1

BIOACTIVE &
BIOMIMETIC MATERIALS
Guided by: Presented by:

1. Dr P.Karunakar Nishat Zaidi.S

Pg 2nd year
2. Dr Raji Viola
Solomon

3. Dr Shanti priya
CONTENTS: PART 1:
3

• Introduction
• History
• Definitions
• Concept of Biomimetic dentistry
• Bioactive materials
• List of Biomimetic & Bioactive materials
• Discussion of bioactive & bionmimetic aspect of all
materials in detail:
a) GIC
i. Resin Modified
ii. Smart GIC
iii. Giomers
b) Composites
iv. Smart Composites
v. Ormocers
vi. Ceromers
c) Calcium Hydroxide
 4

d) Bio Ceramics
i. Bioactive glass
ii. Bioactive glass Composites
iii. Hydroxyapitite
iv. Calcium Silicates
a. Cements
b. Sealers
c. Mixture of Calcium silicate & Calcium
Phosphate

e) Bioceramic Gutta percha

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PART 2:
Chitosan
MTYA1-Ca filler
Calcium Sulfate
Calcium Phosphate
Calcium Enriched Mixture (CEM)
• Calcium Aluminate Cement
• Doxadent
• Carbon dioxide laser
• Propolis
• Ceramir
• Theracal
• Endosequence Root Repair Material (ERRM) putty
• ERRM paste RRM putty fast set (FS)
• iroot FS
 6

Remineralizing Agents
A) Casein phosphopeptide amorphous calcium
phosphate (CPP-ACP)
B) Fluoride compounds
• Demineralized dentin (dDM)
• Enamel matrix derivative (EMD)
• Growth Factors
• Bone Morphgenic Proteins (BMP)
• Platelet Concentrates
i) PRP
ii) PRF
• Polyhedral Oligomeric Silsesquioxanes (POSS)
7
 8

INTRODUCTION
 9

15th century

20th century
 10

Thus Nature acts as a motivation factor which lead to development of new era
of science called BIOMIMETICS Or Bio-inspired technology.
 11

BIOMIMICRY

Biomimicry is the
science and art of
emulating Nature's best
biological ideas to solve
human problems.

In biomimicry, we look at nature as model, measure, and mentor.

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» In every field of including dentistry and medicine,

bioactive and biomimitic materials have been widely used.

» These materials are used for regeneration, repair, and

reconstruction in the field of conservative dentistry and
endodontics.
 13

HISTORY:

» Name biomimetic was coined by Ottoschmit in the 1950s.

» Jack Steele in 1960 coined the word ‘BIONICS’ which

means taking ideas from nature.

» Replacing body parts goes back at least 2,500 years

when bridges were made from artificial teeth from bones
of oxen .
 14

» 1974- The term biomimetics only entered the

Websters Dictionary.

» 1982- The term biomimicry appeared.

» 1997- The term biomimicry was popularized by

scientist and author Janine Benyus in her book
‘Biomimicry: Innovation Inspired by Nature.’
 15

DEFINITIONS:
Biomimetic material  is a A Bioactive material is one
material fabricated by that elicits a specific
imitating nature based on biological response at
natural process found in the interface of the
biological systems. material which results in
the formation of a bond
Karma M, et al. Biomimetics in dentistry. Indian J between the tissues and
Dent Edu 
the material.
Hench LL, Splinter RJ, Allen WC, Greenlee TK Jr.;
Bonding mechanisms at the interface of
ceramic prosthetic materials. J Biomed
Mater Res., 1972; 2:117-141

It is widely regarded as being synonymous with BIOMIMICRY, BIOMIMESIS,  BIOGNOSIS and

similar to biologically inspired design.
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Key points of biomimetic materials

1) Should be synthetic in origin

2) Should mimic biology
3) Should bond with natural structure
4) Should not elicit any biological responses 
Advanced Ceramics for Strategic Applications, Prof. H. S. Maiti,
Department of Mechanical Engineering, Indian Institute of Technology,
Kharagpur , Lecture – 47, Bio ceramics
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CONCEPT OF BIOMIMETIC
DENTISTRY
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Why???
Natural hard tooth structure once lost
for any reason is not ever reproduced
by the body system, hence
dependence on simulating materials
becomes essential for restoring it to
form and function.
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• The use of dental materials and technologies that mimic

tooth structure and function.

• Maintaining as much natural tooth structure as possible.

• Materials should absorb and distribute stress like tooth

structure and should bond with natural structure.
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BIOACTIVE
MATERIALS
 21

BIOACTIVITY
• In 1989, Hench gave the concept of bioactivity as “A bioactive material
is one that elicits a specific biological response at the interface of the
material which results in the formation of a bond between the tissues
and the material”.

• Hench gave a new classification was proposed in 1994 according to

which bioactive materials are divided into 2 groups:

Osteoproductive
 22

» In osteoproductive » The osteoconductive

materials the bioactive materials simply
surface is colonized by provide a
osteogenic stem cells. biocompatible
interface along which
Eg: bioglass bone migrates.

» Eg : Synthetic
Hydroxyapitite
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Mechanism of action
• The performance of bioactive materials are largely attributable to its capacity to
produce spontaneously an apatite layer when in contact with phosphate-
containing physiological fluids.

• The apatite formation is promoted via an interaction of Ca2+ released from the
material with phosphates.

• Bioactive materials induce cytological and functional changes within pulpal

cells, resulting in the formation of reparative dentin at the surface of exposed
dental pulp in vital pulp therapy.

