Biodentine

On the other hand, the new material known commercially as Biodentine is much more promising [61,69]. It is a hydraulic cement manufactnred by the French company Septodont and consisting mainly of tricalcinm silicate [70]. In this it resembles the endodontic sealer Mineral Trioxide Aggregate, MTA, thongh it has a different... 

Biodentine is supplied as a powder and a liquid. The powder contains, in addition to the calcium silicates, calcium carbonate and calcium oxide as fillers, iron oxide for pigmentation, and zirconium oxide as a radiopacifier. The liquid is mainly water and contains calcium chloride as an accelerator, plus a water-soluble polymer [70]. 

When hardened. Biodentine shows good biocompatibihty with the oral tissues and, in particular, exerts minimal influence on cells of the adjacent pulp. Some loss of cell viability has been reported, but this has been attributed to apoptosis and necrosis, rather than the toxicity of the material [71]. In one study of the performance of Biodentine, it was found that the material caused complete dentinal bridge formation in molars while creating no inflammatory response on the cells of the pulp [72]. Both of these features suggest that this material has promise for application in pulp capping. Its ability to promote regeneration of the hard tissue is particularly noteworthy, and will be considered in more detail in Chapter 9. 

O. Malkondu, M.K. Kazandag, E. Kazazglu, A review of Biodentine, a contemporary dentine replacement and repair material, BioMed. Res. Int. 2014 (2014) 160951. 

A. Nowicka, M. Lipska, M. Parafiniuk, D. Lichota, J. Buczkowska-Radlinska, Response of human dental pulp capped with biodentine and mineral trioxide aggregate, J. Endod. 39 (2013) 743-747. 

Biodentine is a specific proprietary brand of calcium silicate cement that has been available to the profession since 2009 [20], It is manufactured by Septodont, St Maur des Faussds, France. The material is formulated to set more rapidly than MTA or similar calcium silicate cements, and is produced as a dentine replacement material. It is recommended for pulp capping, and also for various aspects of endodontic repair, including root perforations, apexification and retrograde filling [20],... 

Biodentine is supplied as a powder and a liquid. The main powder components are listed in Table 9.7, which also indicates the function of each component. 

Other components may be present, according to the manufacturer, but they are not essential for the material to fulfil its clinical function, and it is apparent from the research literature that they are not generally included in the formulation of Biodentine [20]. 

The liquid consists of water containing calcium chloride and an unspecified water soluble polymer. Calcium chloride acts as an accelerator in the hydration processes of the tricalcium silicate substance [78], It forms an acidic solution in water, and its reaction with calcium carbonate, which is basic, also helps to speed up the setting reaction. The overall effect of these components is that Biodentine sets in 9-12min, which is much faster than MTA materials based on unmodified calcium silicates [79], The set material has been shown to release calcium ions into aqueous solution [63,80] and this stimulates the deposition of hydroxyapatite in contact with simulated body fluid [81,82],... 

Setting of Biodentine is partly caused by condensation polymerization of the silicate phase to form a chain structure based on SiO tetrahedra joined at two comers (Q2 structures). This is similar to the setting of Portland cement [61], though it occurs faster due to the accelerating effect of calcium chloride. Setting is accompanied first by a contraction in volume, as the initial solidification occurs. This is followed by expansion as secondary hydration reactions take place to form the various calcium silicate hydrates [83]. 

Set Biodentine material consists substantially of hydrated calcium silicate [79], some of which forms more rapidly in Biodentine than in MTA because of the presence of calcium chloride and calcium carbonate. This latter component, which accounts for 15% of the powder by mass, acts as nucleation sites for the deposition of calcium silicate hydrate. Consequently, the precipitation of calcium silicate hydrate occurs more rapidly within this material, which leads to a shorter setting time [79]. 

Physical and chemical properties of Biodentine are shown in Table 9.8. The material can be seen to set rapidly, and to have a reasonable compressive strength and Vicker s Hardness Number at 24h [85,86]. It shows a snbstantial wash out (solubility) in Hank s balanced salt solution (HBSS), which is presumably at least matched in deionized water. However, the pH of deionized water following storage of set Biodentine is only around 9 at 24h, rather than the 11-12.5 of traditional calcium hydroxide chelate cements or supersaturated solution. This may suggest that Biodentine is less bioactive than such materials, and hence less effective at promoting the growth of reparative dentine. 

In one study where Biodentine was placed over dentine, the elements calcium and silicon (in the form of silicate) were found to be transported into the dentine and also tag-like structures were formed [87]. This was similar to the behaviour of ProRoot MTA, despite the much more rapid hardening reaction of Biodentine. The release of calcium by Biodentine appeared to be well accepted by human fibroblast cells in cell culture studies [91]. The material stimulated the release of increased amounts of TGF-pi from pulp cells [92], which is probably associated with increased rates of cell differentiation and of mineralization in vivo. 

In an animal stndy with the pig as the animal model. Biodentine was shown to in-dnce the formation of thick calcified layers after 90 days following direct pnlp capping [93], As in previons studies, the underlying soft tissue of the pulp showed no sign of inflammation and the cells remained entirely normal. 

Literature provided by the manufacturers suggests that Biodentine can be used for various applications, not only for pulp capping but also for other endodontic applications, such as repair of pulp chamber floor perforations and of lateral root perforations [95]. It can also be used for indirect pulp capping and to line deep carious lesions. However, to date systanatic smdies are lacking, and there is only limited evidence of clinical success of Biodentine in these applications. Early published results are promising, but more work is necessary before a definitive opinion on this material is possible [95]. 

Materials used are either calcium hydroxide-based or tricalcium silicate-based (MTA or Biodentine). 

Both MTA and Biodentine show a high degree of solubility and are able to make the surrounding tissues alkaline, thereby acting as bioactive materials to promote production of reparative dentine. 

J. Camilleri, F. Sorrentino, D. Damidot, Investigation of the hydration and bioactivity of radiopacified tricalcium sihcate cement. Biodentine and MTA Angelus, Dent. Mater. 29 (2013)580-593. 

L. Grech, B. Mallia, J. Camilleri, Characterization of set intermediate restorative material, Biodentine, Bioaggregate and a prototype calcium silicate cement for use as root-end filling materials, Int. Endod. J. 46 (2013) 632-641. 

M. Perard, J. le Clerc, T. Watrin, F. Meary, E. Perez, S. Tricot-Doleux, P. Pellen-Mussi, Spheroid model study comparing the biocompatibility of Biodentine and MTS, J. Mater. Sci. Mater. Med. 24 (2013) 1527-1534. 

P. Laurent, J. Camps, M. De Meo, J. Dejou, I. About, Biodentine induces TGF-pi release from human pulp cells and early dental pulp mineralization, Int. Endod. J. 45 (2012) 439 48. 

M. Zanini, J.M. Sautier, A. Berdal, S. Simon, Biodentine induces immortalized murine pulp cell differentiation into odontohlast-hke cells and stimulate biominerahzation, J. Endod. 38 (2012) 1220-1226. 

MTA has a wide variety of clinical uses within endodontics. The main one is a root-end filling material [116-120], but it is also used for pulp capping, pulpotomy and to repair lateral root perforations [121-125]. It can be used for apical barrier formation in teeth with open apexes [126], Its relatively long setting time may be a disadvantage, but this has been addressed in related products such as Biodentine by the inclusion of calcium chloride as an accelerator. 

---