3D bioprinting strategies for dentin–pulp complex regeneration: a systematic review

Dental pulp injury due to caries, trauma, or restorative procedures may require root canal therapy, which eliminates infected pulp tissue but does not restore the biological functions of the native pulp. Additive manufacturing technologies, including three-dimensional (3D) printing and bioprinting, have emerged as potential approaches for developing biomaterial constructs for dentin–pulp tissue engineering. This systematic review synthesized experimental evidence on additive manufacturing strategies relevant to dentin–pulp complex regeneration, with emphasis on printing approaches, scaffold and bioink materials, and reported biological outcomes. A systematic literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science Core Collection from inception to September 11, 2026. Experimental studies using 3D printing or bioprinting to fabricate constructs intended for dentin, pulp, or the dentin–pulp complex were eligible. Outcomes included odontogenic differentiation, mineralization, vascularization, and tissue formation. Two reviewers independently performed study selection and data extraction, with third-reviewer adjudication when required. Methodological reporting and potential sources of bias were assessed using a six-domain review-specific framework. Owing to substantial heterogeneity in materials, fabrication strategies, experimental models, and outcomes, findings were synthesized narratively. Forty-two experimental studies met the inclusion criteria. Extrusion-based printing was the most frequently used fabrication approach, followed by fused deposition modeling and light-based methods such as stereolithography and digital light processing. Common material systems included polycaprolactone composites, gelatin methacryloyl-based bioinks, and bioactive ceramics. Reported outcomes included odontogenic marker expression, mineralization, vascularization, cell viability, and tissue-level responses in preclinical models. Dentin bridge formation and tertiary dentin deposition in pulp injury models were interpreted as reparative outcomes rather than evidence of complete dentin–pulp complex regeneration. The available evidence supports the biological potential of 3D printing and bioprinting for dentin–pulp tissue engineering, but confidence in the evidence remains limited. Most studies were in vitro or preclinical and showed substantial heterogeneity in fabrication methods, biomaterials, experimental models, outcome measures, and methodological reporting. Further standardized and adequately reported preclinical studies using clinically relevant models and validated outcome measures are needed before predictable clinical regeneration of a functional dentin–pulp complex can be established.