Owing to substantial heterogeneity in study design, interventions and outcome measures, findings were synthesised narratively. Results Eleven studies met the inclusion criteria, comprising six clinical investigations evaluating calcium-silicate biomaterials and five preclinical animal studies investigating scaffold-based regenerative approaches. Clinical evidence consistently demonstrated favourable outcomes for calcium-silicate biomaterials in preserving pulpal vitality and promoting reparative dentine formation. Scaffold-based systems demonstrated promising regenerative characteristics, including enhanced angiogenesis, odontogenic differentiation and formation of organised pulp-like tissue under experimental conditions. However, scaffold evidence was limited to preclinical models, and no included study directly compared scaffold-based and calcium-silicate biomaterials within the same experimental or clinical framework. Conclusions Current evidence supports calcium-silicate biomaterials as the clinical standard for VPT, whereas scaffold-based regenerative biomaterials remain a promising area of translational research. Although experimental findings suggest considerable regenerative potential, the absence of direct comparative clinical evidence precludes conclusions regarding comparative effectiveness. Future well-designed clinical studies are required to determine whether scaffold-based approaches can successfully translate into predictable clinical regeneration of the dentine–pulp complex.