• When placed, it helps in proliferation, migration, and differentiation of

odontoblast-like cells that produce a collagen matrix. This unmineralized matrix
is then mineralized by osteodentin initially and then by tertiary dentin formation

Hegde, Mithra & Shruthi Attavar, Dr & Narayanan, Sreenath. (2017). BIOACTIVE MATERIALS – A REVIEW.
INTERNATIONAL JOURNAL OF ADVANCED SCIENTIFIC AND TECHNICAL RESEARCH. 6. 10.26808/rs.st.i7v6.01.
 24

USES OF BIOACTIVE MATERIALS:

1.It can be used as pulp capping material

2. Used for permanent restorations

3. It can be used for dentinal tubule occlusion & an effective material for
reducing dentine permeability and thus can be used for the treatment of
dentinal hypersensitivity

4. Act as scaffold and helps in regeneration of bone tissue.

5. It promotes tooth remineralization

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Various Biomimetic and Bioactive materials are

• Glass Ionomer Cement (GIC)

• Composites
• Smart Dentin Replacement (SDR)
• Bioactive Ceramics
• Castor Oil Bean Cement
• Calcium Hydroxide
• MTYA1-Ca filler
• Calcium Sulfate
• Calcium Phosphate
• Calcium Enriched Mixture (CEM)
• Mineral Trioxide Aggregate (MTA)
• Calcium Aluminate Cement
• Doxadent
• Carbon dioxide laser
• Propolis
 26
Various Biomimetic and Bioactive materials are
• Ceramir
• Biodentine™
• Theracal
• Bioaggregate (BA)
• Endosequence Root Repair Material (ERRM) putty, ERRM paste
RRM putty fast set (FS) and iroot FS
• Bioceramic Sealers
• Bioceramic Gutta-Percha
• Bioactive Glass (BAG)
• Remineralizing Agents
A) Casein phosphopeptide amorphous calcium phosphate
(CPP-ACP)
B) Fluoride compounds
• Demineralized dentin (dDM)
• Enamel matrix derivative (EMD)
• Growth Factors
 27

Various Biomimetic and Bioactive materials are

• Bone Morphgenic Proteins (BMP)

• Platelet Concentrates
• Polyhedral Oligomeric Silsesquioxanes (POSS)
• Metallic Biomaterials
• Implant Biomaterials/Biomimetic Coatings on Implants •
Polymers
• Root Canal Revascularization via Blood Clot
• Smart Materials
A) Smart pressure bandages
B) Smart suture
C) Hydrogel
D) Smart composites containing amorphous calcium phosphate
(ACP)
E) Cercon
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DISCUSSION OF
BIOACTIVE &
BIOMIMETIC
ASPECT OF ALL
THE MATERIALS
IN DETAIL
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GLASS IONOMER
CEMENT

Dentin substitute, Madmade Dentin, Artificial

Dentin
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• Water based material that hardens following

an acid base reaction between basic
fluoroaluminosilicate glass and an aqueous
solution of polyacids. (Anusavice)
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Why is GIC a biomimetic material??

1.It is synthetic
2. It does not form any natural tooth
structure.
3. It’s similar mechanical properties to
dentin.
4. Adheres chemically to the tooth structure
5. Less shrinkage ,so less microleakage
6. Dimensional stability at high humidity.
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Setting Reaction:

1. Dissolution
2. Precipitation of salts ,
gelation & Hardning
3. Hydration of salts.
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GIC as a biomimetic
material in
conservative
dentistry:
 34

GIC as a biomimetic
material in
Endodontis

 
• Disadvantage :
1. It has minimum
anti bacterial
property.
2. Removal is
difficult in case
of retreatment
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 Properties of GIC not adequately matching it’s biomimetic behaviour

1. Low Tensile strength
2. High opacity (Contrast ratio- 0.9 )
3. Less Wear Resistance
 36

RECENT ADVANCES IN GIC

1. HIGH VISCOSITY GIC

2. LOW VISCOSITY GIC
3. METAL MODIFIED GIC
4. RESIN MODIFIED Fluoride charged GIC
5. POLYACID MODIFIED COMPOSITE RESIN
6. Self hardening RM GIC
7. “Smart” GIC Material
8. Fiber-reinforced Glass Ionomer Cements
9. GIOMERS
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ESIN MODIFIED Fluoride charged GIC

 38
“Smart” GIC Material The GICs have a CTE close to that of dental
hard tissues. Through observation, there
were minimal or no dimensional changes in
GICs in terms of heating (expansions) and
cooling (contractions) between 20° and 50°C
in wet conditions
Smart GIC mimic the effect of dentinal
tubules, the water flowable character
through the porosities resemble the dentinal
tubules and also Recharge of fluorides

International Journal of
Pedodontic Rehabilitation
¦ Volume 2 ¦ Issue 2 ¦
July-December 2017
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GIOMER

of composite
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COMPOSITES
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Materials formed from two constituents that are insoluble in

one another, forming a material with properties that are
superior or intermediate to those of the constituents but at
the same time maintaining their own characteristics..
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Resin Based Composites

These composites include

1. Smart composites
2. Ormocers
3. Ceromers
 45

Smart Composites (bioactive)

• A new approach in restorative dentistry was the introduction of an
ion releasing composite material in 1998. (Intelligent composites)

• Ariston PHC was presented by its manufacturers as an alkaline

glass filled ion releasing substitute.

• It is based on a new developed alkaline glass which aims at

reducing secondary caries, reducing demineralization..
 46
• Contain bioactive amorphous calcium phosphate (ACP) filler
capable of responding to environmental pH by releasing calcium
and phosphate ions thus become adaptable to the surroundings.

• It acts by buffering the acid produced by micro-organisms, when

the pH around the restorative material falls below 5.5, the material
releases hydroxyl, calcium and fluoride ions.

• It is available in unit dose capsules (cavifils) and in syringes.

 47
ORMOCERS

• It is the acronym of organically modified ceramic. It was

developed by Fraunhofer institute for silicate research, Wurzburg
in co-operation with partners form the dental industry in 1998.

• They are new type of material which chemically are methacrylate

substituted alkoxysiyl.

• New multifunctional urethane and thioether (meth) acrylate

alkoxy as sol-gel precursors have been developed for preparation
of inorganic –organic co-polymers composites.
 48

Composition
Ormocer matrix – Ceramic polysiloxane

(silicon-oxygen chain)
Zirconium and glass fillers (1-1.5µm in

size)
Coupling agents

Eg. Admira  Voco

Definite  Deguassa
Advantages
•Biocompatible
•Reduced polymerization
shrinkage
•High abrasion resistance
•Esthetics
•Anticaries property
 49

CEROMERS  Ceramic optimized polymers

• They are specific combination of the latest in ceramic filler

technology and advanced polymer chemistry which provide
enhanced function and esthetics.

