Biodentine™: Properties and Clinical Applications

Acknowledgments
Contents
Contributors
About the Editor
Introduction
1: BiodentineTM Microstructure and Composition
	1.1	 Introduction
	1.2	 Presentation and Mixing
	1.3	 Chemical Composition
		1.3.1	 Cement Base
		1.3.2	 Modifiers
	1.4	 Biodentine Microstructure
	1.5	 Conclusions
	References
2: BiodentineTM Physico-Chemical Properties: From Interactions with Dental Tissues to Ageing
	2.1	 Introduction
	2.2	 Properties of the Cement
		2.2.1	 The CSH Gel
			2.2.1.1	 Setting Time
			2.2.1.2	 Viscosity and Flowability
			2.2.1.3	 Porosity
		2.2.2	 The Ion-Rich Water (Pore Solution)
			2.2.2.1	 Water Sorption
			2.2.2.2	 Solubility
			2.2.2.3	 Pore Solution pH
			2.2.2.4	 Ca and Si Ions
	2.3	 Ageing and the Effect of Curing Environment on Biodentine
		2.3.1	 Phosphate-Rich Media
		2.3.2	 Carbonation and the Bicarbonate Ion
		2.3.3	 pH of the Surrounding Environment
	2.4	 Biodentine in Relation to Dentine
		2.4.1	 Interaction with Sound Dentine
			2.4.1.1	 Tag-Like Structures
			2.4.1.2	 Structurally Altered Dentine Layer (Mineral Infiltration Zone)
		2.4.2	 Interaction with Carious or Demineralised Dentine
	2.5	 Conclusion
	References
3: Biocompatibility and Bioactive Properties of BiodentineTM
	3.1	 Introduction
	3.2	 Biocompatibility
		3.2.1	 Effects on Target Cells Following Pulp Capping Procedures
		3.2.2	 Interaction with Tooth-Surrounding Tissues
	3.3	 Effects of Biodentine™ on Pulp-Dentine Regeneration Potential
		3.3.1	 Biodentine™ Implication in the Resolution of Inflammation
		3.3.2	 Biodentine™ Implication in Neoangiogenesis
		3.3.3	 Biodentine™ Induces Pulp Fibroblast Proliferation and Recruitment
		3.3.4	 Biodentine™ Enhances Dental Pulp Stem Cell Recruitment
		3.3.5	 Effects on Differentiation and Mineralization
			3.3.5.1	 In Vitro
			3.3.5.2	 In Vivo
		3.3.6	 The Role of Hydration By-Products upon Setting
	3.4	 Osteogenic Potential
		3.4.1	 In Vitro
		3.4.2	 In Vivo
	3.5	 Conclusions
	References
4: BiodentineTM in Inflammation and Pain Control
	4.1	 Introduction
	4.2	 The Physiology of Pulpal Pain
		4.2.1	 Nerves
		4.2.2	 Odontoblasts
	4.3	 Odontoblasts and Pulp Cells Express Functional Hot and Cold Receptors
	4.4	 Pulpal Pain and Inflammation
	4.5	 Biodentine Sealing and Antibacterial Potentials
	4.6	 Modulation of Pulpal Pain and Inflammation by Biodentine: Evidence from In Vitro Studies
		4.6.1	 Biodentine Modulation of Pro- and Anti-inflammatory Molecules
		4.6.2	 Modulation of Inflammatory Cell Recruitment
	4.7	 Modulation of Inflammation: Evidence from In Vivo Studies
	4.8	 Modulation of Pulpal Pain by Biodentine: Evidence from Clinical Studies
	References
5: BiodentineTM Clinical Applications in Vital Pulp Therapy in Permanent Teeth
	5.1	 Introduction
