Bioceramics is the first group of endodontic sealers that exhibit both expansion during
setting and also an adhesive bond to the dentinal wall. These properties suggest more
predictable results
Year 2013: A tissue engineering approach based
on the use of bioceramics for bone repair
Antonio J. Salinas,ab Pedro Esbritcd and María Vallet-Regí*ab
Abstract
Biomimetics takes advantage of natural strategies for the solution of
technological problems, including the proper design of biomaterials. Living
bone exhibits a hierarchical porosity with both giant and nanometric pores
which must be reproduced for the design of biomaterials for hard tissue repair.
Bioactive and degradable bioceramics are a good alternative for the
manufacture of scaffolds. Tissue engineering approaches to improve bone
regeneration include strategies supporting endogenous osteoblast adhesion,
proliferation (osteoconduction), osteoinduction by growth factors, and
osteoprogenitors. Understanding the natural ossification mechanisms and the
role of biomolecules involved in this process is a requirement for the design of
bone tissue scaffolds. Mesoporous bioactive ceramics, namely
mesoporous silica and templated glasses with nanometric pores to host
growth factors, conformed into 3D scaffolds with micrometric porosity by rapid
prototyping, are a good option for bone regeneration. In this regard,
biomolecules such as well characterized bone morphogenetic proteins and
others under current research, such as osteostatin and osteoprogenitors, are
promising strategies in bone tissue engineering applications. Future
developments in biomaterials will come in both micro- and nano- scales, and
molecular and cell biology approaches will provide suitable solutions to the
demanding needs of these compounds.
The use of Bioceramics as root-end filling materials in
periradicular surgery: A literature review
Author links open overlay panelSumaya M.AbusrewilWilliamMcLeanJ. AlunScott
Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of
Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall
Street, Glasgow G2 3JZ, United Kingdom
Received 17 March 2018, Revised 15 July 2018, Accepted 16 July 2018, Available online
24 July 2018.
Abstract
Introduction
Periradicular surgery involves the placement of a root-end filling
following root-end resection, to provide an apical seal to the root
canal system. Historically several materials have been used in order
to achieve this seal. Recently a class of materials known
as Bioceramics have been adopted. The aim of this article is to
provide a review of the outcomes of periradicular surgery when
Bioceramic root-end filling materials are used on human permanent
teeth in comparison to “traditional” materials.
Methods & results
An electronic literature search was performed in the databases
of Web of Science, PubMed and Google Scholar, between 2006 and
2017, to collect clinical studies where Bioceramic materials were
utilised as retrograde filling materials, and to compare such materials
with traditional materials. In this search, 1 systematic review and 14
clinical studies were identified. Of these, 8 reported the success rates
of retrograde Bioceramics, and 6 compared treatment outcomes
of mineral trioxide aggregate (MTA) and traditional cements when
used as root-end filling materials.
Conclusion
Bioceramic root-end filling materials are shown to have success rates
of 86.4–95.6% (over 1–5 years). Bioceramics has significantly higher
success rates than amalgam, but they were statistically similar to
intermediate restorative material (IRM) and Super ethoxybenzoic
acid (Super EBA) when used as retrograde filling materials in apical
surgery. However, it seems that the high success rates were not solely
attributable to the type of the root-end filling materials. The
surgical/microsurgical techniques and tooth prognostic factors may
significantly affect treatment outcome.
The use of premixed bioceramic materials in
endodonticsL’utilizzo dei materiali bioceramici premiscelati in
Endodonzia
Author links open overlay panelGilbertoDebelianDMD, PhD MartinTropeDMD
a b
Adjunct associate professor of endodontics, Department of endodontics, School
of dental medicine, University of Pennsylvania, USA and Endo Inn endodontic
training center, Norway
b
Clinical professor of endodontics, Department of endodontics, School of dental
medicine, University of Pennsylvania, USA
Received 12 July 2016, Accepted 13 September 2016, Available online 3 November
2016.
Abstract
With both antimicrobial and sealing properties,
premixed bioceramic materials are unique materials available
in endodontics that contribute to the success of both the microbial
control phase (instrumentation, irrigation, intra-canal medication)
and the filling phase (root and top filling) of root canal treatment.
Bioceramic material may be an essential element in the indirect and
direct pulp capping and pulpotomy procedures that are an integral
part of endodontic therapy's goal of maintaining the vital pulp to
ensure a healthy periradicular periodontium.
For all these reasons, premixed bioceramic materials are now the
material of choice for pulp capping, pulpotomy, perforation repair,
root-end filling, and obturation of immature teeth with open apices,
as well as for sealing root canal fillings of mature teeth with closed
apices.
5 tips for using
bioceramics in the general
dental practice
As a practicing endodontist, I would like to share
with you five tips for effective use of bioceramic
technology in your general dental practice.
Mar 25th, 2013
View Image Gallery
Dr. Allen Ali Nasseh
March 25, 2013
As a practicing endodontist, I would like to share with you five
tips for effective use of bioceramic technology in your general
dental practice. These tips will allow you to not only perform
better endodontics, but to accomplish it in a more expeditious
manner. Additionally, for those dentists not yet using bioceramic
sealers for their root canal therapy procedures, it is my hope this
article will stimulate you to further investigate the use (and
multiple applications) of this material.
Here are my five tips for using bioceramics in the general dental
practice:
1. Do not store in a refrigerator. Store at room
temperature.