• They are composed of specially developed and conditioned

homogenous three dimensional fine particle ceramic fillers
(0.04 -1mm) of sub-micrometer size which are densely packed
(approx 80% in weight) and embedded in an advanced organic
matrix with optimum light and heat curing potential.

e.g Targis / Vectris – Ivoclar

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Composition
Barium glass
Spheroidal mixed oxide
Ytterbium trifluroide
BIS-GMA
Urethane dimethacrylate

Advantages
•Durable esthetic quality
•High abrasion
resistance
•High stability
•Excellent polishability
•Fluoride release
 51

Dental composites with their excellent esthetics, excellent biocompatibility

and good strength comparible to dentin and enamel make them one of
the most promising biomimetic materials in restorative dentistry.
 52

CALCIUM
HYDROXIDE
 53

Chemically, it is classified as a strong base in contact with aqueous

fluids (its pH is about 12.5 - 12.8), and dissociate into calcium and
hydroxyl ions.

Mechanism of Action:
The release of hydroxyl ions in an aqueous environment is essential
for the activation of calcium hydroxide against microbes.

a) These ions react ntensively with several biomolecules due to

their highly oxidant free radicals.

b) As this reactivity is unspecified, the free radicals most likely

gathered at the sites of generation. Hydroxyl ions have fatal
effects on bacterial cells.
c) They may damage the cytoplasmic membrane of bacteria,
denature their proteins, or damage the DNA.

It is difficult to prove which of these three mechanisms is mainly

involved in the death of bacterial cells after their exposure
 54

Uses:

1. When used as a liner, it neutralises the acids which migrate towards the
pulp and induces secondary dentin formation.

2. Calcium hydroxide can induce profilaration, healing and repair of fibroblasts

and therefore soft or hard tissue replacement can occur

3. The standard material for pulp capping of normal vital pulp tissue is calcium
hydroxide which have an antibacterial effect because of its high pH.
 55

SMART DENTIN
REPLACEMENT
 56
• Is based on ‘Stress Decreasing Resin’

• Substance described a ‘polymerisation modulator’ is chemically

embedded in the backbone of the polymerisable resin.

• Decrese stress by up to 60%.

• Bulk filling upto 4mm

• Easy placement technology with self levelling handling.

 57

CERAMICS
Dental ceramics with their
unmatched esthetics, excellent
biocompatibility and good strength
make them one of the most
promising materials in restorative
dentistry and with the recent
advances to overcome their few short
comings can be termed as
‘biomimetic materials.’
58
 59
COMPOSITION:
• It mainly consist of silicate glasses, porcelains, glass ceramics,
or highly crystalline solids.

• Wide variety of porcelain products available in the market

• So its virtually impossible to provide a single composition for

them all.
 60

BIOCERAMICAS
BIODEGRADABL
OACTIVE BIOINERT E
 61

Various Bioactive Bioceramics :

• Bioactive Glass
• Bioactive Glass Composites
• Hydroxyapatite
• Calcium Silicates
ADVANTAGES

Excellent biocompatibility

Intrinsic osteoinductive capacity

Function as a regenerative scaffold

Excellent hermetic seal

Good radiopacity

Antibacterial properties
 62

BIOACTIVE GLASS:
• Teeth go through a natural, continuous process of demineralization
and re-mineralization.

• Mineralization occurs from the calcium and phosphorus (normally

present in saliva) precipitating into a crystalline form of calcium
phosphate called Hydroxy Carbonate Apatite (HCA), which is the
mineral component of all teeth and bones.
•
• Since natural re-mineralization is inadequate to maintain strong
enamel, the natural re-mineralization process needs to be augmented.
The discovery of Bioactive Glass pushed the boundaries of
biomaterials capability and their function.
63
64
 65

EC Reynolds, Australian Dental Journal 2008; 53:268-273

A.K. Burwell, L.Litkowski,D.Greenspan Adv. Dent. Res.

2009;21: 83-86
66
 67

BIOACTIVE GLASS COMPOSITES

• This composites, made of bioactive glass, help repair tooth
decay through the release of fluoride, calcium and phosphate;
components that are all key to the formation of tooth mineral.

• The bioactive glass actually replenishes these minerals that

were lost due to tooth decay. Additionally, the bioactive glass
can prevent oral bacteria from infiltrating the tooth further, by
filling in the gaps with tooth mineral.
 68

Dentin
Dentin

L. C. Nicolae et al., "The Effect of Bioglass Addition on Mechanical and Physical Properties of
Photoactive UDMA-TEGDMA Resin Composites", Key Engineering Materials, Vol. 587, pp. 215-221, 2014
 69

SYNTHETIC HYDROXYAPITITE
• The main substance of our teeth is hydroxyapatite (97 % of
enamel and 70 % of dentin).

• Synthetic medical hydroxyapatite (<mHAP>) particles penetrate

below the surface of the enamel, providing replacement calcium
and phosphate ions to areas from which minerals have
dissolved, thereby remineralizing the demineralized enamel and
restoring its integrity and translucent gloss.

• Also it is used in periodontal surgeries and treatment of bone

defects as a graft material as it is osteoinductive.
70
 71

Hence it is a both bioactive as well as

biomimetic material
 72

CALCIUM
SILICATES
 Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P.
CALCIUM SILICATE BASED Bioceramics in endodontics–a review. Journal of Istanbul
73
University Faculty of Dentistry. 2017;51(3 Suppl 1):S128
A.CEMENTS-
1.Portland Cement
2.Mineral trioxide aggregate (MTA)
3.Biodentine (Septodont, France)

B.SEALERS :
1.Endo CPM Sealer (EGO SRL, Buenos Aires, Argentina)
2.MTA Fillapex (Angelus, Brazil)
3.BioRoot RCS (Septodont, France)
4.TechBiosealer (Profident, Kielce, Poland).

C.PHOSPHATES/ TRICALCIUM PHOSPHATE/ HYDROXYAPATITE BASED

Mixture of calcium silicates and calcium phosphates :
1.Root SP (Innovative Bioceramix Inc., Vancouver, Canada)
2.EndoSequence BC Sealer (Brasseler, Savannah, GA, USA)
3. Bioaggregate (Innovative Bioceramix Inc., Vancouver, Canada)
4.Capseal I and II
 74

CEMENTS
1.Portland Cement
2.Mineral trioxide aggregate
(MTA)
3.Biodentine (Septodont, France)
 75

PORTLAND CEMENT
• In 1824, Joseph Aspdin patented - Portland cement (PC)
obtained from the calcination of the mixture of lime stones.
• Inexpensive
• Limitation:
1.PC released- Higher amount of lead and arsenic released
2.Higher solubility
3.Excessive setting expansion
 76

MTA
• MTA introduced by Torabinejad in 1990. It’s a bioactive material
that is mainly composed of calcium and silicate.

