BIODENTINE
Introduction. The latest calcium silicate cement, Biodentine® (the first pure tricalcium silicate to appear on the market) has mechanical properties similar to dentine.
After ten years of research, it was created to overcome the drawbacks of calcium hydroxide, the “gold standard” of dental materials.
- Composition. Like most materials, Biodentine® comes in two parts: an encapsulated powder and a liquid contained in a single-dose bottle.
- Product presentation. Septodont™ and ATO Zizine™ laboratories market Biodentine™. The packaging is as follows: 15 powder capsules and 15 doses of liquid, as well as plastic spatulas.
- instructions for use.
First tap the capsule on a hard surface to mobilize the powder.
Open the capsule and place five drops of liquid inside. Close and place the capsule in a vibrator for 30 seconds, at a frequency of 4000 to 4200 oscillations per minute.
Open and remove the material with the spatula.
Once mixed, Biodentine® hardens in 12 minutes.
The consistency of Biodentine® is reminiscent of a zinc oxy-phosphate cement.
4. Properties of Biodentine.. 4.1. Mechanical resistance
Due to a lower water content used for mixing, Biodentine is denser than MTA and has less porosities. It has better resistance to compression and flexure.
Its mechanical properties appear to be sensitive to environmental aggressions such as tooth whitening.
4.2. Mechanical properties
They are similar to healthy dentin and can therefore replace it both at the coronal and radicular levels, without prior treatment of the calcified tissues.
4.3. Antimicrobial properties
Biodentine® has an antibacterial effect for 4 hours.
4.4. Dimensional stability
Biodentine loses some of its cohesion when exposed to water during setting, which results in altered mechanical properties. This is why the establishment of an operating field is necessary as for any quality care with a restorative material.
As with MTA, Biodentine also creates deposits of apatite-like crystals appearing on its surface. This layer is called the CSH and CaOH2 gel, and it allows the progressive sealing of the porosities of the material, like a self-repair.
After 6 months in vivo, defects in anatomical shape, marginal adaptation and proximal contact were noted. This would be due to low abrasion resistance.
4.5. Ease of implementation
Biodentine is considered to have a setting time of 40 minutes, but as with any cement, it takes a certain number of days for its characteristics to stabilize.
These observations are however contradictory with the manufacturer’s recommendations which recommend either a re-intervention in the medium term or bonding to the material after 12 minutes of waiting.
The precautionary principle, in view of the data acquired from science, would be to carry out the adhesive protocol at a distance from the installation of the material.
4.6. Waterproofing properties and resistance to micro-infiltration
Biodentine® has similar behavior in terms of infiltration resistance as a glass ionomer cement at the interface with enamel, dentin and adhesives
4.7. Membership
The adhesion of Biodentine to dentine is of a chemical and micromechanical type. Two types of interfaces can be distinguished: an intra-tubal crystalline diffusion zone, due to penetration of the material into the canaliculi (mineral tag) and an inter-tubular mineral infiltration zone. This results in the formation of a layer resembling a hybrid layer typical of adhesion systems.
4.8. Biocompatibility
ISO tests studying the cytotoxicity of Biodentine on fibroblasts show us that this material can be considered non-cytotoxic, unlike calcium hydroxide which causes a less favorable reaction on fibroblasts. Many studies support this view.
Beyond the biocompatibility of the material, Biodentine is known for its bioactivity. It is indeed capable of inducing the formation of hydroxyapatite on contact but also of stimulating pulp repair to a degree equal to or greater than MTA according to studies.
Also, placed in contact with the periodontium, it has been shown a real long-term cellular survival, the formation of a periodontal ligament opposite the cement, a stimulation of the activity of the cementoblasts and an inhibition of that of the osteoclasts.
4.9. Aesthetics
According to most authors, Biodentine has very good colorimetric stability. Despite this, its color is yellow and unaesthetic and requires compliance with certain rules, particularly in terms of thickness, to obtain satisfactory aesthetic results.
- Indications of Biodentine
Dentin can be used both in the crown and in the roots as a substitute dentin.
In endodontics, it can be used to repair perforations of the canal walls or floor, to fill external or internal resorptions, to perform apexification of immature teeth in one visit and to perform retro canal fillings in endodontic surgery.
In summary, Biodentine® is both a replacement dentin and a cement intended to preserve pulp vitality and stimulate the formation of calcified tissue (reaction dentin or reparative dentin).
The manufacturer indicates several applications for Biodentine™ (Septodont.
Biodentine™: instructions for use):
Dentin substitute and indirect pulp capping
Direct pulp capping
Pulpotomy
Repair of perforations and resorptions
Apexification
Retro root filling
Conclusion. The development of Biodentine™, which has a composition similar to MTA but with greater purity, combines the advantages of calcium silicate cements with a significant reduction in their disadvantages. Thus, the combination of short setting time, ease of use, colorimetric stability and good mechanical properties allows placement in a single session and obturation over the entire height of the tooth.
BIODENTINE
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