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Giornale Italiano di Endodonzia (2016) xxx, xxx—xxx

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LITERATURE REVIEW/REVISIONE DELLA LETTERATURA

Biodentine: From biochemical and bioactive

properties to clinical applications
Biodentine: dalle proprietà biochimiche e bioattive alle applicazioni cliniche

Imad About *

Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France

Received 15 July 2016; accepted 13 September 2016

Available online xxxxxx

KEYWORDS Abstract Biodentine is a tricalcium silicate-based material designed as a permanent dentin

Biodentine; substitute. It is biocompatible and bioactive material. Its interactions with both hard and soft
Tricalcium silicate-based tissues lead to a marginal sealing preventing marginal leakage and provide protection to the
material; underlying pulp by inducing tertiary dentin synthesis. Unlike other dentin substitutes, Biodentine
Dentin substitute; application does not require any conditioning of the dentin surface and the restoration sealing is
Bioactivity; provided by micromechanical retention as Biodentine penetrates into the dentin tubules forming
Clinical applications. tag-like structures. After setting, Biodentine can be cut and reshaped like natural dentin. It can
also be bonded with different types of adhesives before finishing the final restoration with
composite resin. Published clinical trials, histology of human teeth and clinical cases show that
Biodentine has a wide spectrum of clinical applications as a permanent bulk dentin substitute in
endodontics, in restorative dentistry, and pediatric dentistry as a possible replacement material
of formecresol. This review brings a comprehensive understanding of Biodentine composition,
preparation properties and the mechanism of interactions with hard and soft tissues. It explains
the scientific mechanisms of the induction of these specific functions and illustrates the scientific
basis beyond their clinical successful use. The article provides an overview of Biodentine clinical
applications summarizing published clinical trials and reporting published clinical cases with this
material in restorative and pediatric dentistry as well as in endodontics.
ß 2016 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

* Correspondence to: Institut des Sciences du Mouvement (ISM), UMR 7287 CNRS & Université d’Aix-Marseille, Faculté d’Odontologie, 27 BD
Jean Moulin, 13385 Marseille cedex 5, France.
E-mail: imad.about@univ-amu.fr.
Peer review under responsibility of Società Italiana di Endodonzia.

http://dx.doi.org/10.1016/j.gien.2016.09.002
1121-4171/ß 2016 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: About I. Biodentine: From biochemical and bioactive properties to clinical applications. Giornale Italiano
di Endodonzia (2016), http://dx.doi.org/10.1016/j.gien.2016.09.002
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2 I. About

PAROLE CHIAVE Riassunto Biodentine è un materiale a base di silicato tricalcico progettato come sostituto
Biodentine; permanente della dentina. Si tratta di un materiale biocompatibile e bioattivo. Le sue interazioni
Cementi a base di con entrambi i tessuti duri e molli portano ad una sigillatura marginale in grado di prevenire
trisilicato di calcio; l’infiltrazione marginale e forniscono una protezione alla polpa sottostante inducendo sintesi
Sostituti della dentina; dentina terziaria. A differenza di altri sostituti della dentina, l’applicazione di Biodentine non
Ricerca; richiede alcun condizionamento della superficie dentinale e la tenuta della restaurazione è
Applicazioni cliniche. fornito dalla ritenzione micromeccanica in quanto Biodentine penetra nei tubuli dentinali
formando strutture di simili ai resin-tag. Dopo l’indurimento, il Biodentine può essere tagliato
e rimodellato come dentina naturale. Può anche essere trattato con diversi tipi di adesivi prima di
terminare il restauro definitivo. Studi clinici pubblicati, istologia di denti umani estratti e casi
clinici dimostrano che Biodentine ha un ampio spettro di applicazioni cliniche, come sostituto
permanente della dentina in endodonzia, in odontoiatria restaurativa e odontoiatria pediatrica.
Questa review si propone di descrivere in maniera completa la composizione di Biodentine, le
proprietà di preparazione e il meccanismo di interazione con i tessuti duri e molli. Essa spiega i
meccanismi scientifici che caratterizzano queste funzioni specifiche e illustra la base scientifica
del suo successo nell’utilizzo clinico. L’articolo fornisce inoltre una panoramica delle applicazioni
cliniche di Biodentine riassumendo gli studi clinici e riportando i casi clinici pubblicati con questo
materiale in odontoiatria restaurativa e pediatrica, cosı̀ come in endodonzia.
ß 2016 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. Cet article est
publié en Open Access sous licence CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-
nd/4.0/)