• Applications of MTA:
1. Vital pulp therapy and pulpotomy
2. Root-end filling material
3. Repair of perforations (furcation and lateral)
4. Apexification and apexigenesis

• It forms an apatite-like layer on its surface when in contact with

physiologic fluids.
Asgary et al. Aust Endod J 2004;30:89–92.
Camilleri et al. Dent Mater 2005;21:297–303.
Enkel et al. Expert Rev Med Devices 2008;5:475–94
 77

Biocompatibility, sealing ability and dentinogenic activity are

resulted from the physiochemical reactions with tissue fluids
during the formation of HA.
Sarkar et al. J Endod 2005;31:97–100.
Many animal studies have analyzed the hard structure formed
between the tissue-MTA interface and show the presence of
phosphorus and calcium, the main components of HA.
Tziafas et al. Int Endod J 2002;35:245–54.
Dominguez et al. J Endod 2003;29:324–33.
Asgary et al. Aust Endod J 2006;32:26–30
78
 79

Yaltirik M, Ozbas J Endod 2004;30:95–9.

 80

In direct contact with human tissues, MTA is able to:

1.Release calcium ions for cell attachment and proliferation

2.Create an antibacterial environment by its alkaline pH

3.Modulate cytokine production

4.Encourages differentiation & migration of hard tissue - producing cells

5.Form HA(or carbonated apatite) on its surface and provide a biologic

seal.
81
 82

The calcified bridge in teeth that were capped with MTA was significantly thicker
than Calcium hydroxide at 30 and 60 days and was more porous and less
mineralized.

Calcium Hydroxide MTA

A comparative study on dental pulp response to calcium hydroxide, mineral trioxide aggregate as pulp
capping agents
Journal of Conservative Dentistry 14(4):351-5 · October 2011
 83

BIODENTINE:

• Biodentine was developed by Septodont’s Research Group as

a new class of dental material which could conciliate high
mechanical properties with excellent biocompatibility, as well as
a bioactive behavior.
 84

Setting Reaction
The calcium silicate has the ability to interact with water leading to the setting and
hardening of the cement. This is a hydration of the tricalcium silicate (3CaO.SiO2 =
C3S) which produces a hydrated calcium silicate gel (CSH gel) and calcium
hydroxide (Ca (OH)2).

2(3CaO.SiO2) + 6H2O  3CaO.2SiO2.3H2O + 3Ca(OH)2

C3S CSH
The unreacted tricalcium silicate grains are surrounded by layers of calcium silicate
hydrated gel, which are relatively impermeable to water, thereby slowing down the
effects of further reactions.

The C-S-H gel formation is due to the permanent hydration of the tricalcium silicate,
which gradually fills in the spaces between the tricalcium silicate grains.

The hardening process was resulted due to the formation of crystals that are
deposited in a supersaturated solution.
 85

Powder before hydration Deposition of CSH Biodentine™ after setting

86
 87
Advantages Of Biodentine
• Promotes remineralisation of dentin
• Preserves pulp vitality and promotes pulp healing
• Replaces natural dentin with the same mechanical properties
• No surface preparation: micro-mechanical anchorage, no tedious bonding
is required
• Excellent sealing properties: mineral tags in the dentin tubules
• Outstanding microleakage resistance, enhanced by the absence of
shrinkage due to the resin-free formula.
• High dimensional stability: long lasting sealing properties
• Biodentine prevents caries recurrence in deep cavities due to its alkaline
pH (pH=12) giving it bacteriostatic properties
• Excellent radiopacity.
• Biodentine induced mineralized foci formation is seen early after its
application. 
 88

• The mineralization was appeared under the form of osteodentine and

expressed markers of odontoblasts.

• Biodentine significantly increased TGF- β1 secretion from pulp cells ( P <

0.03) independently with the contact surface increase.

Laurent P, Camps J, About I: Int Endod J; May 2012, Vol. 45 Issue 5, p439-448.
 89

SEALERS
1.Endo CPM Sealer (EGO SRL, Buenos Aires,
Argentina)
2.MTA Fillapex (Angelus, Brazil)
3.BioRoot RCS (Septodont, France)
4.TechBiosealer (Profident, Kielce, Poland).
 90

GENERAL PROPERTIES OF BIOCERAMIC

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 fibres 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.
 91

Endo CPM Sealer

 92

MTA Fillapex

• Is a mineral trioxide aggregate-based, salicylate resin root canal sealer. It

is designed to provide a high flow rate and a low film thickness for easy
penetration of lateral and accessory canals. .

• It contains 13% MTA and salicylate resin for their antimicrobial and
biocompatibility properties

• Biocompatible ,Excellent Flow ,Setting expansion , Calcium ion release

 93
BioRoot RCS

 BioRoot RCS leaches Ca 2+ and OH À and creates an alkaline environment .

The Ca 2+ release and alkalinizing activity are significantly higher and more prolonged
for BioRoot RCS than for MTA- Fillapex contributing to its bioactivity.
 94

PHOSPHATES/ TRICALCIUM
PHOSPHATE/
HYDROXYAPATITE BASED
Mixture of calcium silicates
and calcium phosphates :
1.Root SP (Innovative Bioceramix Inc.,
Vancouver, Canada)
2.EndoSequence BC Sealer (Brasseler,
Savannah, GA, USA)
3. Bioaggregate (Innovative Bioceramix
Inc., Vancouver, Canada)
4.Capseal I and II
 95
ROOT SP
• iRoot SP promotes the production of the proinflammatory cytokines and the
initiation of acute inflammation response for the integration of endodontic
materials and the subsequent influence on the wound healing of the
periapical lesion.

Yuan et al. BMC Oral Health (2018) 18:56

 96

EndoSequence BC Sealer

Nano technology based due to

which there is increased
penetration into tubules.

