Biodentine (newer material in dentistry)

major advantages and unique features as well as its ability to overcome the disadvantages of other materials, biodentine has great potential to revolutionize the different aspects of managing both primary and permanent in endodontics as well as operative dentistry.

1. BIODENTINE Presented by Mutyala jhansi( Jr 1) Department of pediatric and preventive dentistry King george’s medical university

2. CONTENTS Introduction Composition Setting reactions Mechanism of action Properties Advantages clinical application Conclusion

3. INTRODUCTION “ Biodentine ” calcium silicate based product which became commercially available in 2009 by septodont , and that was specifically designed as a “dentine replacement” material.

4. COMPOSITION

5. A. Powder: Packaged in capsule (0.7 g) Tricalcium Silicate Main Core Material Dicalcium Silicate Second Core Materials Calcium Carbonate As Oxide Filler Iron Oxide Responsible For Shade Zirconium Oxide Radiopacifier Grechetal.2013, Camillerietal.2013

6. B. Liquid: packaged in pipette (0.18 ml) Calcium Chloride Accelerator Hydrosoluble Polymer Water Reducing Agent Fast Setting Time Water Grechetal.2013, Camillerietal.2013

7. SETTING TIME 9-12 min Calcium chloride as accelerator Hydrosoluble polymer (water reducing agent)

8. SETTING REACTION CSH gel matrix of the cement

9. The final result - Unreacted particles of cement CSH gel, C a (OH)2 Fills the spaces b/w the gel

10. MECHANISM OF ACTION Mineralisation Osteodentine Reparative dentine Succesful Pulp Therapies Due to release of Ca Differentiation Proliferation Mineralisation of Pulp cells

11. TGF- β 1 is responsible for early mineralization of reparative dentin.

12. PROPERTIES

13. COMPRESSIVE STRENGTH This value is quite stable and is in the range of compressive strength of natural dentine ( 297 MPa ) After 1 Hr After 24 Hrs After 1 Month

14. Grech et al. attributed this result to the enhanced strength due to the low water/cement ratio used in biodentine Kayahan et al aimed to evaluate the compressive strength following the etching procedure. They concluded that acid etching procedures after 7 days did not reduce the compressive strength of proroot MTA and biodentine

15. Micro hardness With time micro hardness After 1 month Microhardness of Biodentine Microhardness of Dentin

16. Grech et al. evaluated the microhardness of the material using a diamond shaped indenter. Their results showed that Biodentine displayed superior values compared to Bioaggregate and IRM. Camilleri , this study showed that Biodentine exhibited higher surface microhardness compared to the other materials when unetched .

17. Bond Strength . Biodentine is recommended for use as a dentine substitute under permanent restorations and perforation repair material. It should have sufficient amount of push-out bond strength with dentinal walls for the prevention of dislodgement from the repair site. Push-out bond strength increases with time.

18. Odabas ¸ et al.evaluated the shear bond strength of an etch-and-rinse adhesive, a 2-step self-etch adhesive and a 1-step self-etch adhesive system to Biodentine at different intervals. Aggarwal et al. studied the push-out bond strengths of Biodentine , Push-out bond strength increased with time. Blood contamination had no effect on the push-out bond strength. El- Maaita et al. aimed to assess the effect of smear layer on the push-out bond strength of calcium silicate cements ,Harvard MTA as root fillings. The results showed that the removal of the smear layer significantly reduced the push out bond strengths of calcium silicate cements.

19. Hashem et al. reported that Biodentine is a weak restorative material in its early setting phase. In a study by Guneser et al. Biodentine showed considerable performance as a repair material even after being exposed to various endodontic irrigation solutions, such as NaOCl , chlorhexidine , and saline, where as MTA had the lowest push-out bond strength to root dentin

20. DENSITY AND POROSITY Hydrosoluble polymer Reduces the amount of water Positive influence on density Lower porosity leads to higher mechanical strength. POROSITY Camilleri et al evaluated the Biodentine and IRM exhibited the lowest level or degree of porosity.

21. Ion release Biodentine has got the ability to release OH ¯ and calcium ions. The release of free calcium ion in biodentine is higher than MTA and dycal .