Introduction dental tissues will be explained and finally, Biodentine clin-

ical applications based on published works will be reported.
Over the past decades, search on restorative materials
focused on replacing amalgams in small anterior restorations
Biodentine composition
and on posterior restorations of moderate size by direct
composite restorations. Opposed to amalgams, a micro- Biodentine is a two components material. The powder is
mechanical retention of resin composites can be achieved mainly composed of Tricalcium silicates. It also contains Di-
with these materials by applying different adhesives. How- Calcium Silicate as a second core material and Calcium
ever, some drawbacks have been reported with resin-based Carbonate and Oxide as filler. The powder contains Zirco-
materials such as wear resistance under high stress, shrink- nium oxide as a radio-opacifier. The liquid contains Calcium
age upon polymerization leading to microleakage and toxic Chloride as a setting accelerator and a water reducing agent
monomers release.1,2 In order to protect the pulp from resin- (Table 1). The presence of a setting accelerator allows the
based materials toxic components, Calcium hydroxide-based material setting in 12 min and the presence of a water
materials have been widely used in direct pulp capping reducing agent avoids the formation of cracks within the
procedures. In spite of a highly alkaline pH of this material, material. Such cracks are usually observed after setting of
a dentin bridge can form within 3 months providing a protec- cements containing high percentage of water.9 The material
tion to the underlying pulp with mild or moderate inflamma- is prepared by adding 5 drops of liquid to the powder present
tion. However, several studies demonstrated a partial in the capsule. These components are then triturated with
dissolution and that this bridge has tunnel defects.3,4 The an amalgamator for 30 s at 4000 rpm leading to the forma-
recent focus on biocompatible materials such as Portland led tion of a paste of creamy consistency. The preparation
to the development of Mineral trioxide aggregate (MTA) as a method and proportions between powder and liquid should
root-end filling material and direct pulp capping. This mate-
rial is mainly composed of tricalcium and dicalcium silicates.5
When applied for pulp capping, it induces reparative dentin Table 1 Biodentine composition: two components: liquid
production leading to a regular tubular dentin bridge forma- and powder to be mixed with an amalgamator for 30 s at
tion within 2 months with no signs of inflammation.4 How- 4000 rpm.9
ever, some shortcomings have been reported with this Powder Role
material. These are related to its long setting time of 2 h
45 min, weak mechanical properties and difficult handling Tri-calcium silicate (C3S) Main core material
properties.6 Additionally, tooth discoloration has been Di-calcium silicate (C2S) Second core material
reported when this material is used for revascularization.7,8 Calcium carbonate and oxide Filler
Biodentine is a recently released tricalcium silicate-based Iron oxyde Shade
material developed as a permanent dentin substitute to Zirconium oxyde Radio-opacifier
replace the damaged dentin.9 Liquid
In this review, the material composition, preparation Calcium chloride Setting accelerator
method and application, mechanical and physical properties Hydrosoluble polymer Water reducing agent
will be described, its interactions with the soft and hard

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Biodentine bioactive properties 3