Bioceramic-Based Root Canal Sealers: A

Review, International Journal of Biomaterials,
2016
 97

BIOAGGREGATE
• Similar to MTA with a few differences.
98
 99

BIOCERAMIC GUTTA PERCHA

Bioactivity of Bioceramic Gutta percha occurs when bioactive glasses coated
GP interact with bone or dentine by forming a calciumphosphate-rich layer
that chemically bonds to these hard tissues
(Hench & Wilson 2004, Filgueiras et al)
 100

Charisma
ANTI-CARIOGENIC SMARTER COMPOSITES
Admira
ACTIVITY ORMOCERS
CEROMERS
Tragis
 101

CONCLUSION :

• Materials used in Conservative dentistry & Endodontics are placed

in direct contact with pulpo-dentin complex & vital periapical
tissues respectively.

• Hence, the tissue response to these materials becomes important

and biocompatibility of the materials should be evaluated for
successful outcome of the treatment.

• There is much room for the improvement and further development

of materials used in dentistry. The most sophisticated class of
Bioactive and biomimetic materials in the foreseeable future will be
that which emulate biological systems.
 102

Referrences
» JOJO KOTTOOR - BIOMIMETIC ENDODONTICS : BARRIERS AND STRATEGIES- Health Sciences 2013;2(1):JS007
» Graham Mount - Minimal intervention in dentistry: Aims and limitations - Journal of Minimum Intervention in Dentistry 2012; 5:
190 - 208
» Zohaib Khurshid , Muhammad Zafar 2, Saad Qasim 3, Sana Shahab 4, Mustafa Naseem 5 and Ammar AbuReqaiba , Advances in
Nanotechnology for Restorative Dentistry, Materials 2015, 8, 717-731
» Bio smart dentistry-stepping into future, Pawan Goutam & Ashima Valiathan, Trends Biomatter. Artif.Organs, Vol 21(2),pp 94-
97(2008)

» BIOMIMETICS - A REVIEW, Amrinder Singh , Avantika Tuli, Indian Journal of Dental Sciences.

» Biomimetic Materials in Our World: A Review. 1Olugbenga Solomon Bello, Kayode Adesina Adegoke, Rhoda Oyeladun Oyewole,
IOSR Journal of Applied Chemistry (IOSR-JAC) e- ISSN: 2278-5736. Volume 5, Issue 3 (Sep. – Oct. 2013), PP 22-35

» Anusavice : Philips’ Science of Dental Materials ( South Asia Edition)

» Craig : Dental Materials : Properties & Manipulation ,XIII th. Edition

» BIOMIMETIC SYNTHESIS OF MATERIALS,P.RAMACHANDRA RAO RAJA RAMANNA FELLOW INTERNATIONAL ADVANCED

RESEARCH CENTRE FOR POWDER METALLURGY AND NEW MATERIALS (ARCI) HYDERABAD

» Bioactive Materials: A Comprehensive Review Geeta Asthana, Shaveta Bhargava, J. App. Med. Sci., 2014; 2(6E):3231-3237
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To Be Continued…
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 BIOACTIVE &
BIOMIMETIC MATERIALS
Guided by: Presented by:

1. Dr P.Karunakar Nishat Zaidi.S

Pg 2nd year
2. Dr Raji Viola
Solomon

3. Dr Shanti priya
CONTENTS: PART 1:
106

• Introduction
• History
• Definitions
• Concept of Biomimetic dentistry
• Bioactive materials
• List of Biomimetic & Bioactive materials
• Discussion of bioactive & bionmimetic aspect of all
materials in detail:
a) GIC
i. Resin Modified
ii. Smart GIC
iii. Giomers
b) Composites
iv. Smart Composites
v. Ormocers
vi. Ceromers
c) Calcium Hydroxide
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d) Bio Ceramics
i. Bioactive glass
ii. Bioactive glass Composites
iii. Hydroxyapitite
iv. Calcium Silicates
a. Cements
b. Sealers
c. Mixture of Calcium silicate & Calcium
Phosphate

e) Bioceramic Gutta percha

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PART 2:
• Theracal
• Chitosan
• MTYA1-Ca filler
• Calcium Sulfate
• Calcium Phosphate
• Calcium Enriched Mixture (CEM)
• Calcium Aluminate Cement
• Ceramir
• Doxadent
• Carbon dioxide laser
• Propolis
• Endosequence Root Repair Material (ERRM)
• Castor bean oil
• Statin
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Remineralizing Agents
1. CPP-ACP
2. Chewing gum with added Xylitol
3. Carbonate- hydroxyapatite nanocrystals
4. Fluoride compounds
5. Novamin Technology
• Bone Morphgenic Proteins (BMP)
• Demineralized freeze dried bone graft
• Enamel matrix derivative (EMD)
• Growth Factors
• Platelet Concentrates
i) PRP
ii) PRF
• Polyhedral Oligomeric Silsesquioxanes (POSS)
• Stem Cells
»
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MTA
Vs
BIODENTIN
Vs
BIOAGGREGATE
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Evaluation of reparative dentin formation of ProRoot MTA, Biodentine and

BioAggregate using micro-CT and immunohistochemistry
Restor Dent Endod. 2016 Feb;41(1):29-36. 

Histological analysis of rat molar

teeth. (a, b) MTA; (c, d)
Biodentine; (e, f) BioAggregate. At
4 weeks, hematoxylin and eosin
stained sections showed
reparative dentin bridge formation
in all samples. A thick,
homogeneous reparative dentin
bridge and reactionary dentin
could be seen in the MTA group
(a, b). Reparative tissue was
continuous and thick in the
Biodentine group (c, d). Bridges in
the BioAggregate group had a
dense mineralized structure (e,
f). *Biomaterial.P, pulp; RD,
reparative dentin.
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The results of this study suggested that Biodentine and BioAggregate might
provide an optimal environment for pulp healing and repair and were comparable
to MTA. Although there were some differences in the thickness and morphology of
the new hard tissue, all three materials showed acceptable biocompatibility. Based
on these results, calcium silicate-based materials induced favorable effects on the
reparative process during vital pulp therapy and could be considered as
alternatives to MTA. Further long-term studies are required for thorough evaluation
of the pulpal response to these materials.
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Endosequence Root Repair Material (ERRM)

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CHITOSAN
 CHITOSAN – A Marine Miracle
Properties
Bio e com Bio
SOURCE: iv pat
As an
Improving act ible