	5.2	 Histopathology of Carious Dentine
	5.3	 Indirect Pulp Protection
		5.3.1	 One-Step Approach
		5.3.2	 Two-Step Approach
		5.3.3	 Materials Used for Indirect Pulp Protection
	5.4	 Biodentine™
		5.4.1	 Pulp Protection and Dentine Replacement (Table 5.2)
	5.5	 Direct Pulp Protection
		5.5.1	 Direct Pulp Protection: Clinical Procedure
		5.5.2	 Partial/Full Pulpotomy: Clinical Procedure
		5.5.3	 Materials Used for Direct Pulp Protection
	References
6: BiodentineTM: Applications in Pulpotomy of Deciduous Teeth
	6.1	 Introduction
	6.2	 Pulpotomy in Deciduous Teeth
	6.3	 Deciduous vs. Permanent Tooth Pulp
	6.4	 Regenerative Potential of Dental Pulp
	6.5	 Interaction of Pulpotomy Materials with Dentine–Pulp Complex
	6.6	 Materials Used in Pulpotomy
	6.7	 Classification of Pulpotomy Medicaments
	6.8	 Efficacy of Biodentine as a Pulpotomy Medicament in Deciduous Teeth
	6.9	 Biodentine vs. Formocresol
	6.10	 Biodentine vs. MTA
	6.11	 Biodentine vs. Other Pulpotomy Materials
	6.12	 Pulpotomy Procedure with Biodentine
	6.13	 Conclusion
	References
7: BiodentineTM Applications in Traumatology and Fractures
	7.1	 Introduction
		7.1.1	 Paradigm Shift
		7.1.2	 Casuistics
		7.1.3	 Choice for Biodentine
	7.2	 Direct Pulp Capping in Traumatised Immature Incisors
		7.2.1	 Casuistics
	7.3	 Pulpotomy in Traumatised Immature Incisors
		7.3.1	 Casuistics
	7.4	 Full Obturation in Traumatised Incisors
		7.4.1	 Casuistics
			7.4.1.1	 Case 1: 9-Year-Old Girl with Infection of 22
			7.4.1.2	 Case 2: 8-Year-Old Girl with Recurrent Infection After Trauma of 11
	7.5	 Root Fractures
		7.5.1	 Casuistics
	7.6	 Save the Unsaved
		7.6.1	 Necrotic Immature Teeth After Trauma
			7.6.1.1	 Casuistics
		7.6.2	 Saving the Unsaved
			7.6.2.1	 Casuistics
				Case 1: 5-Year-Old Boy with a Unilateral Root Fracture on the Immature Tooth 21
				Case 2: 6-Year-Old Boy with a Severe Trauma on a Freshly Erupted Incisor
	7.7	 Conclusion
	References
8: BiodentineTM Applications in Irreversible Pulpitis Management in Children and Adults
	8.1	 Pulpal Status Beneath Carious Exposures and the Classification of Pulpitis
	8.2	 Diagnosis of Irreversible Pulpitis and Its Limitations in Children and Adults
		8.2.1	 Preoperative Clinical and Radiographic Examination
			8.2.1.1	 Signs and Symptoms
			8.2.1.2	 Sensibility Tests
			8.2.1.3	 Radiographic Examination
		8.2.2	 Intraoperative Assessment
	8.3	 Case Selection for Vital Pulp Therapy in Teeth with Irreversible Pulpitis in Children
		8.3.1	 Restorability of the Affected Tooth and Stage of Developing Dentition
		8.3.2	 Incomplete Root Formation and Thin Dentine Wall
	8.4	 Is Vital Pulp Therapy a Viable and Even Preferred Alternative to Pulpectomy for Teeth with Clinical Diagnosis of Irreversible Pulpitis in Children and Adults?
