A review on biodentine, a contemporary dentine replacement and repair material

In vitro evaluation of coronal discoloration following the application of calcium-enriched mixture cement, Biodentine, and mineral trioxide aggregate in endodontically treated teeth

BACKGROUND

This study sought to assess and compare coronal discoloration following the application of white mineral trioxide aggregate, Biodentine, and calcium-enriched mixture cement in endodontically treated teeth.

MATERIALS AND METHODS

In this in vitro experimental study, 64 freshly extracted sound human premolars were selected, cleaned, and stored in saline. After cleaning, shaping, and obturation the root canal of the teeth, the teeth were randomly assigned to one control (n = 4) and three experimental (n = 20) groups. In the experimental groups, the cement were applied over the canal orifices in 3-mm thickness. All teeth were then restored with composite resin. Color parameters, according to the CIE L^*a^*b^* system, were measured using Vita Easyshade spectrophotometer before application of cement and at 1 week, 1 month, 2 months, and 3 months after the application of cement. The recorded values were statistically analyzed using descriptive and analytical statistics. For analytical statistics, Kolmogorov-Smirnov test was applied to assess normal distribution of data. ANOVA was used to compare the results at baseline and repeated measures. P < 0.05 was considered statistically significant.

RESULTS

Significant differences were noted in color change (ΔE) between all time points except between ΔE4 (2 months) and ΔE5 (3 months) (P < 0.01). However, tooth discoloration caused by the three cement was not significantly different (P = 0.343).

CONCLUSION

The three tested cement were not significantly different in terms of causing coronal discoloration in endodontically treated teeth.

The Chemical and Morphological Study of Calcium Silicate-Based Material (Biodentine®) and Glass Ionomer Cement (GIC®)

Background:

Attention was paid to the chemical properties of bioactive materials, and the reaction that could occur on their surface.

Objective:

The evaluation of the chemical properties includes the solubility, water sorption, pH changes and calcium release of two dental materials (BD and GIC). In addition, the morphological structure of each material was studied after its immersion in two different solutions,i.e.deionized water and phosphate solution.

Methods:

The chemical study was carried out for two sets of samples; 28 samples of each material. Samples were immersed in 10 mL of deionized water and stored at 37 °C for different times. The morphological structure and elemental analysis of BD and GIC samples were studied after immersion in the two solutions for 1, 7, 14 and 28 days.

Results:

Solubility of BD increased with time reaching a maximum value after 60 days (13.63 ± 2.08%). The solubility of GIC was negatively correlated with time, with a maximum value of 4.11 ± 0.47% for 3 h. The released Ca+2ions varied between 1.0 ± 0.3 mg (3 h) and 5.3 ± 0.8 mg (60 days) for BD. However, calcium was not detected in the GIC samples. The formation of calcium hydroxy-fluorapatites and strontium-fluoro-alumino-silicate, on the surface of BD and GIC, respectively, was clarified for the first time in this study.

Conclusion:

A comparative study was carried out revealing the difference in the chemical properties and the morphological structure between the two studied materials. The results confirmed the biointeractivity and the bioactivity of BD and GIC.

Effects of a New Bioceramic Material on Human Apical Papilla Cells

BACKGROUND

The development of materials with bioregenerative properties is critically important for vital pulp therapies and regenerative endodontic procedures. The aim of this study was to evaluate the cytocompatibility and cytotoxicity of a new endodontic biomaterial, PulpGuard, in comparison with two other biomaterials widely used in endodontic procedures, ProRoot Mineral Trioxide Aggregate (MTA) and Biodentine.

METHODS

Apical papilla cells (APCs) were isolated from third molars with incomplete rhizogenesis from patients with orthodontic indication for dental extraction. Cultured APCs were incubated for 24, 48, or 72 h with different dilutions of eluates prepared from the three materials. Cellular viability, mobility, and proliferation were assessed in vitro using the Alamar Blue assay and a wound-healing test. The cells were also cultured in direct contact with the surface of each material. These were then analyzed via Scanning Electron Microscopy (SEM), and the surface chemical composition was determined by Energy-Dispersive Spectroscopy (EDS).

RESULTS

Cells incubated in the presence of eluates extracted from ProRoot MTA and PulpGuard presented rates of viability comparable to those of control cells; in contrast, undiluted Biodentine eluates induced a significant reduction of cellular viability. The wound-healing assay revealed that eluates from ProRoot MTA and PulpGuard allowed for unhindered cellular migration and proliferation. Cellular adhesion was observed on the surface of all materials tested. Consistent with their disclosed composition, EDS analysis found high relative abundance of calcium in Biodentine and ProRoot MTA and high abundance of silicon in PulpGuard. Significant amounts of zinc and calcium were also present in PulpGuard discs. Concerning solubility, Biodentine and ProRoot MTA presented mild weight loss after eluate extraction, while PulpGuard discs showed significant water uptake.

CONCLUSIONS

PulpGuard displayed a good in vitro cytocompatibility profile and did not significantly affect the proliferation and migration rates of APCs. Cells cultured in the presence of PulpGuard eluates displayed a similar profile to those cultured with eluates from the widely used endodontic cement ProRoot MTA.

[Recent advances in direct pulp capping materials]

The long-term effect of direct pulp capping and pulpotomy is closely related to the type of pulp capping materials. Various kinds of direct pulp capping materials are available, such as calcium hydroxide and mineral trioxide aggregates. Diverse new pulp capping materials have been reported recently. The excellent performance of calcium silicates has attracted much attention in previous studies. Moreover, enamel matrix derivative (Emdogain), which is capable of regeneration and remineralization, and other materials with similar capabilities have shown potential for use in pulp capping.

A review of bioceramics-based dental restorative materials

Currently, much has been published related to conventional resin-based composites and adhesives; however, little information is available about bioceramics-based restorative materials. The aim was to structure this topic into its component parts and to highlight the translational research that has been conducted up to the present time. A literature search was done from indexed journals up to September 2017. The main search terms used were based on dental resin-based composites, dental adhesives along with bioactive glass and the calcium phosphate family. The results showed that in 123 articles, amorphous calcium phosphate (39.83%), hydroxyapatite (23.5%), bioactive glass (16.2%), dicalcium phosphate (5.69%), monocalcium phosphate monohydrate (3.25%), and tricalcium phosphate (2.43%) have been used in restorative materials. Moreover, seven studies were found related to a newly developed commercial bioactive composite. The utilization of bioactive materials for tooth restorations can promote remineralization and a durable seal of the tooth-material interface.

