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Biodentine™ with Active Biosilicate Technology™ was announced by dental materials manufacturer
Septodont in September of 2010, and made available in January of 2011. According to the research and
development department of said manufacturer, “a new class of dental material which could conciliate high
mechanical properties with excellent biocompatibility, as well as bioactive behaviour” (Septodont
Biodentine™ scientific file, 2010) had been produced. According to the manufacturer, the material can be
used as a “dentine replacement material whenever original dentine is damaged

Veröffentlicht in: Gesundheit & Medizin
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  2. 2. Introduction  Introduced by septodont.  New class of dental material with high mechenical properties and excellent biocompatibility.  Short setting time and high mechenical strength which makes it clinically easy to handle and compatible.  Forms reactionary dentine when used in both direct and inderect pulp capping.  Besides endodontic application it has been evaluated for it’s use as restorative material.
  3. 3. Physical properties
  4. 4. Composition  Powder  Ca3SiO5 (tricalcium silicate C3S) Main core material  Ca2SiO5 (dicalcium silicate C2S) Second core material  CaCO3 (calcium carbonate) Filler  CaO (calcium oxide) Filler  Fe2O3 (iron dioxide) Shade  ZrO2 (zirconium dioxide) Radiopacifier  Liquid  CaCl2 . 2 H2O Accelerator  Hydrosoluble polymer Water reducing agent  Water
  5. 5.  The calcium silicate has the ability to interact with water leading to the setting and hardening of the cement.  Hydration of the tricalcium silicate (3CaO.SiO2 = C3S) produces a hydrated calcium silicate gel (CSH gel) and calcium hydroxide (Ca (OH)2).  2(3CaO.SiO2) + 6H2O 3CaO.2SiO2.3H2O + 3Ca(OH)2 Setting reaction C3S CSH
  6. 6. This dissolution process occurs at the surface of each grain of calcium silicate. The hydrated calcium silicate gel and the excess of calcium hydroxide tend to precipitate at the surface of the particles and in the pores of the powder, due to saturation of the medium. This precipitation process is reinforced in systems with low water content.
  7. 7. The unreacted tricalcium silicate grains are surrounded by layers of calcium silicate hydrated gel, which are relatively impermeable to water, thereby slowing down the effects of further reactions. The C-S-H gel formation is due to the permanent hydration of the tricalcium silicate, which gradually fills in the spaces between the tricalcium silicate grains. The hardening process results from of the formation of crystals that are deposited in a supersaturated solution.
  8. 8. Setting time  The working time of Biodentine™ is up to 6 minutes with a final set at around 10-12 minutes.  The classical glass ionomer sets faster that Biodentine™ in less than 4 minutes.  This represents a great improvement compared to the other calcium silicate dental materials (ProRoot® MTA), which set in more than 2 hours.  The setting times of Biodentine™ are in the same range as the amalgams
  9. 9.  Compressive strength is a classical mechanical evaluation of the dental biomaterials  The setting of Biodentine™ is illustrated by a sharp increase in the compressive strength reaching more than 100 MPa in the first hour.  The mechanical strength continues to improve to reach more than 200 MPa at 24h which is more than most glass ionomers values.  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, (O’Brien 2008)).  This maturation process can be related to the decrease of porosity with time, which was illustrated previously.  Biodentine™ is an evolutive biomaterial which improves its mechanical properties with time
  10. 10. Physical Properties :
  11. 11. Time (h) Compressivestrength(Mpa)
  12. 12. Micro hardness  The reported micro hardness values for natural dentine are in the range of 60-90 HVN (O’Brien 2008).  Biodentine™ has surface hardness in the same range as natural dentine.  In a study comparing the physical properties of Biodentine with a conventional glass ionomer (Fuji IX) and a resin modified glass ionomer (Vitrebond), showed that Biodentine exhibited higher surface microhardness compared to the other materials when unetched.
  13. 13. Bond strength  Considering that Biodentine is recommended for use as a dentine substitute under permanent restorations, studies were performed that assess the bond strength of the material with different bonding systems.  No significant differences were found.
