Biodentine™A Promising Dentine substitute

Loss of dentine is perhaps one of the major losses which restrict the integrity of the

tooth structure to a significant extent. Whether be in the coronal or radicular

portion, dentine loss must be substituted with an artificial material, which can

restore the physiological integrity of the tooth structure.

Also, the preservation and protection of the dental pulp with specific emphasis on

regeneration is the new treatment strategy in the fields of dentistry.

For many decades since 1928, calcium hydroxide (Dycal) has been standard

material for maintaining the vitality of pulp since it is capable of stimulating

tertiary dentine formation. However it has some drawbacks like poor bonding to

dentine, material resorption.

After that, hydraulic calcium silicate cements were available which showed a

bioactive dynamic interaction with dentine and pulp tissue interface.

Recently, various calcium silicate based products have been launched to the

market, one of these is Biodentine; which became commercially available in

2009 by (Gilles and Olivier in corporation with Septodont's, France).

Biodentine is a new tricalcium silicate (Ca3SiO5) based inorganic restorative

commercial cement and advertised as ‘bioactive dentine substitute’.

This material is claimed to possess better physical and biological properties

compared to other tricalcium silicate cements such as mineral trioxide

aggregate (MTA) and Bioaggregate.

A. Powder: packaged in capsule (0.7 g).

1. Tricalcium Silicate: it’s the main component.

2. Diclacium Silicate: it’s the second main component.

3. Calcium Carbonate: as filler.

4. Zirconium Oxide: responsible for radiopacity.

5. Iron Oxide: responsible for shade.

B. Liquid: packaged in pipette (0.18 ml).

1. Calcium Chloride: as accelerator.

2. Hydrosoluble polymer: (water reducing agent) maintain the balance

between low water content and consistency of mixture.

3. Water.

The calcium silicate has the ability to interact with water leading to the setting

and hardening of the cement as following:

CSH gel is considered as the matrix of the cement, and the crystals of

CaCO3 (rough and irregular) are filling the spaces between gel of cement.

Calcite (CaCO3) has two distinct functions: as an active agent (implicated

in the process of hydration) and as filler (improves the mechanical

properties of the cement).

The final result of hydration reaction includes: unreacted particles of cement

(slowing down the effect of further reaction), CSH gel, Ca (OH)2.

The powder is mixed with liquid in capsule in triturator for 30 seconds.

The setting time of Biodentine is between (9-12 minutes) due to the presence of:

Calcium Chloride as accelerator.

Hydrosoluble polymer (water reducing agent).

This represents a great improvement compared to the other calcium silicate

dental materials (MTA), which set in more than 2 hours.

There are two hypothesis or two processes may well combine, eventually in

contributing to the adhesion of the Biodentine cement to dental surface:

Physical process of crystal growth within dentine tubules leading to a

micromechanical anchor (tag) which ensuring long lasting seal.

Ion exchanges between the cement and dental tissues Biodentine - adhesive

systems.

Adhesion of Biodentine is higher than Dycal and MTA.

Mineral tags inside dentine tubules

Plugs of crystals in tubules openings

The use of hydrosoluble polymer in Biodentine composition which

reduce the amount of water which has positive influence on

density of Biodentine.

The lower porosity of Biodentine leads to higher mechanical

strength. Biodentine exhibits lower porosity than Dycal and MTA.

Biodentine contains zirconium oxide allowing identification on

radiographs Biodentine displays radiopacity.

There is a sharp increase in the compressive strength reaching more than 100

MPa in the first hour.

Then compressive strength continues to improve to reach more than 200 MPa

at 24h which is more than most glass ionomer value.

A specific feature of Biodentine is its capacity to continue improving with time

over several days until reaching 300 MPa after one month. This value becomes

quite stable and is in the range of the compressive strength of natural dentine

(297 MPa).

There is an increase in the micro hardness of Biodentine with

time.

After 1 month, hardness of Biodentine reach in the same range as

natural dentine.