22. ADHESION Adhesive strength of Biodentine is higher than Dycal and MTA .

23. RADIOPACITY Biodentine contains zirconium oxide allowing identification on radiographs. It is a bioinert material with favorable mechanical properties and resistance to corrosion

24. Grech et al camilleri et al valuating the prototype radiopacified tricalcium silicate cement, bioaggregate , and biodentine , concluded that all materials had radiopacity values greater than 3mm al. Tanalp et al. where the radiopacity of biodentine was found to be lower compared to other repair materials tested (MTA, and MTA angelus) and slightly lower than the 3mm al baseline value set by ISO

25. Solubility Grech et al. demonstrated negative solubility values for biodentine It is due to the deposition of substances such as hydroxyapatite on the material surface when in contact with tissue fluids.

26. Microleakage Good marginal integrity of biodentine is due to 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.  

27. Discoloration Biodentine has the color stability. It could serve as an alternative for use under light-cured restorative materials in areas that are esthetically sensitive.

28. 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 has the least wash out resistance to avoid this effect water soluble polymer added to the material to reduce the water/cement ratio.

29. Biocompatibility Biodentine was found to be less toxic compared to glassionomers In a study by laurent et al. biodentine was found to significantly increase TGF- β 1 secretion from pulp cells.TGF is a growth factor whose role in angiogenesis, recruitment of progenitor cells, cell differentiation, and mineralization P. Laurent, J. Camps, and I. About, “ BiodentineTM induces TGF-𝛽1 release from human pulp cells and early dental pulp mineralization,” International Endodontic Journal, vol.45,no.5, pp.439–448,2012

30. ANTIBACTERIAL PROPERTIES 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 .

31. Adavantages High Purity Highly Biocompatible And Bioactive Short Setting Time Easily Material Handling Versatile Superior Mechanical Properties Excellent Sealing Properties Excellent Antibacterial Properties Universal

32. Clinical applications

33. Dentin substitute Biodentine has dentin like mechanical properties. It can be used as permanent dentine substitute (base) under composite or amalgam especially in deep carious teeth.

34. Pulp capping Biodentine can be used safely and effectively as pulp capping material. .

35. In 2012, tran et al demonstrated in vivo that biodentine induced an effective dentinal repair (pulp healing) when applied directly to mechanically exposed rat pulps. They observed the formation of a homogeneous reparative dentin bridge at the injury site with biodentine which was significantly different than the porous reparative tissue induced by calcium hydroxide   Tran X, Gorin C, Willig C, Baroukh B, Pellat B, et al. (2012) Effect of a calcium-silicate-based restorative cement on pulp repair. J Dent Res 91: 1166-1171. biodentin 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 .

36. Histological section showing thick homogenous reparative dentine formation after the application of biodentine .

37. Pulpotomy Pulpotomy is another widely used vital pulp therapy method in which biodentine is advocated. 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.

38. Rajasekharan et al. They concluded, “there was no significant difference between the new product biodentine in comparison to the well-known products (mineral trioxide aggregate ( mta ) Recently at the 12th congress of european academy of pediatric dentistry (EAPD) in poland , rubanenko et al. Presented their preliminary results of comparing biodentine versus formocresol as dressing agents in pulpotomized primary molars. They demonstrated a success rate of 100% for biodentine while that of formocresol was 94%.

39. Repair of perforations Biodentine has its own unique properties that make it preferred for perforation repair either in root canal or pulp chamber floor. Due to their good adhesion to dentin surface and fast setting time.

40. Retrograde root end filling Amalgam Zinc oxide eugenol GIC MTA Better consistancy Good handling BIODENTINE

41. REPAIR OF RESORPTION Biocompatibility and ability to induce calciumphosphate precipitation at the interface to the periodontal tissue, calcium silicate cements play a major role in bone tissue repair

42. In two case reports, nikhil et al. And ali et al. Showed successful results of biodentine when it is used in treatment of cervical and apical external root resorption with more than 1 year of follow up. On the other hand, there is some difficulty in removal of biodentine in case of retreatment. Arora V, nikhil V, sharma N, arora P (2013) bioactive dentin replacement. J dent med sci 12: 51-57

43. Apexification Tight bacterial seal Induction of formation of new cementum Induction of formation of new pdl biodentine can be used successfully in necrotic immature teeth. Cauwels et al. Found that necrotic immature teeth can still achieve continued root development after proper regenerative endodontic treatment with biodentine .

