Oral Hygiene and Health Sulaiman et al.

, Oral Hyg Health 2015, 3:3

http://dx.doi.org/10.4172/2332-0702.1000179

Research Article Open Access

Clinical Applications of Biodentine in Pediatric Dentistry: A Review of

Literature
Sulaiman Mohamed Allazzam1,Najlaa Mohamed Alamoudi2 and Omar Abd El Sadek El Meligy2,3*
1Security Dental Center, Qassim, Kingdom of Saudi Arabia
2Faculty of Dentistry, King Abdulaziz University, Saudi Arabia
3Faculty of Dentistry, Alexandria University, Egypt
*Corresponding author: Omar Abd El Sadek El Meligy, Professor of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, P.O.Box: 80209, City: Jeddah
21589, Kingdom of Saudi Arabia, Tel: 0122871660; Fax: 0126403316; E-mail: omeligy@kau.edu.sa
Received date: May 23, 2015; Accepted date: June 04, 2015; Published date: June 11, 2015
Copyright: 2015 Sulaiman MA, et al. 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.

Abstract

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. There has been considerable research performed on this
material since its launching; however, there is scarce number of review articles that collates information and data
obtained from these studies. 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 1992 to 2015 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.

Keywords: Clinical applications; Biodentine; Pediatric dentistry
Introduction
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 (biodentine), which was
recently introduced by Septodont Company and could conciliate high
mechanical properties with excellent biocompatibility, as well as a
bioactive behavior [1].
The commercialized tricalcium silicate of biodentine is different
from the usual dental calcium silicate Portland Cement materials.
The manufacturing process of the active biosilicate technology
eliminates the metal impurities (such as aluminates and other
impurities) seen in the Portland Cement calcium silicates. 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. Box is
containing 15 capsules & 15 single-dose containers and another
smaller box which contains only 5 capsules & 5 single-dose containers
[6]. The powder is mainly composed of tricalcium silicate (main core),
dicalcium 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 or water reducing agent) [5-8].
Biodentine was developed based on the most biocompatible
chemistry available for dental materials: calcium silicate, which can set
in the presence of water [5]. 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
[5,9]. In contact with phosphate ions, it creates precipitates that
resemble hydroxyapatite [6].
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 [4-6,10]. However, it has also
been proved that biodentine has an excellent antimicrobial properties
due to its very high pH (pH=12). In addition to that, it is much more
cost effective in comparison to similar materials [1,4,5,10,11].
Many in vivo and in vitro studies support its bioactivity as well as its
successful performance in many clinical applications [1,10-23]. On the

