Abstract Background. The aim of this study was to evaluate the effect of acidic, neutral and alkaline environments on the solubility of white mineral trioxide aggregate WMTA and Biodentine BD. Each group was further divided into two subgroups 1 and 2 according to the material studied. The samples in groups A, B and C were transferred into synthetic tissue fluid buffered at pH values of 7. Daily solubility at 1-, 2-, 5-, , , and day intervals and cumulative solubility up to 5-, , and day intervals were calculated.
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Published16 Jun Abstract Biodentine is a calcium-silicate based material that has drawn attention in recent years and has been advocated to be used in various clinical applications, such as root perforations, apexification, resorptions, retrograde fillings, pulp capping procedures, and dentine replacement.
There has been considerable research performed on this material since its launching; however, there is scarce number of review articles that collates information and data obtained from these studies.
Therefore, this review article was prepared to provide the reader with a general picture regarding the findings about various characteristics of the material. The results of a PubMed search were classified and presented along with some critical comments where necessary. The review initially focuses on various physical properties of the material with subheadings and continues with biocompatibility. Another section includes the review of studies on Biodentine as a vital pulp treatment material and the article is finalized with the summary of some case reports where the material has been used.
Background Calcium silicate based materials have gained popularity in recent years due to their resemblance to mineral trioxide aggregate MTA and their applicability in cases where MTA is indicated. Although various calcium silicate based products have been launched to the market recently, one of these has especially been the focus of attention and the topic of a variety of investigations. Biodentine has a wide range of applications including endodontic repair root perforations, apexification, resorptive lesions, and retrograde filling material in endodontic surgery and pulp capping and can be used as a dentine replacement material in restorative dentistry.
The material is actually formulated using the MTA-based cement technology and the improvement of some properties of these types of cements, such as physical qualities and handling [ 1 ]. This review article makes a general analysis, provides a summary of studies on Biodentine, and critically evaluates the existing knowledge regarding the properties of the product.
A total of 52 papers were included that consisted of those directly focusing on Biodentine as well as relavant papers that do not include Biodentine but are related to dental materials in general.
Physical Properties of Biodentine 2. Composition The product file of Biodentine states that the powder component of the material consists of tricalcium silicate, dicalcium silicate, calcium carbonate and oxide filler, iron oxide shade, and zirconium oxide.
Tricalcium silicate and dicalcium silicate are indicated as main and second core materials, respectively, whereas zirconium oxide serves as a radiopacifier. The liquid, on the other hand, contains calcium chloride as an accelerator and a hydrosoluble polymer that serves as a water reducing agent. It has also been stated that fast setting time, one unique characteristics of the product, is achieved by increasing particle size, adding calcium chloride to the liquid component, and decreasing the liquid content.
The setting period of the material is as short as 9—12 minutes. This shorter setting time is an improvement compared to other calcium silicate materials [ 1 ]. Some authors have indicated that there are few studies on the properties of newly developed materials such as Biodentine [ 2 ]. The material is characterized by the release of calcium when in solution [ 3 , 4 ].
Tricalcium silicate based materials are also defined as a source of hydroxyapatite when they are in contact with synthetic tissue fluid [ 5 — 7 ]. A search of the literature reveals a few studies that aim to further investigate the composition and setting characteristics of the material.
Grech et al. Their main purpose was to assess the effect of the additives used in commercial brands. They concluded that Biodentine resulted in the formation of calcium silicate hydrate and calcium and hydroxide, leached in solution.
The materials, when hydrated, consisted of a cementitious phase, rich in calcium, silicone, and a radiopacifying material. Biodentine was further described as having calcium carbonate in powder and the carbonate phase of the material was verified by XRD and FT-IR analysis.
The Biodentine powder also had inclusions of calcium carbonate which were relatively large compared to cement particles. There were hydration products around the circumference of the calcium carbonate particles. The authors added that calcium carbonate acts as a nucleation site, enhancing the microstructure [ 7 ]. Similar results were reported by Camilleri et al.