Biological interactions of a calcium silicate based cement (Biodentine™) with Stem Cells from Human Exfoliated Deciduous teeth

OBJECTIVE

To investigate the biological interactions of a calcium silicate based cement (Biodentine™) with Stem Cells from Human Exfoliated Deciduous teeth (SHED), focusing on viability/proliferation, odontogenic differentiation, biomineralization and elemental release/exchange.

METHODS

Biodentine™ specimens were used directly or for eluate preparation at serial dilutions (1:1-1:64). SHED cultures were established from deciduous teeth of healthy children. Viability/proliferation and morphological characteristics were evaluated by live/dead fluorescent staining, MTT assay and Scanning Electron Microscopy. Odontogenic differentiation by qRT-PCR, biomineralization by Alizarin red S staining, while ion elution by Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES).

RESULTS

SHED effectively attached within the crystalline surface of Biodentine™ specimens acquiring a spindle-shaped phenotype. Statistically significant stimulation of cell proliferation was induced at day 3 by eluates in dilutions from 1:16 to 1:64. Differential, concentration- and time-dependent expression patterns of odontogenic genes were observed under non-inductive and inductive (osteogenic) conditions, with significant up-regulation of DSPP and Runx2 at higher dilutions and a peak in expression of BMP-2, BGLAP and MSX-2 at 1:8 dilution on day 7. Progressive increase in mineralized tissue formation was observed with increasing dilutions of Biodentine™ eluates. ICP-OES indicated that Biodentine™ absorbed Ca, Mg and P ions from culture medium, while releasing Si and Sr ions from its backbone.

SIGNIFICANCE

Biodentine™ interacts through elemental release/uptake with the cellular microenvironment, triggering odontogenic differentiation and biomineralization in a concentration-dependent manner. These results reveal a promising strategy for application of the calcium silicate based cement (Biodentine™) for vital pulp therapies of deciduous teeth in Paediatric Dentistry.

Evaluation of Biodentine Pulpotomies in Deciduous Molars with Physiological Root Resorption (Stage 3)

INTRODUCTION

Conservation of primary dentition is essential for maintenance of arch length, esthetic, mastication, speech and prevention of abnormal habits. The commonly supported treatment for retaining carious primary molars with affected pulp is pulpotomy.

AIM

The study aims to evaluate clinically and radiographically the rates of success and efficacy of Biodentine™ as pulpotomy medicament exclusively on primary molars with physiological root resorption.

MATERIALS AND METHODS

A total number of 35 primary molars in stage three of formation were selected to undergo pulpotomy treatment. All teeth were restored with pediatric stainless-steel crowns.The clinical findings were evaluated at 1, 3, 6 and 12-month intervals and the radiographic follow-ups evaluations were done at 6 and 12 months. The resulting data were tabulated and statistically analyzed using IBM SPSS© for Windows version 20.0 (SPSS, Chicago, IL, USA). Mc Nemar test was conducted to evaluate the differences in results between months 6 and 12.

RESULTS

Periodontal ligament space (PLS) widening and alveolar bone lesion were not seen in any of the 35 cases, 9 teeth (25.7%) manifested pulp canal obliteration (PCO), and none of the cases showed signs of pathologic root resorption. The clinical and radiographic success rates in pulpotomy using Biodentine™ at 6 and 12 months were 100%.

CONCLUSION

Pulpotomies performed with Biodentine™ were entirely successful. This dressing material appears to be a serious pulpotomy agent in primary molars with root resorption.How to cite this article: Nasseh HN, Noueiri BE, Pilipili C, Ayoub F. Evaluation of Biodentine Pulpotomies in Deciduous Molars with Physiological Root Resorption (Stage 3). Int J Clin Pediatr Dent., 2018;11(5):393-398.

Biodentine for Furcation Perforation Repair: An Animal Study with Histological, Radiographic and Micro-Computed Tomographic Assessment

Introduction:

Biodentine has been scarcely studied as a furcation perforation (FP) repair material, mostly by in vitro methodologies. This animal study aimed to compare the histological responses, radiographic, and micro-computed tomographic (micro-CT) outcomes after FP repair with Biodentine or ProRoot MTA (MTA) in dogs’ teeth.

Methods and Materials:

Fifty teeth from five dogs were divided into 4 groups: MTA (n=20, FP repaired with ProRoot MTA), BDT (n=20, FP repaired with Biodentine), PC (n=5, positive control, FP without repair) and NC (n=5, negative control, without perforation). The animals were euthanized after 4 months. Histological assessment included inflammatory cell infiltration, hard tissue resorption, hard tissue repair, and cement repair in the furcation area. Immediate postoperative and 4 months follow-up radiographs were compared for radiolucency in the furcation region. The volume of extruded material was quantified using micro-CT images.

Results:

The tested materials showed equivalent radiographic response, together with similar hard tissue resorption and repair but, BDT group showed significantly less inflammation, lower volume of extruded material and higher cement repair than MTA group.

Conclusion:

The outcomes of this study, taken together with other favorable results in literature, are highly suggestive that Biodentine is a promising biomaterial to be used for FP repair.

Bone tissue reaction, setting time, solubility, and pH of root repair materials

OBJECTIVES

This study aims to compare the bone tissue reaction, setting time, solubility, and pH of NeoMTA Plus, Biodentine (BD), and MTA Angelus (MTA-A).

MATERIALS AND METHODS

Initial and final setting times (n = 7) and solubility up to 7 days (n = 11) were evaluated in accordance with ASTM C266-15 and ANSI/ADA Specification No. 57, respectively. pH (n = 10) was measured up to 28 days. Bone tissue reactions in 48 rats' femur were histologically analyzed after 7, 30, and 90 days. ANOVA and Tukey's tests compared setting time, solubility, and pH data; bone reactions data were compared by Kruskal-Wallis and Dunn's tests.

RESULTS

NeoMTA Plus had longer initial and final setting times than MTA-A and BD (P < 0.05). At 7 days, BD showed the highest solubility, similar to NeoMTA Plus (P > 0.05) and different from MTA-A (P < 0.05). NeoMTA Plus had a progressive mass loss over time; at 7 days, it was significantly different from the initial mass (P < 0.05). BD showed higher pH in the periods assessed when compared to the other materials (P < 0.05). Bone tissue repair had no differences between groups in each experimental period (P > 0.05). All groups presented no difference from 30 to 90 days (P > 0.05) and had better bone repair at 90 days than at 7 days (P < 0.05).