be respected and applied according to the manufacturer’s replacing dentin and enamel without any conditioning treat-
instructions as these proportions greatly influence the mate- ment. No leakage was observed when Biodentine surface was
rial’s setting and mechanical properties. This is of particular prepared with the total etch technique and resin composite
significance mainly for applications under mechanical loads application. The results of this investigation demonstrated
such as applications in Class II cavities. that the results obtained with Biodentine were similar to
those obtained with resin-modified glass ionomer cement
The setting reaction is a hydration reaction (Fuji II LC) considered as a reference material in this type
of indications.13 An interesting study compared the shear
When Biodentine powder and liquid are mixed with an amal- bond strengths of different adhesive systems to Biodentine.
gamator, the setting of the material is a hydration reaction. Adhesive systems such as Prime & Bond NT: etch-and-rinse
While Calcium silicates partially dissolve by adding the liquid, adhesive system, Clearfil SE Bond: 2-step self-etch adhesive
a hydrogel of hydrated silicate is produced. This will pre- system and Clearfil S3 Bond: 1-step self-etch adhesive system
cipitate on the remaining Silicate particles’ surface and in the were applied onto Biodentine discs for 12 min and 24 h then a
spaces between the particles leading to a significant Composite (Clearfil Majesty) was applied. Data showed that
decrease in the material’s porosity and an increase in its the shear bond strengths were the same for different adhe-
compressive strength over time.9 sive systems to Biodentine.14 This confirms that the marginal
sealing of Biodentine is equivalent to that of RMGIC (Fuji II
Biocompatibility LC) and that Biodentine can be etched and treated like
natural dentin. Different restorative materials can be suc-
cessfully applied on top of Biodentine. Whatever the surface
Like any other restorative material, Biodentine Biocompat-
treatment used on Biodentine, this material can be used in
ibility was investigated to ensure its safety when applied onto
combination with composite resins.13,14
the cells. Evaluation of its genotoxicity on bacteria strains by
the Ames test and its effects on the formation of micronuclei
by human lymphocytes demonstrated the absence of any
Biodentine interacts with hard tissues by
mutagenic effect of the material. Similarly, when tested micromechanical retention
on target human pulp cells, no DNA breaks or damage was
observed with the Comet assay. These results demonstrated Interactions of Biodentine with the dentin provided cues to
no genotoxic effects of Biodentine in vitro. The biocompat- understanding how this material provides a marginal sealing
ibility of the material was also investigated through its direct without any dentin surface preparation: no etching and no
application to human pulp cells simulating the direct pulp bonding. In an experimental work performed ex vivo, dentin
condition and indirectly through a dentin slice to simulate its slices were prepared and Biodentine was prepared and mixed
indirect pulp capping in vivo. Under both conditions Bioden- with a fluorescent dye before its application onto the dentin
tine was not found to affect target cell viability under in vivo surface. Confocal laser scanning electron microscopy and
application conditions.9 Additionally, when Biodentine was scanning electron microscopy were used to study the inter-
applied onto human pulp cells to investigate its effects on face between Biodentine and dentin. Confocal laser scanning
their specific functions by studying expression of odontoblast electron microscopy revealed that Biodentine penetrated
specific functions such as expression of Nestin (a human into the dentin tubules forming tag-like structures into the
odontoblast specific marker) and Dentin Sialoprotein, Bio- dentin tubules. Scanning electron microscopy revealed that
dentine was not found to inhibit the expression of these the dentin tubules appeared with plugs of mineralization
proteins but rather induce their expression and the cells crystals just beneath the interface obliterating the dentin
mineralization capacity.9—11 Further investigations demon- tubules. These results explain the micromechanical reten-
strated the absence of toxicity of Biodentine to human MG63 tion of the material on the one side and the marginal sealing
human osteoblast cells with the MTT assay with properties on the other side.15
comparable to that of MTA.12
Bioactive properties in vitro
Interactions with hard tissues: no surface
preparation is needed to apply BiodentineTM An entire human tooth culture model was used to investigate
both the material hydration when placed for pulp capping
Clinical application of Biodentine in restorative dentistry and its effects on the pulp response. The tooth culture model
implies an intimate interaction with hard and soft tissues provides a useful tool to investigate the initial steps of
as well as with other restorative materials. This should lead dentin-pulp regeneration and the consequence of applying
to a marginal sealing in vivo which provides pulp protection pulp capping materials. Since the teeth used are immature
and marginal sealing. Thus investigating these properties in impacted third molars, they also have the advantage of a high
ex vivo is of prime importance. regeneration potential and not to be in contact with the oral
An experimental work using third molar teeth was used to flora. Biodentine was applied into pulp cavities then an
investigate the marginal sealing of Biodentine alone or in adhesive resin was applied onto Biodentine and overlayed
combination of other resin-based materials using the silver with a composite resin. Hydration was allowed to proceed
nitrate penetration method in Class II cavities. No marginal under conditions similar to those in vivo by incubating teeth
leakage was observed at the Biodentin/dentin interface or at in culture medium. After 14 days, back-scatter scanning
the enamel/Biodentine interface when the whole cavity was electron micrographs revealed that the material was homo-
filled with Biodentine alone as a bulk restorative material genous and appeared completely hydrated at all areas