Bio le
antibacterial

b
Stability of

rial

rada
in GIC &

Anti
Dentin

bacte
composites
collagen

deg
As
As an
an

in
Removal additive
additive

fla

e
An mat
in

tiv
ne e
of in

ge R
ti- or

ra
Pulp Smear TAP
TAP
Regeneration layer Uses:

y
• Biomedicine
Component
Component Direct & • Industrial
of of indirect
Toothpaste • Agriculture
Toothpaste pulp • Food industries
capping
Dentistry and Endodontics

Conclusion
FUTURE SCOPES:
Uses in conservative

Chitin • Ename
l
Deacetylation repair
USES
• Nano
USES
IN
IN
DENTISTRY
DENTISTRY
Dentistry
• Tissue
Chitosan Scaffolds

PRESENTED BY : Dr Syed Wali Ahmed , Dr Nishat Zaidi.S

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1.Removal of smear layer 1.Direct pulp capping

2.Improving stability of dentine 2.Anti-bacterial against

collagen. S.mutans
3.Inhibition of biofilm by incorporation
of ZnO eugenol based paste 3.Indirect pulp capping

4.Ingredient of triple antibiotic intra 4.Component of toothpaste

canal paste used for erosion and abrasion\
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MTYA1-Ca filler
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Newly developed resinous direct pulp capping agent containing calcium

hydroxide (MTYA1-Ca)
International Endodontic Journal 32(6):475-83 · December 1999

• The physical properties of MTYA1-Ca were significantly superior to those

of Dycal. Both MTYA1-Ca and Dycal maintained high levels of alkaline
activity (pH 10.96-12.20) over the 168-h duration of the study.

• Cell viability by MTT assay in the intact eluate of MTYA1-Ca was

significantly higher than that of Dycal and A dentine bridge formed more
slowly under MTYA1-Ca than under Dycal, but similar amounts had
formed at 90 days.
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Calcium Sulphate
• It has favorable release of calcium ions and is found to be very useful in
surgical cases to fill bone defects.

• They are excellent constituents of calcium sulphate based temporary

restorations namely cavit and cavidentin as they do not undergo much of
changes in the oral environment and properties closed to that of dentin.

• Also they cause less amount of microleakage and for a good seal against the
oral environment.
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Management of Periradicular Lesion Using Calcium Sulfate Graft: An Unique Case

Report
2017 CHRISMED Journal of Health and Research
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Calcium Phosphate
• It has properties such as good biocompatibility, superior compressive
strength, and its transformation into hydroxyapatite over time.

• It induces bridge formation with no superficial tissue necrosis and significant

absence of pulpal inflammation.
Applications: Advantages:
1.  Bone substitute &repair of bone defects
1. Can be injected directly into the
2. Direct pulp capping: Compared to bone defects, where they
calcium hydroxide, both materials were intimately adapt to the bone cavity
equally capable of producing secondary regardless its shape
dentin at ~24 weeks.
2. Minimal invasive surgery, quicker
3. Pulpotomy. recovery

3. Inexpensive

4. Bioresorbable & can be replaced

by newly formed bone.
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Calcium Enriched Mixture:

• It is also known as NEC and was introduced by Asgary. It consists
of calcium oxide, whereas calcium oxide and silica in Portland
cement and calcium oxide, silica, and bismuth oxide in MTA are the
major ingredients.

• This cement releases both calcium and phosphorus ions leading to

hydroxyapatite production.

• It is also known as CEM. It is composed of calcium oxide, calcium

phosphate, calcium carbonate, calcium silicate, calcium sulfate, and
calcium chloride.
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132
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Vital Pulp Therapy for Permanent Dentition Using Calcium Enriched

Mixture Cement: A Review Article
Iranian dental journal, 2010
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Calcium-enriched mixture cement as artificial apical barrier: A case series

Nosrat A, Asgary S, Eghbal MJ, Ghoddusi J, Bayat-Movahed S –
J Conserv Dent,2012

Figure 1: The steps of treatment. (a) Initial radiography showing temporized upper left second
molar exposing the pulp. (b) Immediately, after miniature pulpotomy with calcium-enriched
mixture cement. (c) Fifteen month follow-up showing dentinal bridge formed under capping
material and no pathosis, pulpally, and periapically.
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Figure 1 :Initial periapical image of left

first mandibular molar showing furcal
perforation and apical lesions

Figure 2 :Periapical image after treatment

Figure 3 :At 2-year follow-up, there is

complete osseous healing at the apex and
the bifurcation
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Calcium Aluminate Cement

Composition: Characteristics of Calcium Aluminate Cements:

• Powder :Calcium •  Nano crystals (hydroxyapatite) form on the

aluminate & some glass surface of the tooth & crown that seal the interface
ionomer components added •  Bonds to the tooth using the same principle as
to improve handling (GI remineralization
components are not •  Fluoride released initially
identifed) •  No hydraulic pressure resistance
•  Does not produce pulpal inflammation
•  Liquid : Water
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Ceramir
It is calcium aluminate cement used as a luting agent. It works on the
principle of two cements they are calcium aluminate and glass ionomer
cement.

This cement helps in luting of permanent crowns and fixed partial

dentures, gold inlays and onlays, prefabricated metal and cast dowel
and cores, and high strength all-zirconia or all-alumina crowns.
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Doxadent:
• It is a calcium aluminate product available in powder liquid
form. It can be used as a permanent restorative material

• It consists of alumina, calcium oxide, water, zirconium dioxide

and other alkali oxides.

• When powder and liquid are mixed water dissolves the

calcium aluminate powder leading to the formation of
calcium, aluminum and hydroxyl ions leading to the formation
of katoite and gibbsite
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Cytotoxicity of a calcium aluminate cement in comparison

with other dental cements and resin-based materials
Acta Odontologica Scandinavica 64(1):1-8 · March 2006

Fresh DoxaDent exhibited the lowest cytotoxicity, after

7 days of preincubation while Harvard Cement and
Filtek Supreme demonstrated more cytotoxicity. Ketac
Molar showed the highest cytotoxicity.
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Carbon Di Oxide Laser:

• Different types of lasers are used in dentistry such as
CO2,Erbium,neodynium etc

• Different lasers have varied effect on same tissue & same

lasers have varying effect on different tissues

• Moritz et al & Melcer et al reported use of high power

CO2 laser on exposed pulp surfaces in direct pulp capping
and found neo-dentin bridge formation
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• The major advantage of CO2 laser in the field of preserving

pulp vitality is its thermal effect; it sterilizes and heals the
irradiated area, ensures a close contact between the dental pulp
and the capping agent by reducing inflammation and the size of
the blood clot, and it may also help to prevent bacterial
microinfiltration, which is the key factor in pulp capping
failure.