CONCLUSIONS

NeoMTA Plus, BD, and MTA-A showed satisfactory setting time, high mass loss, alkaline pH, and allowed bone repair.

CLINICAL RELEVANCE

Calcium silicate-based cements are indicated for multiple clinical situations. NeoMTA Plus and BD showed satisfactory physical-chemical and biological properties, being considered as alternatives to MTA-A, as root repair materials for clinical use.

Effect of a hyperbaric environment (diving conditions) on adhesive restorations: an in vitro study

Objectives No recent study has addressed the effect of diving conditions (pressure increase) on adhesive restorations. We evaluated the impact of a simulated hyperbaric environment on microleakage of the dentine-composite resin interface. The ultimate aim was to propose recommendations for restorative dentistry for patients who are divers to limit barodontalgia (dental pain caused by pressure variations of the environment) and may lead to dangerous sequelae.Methods We bonded 20 dentine disks by using an adhesive system (Scothbond Universal) to ten intact composite cylinders and ten composite cylinders with porosity (Ceram X mono). For each group, the samples were divided into two subgroups, one submitted to a simulated hyperbaric environment and the other to an ambient environment. All samples were immersed in a silver nitrate solution to evaluate microleakage at the interface after analysis with a camera.Results Dye percolation for groups in the hyperbaric environment was greater than groups in ambient environment. For each subgroup, dye percolation was greater for samples with than without porosity.Conclusions High percolation percentages demonstrate that our simulated hyperbaric condition led to loss of sealing at the dentine-composite resin interface, especially with porous composites.Clinical significance Respect of the protocol and the quality of condensation for adhesive restorations are important in all clinical situations, especially for patients who are divers. A more interventionist approach must be adopted with these patients.

The Effect of a Mineralized Bone Graft on the Surface Microhardness of Mineral Trioxide Aggregate and Biodentine

Introduction:

This study was designed to determine the effect of Osteon II mineralized bone powder on the surface microhardness of two retrofilling materials: Mineral trioxide aggregate (MTA) and Biodentine (BD).

Methods and Materials:

Each retrograde material was mixed and carried into 30 sterile custom-made plastic cylinders. Half of the samples in each group were exposed to Osteon II. All cylinders were submerged in simulated tissue fluid and incubated at 37^°C and 100% relative humidity for 7 days. Surface microhardness values of each study group was attained using Vicker’s microhardness test. The data were analyzed statistically using two-way ANOVA and independent t test at a significance level of 0.05.

Results:

In all the setting conditions, BD had significantly greater surface microhardness than MTA (P<0.001). Surface microhardness of both materials was significantly reduced in the presence of osteon II (P=0.006 for BD and P<0.001 for MTA).

Conclusion:

Mineralized bone graft materials negatively affect surface microhardness of both MTA and BD. In presence of osteon II, BD had the highest surface microhardness.

Microstructure and chemical analysis of four calcium silicate-based cements in different environmental conditions

OBJECTIVE

The objective of this study was to analyze the microstructure and crystalline structures of ProRoot MTA, Biodentine, CEM Cement, and Retro MTA when exposed to phosphate-buffered saline, butyric acid, and blood.

METHODS AND MATERIALS

Mixed samples of ProRoot MTA, Biodentine, CEM Cement, and Retro MTA were exposed to either phosphate-buffered saline, butyric acid, or blood. Scanning electron microscope (SEM) and energy-dispersive X-ray spectroscopic (EDX) evaluations were conducted of specimens. X-ray diffraction (XRD) analysis was also performed for both hydrated and powder forms of evaluated calcium silicate cements.

RESULTS

The peak of tricalcium silicate and dicalcium silicate detected in all hydrated cements was smaller than that seen in their unhydrated powders. The peak of calcium hydroxide (Ca(OH)₂) in blood- and acid-exposed ProRoot MTA, CEM Cement, and Retro MTA specimens were smaller than that of specimens exposed to PBS. The peak of Ca(OH)₂ seen in Biodentine™ specimens exposed to blood was similar to that of PBS-exposed specimens. On the other hand, those exposed to acid exhibited smaller peaks of Ca(OH)₂.

CONCLUSION

Exposure to blood or acidic pH decreased Ca(OH)₂ crystalline formation in ProRoot MTA, CEM Cement and Retro MTA. However, a decrease in Ca(OH)₂ was only seen when Biodentine™ exposed to acid.

CLINICAL RELEVANCE

The formation of Ca(OH)₂ which influences the biological properties of calcium silicate cements was impaired by blood and acid exposures in ProRoot MTA, CEM Cement, and Retro MTA; however, in the case of Biodentine, only exposure to acid had this detrimental effect.

Push-out bond strength of different tricalcium silicate-based filling materials to root dentin

The aim of this study was to evaluate the bond strength of different triccalcium silicate cements to retrograde cavity using a push out test. Thirty maxillary central incisors were shaped using #80 hand files and sectioned transversally. Root slices were obtained from the apical 4 mm after eliminating the apical extremity. The specimens were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. The samples were divided into three groups according to the root-end filling material (n = 10): MTA Angelus, ProRoot MTA and Biodentine. A gutta-percha cone (#80) was tugged-back at the limit between the canal and the root-end cavity. The root-end cavity was filled and the gutta-percha cone was removed after complete setting of the materials. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and push out testing was performed at a crosshead speed of 1.0 mm/min. There was no statistically significant difference in resistance to push out by the materials tested (p > 0.01). MTA Angelus and ProRoot MTA showed predominantly mixed failure while Biodentine exhibited mixed and cohesive failures. The tricalcium silicate-based root-end filling materials showed similar bond strength retrograde cavity.

Cytocompatibility of Biodentine and iRoot FS with human periodontal ligament cells: an in vitro study

AIM

To evaluate the cytocompatibility of Biodentine and iRoot FS with human periodontal ligament cells (hPDLCs).