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4 I. About

Figure 1 Biodentine direct application onto human pulp in human entire tooth culture for 4 weeks. Biodentine induced odontoblastic
differentiation and reparative dentin secretion. Mineralization foci containing sequestered cells are observed in the dental pulp
beneath Biodentine. The sequestered cells express odontoblast markers such as Dentin Sialoprotein (DSP) and nestin.10

examined: within the material, at the Biodentine/dentin Indeed, after application of Biodentine and culture for
interface, at Biodentine/composite resin interface and at 14 days, mineralized structures appeared in the form of foci
the Biodentine/pulp interface. The hydration of this type of in close vicinity of the material. This mineralization seemed
materials leads to the release of Calcium ions which are to be directly linked to Biodentine as some cement particles
necessary for the mineralization. X-ray diffraction analysis were seen within the mineralized structures but not in the
of the material after setting demonstrated a significant peak neighboring pulp tissue. This mineralized tissue corresponds
of Calcium hydroxide formation which has long been used for to an early form of reparative dentin as cells sequestered
pulp capping with a well demonstrated ability to induce within these mineralizations express odontoblastic markers
dentin bridge formation.16 such as nestin and dentin sialoprotein (Fig. 1).
This culture model provided valuable information on the This mineralization seems to be due to the release of a
response to Biodentine application directly onto the pulp. growth factor, namely Transforming factor beta 1 (TGF-b1)
from pulp cells incubated with Biodentine (Fig. 2). This factor
has been shown to be involved in odontoblastic differentia-
tion and recent investigations revealed that this factor is
involved in the recruitment of pulp stem cells to TGF-b1pro-
duction site17 which is related to Biodentine application.
Interestingly, increase in TGF-b1 was significant whatever
the ratio between the Biodentine surface area and cell
culture volume.10 This has a clinical significance as it indi-
cates that this cement can be applied onto the pulp whatever
the injured pulp surface area (Fig. 2).

Biodentine interactions with soft tissues

induce tertiary dentin synthesis
Figure 2 Effect of Biodentine on TGF-b1 release from human
pulp cells. Biodentine induces release of TGF-b1 from human When Biodentine was used for vital pulp therapy in vivo,
pulp cells. *Significant as compared to the control.10 investigations carrier out on different animal models showed

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Biodentine bioactive properties 5

