If the properties and mechanisms of actions on dental pulp of a material are to be assessed in vital processes, in vivo studies using animal and human teeth are generally more suitable than in vitro study models.
MTA, which continues to be regarded as the gold standard medication to preserve pulp vitality, has been very well researched in numerous investigations and long-term studies. By contrast, the number of studies in which Biodentine and MTA were compared with regard to their effectiveness and reliability in preserving pulp vitality is limited.
Tran et al. (2012) published one of the first studies in which materials were investigated with regard to their effectiveness for dentin repair when pulp was exposed.
Biodentine was compared with
MTA and
calcium hydroxide under the aspect of their ability to stimulate a tertiary dentin bridging effect. The structure that was induced by the CaOH2 product showed numerous cell inclusions, which are also known as tunnel defects
(Cox et al. 1996). These defects are entirely undesirable as it can be assumed that they can act as a kind of channel system for the invasion of harmful microorganisms toward the pulp. Endodontic infection is therefore the logical consequence. On the other hand, the structure of the repair dentin induced by Biodentine exhibits a narrowly circumscribed zone at the previously exposed site. Moreover, the structure of the repair dentin showed orthograde organization similar to natural dentin with clearly identifiable dentin tubules. Increasing expression of DSP (dentine sialoproteins) and osteopontin by secreting odontoblasts was also observed
(Cox et al. 1996). DSP and osteopontin act as important regulatory proteins in the initiation and formation of repair dentin.
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In 2013
Nowicka et al. published an interesting clinical and histological study in which they found that
Biodentine has similar effectiveness as
MTA with regard to clinical use. In their estimation, Biodentine is a good alternative product for maintaining pulp vitality with direct capping. A further result was that use of Biodentine led to complete development and formation of dentin bridging. Inflammatory processes were not found.
Using pigs' teeth,
Shayegan et al. (2013) studied the pulpal reaction to Biodentine over a period of 7, 28 and 90 days. Their results show that Biodentine has bioactive properties, promotes hard tissue production and does not provoke any signs of an inflammatory process of the pulp. The authors also point out that Biodentine has the ability to preserve the marginal integrity on account of the formation of hydroxyapatite crystals on the surface, which considerably increase the sealing properties of the Biodentine. Due to this superior sealing ability, there are usually no microleakages, which in turn can be responsible for infection of the pulp tissue (and therefore for the potential failure of measures to preserve pulp vitality). Another important conclusion of the authors is that the hard tissue formation, stimulated by calcium hydroxide, is attributable to a defensive reaction of the pulp to the CA(OH)2 product. By contrast, calcium silicate-based materials do not trigger this protective mechanism by the cells as they are compatible with them and do not cause irritation. They showed that the necrotic layer caused by calcium hydroxide appears much larger compared with other products
(Shayegan et al. 2013).
Zanini et al. (2012) studied the biological effect of Biodentine on murine pulp cells by analyzing the expression of different biomolecular markers after setting up an OD-21 cell culture. Biodentine proved to be a bioactive material as it is able to stimulate proliferation of the OD-21 cell population and promote the biomineralization process.
Laurent et al. (2012) point out the important role of growth factors in the interaction between capping products and compromised pulp tissue, with TGF-ß1 occupying a prominent position. The essential function of growth factors in this connection is to transmit the signal for induction of reparative dentinogenesis. Biodentine possesses the ability to modulate TGF-ß1 secretion by the pulp cells, thereby influencing the entire repair dentin synthesis process
(Graham et al. 2006, Tomson et al. 2007). A study in human pulp cells showed that Biodentine is able to increase TGF-ß1 secretion significantly and induces the early form of repair dentin synthesis
(Laurent et al. 2012).
Marijana et al. (2013) came to similar positive results when they studied Biodentine and ProRootMTA with regard to their therapeutic effect in porcine pulp tissue after direct capping.
Overview of some studies of Biodentine™
| Property |
Reference |
| Composition |
Grech et al. 2013, Camilleri et al. 2012 Camilleri et
al. 2013 |
| Setting time |
Grech et al. 2013, Villat et al. 2010 |
| Compressive strength |
Kayahan et al. 2013, Grech et al. 2013 |
| Microhardness |
Grech et al. 2013, Camilleri et al. 2013, Odabas et al. 2013, Aggarwal et al. 2013 |
| Bond strength |
El-Ma’aita et al. 2013, Hashem et al. 2014, Guneser
et al. 2013 |
| Porosity |
Atmeh et al. 2012, Camilleri et al. 2013, De Souza
et al. 2013, Gjorgievska et al. 2013 |
| Radiopacity |
Grech et al. 2013, Camilleri et al. 2013, Tanalp et al. 2013 |
| Solubility |
Grech et al. 2013 |
| Bending strength |
Sawyer et al. 2012, Koubi et al. 2012, Raskin et al.
2012 |
| Microleakage |
Raskin et al. 2012, Camilleri et al. 2013 |
| Stability |
Grech et al. 2013 |
| Color stability |
Valles et al. 2013 |
| Biocompatibility |
Laurent et al. 2008, Laurent et al. 2012, Han and Okiji 2011, Han and Okiji 2013, Zhou et al. 2013, Pérard et al. 2013, Luo et al. 2014, Camilleri et al. 2013 |
| Preservation of vitality |
Shayegan et al. 2012, Zanini et al. 2012, Laurent et al. 2012, Tran et al. 2012, Nowicka et al. 2013, Marijana et al. 2013 |
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