EndoSequence BC Sealer (Brasseler USA, pictured above) comes
premixed in a syringe which does not have to be stored in a
refrigerator. In fact, since it is the moisture inherent in the
dentinal tubules which initiates the setting reaction, it is strongly
recommended not to keep it in a refrigerator. The introduction
of an endodontic sealer that comes premixed in a syringe and
can be stored at room temperature is a major upgrade from
many of the previous sealers. The premixing not only insures a
proper mix every time, but more importantly, it gives
predictability to the clinician in terms of handling
characteristics.
2. Use the bioceramic sealer as part of an advanced
obturation technique.
In canals where the final prepared shape is round enough so that
the master gutta-percha cone is in very close proximity to the
prepared canal walls, simply inject a small amount of the
bioceramic sealer into the canal and then take your
EndoSequence Master Apical File (e.g. if size 40/.04 is the final
instrumented size and a 40/.04 GP master cone has been
verified to fit) and place it into the canal by hand (do not use a
handpiece). While inserting the file into the canal, slightly turn it
in a counterclockwise manner, so that the sealer is carried down
with the file, as opposed to simply filling the flutes. Generally,
one 360-degree rotation for the full length of the canal should be
enough. Once the file reaches its apical termination, remove it
from the canal with an additional counterclockwise motion. This
action takes the sealer that was placed in the canal and simply
spreads it against the walls. (Any excess sealer will fill in the
flutes of the file.) Then you may simply coat the master cone
with some sealer and gently insert it into the canal.
Particularly noteworthy with this technique is that this action of
placing a file into the canal (prior to final obturation) helps to
remove the excessive hydraulic force that may cause either sealer
extrusion or trapping of the sealer under the cone (in the case of
a closed apex) that may ultimately prevent the full seating of the
master cone. It is also important to note that the reinsertion of
the master apical file into a canal that has been previously
disinfected (with our final disinfection protocol) is only made
possible if this file has been wiped thoroughly with an alcohol
gauze pad and properly disinfected (we recommend fitting your
master cone, then placing both the master cone and the master
file for each canal in full-strength bleach for one minute to
disinfect it before placing inside the canal, during which time
you can disinfect the canal more and proceed to dry it).
3. Do not use too much sealer. One option is to not
place the syringe into the tooth.
Too often we see clinicians use too much sealer when performing
obturation. This is true for any obturation technique. Also, for
those doctors just beginning to use a bioceramic sealer, it may be
wise to do a few cases where you simply syringe the material
onto a glass slab (or pad). Then lightly coat the primary cone
with sealer, and use this cone to deliver sealer into the canal
(lightly coating the walls with BC Sealer). This particular method
is similar to previous techniques, but the key is that this will
allow you to get a feel for how the bioceramic material flows.
This is very important. You will discover that the bioceramic
sealer flows much better than conventional sealers. This is due
to its small particle size (less than two microns).
4. Use a bioceramic root repair material for a single-
visit direct pulp cap.
Bioceramic technology is available in the following forms: as a
sealer in a premixed syringe, as a root repair material in a
premixed syringe, and as a premixed putty in a glass jar. We
favor the root repair material (particularly the putty) for direct
pulp caps. The following technique can be used:After the
placement of the bioceramic putty (over the exposure), we like to
place a hard substance over the unset bioceramic material,
because (in the past) a direct pulp capped tooth has usually been
restored in two visits. Glass ionomer seems to be the best
material for such a technique, prior to placing a permanent
restoration, such as a bonded composite. It will be difficult to
place a bonded restoration over the unset bioceramic material.
Instead, place a thin layer of GIC over the pulp cap. The great
news is that the ceramic particles in the GIC will bond to the
ceramic particles in the bioceramic root repair material.
Subsequently, the composite material can be bonded to the GIC,
just like a conventional sandwich technique. This is a technique
that works well and can be accomplished in an expeditious
manner (single visit).
5. Using bioceramics as a perforation repair material.
Bioceramics are a great indication for perforation repairs. In
particular, we like it for floor perforations. Historically, we have
used amalgam, glass ionomer, super EBA, and MTA. All of these
materials worked, but all had handling challenges. Now, when
performing perforation repairs or apical surgery, we have the
option of using either a bioceramic filling material that comes
premixed in a syringe, or a premixed bioceramic putty that
comes in a jar. Either way, this is so much easier than mixing
MTA or super EBA. Furthermore, you are getting all the benefits
associated with the physical properties of bioceramics. Once
again, you can use the sandwich technique here and do your
perforation repairs in a single visit using a combination of putty
to repair the perforation and GIC to cover it and have a set
surface to work with.
Summary
We have given you five tips for using bioceramic technology in
your practice. Bioceramics and their use are not just limited to
the specialist practice – they have great application of use for the
general practitioner as well. If you have not yet experienced this
material, we suggest that you make the effort to check it out. You
will not be disappointed! For more information, please
visit nasseh.net for videos that demonstrate the various
applications of this technology.
Dr. Nasseh is the president and chief executive officer of Real World Endo,
and MicroSurgical Endo Educational Institute. He is the endodontic advisor to
several educational groups and study clubs and is editor to several peer reviewed
journals and periodicals. He has been a Clinical Instructor and lecturer in the Post-
doctoral endodontic program at Harvard School of Dental Medicine since 1997
and the Alumni editor of Harvard Dental Bulletin. He has published numerous
articles and lectures extensively nationally and internationally in surgical and non-
surgical endodontic topics. Dr. Nasseh is in solo private practice in downtown
Boston.