• Paschoud and Holz ‑ stated that CO2 laser has the ability to
directly stimulate the dentinogenesis process.

• Laser irradiation might stimulate release of HSP which are

induced by stress from heat & chemical stimuli

Taqkahito et al j of oral laser 2008

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Taqkahito et al j of oral laser 2008

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Propolis
144
Propolis: A natural biomaterial for dental and oral health
care JODDD, Vol. 11, No. 4 Autumn 2017

inhibited the activity of glucosyltransferases

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• It is proposed that propolis reduces dentinal hypersensitivity by decreasing hydraulic
conductance of dentin

• Propolis, when added to GIC, has a distinct antibacterial and anti-biofilm efficacy and can be
used as a promising material in future restoration.In vitro extracts of propolis were added to
GIC for evaluation of microhardness and microleakage.

• The results showed that GIC treated with propolis resulted in an increase in microhardness with
no changes or effects on microleakage.
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Castor Bean Oil:

• A material based on polymer derived from Castor oil plant –
Ricinus Comminus.

• The material Castor Bean Polyurethane cement is composed

of 81-96% triglyceride of Ricinoleic acid

• Reported to have antibacterial properties, tissue compatiblity,

potential to facilitate tissue healing

• Has been successfully used as root end filling in apical

surgery & as endodontic sealer- Pascon et al
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• Studies indicate that the Castor Bean Polyurethane cement presented

efficient sealing ability when used as a root-end filling material showing
results significantly better than MTA and GIC.
J Appl Oral Sci. de Martins GR 2009 May-Jun

• Camargo et al evaluated the cyto & genotoxicity of Castor Bean

Polyurethane cement in comparision with Calcium Hydroxide & MTA
and concluded that CBP showed least cytotoxicity

• Moreover formation of micronuclei & additional osseointegration

features reported from studies make CBP cement a promising material
for future pulp capping studies.
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Subcutaneous tissue reaction to castor oil bean and calcium hydroxide in rats
J. Appl. Oral Sci. vol.18 no.3 Bauru May/June 2010

These results demonstrate that the castor oil bean cement (COB)
induces less inflammatory response within long periods which is in
comparison with calcium hydroxide with no significant difference. Hence
it can be used in pulp capping.
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Statin

• Simvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase

inhibitor widely used as a cholesterol-lowering agent in the treatment
and prevention of atherosclerosis.

• Yazawa et al study, the effects of simvastatin on cell proliferation and

osteoblastic differentiation in PDL cells were analyzed.

• These showed that at low concentration, simvastatin exhibited a positive

effect on proliferation and osteoblastic differentiation of human PDL
cells, and these effects might be caused by the inhibition of the
mevalonate pathway.
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BIOACTIVE
REMINERALIZING
AGENTS:
1. CPP-ACP
2. Chewing gum with added xylitol
3. Carbonate- hydroxyapatite nanocrystals
4. Fluoride compounds
5. Novamin Technology
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CPP-ACP (casein phosphopeptide-amorphous calcium phosphate)

• CPP-ACP, is a milk-derived product that strengthens and remineralizes

teeth and helps prevent dental caries.

• These complexes of amorphous calcium phosphate and amorphous

calcium fluoride phosphate stabilized by the CPP have been demonstrated
in a range of laboratory, animal and short-term human clinical trials to
repair (remineralise) early stages of tooth decay by replacing the calcium
and phosphate ions lost due to decay.
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• Three longer-term, randomized, controlled clinical trials (RCTs)

have demonstrated the efficacy of CPP-ACP in slowing the
progression of dental caries and in regressing (repairing) early
stages of tooth decay

• When fluoride ions come into contact with (CPP-ACP), the

peptide preferentially combines with and stabilises fluoride, to
create the ideal source of ions for building fluorapatite; CPP-
ACPF.

• By matching bio-available calcium, phosphate and fluoride in the

ideal 5:3:1 ratio, the full potential of fluoride to help protect and
repair teeth can be achieved.
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Uses of CPP-ACP

• Active caries
• Tooth erosion and wear
• Dry mouth, xerostomia
• White spot lesions
• During orthodontic treatment
• Whitening treatment
• Developmental defects in enamel
• During and after periodontal care
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Chewing Gum With Added Xylitol

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Carbonate- hydroxyapatite nanocrystals

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CHA Fluoride
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Fluoride Compounds:
• Fluoride exerts its major effect by creating low levels of fluoride ions in
saliva and plaque fluid, thus exerting a topical or surface effect.

• Technically, this fluoride does not prevent cavities but rather controls the
rate at which they develop.

• When fluoride ions are present in plaque fluid along with dissolved
hydroxyapatite, and the pH is higher than 4.5, a fluorapatite -like
remineralised veneer is formed over the remaining surface of the enamel;
this veneer is much more acid-resistant than the original hydroxyapatite, and
is formed more quickly than ordinary remineralised enamel would be.

• The cavity-prevention effect of fluoride is partly due to these surface effects,

which occur during and after tooth eruption.
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Novamin Technology
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Bone Morphgenic Proteins (BMP)

1.acting as mitogens on undifferentiated mesenchymal cells and

osteoblast precursors

2. inducing the expression of the osteoblast phenotype (e.g.,

increasing alkaline phosphatase activity in bone cells

3.acting aschemoattractants for mesenchymal cells and

monocytes as well as binding to extracellular matrix type IV
collagen
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Demineralized freeze dried bone graft

• Bone allografts are being widely used in the field of dentistry.

• They are generally used in two forms—freeze dried bone allograft

(FDBA) and demineralized freeze dried bone allograft (DFDBA).

• DFDBA was first used in dentistry and medicine in 1965 but for the
treatment of periodontal defects

• DFDBA contains bone morphogenic proteins (bmps) such as bmp 2, 4,

and 7,which help stimulate bone formation.
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• Cut in pieces.

• Defatted.

• Washed in absolute alcohol.

• Ground & sieved (250-750µm).

• Freeze-dried.