METHODOLOGY

Human periodontal ligament cells were characterized by flow cytometry and immunocytochemical analysis. Human periodontal ligament cell adhesion was assessed by scanning electron microscopy at day 3; proliferation by live/dead assay at days 1, 3 and 7; and osteogenic differentiation by alkaline phosphatase (ALP) activity staining, ALP quantification analysis and qRT-PCR at days 7 and 14. Data were analysed with anova and independent sample t-tests with SPSS 21.0.

RESULTS

Both iRoot FS and Biodentine increased the adhesion of hPDLCs at day 3. Compared to Biodentine, iRoot FS positively increased hPDLC proliferation on days 3 (P = 0.03) and 7 (P = 0.00). Osteogenic marker ALP was observed consistently in all samples, with iRoot FS having significantly higher ALP activity at day 14 (P = 0.00). Compared with Biodentine, iRoot FS significantly increased the mRNA level of ALP, COL1 and Runx2, and OCN increased only on day 14 (P < 0.05).

CONCLUSIONS

iRoot FS had a positive effect on the adhesion, proliferation and biomineralization of hPDLCs compared with Biodentine.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

In vitro effects of two silicate-based materials, Biodentine and BioRoot RCS, on dental pulp stem cells in models of reactionary and reparative dentinogenesis

Background

Calcium silicate-based cements are biomaterials with calcium oxide and carbonate filler additives. Their properties are close to those of dentin, making them useful in restorative dentistry and endodontics. The aim of this study was to evaluate the in vitro biological effects of two such calcium silicate cements, Biodentine (BD) and Bioroot (BR), on dental stem cells in both direct and indirect contact models. The two models used aimed to mimic reparative dentin formation (direct contact) and reactionary dentin formation (indirect contact). An original aspect of this study is the use of an interposed thin agarose gel layer to assess the effects of diffusible components from the materials.

Results

The two biomaterials were compared and did not modify dental pulp stem cell (DPSC) proliferation. BD and BR showed no significant cytotoxicity, although some cell death occurred in direct contact. No apoptosis or inflammation induction was detected. A striking increase of mineralization induction was observed in the presence of BD and BR, and this effect was greater in direct contact. Surprisingly, biomineralization occurred even in the absence of mineralization medium. This differentiation was accompanied by expression of odontoblast-associated genes. Exposure by indirect contact did not stimulate the induction to such a level.

Conclusion

These two biomaterials both seem to be bioactive and biocompatible, preserving DPSC proliferation, migration and adhesion. The observed strong mineralization induction through direct contact highlights the potential of these biomaterials for clinical application in dentin-pulp complex regeneration.

Effect of Exposed Surface Area, Volume and Environmental pH on the Calcium Ion Release of Three Commercially Available Tricalcium Silicate Based Dental Cements

Tricalcium silicate cements (TSC) are used in dental traumatology and endodontics for their bioactivity which is mostly attributed to formation of calcium hydroxide during TSC hydration and its subsequent release of calcium and hydroxide ions. The aim of this study was to determine the effect of volume (Vol), exposed surface area (ESA) and pH of surrounding medium on calcium ion release. Three commercially available hydraulic alkaline dental cements were mixed and condensed into cylindrical tubes of varying length and diameter (n = 6/group). For the effect of ESA and Vol, tubes were immersed in 10 mL of deionized water. To analyze the effect of environmental pH, the tubes were randomly immersed in 10 mL of buffer solutions with varying pH (10.4, 7.4 or 4.4). The solutions were collected and renewed at various time intervals. pH and/or calcium ion release was measured using a pH glass electrode and atomic absorption spectrophotometer respectively. The change of pH, short-term calcium ion release and rate at which calcium ion release reaches maximum were dependent on ESA (p < 0.05) while maximum calcium ion release was dependent on Vol of TSC (p < 0.05). Maximum calcium ion release was significantly higher in acidic solution followed by neutral and alkaline solution (p < 0.05).

Clinical and Radiographic Evaluations of Biodentine™ Pulpotomies in Mature Primary Molars (Stage 2)

Introduction

The preservation of the integrity and health of primary teeth and their supporting tissues is of great importance in maintaining arch length space, mastication, speech, and esthetics. A pulpotomy is a common therapy performed on a primary tooth presenting reversible pulpitis or a traumatic pulp exposure, allowing its conservation on the arch until its loss.

Aim

The study aims to clinically and radiographically evaluate the rates of success and efficacy of Biodentine™ as pulpotomy medicament exclusively on deciduous molars with complete roots formation (stage 2).

Materials and methods

A total number of 75 primary molars in stage 2 of formation were selected to undergo pulpotomy treatment. All teeth were restored with a stainless-steel crown.The clinical success was evaluated at 1, 3, 6 and 12-month intervals. The radiographic follow-up evaluations were at 6 and 12 months. The resulting data were tabulated and statistically analyzed.

Results

Among the 75 teeth treated with Biodentine™, one tooth revealed abnormal mobility and tenderness to percussion at the end of the 1st month. PLS widening and the bone lesion was not seen in any of the 74 remaining cases. Forty teeth (54.1%) showed pulp canal obliteration (PCO), and none of the cases developed a draining sinus or had increased mobility. At the end of the 1-year follow-up, the clinical and radiographic success rates were 98.7% and 100%, respectively.

Conclusion

Pulpotomies performed with Biodentine™ on stage 2 primary molars were generally very satisfactory and fulfilled all requirements, covering all needs. This innovative bioactive medicament seems to be a "heroic" material. The excellent outcomes of the present study are indicative that Biodentine™ is a promising biomaterial to promote pulp repair after pulpotomy in clinical practice.

How to cite this article

Nasrallah H, El Noueiri B, Pilipili C, Ayoub F. Clinical and Radiographic Evaluations of Biodentine™ Pulpotomies in Mature Primary Molars (Stage 2). Int J Clin Pediatr Dent 2018;11(6):496-504.

Comparison of sealing ability of ProRoot mineral trioxide aggregate, biodentine, and ortho mineral trioxide aggregate for canal obturation by the fluid infiltration technique

BACKGROUND

Adequate seal of the root canal is necessary to prevent recontamination and ensure the long-term clinical success. The aim of this study was to evaluate the sealing ability of ProRoot mineral trioxide aggregate (MTA), Biodentine, and Ortho MTA as the root canal obturation materials using the fluid infiltration method.