that this material can be applied for both pulp capping and Formecresol in pulpotomy. The major clinical trials and
pulpotomy. Indeed, Biodentine induced tertiary dentin histological studies in human teeth are detailed below and
synthesis when applied as direct or indirect pulp capping reported (Table 2) while the clinical case reports are only
material in rat teeth.18,19 After direct pulp capping, the listed in the same table.
dentin bridge observed after 4 weeks in rat teeth was tubular
and its porosity was similar to that of MTA.19 Similar results
demonstrated in miniature swine teeth. Indeed, after pulp Indirect pulp capping
capping with Biodentine, no pulp inflammation was observed
while a thick dentin bridge formed after 3 and 8 weeks.20 A randomized clinical study was performed in the restoration
Similar results were reported in primary pig teeth after of posterior teeth with Biodentine. 397 cases were included
4 weeks and 90 days. Application of Biodentine in pulpotomy with a three years follow-up. Biodentine was applied as a bulk
was also investigated in primary pig teeth and compared to restorative material in deep dentin cavities in replacement
formecresol and white MTA (WMTA). The results with Bio- of both dentin and enamel. The scoring scales included
dentine showed no inflammation and a thick dentin bridge consistency, working time, adhesion to instruments, ease
formed in 90% of the cases.21 These data were comparable to of handling, anatomic form, marginal adaption, quality of
the results obtained with WMTA and indicate the biocompat- proximal contact, marginal discoloration, surface roughness,
ibility of these materials and their suitability for pulp capping secondary caries and post-operative pain. The results of this
and pulpotomy. trial reported that Biodentine was easy to handle, showed, a,
excellent anatomic form, marginal adaptation and very good
Clinical applications interproximal contact. During the follow-up, the restoration
with BiodentineTM in comparison to the composite resin Z100
was well tolerated in all cases with no post-operative pain.
Although Biodentine is a recently developed material as it has
The anatomic form, marginal adaptation and interproximal
been released by the end of the year 2010 in Europe,
contact started to deteriorate only after 6 months. Due to the
different clinical applications have been so far published
deterioration, a complementary treatment was performed.
with this material. These include applications in restorative
Biodentine was kept as dentin substitute as the pulp vitality
dentistry, pediatric dentistry and endodontics. Although it
test was positive. Biodentine presented a good resistance to
can be used as a temporary enamel substitute for upto
burring and the composite Z100 was applied onto Biodentine
6 months, Biodentine is mainly used as a permanent dentin
surface and evaluated for up to 3 years. The conclusions of
substitute. It can be used to replace the missing/damaged
this study is that Biodentine can be used as a posterior
bulk dentin volume. It can also be used as an alternative to
restoration material for up to 6 months as a temporary
enamel substitute. When covered with Z1001, it is a well-
Table 2 Biodentine clinical applications and type of clinical tolerated permanent dentin substitute. Additionally, Bioden-
works published on each application. Biodentine can be used tine can be cut and shaped like the natural dentin.22 In
in restorative dentistry, pediatric dentistry and endodontics another clinical study, the efficacy of Biodentine as an indir-
as a permanent dentin substitute. It can be used to replace ect pulp capping material was evaluated and compared to a
the missing/damaged whole dentin volume. It can also be glass ionomer cement (Fuji IX) in irreversible pulpitis. 36
used as an alternative to formecresol in pulpotomy. restorations with Biodentine and 36 Fuji IX were placed
randomly in 53 patients. The clinical efficacy at 12 months
Application Type of investigations/
revealed no statistically significant differences in clinical
references
efficacy between Biodentine and Fuji IX.23
Crown The reported absence of post-operative pain and post-
Temporary enamel restoration Clinical trials 22 operative sensitivity in the clinical trial22 may be due at least
Permanent dentin substitute in to 2 factors:
Deep/large carious lesions Clinical trials 22 1) The infiltration of Biodentine into the dentin tubules15 due
Deep cervical/radicular lesions Case reports36—38 to the precipitation of crystals within the tubules
Indirect pulp capping Clinical trials22,23 decreases the dentin tubule permeability and fluid move-
Direct pulp capping Clinical and ment which may decrease post-operative sensitivity.
histological studies25,26 2) The reduction odontoblast pain receptor expression and
Pulpotomy Clinical trials27,39 function and the reduction of the secretion of pro-inflam-
Root matory cytokines. Indeed, odontoblasts express pain
Root canal/furcation Case reports 40 receptors of the transient receptor potential family of
perforations ion channels (TRP) namely TRPA1. These receptors play a
External resorption Case reports 41 significant role in nociception and neurogenic inflamma-
Internal resorption Case reports 42 tion. When extracts of Biodentine were applied on odon-
Regenerative endodontics Case reports 43 toblast-like cells, expression of these receptors decreased
Apexogenesis after traumatic Case reports33,44 together with their functional activity as measured by an
exposure intracellular calcium level increase. Additionally, Applica-
Apexification Case reports45—48 tion of Biodentine decreased the pro-inflammatory tumor
Retrograde root canal Case reports49,50 necrosis factor secretion (TNF-a) from odontoblast like
obturation cells24 as measured by Enzyme-linked immunosorbent
assay (ELISA).