  14. 14. Porosity  Tricalcium silicate based materials are especially indicated in cases such as perforation repair, vital pulp treatments, and retrograde fillings where a hermetic sealing is mandatory.  Therefore, the degree of porosity plays a very important role in the overall success of treatments performed using these materials, because it is critical factor that determines the amount of leakage.  Biodentine exhibits lower porosity than ProRoot® MTA.  The density and the porosity of Biodentine™ and Fuji IX are equivalent.
  15. 15. Radiopacity  Radiopacity is an important property expected from a retrograde or perforation repair material as these materials are generally applied in low thicknesses and they need to be easily discerned from surrounding tissues  3.5 mm of aluminum.  This value is over the minimum requirement of the ISO standard (3 mm aluminum).  This makes Biodentine™ particularly suitable in the endodontic indications of canal repair.
  16. 16. Effect on flexural properties of dentine  Prolonged contact of root dentine with calcium hydroxide as well as MTA has detrimental and weakening effects on the resistance of root dentine.  it is critical to consider the effects of released calcium hydroxide on dentine collagen, specifically in procedures where there is a permanent contact of dentine with calcium silicate based materials.  careful consideration is necessary when obturating the entire root canal system with these materials or when using them for the purpose of dentine replacement
  17. 17. Resistance to acid Biodentine Ketac Fill Fuji II. Time (h) Depth(μm)
  18. 18. Microleakage Biodentine has the ability to form hydroxyapatite crystals at the surface. These crystals might have the potential to increase the sealing ability, especially when formed at the interface of the material with dentinal walls.  The interaction between the phosphate ions of saliva and the calcium silicate based cements might lead to the formation of apatite deposits, thereby increasing the sealing potential of the material.  Leakage was evaluated separately, in contact with enamel or in contact with Dentine  Biodentine exhibits better leakage resistance both to enamel and to dentine compared to Fuji II LC.
  19. 19. Discoloration  One study evaluated Biodentine from this perspective where Biodentine, along with 4 different materials, was exposed to different oxygen and light conditions and spectrophotometric analysis was performed at different periods until 5 days .  Favorable results were obtained for Portland Cement (PC) and Biodentine and these 2 materials demonstrated color stability over a period of 5 days.  Based on their results, the authors suggested that Biodentine could serve as an alternative for use under light- cured restorative materials in areas that are esthetically sensitive .
  20. 20. Wash out resistance  Washout of a material is defined as the tendency of freshly prepared cement paste to disintegrate upon early contact with fluids such as blood or other fluids.  Biodentine demonstrated a high washout.
  21. 21. Comparison with glass ionomers and pro root® MTA  It can be concluded that Biodentine™ has a mechanical behavior similar to glass ionomers and is also similar to natural dentine.  The mechanical resistance of Biodentine™ is also much higher than that of ProRoot® MTA.
  22. 22. Mta vs biodentine MTA BIODENTINE P:L RATIO 3:1 1 capsule powder : 5 drops of liquid MANIPULATION Manually on glass slab with mixing spatula In amalgamator for 30 sec. SETTING TIME (Minutes) Initial – 70 Final - 175 Initial – 6 Final - 10-12 DENSITY (g/cm3) 1.88 2.26 POROSITY (%) 22.6 6.8 COMPRESSIVE STRENGTH (MPa) - (1 hr.) 7.5 (24 hr.) 131.5 (1 hr.) 241.1 (24 hr.) MECHANICAL RESISTANCE Lower Higher
  23. 23. Mechanism of action  Forms CH that releases calcium ions for cell attachment and proliferation  Creates an antibacterial environment by its alkaline pH  Modulates cytokines production  Encourage differentiation and migration of hard tissue producing cells  Forms HA (or carbonated apatite) on the surface and provides a biological seal
  24. 24. Preclinical safety conclusion  Compared to well known dental materials such as Dycal® (calcium hydroxide), Biodentine™ exhibits less cytotoxicity.  Moreover, when compared to ProRoot MTA, Biodentine™ demonstrates at least equivalent biocompatibility.
