The aim of this study is to compare two pulpotomy medicaments in primary molars Pulpotomy Dental Caries, Drug: Biodentine Drug: ProRoot. Extensive Decay in Primary Molars, Drug: Biodentine pulpotomy Drug: White MTA Pulpotomy using Tempophore as pulpotomy medicine in a control group. Biodentine pulpotomy was performed followed as pulpotomy medicament in primary molar teeth, on follow-up it was found to be successful.
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May 23, ; Accepted Date: June 04, ; Published Date: A Review of Literature.
J Oral Hyg Health 3: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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 dentin replacement. The purpose of this article was to review the clinical applications and advantages of biodentine in the pediatric dental practice.
Electronic search of English scientific papers from to was accomplished using Pub Med search engine. The following search terms used were clinical applications, biodentine, pediatric dentistry, children, advantages, dentin substitute, pulp therapy, root filling, and tooth repair. 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.
Clinical applications; Biodentine ; Pediatric dentistry. The need for more and more new materials is never ending especially in the field of dentistry.
Various materials have been formulated, tested and standardized to obtain maximum benefit for good clinical performance. One such new material is the latest bioactive calcium-silicate based material biodentinewhich was recently introduced by Septodont Company and could conciliate high mechanical properties with excellent biocompatibility, as well as a bioactive behavior [ 1 ].
Therefore, the mechanical properties are improved in biodentine by controlling the purity of the calcium silicate through this Active Biosilicate Technology. Therefore, it has been developed and produced with the aim of bringing together the high biocompatibility and bioactivity of calcium silicates, with enhanced properties, which make it more unique than any other calcium silicate-based materials [ 2 – 5 ]. Biodentine is available as powder in a capsule and liquid in a pipette.
There are two types of boxes available in the market. The powder is mainly composed of tricalcium silicate main pilpotomydicalcium silicate, calcium carbonate, and iron oxide as well as zirconium oxide as the radiopacifier. The liquid contains water, calcium chloride as setting accelerator and a modified polycarboxylate as superplasticising plpotomy water reducing agent [ 5 – 8 ].
Biodentine was developed based on pulpotomh most biocompatible chemistry available for dental materials: The calcium silicate will interact with water leading to the setting and hardening of the cement. This hydration process will produce hydrated calcium silicate CSH gel.
As part of its chemical setting reaction, calcium hydroxide is also formed [ 59 ]. In contact with phosphate ions, it creates precipitates that resemble hydroxyapatite [ 6 ].
Biodentine pulpotomy several days after pulp exposure: Four case reports
This dissolution process occurs at the surface of each grain of calcium silicate. The non reacted tricalcium silicate grains are surrounded by layers of CSH gel, which are relatively impermeable to water, thereby slowing down the effects of further reactions.
Gradually, the CSH gel fills in the spaces between the tricalcium silicate grains. Later on, the hardening process results from the formation of crystals that are deposited in a supersaturated solution [ 5 ]. Biodentine attracted attention in the field of dentistry due to its fast setting time, high biocompatibility, high compressive strength, excellent sealing ability, and ease of handling as well as its versatile usage in both endodontic repair and restorative procedures without causing any staining of the treated teeth [ 4 – 610 ].
In addition to that, it is much more cost effective in comparison to similar materials [ 1451011 ]. Many in vivo and in vitro studies support its bioactivity as well as its successful performance in many clinical applications [ 110 – 23 ]. On the other hand, all the available clinical studies and case reports revealed excellent results for its use in human primary teeth [ 924 – 36 ].
Due to its improved material properties short setting time, better mechanical properties, and easy and ergonomic use as well as its ability to overcome the drawbacks of many other materials, biodentine might be an interesting and promising alternative to the existing materials for dentin-pulp complex regeneration.
Biodentine has the potential of making major contributions in the field of dentistry by maintaining the teeth in a healthy state through numerous exciting clinical applications [ 1 ]. Therefore, biodentine promises to be one of the most versatile materials of this century in the field of dentistry.