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6 I. About

Direct pulp capping has the potential to be used as a substitute for formocresol in
primary molar pulpotomies.
Pulps of 28 non-carious molars scheduled for orthodontic
treatment were exposed mechanically and pulps capped Case reports on the other clinical
directly with Biodentine or MTA in class I cavities. 7 patients applications
complained from mild pain on the day of surgery. 4 of these
patients were treated with Biodentine and 3 with MTA. No In addition to the above detailed indications, many case
symptoms were reported in the other patients. Teeth were reports have been published with Biodentine in different
tested before extraction for cold and electro-sensitivity and clinical indications. These include deep cervical/radicular
all confirmed the pulp vitality. The absence of periapical lesions, root canal/furcation perforations, external/internal
pathology was confirmed radiographically before the treat- resorption, regenerative endodontics, apexogenesis after
ment and just before the tooth extraction. The histological traumatic exposure, apexification and retrograde root canal
examination of the pulp state and response after direct pulp obturation. These applications are listed and corresponding
capping with Biodentine as compared to MTA in human teeth case report references are provided (Table 2).
revealed an absence of pulp inflammation and the formation
of a complete dentin bridge beneath both materials after
6 weeks.25 Tomographic data evaluating the density and
Discussion
volume of reparative dentin revealed that these values were
higher for Biodentine.26 These results indicate that Bioden- Although Biodentine is among the most recently developed
tine can be safely applied directly onto the human vital pulp. tricalcium silicate-based materials, a significant and increas-
ing number of investigations have been published on this
material. While many studies reported its biocompatibility
Pulpotomy and Bioactivity in vitro and in vivo, preclinical investigations
shed the light on the mechanisms of its interaction with the
Clinical application of Biodentine in pulpotomy has been dental hard tissue. Indeed, many investigations performed
investigated in few clinical studies as a pulpotomy medica- both in vitro and in vivo demonstrated that the interactions
ment. A randomized clinical study was performed in children of Biodentine with both hard and soft tissues provide a
of 4—9 years of age. 84 pulpotomies were performed and hermetic seal protecting the dental pulp by preventing
attributed to MTA or Biodentine. All teeth were restored with bacterial infiltration. These studies demonstrated that,
stainless steel crowns. Clinical and radiographic evaluations through its interactions with the hard tissues, Biodentine
were performed after 6 and 12 months. Data showed that one provides a micro-mechanical retention by infiltrating the
molar of the MTA group had an internal resorption while 1 dentin tubules. On the other hand it induces the target
molar of Biodentine treated group had internal resorption tissue specific functions by inducing tertiary dentin synthesis
and another showed a radiographic radiolucency. Over all, which provides further protection to the pulp. These two
both materials had a very high clinical success rate27 and the combined effects might be responsible, at least in part, for
overall clinical success after 12 months is reported (Table 3). the absence of post-operative pain and hypersensitivity.
Another study evaluated Biodentine and compared it to MTA Another important investigation reported that the applica-
in a short term clinical study. Biodentine was applied in tion of Biodentine reduces both TRPA1 pain receptor expres-
pulpotomy in 20 teeth followed by restoration with stainless sion and function. More importantly, when applied on
steel crowns. At 3 and 6 months, patients were recalled odontoblast-like cells Biodentine decreases pro-inflamma-
and Biodentine was shown as equally efficient as MTA with tory TNF-a secretion. This indicates that, in addition to
similar radiographic success.28 A similar study was performed the abovementioned roles of Biodentine, its application onto
comparing Biodentine to MTA and Propolis as pulpotomy the dentin/pulp reduces the inflammation and consequently
medicaments. After 9 months, Biodentine and MTA showed the post-operative pain.
comparable results with a high radiographic success rate and
more favorable than Propolis.29 Finally, a confirmation of all
these data reported no significant differences between MTA
How does Biodentine compare to other
and Biodentine used as pulpotomy medicaments even after widely used and common pulp capping
18 months with clinical success higher than 95% for both materials
materials.30 Taken together, although longer term clinical
evaluations are required, these data indicate that Biodentine When compared to Calcium Hydroxide, Biodentine is stronger
mechanically due to its composition and low porosity. It is less
Table 3 Evaluation of Biodentine as compared to MTA in soluble and the produced dentin bridge shows no tunnel
pulpotomy after 12 months. Clinical success rates are defects as compared to that under Calcium hydroxide thus
reported in number of cases and percentage showing a high it has a better sealing ability than Calcium hydroxide.19,31
clinical success rate of both MTA and Biodentine in pulpotomy When Compared to MTA, Biodentine is easier to handle,22
after 12 months.27 stronger mechanically and has a shorter setting time.6 It can
be used as a temporary enamel substitute up to 6 months and
Success/total number of cases Success (%) in different applications as a permanent dentin substitute
MTA 36/39 92 without any surface treatment. Additionally, while discolora-
Biodentine 38/39 97 tion with MTA32 and its derivatives have been reported in
regenerative endodontics and seem to be mainly due to the