  25. 25. Clinical efficacy  Biodentine™ can be used as dentine substite under the composite  Biodentine™ is used as a direct pulp capping material  Biodentine™ is used as an endodontic repair material - Perforation - Apexification - Resorption
  26. 26. BIODENTINE A NEW BIOACTIVE CEMENT FOR DIRECT PULP CAPPING  Currently, Calcium Hydroxide products serve as gold standard for direct pulp capping.  Reported success rate in excess of 80% of dpc.  Nevertheless, calcium hydroxide has some drawbacks. -poor bonding to dentine -material resorption -mechanical instability -porosities -liquefication necrosis at surface of pulp tissue
  27. 27.  Biodentine is biocompatible and is capable of stimulating hard tissue formation.  Hard tissue formation is shown in both direct and indirect pulp capping.  Used for pulp capping it offers some benefits vesus calcium hydroxide.  It is stronger mechanically, less soluble, produces tighter seal.  Compared to MTA it handles easily and need much less time for setting.  Unlike other portland cement based products it is sufficiently stable and can be used both for pulp protection and temporary fillings.
  28. 28. Bioactivity – In Vitro Pulp Capping To conclude, Biodentine™ is able to stimulate initiation and development of mineralization. Dentine bridge
  29. 29. Biodentine A novel dentinal substitute for single visit apexification.  Use of an apical plug in management of cases with open apices has gained popularity.  In contrast with MTA, the mechanical properties of Biodentine are similar to those of natural dentine.  The compressive strength, elasticity modulus and microhardness are comparable with that of natural dentine.  The material is stable, less soluble, non-resorbable, hydrophilic, easy to prepare and place, needs much less time for setting, produces a tighter seal and has greater radiopacity.  Biodentine has a distinct advantage over its closest alternatives in treatment of teeth with open apex.
  30. 30. Bioactivity- angiogenesis  The concentration level of TGF-β1 was enhanced by both ProRoot® MTA and Biodentine™. Moreover, VEGF and FGF-2 were enhanced in presence of Biodentine™.  Biodentine™ is able to stimulate angiogenesis, in order to heal pulp fibroblasts.
  31. 31. Bioactivity- indirect pulp capping  Biodentine™ was able to stimulate a reactionary dentine which is a naturalbarrier against bacterial invasions. The reactionary dentine formation stabilises at 3 months, indicating that the stimulation process is stopped when a sufficient dentine.
  32. 32. Overall-bioactivity  Biodentin was well tolerated. Moreover, Biodentine™ was able to promote mineralisation, generating a reactionary dentine as well as a dense dentine bridge. These phenomena illustrate the great potential for Biodentine™ to be in contact to the pulp, by demonstrating its bioactivity in several indications.  As a conclusion, Biodentine™ is bioactive.
  33. 33. Clinical tips  Use metal or plastic instruments - spatulas, amalgam gun or MTA gun.  If material is too runny – wait.  If material is too hard – check if all liquid has been poured into the capsule, if yes – re.mix 10 s.  Material is too slumpy – it is not sculptable – wait, do not overwork it – crystal structure can be destroyed and it prevents setting.  12 min is too long? Min working time, 6 min setting time in oral cavity.
  34. 34. Clinical tips  Trimming is not necessary, at the end of the setting it is possible to shape the material do not overwork the material.  Matrix removal – at the end of the setting time, it can be treated with vaseline or orange solvent.  Patints should be advise to be careful forst hours (they should avoid liquids which are too hot, too cold, too acid. The staining is on the surface.  Second visit – the surface layer should be removed using red coded (fine) diamond bur.
  35. 35. CHARACTERISTICS MTA BIODENTINE SETTING TIME (minutes) INITIAL –70 FINAL-175 INITIAL –06 FINAL- 10 DENSITY 1.882 g/cm3 2.260 g/cm3 POROSITY 22.6% 6.8% COMPRESSIVE STRENGTH ( Mpa) 1) 24 HRS 2) 7 DAYS 1) 7.5 2) 164.5 1) 241.1 2) 253.2 Ph initial 10.2 , rises to 12.5 after 3 hours 12 CYTOTOXICITY: Cell Death 0+9 0+8 HANDLING difficult to handle Easier to manipulate RADIOPACITY 7.17 mm of equivalent thickness of aluminum, 3.5 mm of equivalent thicknes of aluminum COMPARISON OF MTA and BIODENTINE