The deposition of apatite like calcium phosphate crystals on the surface.

This improves interface between Biodentine and adjacent phosphate-

rich hard tissue substance. This leads to increase resistance to acid

erosion and microleakage.

Biodentine appeared resistance to

erosion and microleakage more

than MTA, Dycal and GIC.

Biodentine is associated with its ability to release hydroxyl and calcium ions.

The release of free calcium ion in Biodentine is higher than MTA and Dycal.

The high Ca release of Biodentine can be correlated with the presence of a

calcium silicate component and calcium chloride and calcium carbonate.

In addition, the fast hydration reaction of tricalcium silicate can be

correlated with high calcium release at early endpoints.

Biodentine exhibits significant amount of antibacterial activity.

Calcium hydroxide ions released from cement during setting phase

of Biodentine increases pH to 12 (alkaliniztion of medium) which

inhibits the growth of microorganisms and can disinfect the

dentine.

Biodentine is not as stable as a composite material, so that

Biodentine is not suitable as permanent enamel replacement.

However, in comparison to other Portland cement- based

products, Biodentine is stable enough to find use as a temporary

filling even in the chewing load bearing region.

Biodentine induces mineralization after its application. Mineralization

occurs in the form of osteodentine that form reparative dentine.

The ability to release calcium is a key factor for successful pulp

capping therapies because of the action of calcium on differentiation,

proliferation and mineralization of pulp cells (osteoblasts,

cementoblasts, and odontoblasts).

Ca and hydroxide ions enhances the activity of:

(((Osteopontin, Alkaline Phosphatase, Pyrophosphatase, Bone

Morphogenetic Protein-2(BMP-2) which belongs to the TGF-β)))

which helps to maintain dentine mineralization and the formation of

dentine bridge.

TGF-β1 is responsible for early mineralization of reparative dentine

that secrete from the pulp cells .

For crown and root indications.

Helps in reminerlization of dentine.

Preserves pulp vitality and promotes pulp healing.

Replaces natural dentine with the same mechanical properties.

Better handling and manipulation.

Reduced setting time.

Due to its dentine like mechanical properties, Biodentine can be used as

permanent dentine substitute (base) under a composite or amalgam especially

in deep carious teeth.

MTA cant be used as a base under restoration because it contains on aluminates

which increase the brittleness of it, while Biodentine not contains on aluminates

that results smart ideal base under restoration.

It includes direct and indirect pulp capping.

Biodentine can be used as pulp capping agent since it causes early

mineralization by release of TGF-β1 from pulpal cells to encourage pulp healing

and by odontoblast stimulation for dentine bridge formation to protect the pulp.

Histologically, Biodentine were showed complete dentinal bridge formation

(well localized pattern) and absence of inflammatory pulpal response in

contrast to Dycal that associated with tissue necrosis and inflammation during

initial period of placement.

Cell

proliferation

(arrows)

within the

pulp tissue

Reactionary

& reparative

dentine

formation

pattern

Indirect pulp

capping with

Biodentine

Direct pulp capping with

Biodentine

Pulpotomy is another vital pulp treatment method in which Biodentine is

advocated to be used. This method is widely used in pediatric dentistry and

involves the amputation of pulp chamber and the placement of a material for

the preservation of the radicular pulp tissue’s vitality. This methodology is

specifically useful and preferred when the coronal pulp tissue is inflamed and a

direct pulp capping is not a suitable option.

The rate of success of vital pulpotomy with Biodentine is higher than MTA and

Pulpotec.

Due to their good adhesion to dentine surface and fast setting time,

Biodentine is the ideal material for repairing of perforation

(bifurcation, root) after endodontic treatment. Also Biodentine can

be used in repair of root resorption, in apexification.

Many materials (amalgam, ZOE, GIC, MTA) were used as root

end filling, which have many problems.

Biodentine can be used as root end filling after apicectomy because

it has better consistency, better handling, safety and faster setting

time.

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