Their analysis also showed that tricalcium silicate was the main constituent of Biodentine and no dicalcium silicate or calcium oxide was detected. They further noted that Biodentine consisted of other additives for the enhancement of the material.
An important feature of the calcium carbonate additive was to act as a nucleation site for C—S—H, thereby reducing the duration of the induction period, leading to a faster setting time. The tricalcium silicate grains in Biodentine were also reported to be finer and calcium chloride and a water soluble polymer were included in the liquid portion [ 8 ]. Setting Time Grech et al. The authors described that this methodology uses a Vicat apparatus with a needle of specific mass.
The setting time of the mixture is calculated as the time taken from the start of mixing until the indentor fails to leave a mark on the set material surface. The setting time of Biodentine was determined as 45 minutes.
This short setting time was attributed to the addition of calcium chloride to the mixing liquid [ 9 ]. Calcium chloride has also been shown to result in accelerated setting time for mineral trioxide aggregate [ 10 ]. An interesting finding of the study by Grech et al [ 9 ] was that the highest setting period was determined for Bioaggregate, another tricalcium silicate based material. The product sheet of Biodentine [ 1 ] indicates the setting time as 9 to 12 minutes, which is shorter than the one observed in the study by Grech et al.
However, 9—12 minutes indicated in the product sheet is the initial setting time, whereas Grech et al. Therefore, both papers are not comparable. Villat et al. Interestingly, impedance values were stabilized after 5 days for the glass ionomer cement while at least 14 days were necessary for the calcium silicate based cement.
The authors speculated that this result was due to the higher porosity for Biodentine cement, characterizing higher capacity of ion exchanges between the material and its environment [ 11 ]. Compressive Strength Compressive strength is considered as one of the main physical characteristics of hydraulic cements. Considering that a significant area of usage of products such as Biodentine is vital pulp therapies, it is essential that the cement has the capacity to withstand masticatory forces, in other words, sufficient compressive strength to resist external impacts [ 2 ].
The product sheet of Biodentine states that a specific feature of Biodentine is its capacity to continue improving in terms of compressive strength with time until reaching a similar range with natural dentine [ 1 ]. In the study by Grech et al.
They stated that this mode of the material is permissible as a water soluble polymer is added to the mixing liquid. Kayahan et al. Considering that acid etching is one of the steps following the application of Biodentine for the provision of mechanical adhesion, the authors aimed to assess whether any alterations exist in terms of 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 [ 2 ]. Although these studies are limited and further research is definitely warranted; they hold promise for Biodentine as a suitable material for use in procedures, such as vital pulp therapies, where there is direct exposure to external masticatory forces and compressive strength capacity is of primary significance.
Furthermore, in a study by Koubi et al. Microhardness Grech et al. Camilleri [ 13 ], 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.
On the other hand, there was no difference in the microhardness of different materials when they were etched [ 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 between all of the adhesive groups at the same time intervals 12 minutes and 24 hours. When different time intervals were compared, the lowest bonding value was obtained for the etch-and-rinse adhesive at a minute period, whereas the highest was obtained for the 2-step self-etch adhesive at the hour period [ 14 ]. Another area of use of Biodentine, specifically from an endodontic point of view, is the repair of perforations, which is likely to be encountered in clinical practice.
It is essential that a perforation repair material should have sufficient amount of push-out bond strength with dentinal walls for the prevention of dislodgement from the repair site. Aggarwal et al. Push-out bond strength increased with time. Their results showed that the 24 h push-out strength of MTA was less than that of Biodentine and blood contamination affected the push-out bond strength of MTA Plus irrespective of the setting time.
A favorable feature of Biodentine determined by the authors was that blood contamination had no effect on the push-out bond strength, irrespective of the duration of setting time [ 15 ].
The results showed that the removal of the smear layer significantly reduced the push-out bond strengths of calcium silicate cements and the smear layer was a critical issue that determines the bond strength between dentine and calcium silicate cements such as Biodentine.