The following search terms used were clinical applications, biodentine, pediatric dentistrychildren, advantages, dentin substitute, pulp therapy, root filling, and tooth repair.
One hundred and eighteen articles were reviewed as well as some references of selected articles. Thirty-eight recent studies described the clinical applications of biodentine in pediatric dentistry. In the area of the dental crown, it is indicated for pulp capping, pulpotomy, treatment of deep carious lesions using the sandwich technique, and also as temporary enamel restoration or permanent dentine replacement [ 925 – 273738 ]. Its use in root includes managing perforations of furcation or root canalsinternal and external resorption, apexification and retrograde root canal obturation [ 353639 ].
In addition to that, it could be used also as bone substitute material for implant stabilization [ 40 ]. On the other hand, biodentine is not recommended in large or esthetic build-ups [ 5 ].
In comparison to the other calcium silicate based materials, biodentine possess better biological and physico-chemical properties such as material handling, faster setting time, biocompatibility, stability, increased compressive strength, increased density, decreased porosity, tight sealing properties, and early form of reparative dentin synthesis [ 112132741 ].
It is sufficiently stable so that it can be used both for pulp protection and temporary fillings [ 56 ]. Accordingly, these improved properties of biodentine together with its excellent biological behavior suggested its use as permanent dentin substitute [ 13 ]. Biodentine was used safely as a dentin substitute in class I and class II composite restorations without any complication or post operative pain [ 24 ].
Clinically, a 6 month follow up study of biodentine in nineteen class I and II posterior restorations showed a very good marginal adaptation and surface finish along with absence of pain and sensitivity [ 25 ].
Biodentine or MTA for primary teeth pulpotomy? – National Elf Service
In evaluating the in vitro marginal integrity, koubi et al. Additionally, biodentine did not require any specific preparation of the dentinal walls [ 15 ].
In comparing the leakage of biodentine with a resin modified glass ionomer, as dentin substitutes in cervical restorations or as restorative materials in approximal cavitiesRaskin et al. On the other hand, the resin modified glass ionomer had shorter operating time than biodentine [ 41 ]. In another multicentric, randomized, 3-year prospective study by Koubi et al, class I and II posterior restorations and 24 direct pulp capping cases showed no clinical complications after 6 months [ 27 ].
Upon further follow up for up to 3 years, all teeth maintained vitality and symptom free. These results indicated that biodentine could be used under composite as a dentin substitute for posterior restorations [ 27 ]. InGjorgievska et al. They found that both glass ionomers and biodentine yielded favorable results as dentin substitutes.
However, biodentine crystals appeared firmly attached to the underlying dentin surface during scanning electron microscopy analysis. They referred this excellent adaptability between biodentine and the underlying dentin to its micromechanical adhesion [ 18 ]. Through the combination of light and anaerobic conditions in vitroValles et al.
On the other hand, the erosion of biodentine in acidic solution was observed to be limited and lower than other water based cements [ 13 ]. However, in reconstituted saliva containing phosphatesno erosion was observed. Instead, a crystal deposition on the surface of biodentine occurred, with an apatite-like structure [ 13 ].
This deposition process of apatitic structures might increase the marginal sealing of the material [ 13 ]. However, its high acid resistance was demonstrated with less surface disintegration presented in acid erosion tests [ 6 ].
Since biodentine is indicated for use as a dentin substitute under permanent restorations, studies were performed also to assess the bond strength of the material with different bonding systems.
InOdabas et al. They did not found any significant differences between all of the adhesive groups at the same time intervals 12 minutes and 24 hours. When different time intervals were compared, the highest bonding value was obtained for the 2-step self-etch adhesive at the hour period, whereas the lowest was obtained for the etch-and-rinse adhesive at a minute period [ 43 ]. They showed that the removal of the smear layer significantly reduced the push-out bond strengths of biodentine [ 44 ].