MATERIALS AND METHODS

In this invitro study a total of 66 extracted human mandibular premolars were randomly divided into five groups according to the material used for the root canal obturation. Group I - ProRoot MTA (20 samples), Group II - Biodentine (20 samples), Group III - Ortho MTA (20 samples), Group IV - negative group (3 samples), and Group V-positive group (3 samples). MTA, Biodentine, and Ortho MTA were applied using a cotton-tipped K-file #30 and hand plugger into the root canals of each group. In Group 4 (negative control), no filling material was used. In Group 5 (positive control), a single gutta-percha size #40 was inserted into the root canal without using a sealer. The teeth were mounted and exposed to the fluid infiltrarion system. Statistical analysis was performed using Kruskal-Wallis test the level of significance was set at α = 0.05.

RESULTS

Mean values of microleakage in MTA ProRoot, Biodentine and Ortho MTA groups were 1.83 ± 0.62, 1.95 ± 1.27 and 1.72 ± 0.83 μL in 8 minutes. No statistically significant difference was observed between the sealing ability of ProRoot MTA, Biodentine, and Ortho MTA (P = 0.091).

CONCLUSION

Within the limitations of this study, microleakage values were similar to MTA ProRoot, Biodentine, and Ortho MTA using the fluid infiltration technique.

Bioceramics in endodontics - a review

Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates, among others. They have been used in dentistry for filling up bony defects, root repair materials, apical fill materials, perforation sealing, as endodontic sealers and as aids in regeneration. They have certain advantages like biocompatibility, non toxicity, dimensional stability and most importantly in endodontic applications, being bio-inert. They have a similarity to Hydroxyapatite, an intrinsic osteo conductive activity and have an ability to induce regenerative responses in the human body. In Endodontics, they can be broadly classified into Calcium Phosphate/ Tricalcium/ Hydroxyapatite based, Calcium Silicate based or mixtures of Calcium Silicate and Phosphates. This review focuses on an overview of Bioceramics, classification and their advantages. It also gives a detailed insight into individual bioceramic materials currently used in the fields of Endodontics along with their properties and applications.

Success Rates of Pulpotomies in Primary Molars Using Calcium Silicate-Based Materials: A Randomized Control Trial

Objective

The aim of this study was to evaluate and compare, both clinically and radiographically, the effects of calcium silicate-based materials (i.e., ProRoot MTA [PR-MTA], MTA-Plus [MTA-P], and Biodentine [BD]) and ferric sulfate [FS] in pulpotomy of primary molars.

Materials and Methods

In this randomized clinical trial, 29 healthy 5- to 7-year-old children with at least four carious primary molars with no clinical or radiographic evidence of pulp degeneration were enrolled. The pulpotomy agents were assigned as follows: Group 1: BD; Group 2: MTA-P; Group 3: PR-MTA; and Group 4: FS. Clinical and radiographic evaluations were performed at 6, 12, and 24 months. Data were analyzed using chi-square tests.

Results

Total success rates at 24 months were 82.75%, 86.2%, 93.1%, and 75.86%, respectively. No statistically significant differences in total success rates were observed among the groups at 6-, 12-, and 24-month follow-ups. When the groups were compared according to follow-up times, the success rates in each group did not vary significantly among the 6–12-month, 6–24-month, or 12–24-month periods (p > 0.05).

Conclusion

Although the success rates of BD, MTA-P, MTA-PR, and FS did not differ significantly, calcium silicate-based materials appeared to be more appropriate than FS in clinical practice.

Effect of iRoot Fast Set root repair material on the proliferation, migration and differentiation of human dental pulp stem cells in vitro

The present study investigated the effect of iRoot Fast Set root repair material (iRoot FS) on the proliferation, migration and differentiation of human dental pulp stem cells (hDPSCs). The hDPSCs were treated with eluates of iRoot FS at concentrations of 0.2 and 2 mg/mL, referred to as FS0.2 and FS2, respectively, and Biodentine (BD; Septodont, Saint Maur des Faussés, France) eluates at the corresponding concentrations as positive controls. A CCK8 assay was performed to determine cell proliferation. Wound healing and transwell assays were conducted to examine cell migration. Osteogenic differentiation was evaluated based on alkaline phosphatase activity, Alizarin Red S staining and quantitative real-time reverse-transcriptase polymerase chain reaction (qRT-PCR) to analyze the mRNA expression of differentiation gene markers. Cell proliferation was higher in the FS and BD groups than in the blank controls at 3 and 7 days. Moreover, FS0.2 enhanced cell migration and significantly promoted the osteogenic differentiation of hDPSCs. These findings suggested that iRoot FS is a bioactive material that promotes the proliferation, migration and osteogenic differentiation of hDPSCs.

Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial

INTRODUCTION

Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy.

METHODS

In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance.

RESULTS

Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001).

CONCLUSIONS

Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes.

MTA versus Biodentine: Review of Literature with a Comparative Analysis

An ideal dental repair material should possess certain exclusive properties such as adequate adhesive ability, insolubility, dimensional stability, biocompatibility, bioactivity etc. New materials claiming better performance are continuously being introduced in the market to optimize the care of dental patients. Biodentine has been recently introduced as the "the first all-in-one, bioactive and biocompatible material for damaged dentin replacement". Manufacturers claim that Biodentine has noticeably shorter setting time in contrast to other silicate cements such as Mineral Trioxide Aggregate (MTA) and also has better mechanical and handling properties. This article is aimed to compare the properties of MTA and Biodentine analyzing the research work done in this field so far by various researchers all across the globe.

Dentin remineralizing ability and enhanced antibacterial activity of strontium and hydroxyl ion co-releasing radiopaque hydroxyapatite cement

Dental caries is an infection of the mineralized tooth structures that advances when acid secreted by bacterial action on dietary carbohydrates diffuses and dissolves the tooth mineral leading to demineralization. During treatment, clinicians often remove only the superficial infected tooth structures and retain a part of affected carious dentin to prevent excessive dentin loss and pulp exposure. Calcium hydroxide is used to treat the affected dentin because it is alkaline, induces pulp-dentin remineralization and decreases bacterial infection. Presence of strontium ions has also been reported to exhibit anticariogenic activity, and promote enamel and dentin remineralization. The objective of the present study was to develop novel hydroxyapatite cement from tetracalcium phosphate which gradually releases hydroxyl and strontium ions to exhibit antibacterial activity. Its potential to remineralize the dentin sections collected from extracted human molar tooth was studied in detail. The pH of all the experimental cements exhibited a gradual increase to ~10.5 in 10 days with 10% strontium substituted tetracalcium phosphate cement (10SC) showing the highest pH value which was sustained for 6 weeks. 10SC showed better antibacterial property against S. aureus and E. coli at the end of 1 week compared to other cements studied. It also exhibited the highest radiopacity equivalent to 4.8 mm of Al standard. 10SC treated dentin section showed better remineralization ability and highest elastic modulus. We can conclude that the hydroxyl and strontium ions releasing tetracalcium phosphate cement exhibits good antibacterial property, radiopacity and has the potential to encourage dentin remineralization.