The authors attributed this result to the inability of calcium silicate cement particles to penetrate the dentinal tubules due to their particle size. They speculated that the smear layer is important in the formation of the interfacial layer and may be involved in the mineral interaction between the CSC and radicular dentin.
It is appropriate to mention that it is not customary to use calcium silicate based materials for the obturation of the entire root canal system and such an approach might not be preferable especially in narrow and curved root canals. Hashem et al. Biodentine is a weak restorative material in its early setting phase. In a study by Guneser et al. Porosity and Material-Dentine Interface Analysis 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. Porosity has been shown to have an impact upon numerous other factors including adsorption, permeability, strength, and density. It has further been stated that the maximum pore diameter, which corresponds to the largest leak in the sample, along with bacterial size and their metabolites, will be indicative of the leakage that occurs along the root-end filling materials [ 19 ].
Camilleri et al. They used a prototype material TCSZr similar to Biodentine in composition which was composed of a cementitious phase, namely, tricalcium silicate and a radiopacifier zirconium oxide with no additives. The reason for testing such a prototype material was to assess the effects that the additives in Biodentine have on the porosity of the material and to detect any changes in the material characteristics at the root-dentine to material interface.
The testing was performed in two environmental conditions, namely, dry or immersed in a physiological solution. According to their results, Biodentine and IRM exhibited the lowest level or degree of porosity. The confocal microscopy used in conjunction with fluorescent tracers demonstrated that dry storage resulted in gaps at the root dentine to material interface and also cracks in the material and Biodentine was the most affected one from ambient conditions.
Dry storage of Biodentine caused changes in the material microstructure and cracks at the root dentine to Biodentine interface. Furthermore, the gaps occurring due to material shrinkage allowed the passage of the fluorescent microspheres. These gaps were defined as significant as they had the potential to allow the ingress and transmission of microorganisms [ 20 ].
In case the procedure is a retrograde filling where there is a continuously moist environment, lesser porosity that occurs by Biodentine is advantageous. However, in procedures such as liners, bases, or dentine replacement, the material is generally kept dry which might pose a problem in terms of porosity and result in the formation of gaps at the interface, leading to bacterial passage.
This leads to the conclusion that caution must be exercised during the selection of Biodentine in certain clinical conditions where moisture is not necessarily present. Another study on porosity was one by De Souza et al. In addition, no significant differences were found in porosity between the new calcium silicate-containing repair cements and the gold-standard MTA. The authors made similar conclusions in terms of the behavior of tricalcium based materials and drew similarity between them and the conventional MTA in terms of microleakage, solubility, and microfractures in the clinical setting [ 21 ].
Gjorgievska et al. Whilst the cavity adaptation of bioglass was poor owing to its particle size, both glass ionomers and calcium silicate cements yielded favorable results as dentine substitutes.
A Review on Biodentine, a Contemporary Dentine Replacement and Repair Material
Published16 Jun Abstract Biodentine is a calcium-silicate based material that has drawn attention in recent years and has been advocated to be used in various clinical applications, such as root perforations, apexification, resorptions, retrograde fillings, pulp capping procedures, and dentine replacement. There has been considerable research performed on this material since its launching; however, there is scarce number of review articles that collates information and data obtained from these studies. Therefore, this review article was prepared to provide the reader with a general picture regarding the findings about various characteristics of the material. The results of a PubMed search were classified and presented along with some critical comments where necessary. The review initially focuses on various physical properties of the material with subheadings and continues with biocompatibility.
Effect of pH on solubility of white Mineral Trioxide Aggregate and Biodentine: An in vitro study
Daikasa 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 [ 35 ]. Treatment of immature teeth with non vital pulps and apical periodontitis. Biodentine: A Promising Dentin substitute OMICS International The evaluation of bond strength ofa composite and a compomer to white mineral trioxide aggregate with twodifferent bonding systems. Am J Dent ; Mineral trioxide aggregate or calcium hydroxide direct pulp capping: Another area of use of Biodentine, specifically from an endodontic point of view, is the repair of perforations, which is likely to be encountered in clinical practice. The deposition of apatitic structures might increase the marginal sealing of the material.
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