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Biodentine bioactive properties 7

presence of Bismuth oxide as a radio-opacifier,7 no discolora- odontoblast-like cells and stimulates biomineralization. JEn-
tion of tooth crown has been reported after 48 months dod 2012;38:1220—6.
with Biodentine which does not contain Bismuth oxide but 12. Attik GN, Villat C, Hallay F, Pradelle-Plasse N, Bonnet H, Moreau
Zirconium oxide as a radio-opacifier.33—35 K, et al. In vitro biocompatibility of a dentine substitute cement
on human MG63 osteoblasts cells: BiodentineTM versus MTA(1).
Int Endod J 2014;47(12):1133—41.
Conclusions 13. Raskin A, Eschrich G, Dejou J, About I. In vitro microleakage of
Biodentine as a dentin substitute compared to Fuji II LC in
Taken together, through in vitro, in vivo, clinical trials/ cervical lining restorations. J Adhes Dent 2012;14(6):535—42.
14. Odabaş ME, Bani M, Tirali RE. Shear bond strengths of different
reports, this review shows that Biodentine is biocompatible,
adhesive systems to Biodentine. Sci World J 2013;10:626103.
has strong mechanical properties and can safely be applied in
http://dx.doi.org/http://dx.doi.org/10.1155/2013/626103.
restorative dentistry, in pediatric dentistry (as a possible 15. Atmeh AR, Chong EZ, Richard G, Festy F, Watson TF. Dentin-
alternative to formecresol) and in endodontics. It is impor- cement interfacial interaction: calcium silicates and polyalk-
tant to know that Biodentine does not require any surface enoates. J Dent Res 2012;91(5):454—9.
conditioning treatment. It can be cut and reshaped like 16. Camilleri J, Laurent P, About I. Hydration of Biodentine, Theracal
natural dentin. It can be used as a bulk permanent dentin LC, and a prototype tricalcium silicate-based dentin replace-
substitute to replace the whole damaged/lost dentin and not ment material after pulp capping in entire tooth cultures. J
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Conflict of interest 18. Goldberg M, Pradelle-Plasse N, Tran XV, Colon P, Laurent P, Aubut
V, et al. Emerging trends in (bio)material research. In: Goldberg
The author’s original works on Biodentine were partially M, editor. Biocompatibility or cytotoxic effects of dental com-
posites. 1st ed. Oxford, UK: Coxmoor Publishing Company; 2009.
supported by Septodont.
p. 181—203.
19. Tran XV, Gorin C, Willig C, Baroukh B, Pellat B, Decup F, et al.
Acknowledgements Effect of a calcium-silicate based restorative cement on pulp
repair. J Dent Res 2012;91:1166—71.
The author thanks Dr. Jean-Charles Gardon for his support by 20. Tziafa C, Koliniotou-Koumpia E, Papadimitriou S, Tziafas D.
providing the teeth used in the previously published works, Dentinogenic responses after direct pulp capping of miniature
Septodont for the continuous support/collaboration and Aix- swine teeth with Biodentine. J Endod 2014;40(12):1967—71.
Marseille Université and CNRS institutional support. 21. Shayegan A, Jurysta C, Atash R, Petein M, Abbeele AV. Biodentine
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Please cite this article in press as: About I. Biodentine: From biochemical and bioactive properties to clinical applications. Giornale Italiano
di Endodonzia (2016), http://dx.doi.org/10.1016/j.gien.2016.09.002