Bacterial colonization in the apical part of extracted human teeth following root-end resection and filling: a confocal laser scanning microscopy study

OBJECTIVES

The purpose of this study was to evaluate Enterococcus faecalis colonization at the apical part of root canals following root-end resection and filling using confocal laser scanning microscopy (CLSM).

MATERIALS AND METHODS

The apical 3-mm root-ends of 55 extracted single rooted human teeth were resected, and 3-mm retrograde cavities were prepared and filled using either mineral trioxide aggregate (MTA), intermediate restorative material (IRM), or Biodentine (n = 10 each); 25 teeth served as controls. The roots were placed in an experimental model, sterilized, and coronally filled with E. faecalis bacterial suspension for 21 days. Then, the apical 3-mm segments were cut to get two slabs (coronal and apical). The slabs were stained using LIVE/DEAD BacLight Bacterial Viability Kit and evaluated using CLSM.

RESULTS

The fluorescence-stained areas were larger in the bucco-lingual directions compared with the mesio-distal directions (p < 0.05). The mean and maximal depths of bacterial colonization into the dentinal tubules were 755 and 1643 μm, respectively, with no differences between the root-end filling materials (p > 0.05). However, more live bacteria were found in the MTA group in comparison to IRM and Biodentine groups (p < 0.05).

CONCLUSIONS

CLSM can be used to histologically demonstrate bacterial root-end colonization following root-end filling. This colonization at the filling-dentine interfaces and deeper into the dentinal tubules may be inhomogeneous, favoring the bucco-lingual aspects of the root.

CLINICAL RELEVANCE

Following root-end resection and filling bacterial colonization may lead to inflammatory reactions at the periapical tissues; the viability of the colonized bacteria may be affected by the type of root-end filling material.

Vital Pulp Therapy with Calcium-Silicate Cements: Report of Two Cases

This article describes successful use of calcium-enriched mixture (CEM) cement and Biodentine in apexogenesis treatment in two 8-year-old patients, one with immature permanent molar diagnosed primarily with irreversible pulpitis and the other with partially vital maxillary central incisor. After access cavity preparation, partial pulpotomy in molar and full pulpotomy in central was performed, and the remaining pulps was capped with either Biodentine or CEM cement, in each tooth. The crowns were restored with composite filling material at the following visit. The post-operative radiographic and clinical examinations (approx. average of 16 months) showed that both treated teeth remained functional, with complete root development and apex formation. A calcified bridge was produced underneath the capping material. No further endodontic intervention was necessary. Considering the healing potential of immature vital pulps, the use of CEM cement and Biodentine for apexogenesis might be an applicable choice. These new endodontic biomaterials might be appropriate for vital pulp therapies in an immature tooth. However, further clinical studies with longer follow-up periods are recommended.

Dental Material Choices for Pulp Therapy in Paediatric Dentistry

Objective:

The purpose of this study was to assess the restorative choices for pulpal therapy by members of the Australian and New Zealand Society of Paediatric Dentistry (ANZSPD).

Methods:

Members of the ANZSPD were sent an online survey asking about the procedures that they performed and their choice of dental materials.

Results:

The respondents were 31 general dentists (GD) and 55 specialist paediatric dentists (PD). Materials used for indirect pulp capping included calcium hydroxide [Ca(OH)₂] cement (CHC), glass ionomer cement or resin-modified glass ionomer cement (GIC/RMGIC), Ca(OH)₂ paste (CHP) and mineral trioxide aggregate (MTA). Materials for direct pulp capping included MTA, CHP and CHC. Materials and techniques used for pulpotomy included MTA, ferric sulphate, formocresol and diathermy, CHP and CHC. GD and PD were similar in their choice of materials. However, there was no preferred product for pulp therapy. Most GD learnt how to use MTA from CPD lectures, while some PD learnt how to use MTA from their postgraduate training as well as CPD lectures. Many GD and PD did not have hands-on training from their education on how to use MTA (GD: 80%, PD: 43%). Most would like to attend hands-on MTA courses (GD: 86%, PD: 65%).

Conclusion:

There was no clear preferred product for the various types of pulp therapy in paediatric dentistry. Education appears to be the major barrier to the use of MTA rather than the cost of MTA.

Spectrophotometric analysis of coronal discoloration induced by white mineral trioxide aggregate and Biodentine: An in vitro study

Aims:

The aim of this study was to evaluate the specific chromatic alterations in tooth crowns induced by two different endodontic restorative materials.

Settings and Design:

This in vitro study was conducted at the Department of Conservative Dentistry, KMCT Dental College, Kozhikode, Kerala.

Subjects and Methods:

Forty-five freshly extracted, fully developed, single-rooted teeth were prepared and randomly assigned to two experimental groups (n = 15 each) and one negative control group (n = 15). Group 1 consists of white mineral trioxide aggregate (WMTA), Biodentine formed Group 2, and controls formed Group 3. Double-beam ultraviolet spectrophotometer equipment was used to assess the coronal discoloration as determined by CIE L*, a*, and b* and their corresponding total values.

Results:

At baseline, no significant difference was detected for CIE values between the groups. Group 1 showed a significant decrease in L*, a*, and b* values over time. The color change with WMTA led to clinically perceptible crown discoloration after 6 weeks which exceeded the perceptible threshold for the human eye, i.e., ΔE > 3.3. No changes were observed with Biodentine.

Conclusions:

Materials used in endodontics may stain teeth. WMTA induced clinically perceptible crown discoloration, whereas Biodentine demonstrated color stability.

Effect of obturating materials on fracture resistance of simulated immature teeth

Aim:

The aim of this study was to evaluate the fracture resistance of simulated immature teeth, when the root canals were completely filled either with mineral trioxide aggregate (MTA) or Biodentine, comparing with that of roots filled with apexification procedure.