Oral Hyg Health Volume 3 Issue 3 1000179

ISSN:2332-0702 JOHH, an open access journal
Citation: Sulaiman Mohamed Allazzam, Najlaa Mohamed Alamoudi, Omar Abd El Sadek El Meligy (2015) Clinical Applications of Biodentine in
Pediatric Dentistry: A Review of Literature. Oral Hyg Health 3: 179. doi:10.4172/2332-0702.1000179
other hand, all the available clinical studies and case reports revealed
excellent results for its use in human primary teeth [9,24-36].
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 purpose of this article was to review the clinical applications
and advantages of biodentine in the pediatric dental practice.
Materials and Methods
Electronic search of English scientific papers from 1992 to 2015 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.
Results
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.
Discussion
Clinical applications
Biodentine uniqueness not only lies in its innovative bioactive and
pulp-protective chemistry, but also in its universal application on
both crown and root. 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 [9,25-27,37,38]. Its use in root
includes managing perforations of furcation or root canals, internal
and external resorption, apexification and retrograde root canal
obturation [35,36,39]. 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].
Dentin substitute
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 [1,12,13,27,41]. It is sufficiently stable so that it can be used
both for pulp protection and temporary fillings [5,6]. 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
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marginal adaptation and surface finish along with absence of pain and
sensitivity [25]. In evaluating the in vitro marginal integrity, koubi et
al. in 2012 concluded that biodentine performed as well as resin
modified glass ionomer cement in open-sandwich restorations covered
with a light-cured composite [15]. 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 cavities, Raskin et al. showed that biodentine
performed well without any conditioning [41]. 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, 146 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]. In 2013, Gjorgievska et al.
compared the interfacial properties of 3 different bioactive dental
substitutes. 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
vitro, Valles et al., showed that biodentine demonstrated color
stability. Based on their results, they suggested that biodentine could
serve as an alternative for use under light-cured restorative materials
in areas that are esthetically sensitive [42]. 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 phosphates), no 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. In 2013,
Odaba et al. evaluated the shear bond strength of an etch-and-rinse
adhesive, a 2-step self-etch adhesive and a 1-step self-etch adhesive
system to biodentine at different intervals. 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 24-hour period, whereas the lowest
was obtained for the etch-and-rinse adhesive at a 12-minute period
[43].
In 2013, El-Maaita et al. assessed the effect of smear layer on the
push-out bond strength of biodentine. 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].
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Citation: Sulaiman Mohamed Allazzam, Najlaa Mohamed Alamoudi, Omar Abd El Sadek El Meligy (2015) Clinical Applications of Biodentine in
Pediatric Dentistry: A Review of Literature. Oral Hyg Health 3: 179. doi:10.4172/2332-0702.1000179
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].
Additionally, biodentine has a mechanical behavior similar to glass
ionomers and is comparable to that of natural dentin [5,6,10]. 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 [5,41].
Therefore, biodentine can be used safely and successfully as dentin
substitute especially with its dentin like mechanical properties [5].
Pulp capping
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 [5,6,19]. 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 months of using biodentine as direct pulp capping of
iatrogenic pulp exposure [26]. In 2012, Tran 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 bridge 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 al.
investigated the response of human dental pulp capped with
biodentine [20]. 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
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 [6,45]. However,
biodentine required less time for the pulpotomy procedure [22]. While
formocresol acts only as dressing material, which needs a restorative
material to seal the pulp chamber, biodentine acts simultaneously as
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both dressing and filling material [6,45]. Thus, biodentine eliminates
the need for a filling material in the pulp chamber of pulpotomized
teeth. While formocresol requires 35 minutes application before the
cotton pellet is removed, with biodentine the pulp chamber is filled
immediately [6,45]. 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 [1,2,5,6,10,45].
In 2012, Shayegan et al investigated the inflammatory cell response
and hard tissue formation after biodentine pulpotomy in primary pig
teeth. After 90 days, they found that the pulp tissue was normal
without any signs of inflammation and 9 out of 10 teeth showed thick
calcification under the pulpotomy site. They concluded that
biodentine has bioactive properties, encourages hard tissue
regeneration, and provoke no signs of moderate or severe pulp
inflammation response [22].
In support to the aforementioned favorable biological results,
Marijana et al. concluded that the therapeutic effects of biodentine
after vital pulp therapy in Vietnamese pigs are favorable [21].
Biodentine has the potential of making major contributions to
maintaining pulp vitality in patients judiciously selected for
pulpotomy treatment [21]. Therefore, this unique material might be an
interesting alternative to the existing materials for dentin-pulp
complex regeneration [21].
A survey of the available literature shows that there are yet few
