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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 59-62

Bioceramics in endodontics: A review


Department of Conservative Dentistry and Endodontics, Kalka Dental College and Hospital, Partapur, Meerut, Uttar Pradesh, India

Date of Submission27-Feb-2021
Date of Acceptance09-Mar-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Panna Mangat
Department of Conservative Dentistry and Endodontics, Kalka Dental College and Hospital, Partapur, Meerut, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_13_21

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  Abstract 

Endodontics is medicine’s specialized branch that deals with dental care, and it focuses on inner soft tissues. Several dental disease and injuries are associated with the compromised health of the degradation of the various parts related to the inner soft tissues. Bioceramics are materials used for healing damaged parts of the teeth and they have to be biocompatible. The term “bioceramics” may be applied to the category of biomaterials that comprise ceramic as one of its constituents. These materials were developed to have biocompatibility with human tissue, and they were meant to be widely used in the repair and replacement of the organs in the musculoskeletal system. This review is an overview of bioceramics, classification, and their advantages. It also gives a detailed insight into the individual bioceramic materials currently used in the fields of endodontics along with their properties and applications.

Keywords: Bioceramics, capasio, endobinder, endosequence BC sealer, endosequence root canal repair material, Generex A, quick-set


How to cite this article:
Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. Int J Oral Care Res 2021;9:59-62

How to cite this URL:
Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. Int J Oral Care Res [serial online] 2021 [cited 2021 Aug 6];9:59-62. Available from: https://www.ijocr.org/text.asp?2021/9/2/59/317380




  Introduction Top


“Bioceramics” is defined as a type of biomaterial with optimal biocompatibility that is used for medical and dental purposes. Newly developed techniques and technology allow the majority of skilled dentists to produce stellar endodontic results. Paramount among these changes is the introduction of advanced material science. The good news is that the arena of endodontic material science is continuing to evolve and, in fact, a new day has dawned and it is the increased use of bioceramic technology in endodontics.

Bioceramics include alumina and zirconia, bioactive glass, coating and composites, hydroxyapatite, and resorbable calcium phosphates; they are inorganic, non-metallic, chemically stable, non-corrosive, and interact well with organic tissues. Numerous bioceramics are currently in use in both dentistry and medicine.[1]


  Historical Perspective Top


In the 1960s and 1970s, bioceramics were developed for use in the human body, such as for joint replacement, bone plates, bone cement, artificial ligaments, tendons, etc.

In 1969, L. L. Hench introduced a new material called bioglass and had observed that several glasses and ceramics could bond to living bone.[1]

Calcium phosphate was first used as bioceramic restorative dental cement by LeGeros et al.[2]


  Classification Top


In addition to being nontoxic, bioceramics can be classified as:

  1. Bioinert: Noninteractive with biological systems (zirconia and alumina)[3]


  2. Bioactive: Interactive with surrounding tissues to encourage the growth of durable tissues (glass and calcium phosphate)


  3. Biodegradable, soluble, or resorbable: Eventually replaces or gets incorporated into tissue. Particularly important with lattice frameworks.



  Bioceramics Used in Endodontics Top


Calcium Silicate Based

Cements: Portland cement, mineral trioxide aggregate (MTA), biodentine (Septodont, France), ProRoot MTA, Endocem MTA (Maruchi, Wonju, Korea).

NeoMTA Plus is a powder–gel system. The powder components are an extremely fine powder, primarily tricalcium and dicalcium silicate, quite similar to that of white ProRoot MTA, but they contain no bismuth oxide to prevent tooth staining.[4]

Sealers: Endo CPM Sealer (EGO SRL, Buenos Aires, Argentina), MTA Fillapex (Angelus, Brazil), BioRoot RCS (Septodont, France), TechBiosealer (Profident, Kielce, Poland), and EndoCem (Maruchi, Wonju, Korea).

Calcium Phosphates/Tricalcium Phosphate/Hydroxyapatite Based

Triple calcium phosphate, when used in bony defects, promotes osteogenesis.

In 1971, calcium-and-phosphate-containing glass ceramic, referred to as bioglass, was developed, and it showed that it “chemically” bonds with the host bone.

Mixture of Calcium Silicates and Calcium Phosphates

EndoSequence Root Repair Material (ERRM) or Bioceramic Root Repair Material (BC RRM) [trade names- iRoot BP, iRoot BP plus, iRoot FS] (Innovative Bioceramix Inc., Vancouver, Canada) [Table 1].
Table 1: Composition of bioceramic sealers

Click here to view


EndoSequence BC Sealer (Brasseler, Savannah, GA, USA)/ Total Fill, Bioaggregate (Innovative Bioceramix Inc., Vancouver, Canada), Tech Biosealer, Ceramicrete (developed at Argonne National Lab, Illinois, USA).

Experimental Calcium Alumino Silicates[5]

  • EndoBinder: It is a new calcium aluminate-based endodontic cement, seen as presenting a satisfactory tissue reaction.


  • Generex A: It is a calcium silicate-based material that mixes to a dough-like consistency, making it easy to be rolled into a rope-like mass similar to an intermediate restorative material.


  • Capasio: It comprises bismuth oxide, dental glass, and calcium alumino-silicate with a silica and polyvinyl acetate-based gel, showing mineralization properties.


  • Quick-set: Capasio powder has been refined and renamed as Quick-set (Primus Consulting), and it possesses negligible in vitro toxicological risks after time-dependent elution of toxic components.