Materials and Methods:

Sixty mandibular premolar teeth with single, straight canals decoronated at cementoenamel junction were divided into five groups (n = 12 each). Group 1 samples served as negative control and remaining four groups root samples were shaped and cleaned using ProTaper rotary files. To simulate immature roots, a #5 Peeso reamer was passed beyond the apex so that apices were enlarged to a diameter of 1.5 mm. Group 2 and 4 samples were filled with 5 mm of MTA or Biodentine apical plug and backfilling with gutta-percha using AH Plus sealer. Group 3 and 5 root samples were completely obturated with MTA and Biodentine, respectively. All the teeth were loaded vertically until fracture, using the universal testing machine.

Statistical Analysis:

Forces at which fracture of the roots occurred were subjected to statistical analysis using SPSS/PC version 2 software, and the results were analyzed with the one-way analysis of variance and Newman–Keuls multiple post hoc test.

Results:

Complete root canal obturation with MTA or Biodentine has shown significantly higher fracture resistance (P < 0.05) when compared to apexification with MTA or Biodentine.

Conclusion:

Obturation of the root canals with bioactive materials has shown highest fracture resistance when compared to apexification groups.

Effect of Blood Exposure on Push-Out Bond Strength of Four Calcium Silicate Based Cements

INTRODUCTION

The purpose of this study was to compare the push-out bond strength of white ProRoot Mineral Trioxide Aggregate (MTA), Biodentine, calcium-enriched mixture (CEM) cement and Endosequence Root Repair Material (ERRM) putty after exposure to blood.

METHODS AND MATERIALS

A total of 96 root dentin slices with a standardized thickness of 1.00±0.05 mm and standardized canal spaces were randomly divided into 4 main experimental groups (n=24) according to the calcium silicate based cement (CSC) used: white ProRoot MTA, CEM Cement, ERRM Putty and Biodentine. Specimens were exposed to whole fresh human blood and then subdivided into two subgroups depending on the exposure time (24 or 72 h). Push-out bond strength was measured using a universal testing machine. Failure modes were examined under a light microscope under ×10 magnification. Data were analyzed using the two-way ANOVA test.

RESULTS

Biodentine exhibited the highest values regardless of the exposure time. The lowest push-out strength values were seen in white ProRoot MTA and CEM cement in both post exposure times. After exposure to blood, the push-out bond strength of all materials increased over time. This increase was only statistically significant in white ProRoot MTA and ERRM specimens. The dominant failure mode in all CSCs was the adhesive mode.

CONCLUSION

Biodentine showed the highest values of push-out bond strength and may be better options for situations encountering higher dislocation forces in a short time after cement application.

Influence of Biodentine® - A Dentine Substitute - On Collagen Type I Synthesis in Pulp Fibroblasts In Vitro

Preserving a patient’s own teeth—even in a difficult situation—is nowadays preferable to surgical intervention and therefore promotes development of suitable dental repair materials. Biodentine^®, a mineral trioxide aggregate substitute, has been used to replace dentine in a bioactive and biocompatible manner in both the dental crown and the root. The aim of our study was to evaluate the influence of Biodentine^® on pulp fibroblasts in vitro. For this study, one to five Biodentine^® discs with a diameter of 5.1mm were incubated in DMEM. To obtain Biodentine^® suspensions the media were collected and replaced with fresh medium every 24h for 4 days. Primary pulp cells were isolated from freshly extracted wisdom teeth of 20–23 year old patients and incubated with the Biodentine^® suspensions. Proliferation, cell morphology, cell integrity and cell viability were monitored. To evaluate the effect of Biodentine^® on collagen type I synthesis, the secretion of the N-terminal domain of pro-collagen type I (P1NP) and the release of transforming growth factor-β1 (TGF-β1) were quantified. None of the Biodentine^® suspensions tested influenced cell morphology, proliferation or cell integrity. The cell viability varied slightly depending on the suspension used. However, the concentrations of P1NP of all pulp fibroblast cultures treated for 24h with the moderate to high Biodentine^® concentration containing suspensions of day 1 were reduced to 5% of the control. Furthermore, a significant TGF-β1 reduction was observed after treatment with these suspensions. It could be shown that Biodentine^® is biocompatible. However, dissolved particles of the moderate to high concentrated Biodentine^® suspensions 24h after mixing induce a significant reduction of TGF-β1 release and reduce the secretion of collagen type I of primary pulp fibroblasts.

Evaluation of sealing ability of Biodentine™ and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlled in vitro trial

Objective:

The aim of this study was to compare the sealing ability of mineral trioxide aggregate (MTA) and Biodentine™ when used to repair the furcal perforations in primary molars using scanning electron microscope (SEM).

Study Design:

The study sample comprised forty recently extracted primary molars. These teeth were placed in a 5.25% sodium hypochlorite solution for 24 h and washed with tap water. Access cavities were made using a round bur in high-speed handpiece. Perforations were made in the center of the floor of the pulpal chamber using a 0.5 mm round bur. The teeth were randomly assigned into two experimental groups based on the material used to seal the perforation: Group A – MTA and Group B – Biodentine™. The packed materials were allowed to set for 24 h. The samples were sectioned longitudinally and the extent of marginal adaptation was measured by SEM. Wilcoxon-signed rank test was used for statistical analysis using SPSS software.

Results:

All teeth exhibited microleakage, but Biodentine™ showed significantly less leakage (0.149) compared to MTA (0.583).

Conclusion:

Based on the results of this study, Biodentine™ showed lesser microleakage compared to MTA and thus may be a good alternative to MTA.

Cytotoxicity and Initial Biocompatibility of Endodontic Biomaterials (MTA and Biodentine™) Used as Root-End Filling Materials

Objective. The aim of this study was to evaluate the cytotoxicity and cellular adhesion of Mineral Trioxide Aggregate (MTA) and Biodentine (BD) on periodontal ligament fibroblasts (PDL). Methods. PDL cells were obtained from nonerupted third molars and cultured; MTS cellular profusion test was carried out in two groups: MTA and BD, with respective controls at different time periods. Also, the LIVE/DEAD assay was performed at 24 h. For evaluation of cellular adhesion, immunocytochemistry was conducted to discern the expression of Integrin β1 and Vinculin at 12 h and 24 h. Statistical analysis was performed by the Kruskal-Wallis and Mann-Whitney U tests. Results. MTA and BD exhibited living cells up to 7 days. More expressions of Integrin β1 and Vinculin were demonstrated in the control group, followed by BD and MTA, which also showed cellular loss and morphological changes. There was a significant difference in the experimental groups cultured for 5 and 7 days compared with the control, but there was no significant statistical difference between both cements. Conclusions. Neither material was cytotoxic during the time evaluated. There was an increase of cell adhesion through the expression of focal contacts observed in the case of BD, followed by MTA, but not significantly.