published case reports and clinical trials with many non-published
ongoing clinical trials that include the usage of biodentine in
pulpotomy [28-31,33,38]. All these studies showed biodentine as a
favorable and promising alternative for the existing pulpotomy
medicaments.
In multiple case reports, Lavaud et al. showed a successful results of
biodentine without any clinical or radiological symptoms when it is
used for primary teeth pulpotomy (9 months of follow up), indirect
capping on a hypomineralized molar (12 months of follow up), and
apexogenesis (14 months of follow up) [38]. In another published case
report, Villat et al. performed a partial pulpotomy in an immature
second right premolar of a 12-year-old patient [33]. After 6 months,
the patient did not report any pain or complains along the observation
period. Furthermore, the authors detected homogeneous dentin bridge
formation as well as continuation of root development [33].
Accordingly, they commented that fast favorable pulpal response
render this material a suitable choice compared to other materials [33].
Recently at the 12th Congress of European Academy of Pediatric
Dentistry (EAPD) in Poland, Rubanenko et al. presented their
preliminary results of comparing biodentine versus formocresol as
dressing agents in pulpotomized primary molars [29]. They
demonstrated a success rate of 100% for biodentine while that of
formocresol was 94% [29]. Additionally, Cuadros et al confirmed these
interesting preliminary results of biodentine in humans and stressed
that biodentine seems to be a promising alternative for use in
pulpotomies of primary molars with 100% clinical and radiographic
success after 6 months of follow up [30]. On the other hand,
Rajasekharan et al. presented the results of their randomized control
clinical trial and showed clinical as well as radiographic success in
94.73% of biodentine treated teeth [31]. They concluded, there was no
significant difference between the new product biodentine in
comparison to the well-known products (mineral trioxide aggregate
(MTA) or Tempophore) [31]. In evaluating the current preference
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Citation: Sulaiman Mohamed Allazzam, Najlaa Mohamed Alamoudi, Omar Abd El Sadek El Meligy (2015) Clinical Applications of Biodentine in
Pediatric Dentistry: A Review of Literature. Oral Hyg Health 3: 179. doi:10.4172/2332-0702.1000179
endodontic material in children amongst Flemish pediatric dentists,
Vandenbulcke et al. found that biodentine was the most preferred
pulpotomy material in both primary and immature permanent teeth
[46].
Apexification (Apical Plug in teeth with necrotic pulps and
open apices)
Treating a tooth with an open apex and a necrotic pulp has always
been a challenge for dental practitioners [47]. The main goal in this
type of treatment is to prevent the extrusion of the obturation material
[47]. Since a long time, calcium hydroxide has been used widely as an
apical plug in teeth with necrotic pulps and open apices [47]. After
that, most of the drawbacks of calcium hydroxide apexification such as
multiple scheduled visits and susceptibility of treated roots to fracture
have been solved with the use of 4 mm thickness MTA plug in the
apical part of the root [47-49]. On the other hand, MTA has its own
drawbacks of low mechanical properties, difficult handling, slow
setting, and relatively high cost [48]. After the introduction of
biodentine, all these drawbacks of MTA have been solved with keeping
of all its benefits [5,6]. Unlike MTA, biodentine handled easily and
need much less time for setting with better mechanical properties and
acceptable cost [50]. As the setting is faster, there is a lower risk of
bacterial contamination than with MTA. The mechanical resistance of
biodentine is also much higher than that of MTA. Biodentine does not
require a two step obturation as in the case of MTA [6]. In a series of
cases, Cauwels et al. found that necrotic immature teeth can still
achieve continued root development after proper regenerative
endodontic treatment with biodentine [32]. Furthermore, the main
benefits of using biodentine in this procedure is obtaining a
combination of a tight bacterial seal in the apical foramen as well as
inducing the formation of new cementum and periodontal ligament
(PDL) [5]. Therefore, biodentine can be advised successfully in
weakened necrotic immature teeth [5,50].
Retrograde root end filling
At the apical end of the root canal system, establishing an
impermeable hermetic seal by adequate root end filling material is one
of the most important aspects of the periradicular surgery [51]. Many
materials have been used as root end fillings such as amalgam, zinc
oxide eugenol, glass ionomer cements, and MTA [52-54]. Recently,
Septodont introduced the short setting calcium silicate based material
(biodentine) who has better consistency and handling properties and
therefore, it can be considered the best interesting alternative as root
end filling material [5,6,55].
In a case report, Pawar et al. assessed biodentine as a retrograde
material in the management of a large periapical lesion associated with
previously traumatized maxillary right central and lateral incisors [34].
After 18 months of apical surgery, they found an evident progressive
periapical healing. On the other hand, Soundappen et al. concluded
both MTA and IRM were significantly superior when compared to
biodentine in terms of marginal adaptation as retrograde filling
materials [56].
Repair of resorption
With their proven biocompatibility and ability to induce calcium-
phosphate precipitation at the interface to the periodontal tissue,
calcium silicate cements play a major role in bone tissue repair [57,58].
They have gradually become the materials of choice for the repair of all
types of dentinal defects creating communication pathways between
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the root-canal system and the periodontal ligament [6,54]. After its
introduction as fast setting calcium silicate cement, biodentine with its