  • Root-end filling material using epoxy resin and Portland cement (EPC): EPC, a novel composite made from a mixture of epoxy resin and Portland cement, was found to be a useful material for root-end filling, with favorable radio-opacity, short setting time, low micro leakage, and clinically acceptable low cytotoxicity.



  Mechanism of Action Top


The exact mechanism of bioceramic-based sealer bonding to root dentin is unknown; however, the following mechanisms have been suggested for calcium silicate-based sealers:

  • (1) Diffusion of the sealer particles into the dentinal tubules (tubular diffusion) to produce mechanical interlocking bonds.


  • (2) Infiltration of the sealer’s mineral content into the intertubular dentin, resulting in the establishment of a mineral infiltration zone produced after denaturing the collagen fibers with a strong alkaline sealer.


  • (3) Partial reaction of phosphate with calcium silicate hydrogel and calcium hydroxide, produced through the reaction of calcium silicates in the presence of the dentin’s moisture, resulting in the formation of hydroxyapatite along the mineral infiltration zone.



  Properties of Bioceramic as Sealer Top


Bioceramic is exceedingly biocompatible, nontoxic, antibacterial, hydrophilic, and chemically stable. It does not shrink on setting. It will not result in a significant inflammatory response if an overfill occurs during the obturation process or in root repair.[5] It possesses excellent sealing ability with quick setting and is easy to use, as the particle size is so small that it can even be used in a syringe [Table 2].
Table 2: Composition of bioceramic sealers

Click here to view


Recent developments in nanotechnology have made the particle size of BC Sealer so fine that it can actually be used with a 0.012 capillary tip. Further, its hydrophilicity and chemical bonding to the canal wall makes for excellent hydraulics.[6]


  Indications Top


Permanent obturation of the root canal after vital pulp extirpation; after the removal of infected or necrotic pulp and the placement of intracanal dressings.


  Advantages Top


  • ➢ Excellent biocompatibility.


  • ➢ Intrinsic osteoinductive capacity.


  • ➢ Functions as a regenerative scaffold.


  • ➢ Ability to achieve excellent hermetic seal, form a chemical bond with the tooth structure, and have good radio-opacity.


  • ➢ Antibacterial properties.



  Limitations Top


  • ➢ Release of a higher amount of lead and arsenic has raised questions regarding its safety with respect to the surrounding tissues.


  • ➢ Higher solubility may jeopardize the long-term seal of the restoration.


  • ➢ Excessive setting expansion with PC may lead to crack formation with the tooth.


  • ➢ Biomineralization with PC is not as effective and as long term as with MTA, which is critical for a bioactive material.



  Retreatment Top


The key is using bioceramics as a sealer, not as a complete filler. This is why endodontic synchronicity is so important and again, the use of constant tapers minimizes the amount of endodontic sealer, thereby facilitating retreatment.


  Bioceramics as a Root Repair Material Top


ERRM has been specifically created as a white remixed cement for both permanent root canal repairs and apico retro fillings [Figure 1].
Figure 1: (A) Preoperative radiograph. (B) Post-apicoectomy and retroprep. (C) Use of a BC putty over a retroprep cavity filled with BC sealer. (D) Final placement and verification of BC putty retrofill. (E) Immediate postoperative radiograph; note the presence of BC sealer along the post toward the coronal part. (F) 1-year-follow-up with advanced periapical healing. Courtesy Dr. Gilberto Debelian

Click here to view


Advantages as a root repair material: (1) Easier to use and place. (2) Easy dispensing. (3) Radio-opaque. (4) Multiple uses for a variety of clinical conditions. (5) No mixing required.


  Pulp Capping with Bioceramics Top


Bioceramics has enabled clinicians to now easily treat young patients in need of pulp caps or other pulpal therapies [Figure 2].
Figure 2: (A) Preoperative radiograph of carious exposure on tooth 36. (B) Direct pulp coverage with BC sealer. (C) Immediate postoperative radiograph. (D) Radiograph taken at 6-month follow-up visit. Courtesy Dr. Mohammed A. Alharbi

Click here to view



  Conclusion Top


Continuous innovations have led to bioceramics showing a variety of applications in both endodontic and restorative dentistry. Up-to-date knowledge of these new bioactive materials is essential to ensure the selection of the most suitable material in different clinical situations, showing a promising future in dental medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pushpa S, Sawhny A, Ashraf F, Nigam SA. The advent of bioceramics in dentistry: A review. Rama Univ J Dent Sci 2016;3:6-10.  Back to cited text no. 1
    
2.
AL-Haddad A, Aziz ACAZ. Bioceramics-based root canal sealers: A review. Intern Jo Biomat2016;2016:1-10.  Back to cited text no. 2
    
3.
Alghamdi AM. Bioceramics in endodontics – A critical assessment of old and new technologies. EC Microbiol 2017;10:169-76.  Back to cited text no. 3
    
4.
Chang JWW, Praisarnti C, Neelakantan P. Increasing use of bioceramics in endodontics: A narrative review. Oral Health Group2017.  Back to cited text no. 4
    
5.
Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P. Bioceramics in endodontics – A review. J Istanb Univ Fac Dent 2017;51:128-37.  Back to cited text no. 5
    
6.
Malhotra S, Hedge HML, Shetty C. Bioceramic technology in endodontics. Br J Med Med Res 2014;4:2446-54.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
   Abstract
  Introduction
   Historical Persp...
  Classification
   Bioceramics Used...
  Mechanism of Action
   Properties of Bi...
  Indications
  Advantages
  Limitations
  Retreatment
   Bioceramics as a...
   Pulp Capping wit...
  Conclusion
   References
   Article Figures
   Article Tables

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