Thus, the smear layer was a critical issue that determines the bond strength between dentin and biodentine. Also, this study successfully demonstrated the bonding characteristics of this popular calcium silicate based material which is unique in contemporary dental applications [ 44 ].
On the other hand, biodentine is not as stable as a composite resin. Therefore, it is not suitable for a permanent enamel replacement [ 6 ]. But, in comparison to other Portland cement- based products, biodentine is stable enough to be used as a temporary filling even in the chewing load bearing areas [ 5 ].
The Dental Elf
Additionally, biodentine has a mechanical behavior similar to glass ionomers and is comparable to that of natural dentin [ 5610 ]. Both the elasticity modulus of the cement and microhardness as well as compressive and flexural strengths are comparable with dentin [ 6 ]. The sealing ability of this biomaterial was also assessed to be equivalent to glass ionomers, without requiring any specific conditioning of the dentin surface [ 541 ].
Therefore, biodentine can be used safely and successfully as dentin substitute especially with its dentin like mechanical properties [ 5 ]. Due to its high biocompatibility, biodentine has been proposed as a potential medicament for pulp capping procedures [ 6 ].
In comparison with the routinely used calcium hydroxide, biodentine is much superior regarding the tissue reaction as well as the amount and type of dentin bridge formation [ 5619 ]. Because of its faster setting time, easier handling, and more enhanced mechanical properties, biodentine can be used safely and effectively as pulp capping material especially with its ability to initiate early mineralization by releasing Transforming Growth Factor- beta from pulpal cells to encourage pulp healing [ 6 ].
A clinical evaluation over 6 to 35 months of biodentine, as a base and pulp capping, demonstrated excellent biocompatibility and longevity [ 9 ]. In examining the inflammatory cell response and hard tissue formation of biodentine in pulp capped primary pig teeth, biodentine showed normal pulp tissue without any signs of inflammation [ 22 ].
Additionally, Dammaschke showed a successful result after 6 pulpotomg of using biodentine as direct pulp capping of iatrogenic pulp exposure [ 26 ]. InTran et al demonstrated in vivo that biodentine induced an effective dentinal repair pulp healing when applied directly to mechanically exposed rat pulps [ 19 ]. They observed the formation of a homogeneous reparative dentin puulpotomy at the injury site with biodentine which was significantly different than the porous reparative tissue induced by calcium hydroxide [ 19 ].
In an interesting clinical and histological study, Nowicka et pulpotmoy. They found that the majority of specimens showed complete dentin bridge formation without any inflammatory pulpal response [ 20 ]. Therefore, biodentine showed good efficacy in the clinical settings and can be considered as an interesting and promising pulp capping material.
Pulpotomy is another widely used vital pulp therapy method in which biodentine is advocated to be used [ 6 ]. This treatment method is the most frequently accepted clinical procedure in pediatric dentistry when the coronal pulp tissue is inflamed and a direct pulp capping is not a suitable option [ 45 ]. In comparison to formocresol in primary teeth pulpotomy, biodentine is a regenerative material that maintains pulp vitality whereas formocresol is a devitalizing agent [ 645 ].
However, biodentine required less time for the pulpotomy uplpotomy [ 22 ]. While formocresol acts only as dressing material, which needs a restorative material to seal the pulp chamber, biodentine acts simultaneously as both dressing and filling material [ 645 ]. Thus, biodentine eliminates the need for a filling material in the pulp chamber of pulpotomized teeth. While formocresol requires 3—5 minutes application before the cotton pellet is removed, with biodentine the pulp chamber is filled immediately [ 645 ].
Moreover, during the removal of formocresol-soaked cotton pellet, there is a possibility of the cotton fibers adhering to clot, resulting in reoccurrence of bleeding.
This does not occur with biodentine as it is applied directly without cotton pellet [ 12561045 ].