ease of manipulation and handling can be considered as an interesting
and promising resorption repair material [5]. Biodentine has a better
consistency after mixing which allows ease of placement in areas of
resorptive defect or obturation of full root canal system [6].
In two case reports, Nikhil et al. and Ali et al. showed successful
results of biodentine when it is used in treatment of cervical and apical
external root resorption with more than 1 year of follow up [35,36].
On the other hand, there is some difficulty in removal of biodentine in
case of retreatment [5].
Repair of perforations
Perforation is a procedural complication that can occur during
endodontic treatment or post space preparation of teeth [59]. An ideal
perforation repair material should provide a tight seal between the oral
environment and periradicular tissues [59]. It also should remain in
place under dislodging forces, such as mechanical loads of occlusion or
the condensation of restorative materials over it [60,61]. Although
many dental materials have been tried including amalgam, cavit,
composite resin, glass ionomer cement, calcium hydroxide, IRM, and
MTA [59-61]. Most of these materials show significant shortcomings
in 1 or more of the following areas: solubility, leakage,
biocompatibility, handling properties, and moisture incompatibility
[58,62,63].
Biodentine has its own unique properties that make it preferred for
perforation repair either in root canal or pulp chamber floor [23].
These unique properties include its ease of handling, short setting
time, and high push out bond strength as well as its acceptable cost
[64,65]. Many studies demonstrated in vitro the high push out bond
strength of biodentine even after being exposed to various endodontic
irrigation solutions [6,23,65]. Additionally, Aggarwal et al. in 2013
found that the blood contamination had no effect on the push-out
bond strength of biodentine [23]. Due to its high push out bond
strength, biodentine is preferred for perforation repair either in the
root canal or pulp chamber even after being exposed to various
endodontic irrigants [6,23].
Advantages of biodentine (unique features)
High purity: It contains high-purity, monomer-free mineral
ingredients [5].
Highly biocompatible and bioactive: It stimulates the pulp cells to
build a high quality and quantity of reactionary dentin. The dentin
bridges are created faster and are thicker than with similar dental
materials and represent the necessary condition for optimal pulp
healing without any threat on body tissues [5,6,66].
Short setting time: It sets within 10-12 minutes, which allows full
restorations to be completed in one office visit. This unique advantage
is due to increasing particle size, adding calcium chloride to the liquid,
and decreasing the liquid content [5,6].
Easily material handling: The improved physic-chemical properties,
ease of manipulation, better consistency, and favorable setting kinetics
make biodentine clinically easy to handle [5,6].
Versatile: Useable for bulk fill in vital pulp therapy, does not stain,
and there is no surface preparation or tedious bonding required due to
the micro-mechanical anchorage [5].
Volume 3 Issue 3 1000179
Citation: Sulaiman Mohamed Allazzam, Najlaa Mohamed Alamoudi, Omar Abd El Sadek El Meligy (2015) Clinical Applications of Biodentine in
Pediatric Dentistry: A Review of Literature. Oral Hyg Health 3: 179. doi:10.4172/2332-0702.1000179
Superior mechanical properties: it has mechanical properties
comparable to the sound dentin and can replace it both in the crown
and in the root, without any preliminary conditioning of mineral
tissues. Therefore, biodentine saves teeth by preserving the pulp and
promoting pulp healing as well as eliminating the need for root canal
therapy in most cases [10].
Excellent sealing properties: Biodentine has an excellent sealing
ability with mineral tags in the dentin tubules with outstanding
microleakage resistance, enhanced by the absence of shrinkage due to
the resin-free formula [5].
Excellent antibacterial properties: Since calcium hydroxide is
resulting from the setting reaction of biodentine, the released calcium
hydroxide ions result in high alkaline pH (pH=12) of biodentine. This
alkaline change promotes an unfavorable environment for bacterial
growth and leads to the disinfection (basification) of surrounding hard
and soft tissues [5,6].
Universal: Besides the usual endodontic indications of this class of
calcium-silicate cements (vital pulp therapy, repair of perforations or
resorption, apexification, root-end filling), biodentine is suitable as a
permanent dentin substitute and temporary enamel substitute
[9,25-27,37,38].
Conclusion
The clinical applications of biodentine material have been
discussed. Biodentine is an excellent material with innumerable
qualities required of an ideal material. The important applications of
biodentine in pediatric dentistry include dentin substitute, pulp
capping, pulpotomy, apexification, and repair material of perforation
and resorption as well as root end filling material. It can be an
alternative to formocresol in pulpotomy because of the tissue
irritating, cytotoxic and mutagenic effects of formocresol which are
solved with biodentine. However, it can be an alternative to calcium
hydroxide or MTA in pulp capping, pulpotomy, and apexification
because biodentine is very successful in the formation of a dentin
bridge that is faster and thicker with lesser defects. While it is stronger
mechanically, less soluble and produces tighter seals than calcium
hydroxide [5,6], biodentine also avoids the drawbacks of MTA, i.e.
extended setting time, difficult handling characteristics, high cost, and
potential of discoloration [5,54]. Accordingly, biodentine might be an
interesting alternative to the existing materials for dentin-pulp
complex regeneration [1].
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.
On the other hand, further studies are needed to extend the future
scope of this material regarding the clinical applications.
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