		8.4.1	 Does Age Matter in Decision-Making in Vital Pulp Therapy?
		8.4.2	 Cost-Effectiveness of Vital Pulp Therapy
	8.5	 Outcome of Vital Pulp Therapy in Teeth with Irreversible Pulpitis in Children and Adults
		8.5.1	 Coronal Pulpotomy
		8.5.2	 Partial Pulpotomy and Miniature Pulpotomy
		8.5.3	 Direct and Indirect Pulp Capping
	8.6	 Biodentine Applications in Irreversible Pulpitis Management
	8.7	 Which Irreversible Pulpitis Tooth Can Be a Candidate for Vital Pulp Therapy in Children and Adults?
	8.8	 Vital Pulp Therapy Using Biodentine in Teeth with Irreversible Pulpitis: Procedure
	8.9	 Outcome Measures for Successful Vital Pulp Therapy
	8.10	 Possible Complications Following Vital Pulp Therapy with Biodentine in Teeth with Irreversible Pulpitis
		8.10.1	 Pulp Necrosis and Apical Periodontitis
		8.10.2	 Cervical Root Fracture
		8.10.3	 Pulp Canal Obliteration
	8.11	 Conclusions
	References
9: Calcium Silicate-Based Cement (BiodentineTM) as a Bioactive Material for the Long-Term Preservation of Pulp Vitality in Restorative Dentistry and Prosthodontics
	9.1	 Introduction
	9.2	 Clinical Evidence on the Efficacy of Biodentine as an IDP or DPC Material in Vital Pulp Therapy
	9.3	 Studies Evaluating IPC with Biodentine
	9.4	 Studies Evaluating DPC with Biodentine
	9.5	 Case Series
		9.5.1	 Clinical Case 1
		9.5.2	 Clinical Case 2
		9.5.3	 Clinical Case 3
		9.5.4	 Clinical Case 4
		9.5.5	 Clinical Case 5
	9.6	 Discussion
		9.6.1	 Studies of the Preservation of Pulp Vitality After IPC with Biodentine
		9.6.2	 Studies of the Preservation of Pulp Vitality After DPC with Biodentine
	9.7	 Conclusions
	References
10: BiodentineTM Applications in Furcation Perforation and Root Resorption
	10.1	 Furcation Perforations
		10.1.1	 Repair of Fresh Perforations
		10.1.2	 Repair of Old Perforations
		10.1.3	 Matrix Technique
		10.1.4	 Push-Out Bond Strength
		10.1.5	 Reactions of Cells of the Periodontium to Biodentine
			10.1.5.1	 Reactions of Cells of the Periodontium In Vitro
			10.1.5.2	 Reactions of Cells of the Periodontium in Rats
			10.1.5.3	 Reactions of Cells of the Periodontium in Dogs
			10.1.5.4	 Reactions of Cells of the Periodontium in Humans
		10.1.6	 Advantages of Biodentine in the Repair of Furcation Perforations
	10.2	 Root Resorption
		10.2.1	 Internal Resorptions
		10.2.2	 Management of Internal Resorption
		10.2.3	 External Resorptions
			10.2.3.1	 Replacement Resorption
			10.2.3.2	 Cervical Resorption
			10.2.3.3	 Transient Resorptions
		10.2.4	 Management of External Resorption
		10.2.5	 Management of External Cervical Resorption
		10.2.6	 Advantages of Biodentine in the Treatment of Root Resorptions
			10.2.6.1	 Antiresorptive Effect of Biodentine
			10.2.6.2	 Bioactivity and Biocompatibility of Biodentine
			10.2.6.3	 Stabilization of the Tooth Structure Through Biodentine
	10.3	 Conclusion
	References
11: Clinical Application of BiodentineTM in Regenerative Endodontics/Revitalization
	11.1	 Indication of Revitalization Procedures
	11.2	 Clinical Procedure
		11.2.1	 First Visit: Disinfection
		11.2.2	 Second Visit: Intracanal Blood Clot Induction
	11.3	 Outcome
	11.4	 Material Selection
		11.4.1	 Irrigation and Intracanal Medicament
		11.4.2	 Hydraulic Calcium Silicate Cement
	11.5	 Regeneration and Repair
	11.6	 Future Perspectives
	11.7	 Conclusions
	References