44. CONCLUSION Due to its major advantages and unique features as well as its ability to overcome the disadvantages of other materials, biodentine has great potential to revolutionize the different aspects of managing both primary and permanent in endodontics as well as operative dentistry. On the other hand, further studies are needed to extend the future scope of this material regarding the clinical applications.”

45. REFERENCES biodentine active biosilicate technology scientific file, septodont , paris, France. L. Grech , B. Mallia , and J. Camilleri , “characterization of set intermediate restorative material, biodentine , bioaggregate and a prototype calcium silicate cement for use as root-end filling materials,” inter national endodontic journal,vol.46,no. 7,pp.632–641,2013 M.B.Kayahan,m.H.Nekoofar,a.Mccannetal.,“Effec to facid etching procedures on the compressive strength of 4 calcium silicate-based endodontic cements,” journal of endodontics,vol . 39,no.12,pp.1646–1648,2013. L. Grech , B. Mallia , and J. Camilleri , “investigation of the physical properties of tricalciumsilicate cement- basedroot -end filling materials,” dental materials, vol. 29, no. 2, pp. E20–e28, 2013. J. Camilleri , “investigation of biodentine as dentine replacement material,” journal of dentistry, vol.41,no.7,pp.600–610, 2013. M.E.Odabas¸,m.Bani,andr.E.Tirali,“shear bond strengths of different adhesive systems to biodentine,”the scientific world journal,vol.2013,article id 626103,5 pages, 2013

46. v.Aggarwal,m.Singla,s.Miglani,ands.Kohli,“comparative evaluation of push-out bond strength of prorootmta , biodentine , and MTA plus in furcation perforation repair,” journal of conservativedentistry,vol.16,no.5,pp.462–465,2013. M. El- maaita , A. J. E. Qualtrough , and D. C. Watts, “the effect of smear layer on the push-out bond strength of root canal calcium silicate cements,” dental materials, vol. 29, no. 7, pp. 797–803,2013. F. Hashem , R. Foxton , A. Manoharan , T. F. Watson, and A. Banerjee , “the physical characteristics of resin composite calcium silicate interface as part of a layered/laminate adhesive restoration,”dental materials,vol.30,no.3,pp.343–349,2014. H.-M. Zhou, Y. Shen , Z.-J. Wang et al., “In vitro cytotoxicity evaluationofanovelrootrepairmaterial,”JournalofEndodontics,vol.39,no.4,pp.478–483,2013. P. Laurent, J. Camps, and I. About, “ BiodentineTM induces TGF-𝛽1 release from human pulp cells and early dental pulp mineralization,”InternationalEndodonticJournal,vol.45,no.5, pp.439–448,2012. Z.Luo,D.Li,M.R.Kohli,Q.Yu,S.Kim,andW.X.He,“Effect of Biodentine on the proliferation, migration and adhesion of humandentalpulpstemcells,”JournalofDentistry,vol.42,no. 4,pp.490–497,2014. A. M. Pawar , S. R. Kokate , and R. A. Shah, “Management of a large periapical lesion using Biodentine as retrograde restorationwitheighteenmonthsevidentfollow-up,”Journalof ConservativeDentistry,vol.16,no.6,pp.573–575,2013.

47. Arora V, nikhil V, sharma N, arora P (2013) bioactive dentin replacement. J dent med sci 12: 51-57 Priyalakshmi S, ranjan M (2014) review on biodentine -a bioactive dentin substitute. J dent med sci 13: 13-17 Camilleri J, grech L, galea K. Keir D, fenech M, formosa L, damidot D, mallia B (2014). Porosity and root dentine to material interface assessment of calcium silicate-based root-end filling materials. Clin oral investig 18: 1437-46.

48. 1.Final setting time of biodentine according to grech et al A. 2 hours B. 1 hours 45 minutes C. 9-12 minutes D. 45 minutes

49. 2. The compressive strength of dentin is a. 297 Mpa b. 300 Mpa c. 245 Mpa d. 100 Mpa

50. 3.The filler material which is present in biodentine is A. C-S-H gel B. Calcium chloride C. Calcium carbonate D. Calcium hydroxide

51. 4.The shorter setting time of biodentine is achieved by A . decreasing the particle size B. Increasing the calcium chloride C. Increasing the calcium carbonate D. Increasing liquid/powder ratio

52. 5 . For how much time does the powder and liquid components are triturated A. 30 seconds B. 20 seconds C. 40 seconds D. 10 seconds