Management of external invasive cervical resorption of tooth with Biodentine: A case report

Invasive cervical resorption (ICR) of a tooth is relatively uncommon and the etiology is not very clear. It is sometimes misdiagnosed and can lead to improper management or tooth loss. Correct diagnosis and proper management can result in a successful outcome. The treatment should aim toward the complete suppression of all resorbing tissues and the reconstruction of resorptive defect by the placement of a suitable filling material or some biological systems. One of the most significant developments of the past decade, i.e. the operating microscope used for surgical endodontics, helps the surgeon to assess pathological changes more precisely and to remove pathological lesions with far greater precision, thus minimizing tissue damage. The aim of this article was to show the management of maxillary left central incisor diagnosed with external ICR using Biodentine under dental operatory microscope (DOM).

Evaluation of Biodentine in the Restoration of Root Caries

There is no “gold-standard” material for the operative management of root caries. The aim of this study was to determine if the clinical performance of Biodentine would be acceptable for the restoration of root caries in older adults. A randomized controlled clinical trial was conducted comparing a calcium silicate cement (Biodentine), a high-viscosity glass ionomer cement (Fuji IX GP Extra), and a resin-modified glass ionomer cement (Fuji II LC). Of the 334 volunteers assessed for eligibility, 249 were excluded. A total of 303 lesions in 85 participants were randomized, with 151 lesions allocated to receive Biodentine, 77 to Fuji IX GP Extra, and 77 to Fuji II LC. Patients were reviewed by a calibrated dentist who was not involved in restoration placement and who was blinded to material allocation. Restorations were assessed according to a modified US Public Health Service criteria. The cumulative survival percentages after 6 mo and 1 y were 58.6% and 47.2% in the Biodentine group, 89.6% and 83.8% in the Fuji IX GP Extra group, and 89.5% and 84.9% in the Fuji II LC group, respectively. There were statistically significant differences ( χ2 test, P < 0.001) in restoration failure rates between restoration groups. There was no difference between Fuji IX GP Extra and Fuji II LC, but differences ( P < 0.001) were shown between the Fuji II GP Extra group and the Biodentine group and also between the Fuji II LC group and the Biodentine group at both time points. Based on the results of this study, Biodentine cannot be recommended for the operative management of root caries. Fuji IX GP Extra and Fuji II LC displayed similar success rates, and high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option for the restoration of root caries ( ClinicalTrials.gov NCT01866059).

Knowledge Transfer Statement: The results of this study can assist dental practitioners when selecting a restorative material for the operative management of root caries. This randomized controlled trial compared the 1-y clinical performance of a calcium silicate–based material to that of a high-viscosity glass ionomer cement and a resin-modified glass ionomer cement in the operative management of root caries. The study concluded that high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option to dental practitioners when restoring the root surface.

Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials: An ultraviolet spectrophotometric analysis

Aim:

To evaluate the sealing ability of ProRooT MTA, RetroMTA, and Biodentine as furcation repair materials using dye extraction leakage method.

Materials and Methods:

Thirty-five mandibular molars were randomly divided into four groups according to the material used for perforation repair. Group I — ProRoot MTA (10 samples), Group II — RetroMTA (10 samples), Group III — Biodentine (10 samples), and Group IV (Control) — left unrepaired (5 samples). All samples were subjected to orthograde and retrograde Methylene blue dye challenge followed by dye extraction with concentration 65% nitric acid. Samples were then analyzed using ultraviolet-visible spectrophotometer using 550 nm wave lengths.

Statistical Analysis:

One-way analysis of variance, Tukey-Kramer multiple comparisons test.

Results:

Biodentine showed least dye absorbance while RetroMTA showed highest dye absorbance values when compared with other repair materials.

Conclusion:

Within the limitations of this study, it was observed that Biodentine showed better sealing ability when compared with other root repair materials.

Dentine in a capsule: clinical case reports

Biodentine TM , a calcium silicate based material has been popular now and can be used as an alternative to mineral trioxide aggregate (MTA) due to superior physical and biologic properties. It has been known by several terms as Biodentine, dentin substitute, and RD 94. It has varied clinical applications such as apexification, apexogenesis, pulpotomy, internal resorption, root perforation repair, retrograde filling, pulp capping procedure, and dentin replacement. This article describes the clinical case reports using Biodentine in apexification, apexogenesis, pulpotomy, and root perforation repair.

Evaluation of Sealing Ability of Biodentine as Retrograde Filling Material by Using two Different Manipulation Methods: An In Vitro Study

BACKGROUND

The study was aimed to evaluate the microleakage of Biodentine using two different manipulation methods by dye penetration.

MATERIALS AND METHODS

A total of 60 single-rooted human maxillary permanent teeth were cleaned and obturated with gutta-percha using lateral condensation method. Standardized root-end cavities were prepared after apical resection. All teeth were divided randomly into two groups of 30 specimens and were filled with Biodentine by trituration and hand manipulation methods. The samples were coated with varnish and immersed in 1% methylene blue dye for 72 h. Then the teeth were sectioned longitudinally and observed under a stereomicroscope. The depth of dye penetration was measured in millimeters.

RESULTS

There was highly statistical significant difference observed between Group I and Group II (P < 0.001) when dye penetration scores were compared.

CONCLUSION

More microleakage was seen when Biodentine was manually manipulated as compared to machine trituration.

Cone beam CT assisted re-treatment of class 3 invasive cervical resorption

Invasive cervical root resorption is an uncommon external root resorption which initiates at the cervical aspect of the tooth. This case report involves a case of cervical root resorption which was initially misdiagnosed and managed as cervical root caries. It was later diagnosed with cone beam CT and the lesion microsurgically removed and restored with resin modified glass ionomer cement. The importance of increasing awareness of this uncommon pathology and the role of cone beam CT in mapping the extent of the lesion is emphasised.