• Vacuum sealed.
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Enamel matrix derivative (EMD)

» Emdogain is a resorbable, implantable material consisting of enamel
matrix proteins that is intended as an adjunct to periodontal surgery for
topical application onto exposed root surfaces.

» Technically, it is enamel matrix proteins (amelogenins) that are taken

from developing teeth in pigs. These proteins are similar in all mammals,
and humans do not recognize them as foreign

» Once applied to the cleaned root surface, Emdogain forms an insoluable

protein matrix that initiates the process of periodontal tissue regrowth.

» Emdogain mimics normal root development by stimulating release of

autocrine (cell's own) growth factors from PDL cell

He J, et al.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004
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• Enamel matrix derivative contains Amelogenin as a major component in

addition to other E.M proteins like Enamelins, Tuftelin, Amelin & Ameloblastin

• According to NAKAMURA YUKIO demonstrate the potential of EMD as a

biologically active pulp-dressing agent that specifically induces pulpal wound
healing and dentin formation in pulpotomized teeth without affecting the normal
function of the remaining pulp.
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Mechanism of Action:

Application of EMD gel Precipitation of insoluble layer of

Amelogenin Protein

Release of new matrix Attachment of

& growth factors mesenchymal cells
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Osteoinductive
environment Formation of new cementum , PDL & bone
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CLINICAL APPLICATIONS:
ENDODONTICS

INTENTIONAL
RADICULAR GROOVE
PULP CAPPING REPLANTATION
-AVULSED TOOTH
TREATMENT

PERIODONTICS

REGENERATIVE
PROCEDURES
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In vivo studies on both human and animals have shown

considerable reparative dentin formation on capping of the
exposed pulp with EMDOGAIN.

Immunohistochemical staining of a premolar with EMDgel (12

weeks after treatment.
H.Oslon et al; - IEJ VOL 38 2005
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Intentional Replantation Of Avulsed teeth:

Emdogain prevents the major sequelae of intentional replantation i.e,

replacement resorption / ankylosis .

Replacement resorption of One year follow up- no

21 pathological
changes

Dental Traumatology 2012; 18: 138–143 (Filippi A)

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Treatment Of Radicular Groove:

Radicular groove an anatomic anamoly predisposes to both endodontic
and periodontic complications.

Pre-operative radiograph Application of 1 yr followup radiograph-

Of 22 showing periradicular EMDOGAIN to decrease in periradicular
Radiolucency root surface radiolucency
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Growth Factors
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Platelet Concentrates
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Applications in Endodontics

• The use of triple antibiotic paste for canal disinfection along with PRF
strengthens the effectiveness of sterilization in carious teeth, infected
dentin, periapical lesions and necrotic pulp.

• PRF causes proliferation of pulp cells and also increases the expression of
osteoprotegerin and Alkaline phosphatase activity.

• PRF and tricalcium phosphate(TCP) bone graft have synergistic effect in

treating periapical cysts.

• Biological connector for neoangiogenesis and vascularization.

.
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Applications in Endodontics

• Apical matrix barrier for in root end apexification.

• Apical plug in apexification.

• Pulpal floor perforation repair.

• As a scaffold for dentin pulp regeneration.

• Periapical cyst treated with PRF PRF in pulp regeneration periapical

inflammation
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Department case:
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Polyhedral Oligomeric Silsesquioxanes (POSS)

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Stem Cells:

• Tissue engineering is an emerging interdisciplinary science, which aims

at developing strategies for regeneration of damaged organs and tissues,
based on principles of engineering and life sciences.

• Responsive cells are generally stem cells.

• There are two basic categories of stem cells classified according to their
potential of differentiation: embryonic stem cells (ESC) and somatic
stem cells (also called adult stem cells or mesenchymal stem cells -
MSC)
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6
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There are five types of dental MSC were isolated an characterized:

1. Dental pulp stem cells (DPSC) from pulp of permanent teeth.

2. Stem cells of human exfoliated teeth (shed)

3. Immature dental stem cells (IDPSC) from primary teeth

4. Periodontal ligament stem cells (PDLSC)

5. Stem cells from apical papilla (SCAP)

6. Dental follicle progenitor cells (DFPC)

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• Dental pulp stem cells (DPSC) were isolated from permanent teeth and
characterized based on the gold standard criteria established for BMMSC.

• Dental-tissue derived msc-like populations appear to be more committed

to odontogenic rather than osteogenic development.

• Dpsc cells are characterized by their ability to differentiate into multiple

stromal cell lineages and to their clonogenic capacity.
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Conclusion:

• Materials used in Conservative dentistry & Endodontics are placed in

direct contact with pulpo-dentin complex & vital periapical tissues
respectively.

• Since a decade, concept of “less is more” and concept of regeneration are

buzzing in the ears of dentist.

• Hence, the tissue response to these materials becomes important and

biocompatibility of the materials should be evaluated for successful
outcome of the treatment.

• There is much room for the improvement and further development of

materials used in dentistry. The most sophisticated class of Bioactive and
biomimetic materials in the foreseeable future will be
that which emulate biological systems.
 190

REFERENCES

Anusavice : Philips’ Science of Dental Materials ( South Asia Edition)

Craig : Dental Materials : Properties & Manipulation ,XIII th. Edition

BIOMIMETIC SYNTHESIS OF MATERIALS,P.RAMACHANDRA RAO RAJA RAMANNA

FELLOW INTERNATIONAL ADVANCED RESEARCH CENTRE FOR POWDER
METALLURGY AND NEW MATERIALS (ARCI) HYDERABAD

Bioactive Materials: A Comprehensive Review Geeta Asthana, Shaveta Bhargava, J. App.

Med. Sci., 2014; 2(6E):3231-3237

JOJO KOTTOOR - BIOMIMETIC ENDODONTICS : BARRIERS AND STRATEGIES- Health

Sciences 2013;2(1):JS007

Graham Mount - Minimal intervention in dentistry: Aims and limitations - Journal of Minimum
Intervention in Dentistry 2012; 5: 190 - 208
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Snehal Sonarkar, Rucheet Purba, “Bioactive materials in conservative dentistry,” Int J

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Materials 2015, 8, 717-731

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Hegde, Mithra & Shruthi Attavar, Dr & Narayanan, Sreenath. (2017). BIOACTIVE
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