Bioactive materiasl have played significant role in endodontics since the introduction of MTA. other materials have been introduced into the market in order to achieve better results with good prognosis and improved quality in shorter period of time. hence we need to take a quick look on the common available Bioactive materials in the endodontic market in order to investigate the properties of each and to give the practitioner good idea to know how to select the materials.

1. By: dr. Motaz M. El-sadat
Teaching Assistant of endodontics
Dept. of Endodontics, Al-Azhar University

2. Introduction
What is Bioactivity?
Bioactive Materials:
 Composition
 Properties
 uses
 Drawbacks
What is Next??!!
MTA
Biodentine
Root Repair Material
Bioaggregate

3.  In recent years, there were a great concern about Bioactive materials.
 Since then, a lot of Bioactive materials are available in the market.
 In the field of endodontics, the bioactive materials are usually used in procedrures
like: perforation repair, root-end filling, apexification or apexogenesis.

4.  In the past CaOH was used (first developed 1920)
 Since the introduction of MTA into the market, special concern on Calcium-silicate
based materials is drawn.
 Calcium-silicate based materials share common features:
Impervious to moisture, high pH, antibacterial and antifungal effect, hard
tissue inductive and conductive

5. “The ability of a material to elicit a response in a living tissue”
D Grotra, C V Subbarao: Bioactive materials in endodontics.
recent research in science and technology 2012:4(6); 25-27
“Bioactive material must be able to elicit a biological response at the interface and
induce the formation of a bond between tissue and the material”
MG Gandolfi , P Taddei, A Tinti and C Prati : Apatite-forming ability (bioactivity) of ProRoot MTA.,
Int Endod J 2010 43(10); 917–929

6. Bioactive Materials
Mineral Trioxide Aggregate

7. Early 1990s: Introduced into the Market
1993: First described in the dental scientific literature
Lee SJ, Monsef M, Torabinejad M. : Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations.
J Endod 1993;19:541–4.
1998: FDA approval for endodontic use
Schmitt D, Bogen G. Multifaceted use of ProRoot MTA root canal repair material.
Pediatr Dent 2001;23:326–30.

8. Refined
Portland
Cement
Bismuth
Oxide
Trace
elements:
SiO2
CaO
MgO
K2SO4
Na2So4
*Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the
literature. Dent Mater 2008;24: 149–64.

9. Tricalcium Silicate
Dicalcium Silicate Strength
Tricalcium aluminate
Tetracalcium aluminferrite
Gypsum control the hydration reaction

11.  Bioactive and biocompatible material
 Dimensionally stable
 Insoluble in tissue fluids
 The Powder contains fine hydrophilic particles that set in the
presence of moisture
Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature
review—part 1: chemical, physical, and antibacterial properties.
J Endod 2010;36:16–27.

12.  Have some antibacterial and antifungal properties
 Nontoxic, noncarcinogenic
 Hard tissue inductive and conductive
Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature
review—part 1: chemical, physical, and antibacterial properties.
J Endod 2010;36:16–27.

13.  Capable to form apatite-like layer on its surface when come in
contact with the physiologic fluids (in vivo) or simulated body fluids
(in vitro)
Hench LL, Wilson J. Surface-active biomaterials. Science 1984;226:630–6.
 It became the standard material for root perforation repair and vital
pulp therapy

14.  Long setting time (165±5 min)
 The Compressive Strength increases with the presence of moisture.
 High pH value (10.2 after mixing then rises to 12.5)
Torabinejad M, Hong CU, McDonald F, et al. Physical and chemical properties of a
new root-end filling material. J Endod 1995;21:34–53.
 Flexural strength is decreased when MTA absorbs excess moisture.
Walker MP, Diliberto A, Lee C. Effect of setting conditions on mineral trioxide aggregate flexural strength.
J Endod 2006;32:334–6.

16. Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications,
Drawbacks, and Mechanism of Action J Endod 2010; 36: 400-413
Needed for
Bone
Metabolism
Releasing of
Ca
&
Phosphorus
Apatite-like
layer
Contact
with
Physiologic
Fluids

18.  Vital pulp therapy (Pulp capping & Pulpotomy)
 Root-end filling material
 Perforation repair
 Repairing external and internal resorption
 Apical plug in teeth with open apices
 Revascularization
 Root canal Sealer
Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications,
Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413

20.  discoloration potential
 presence of toxic elements in the material composition
 difficult handling characteristics
 long setting time
*Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications,
Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413

21.  high material cost
 absence of a known solvent for this material
 difficulty of removal after curing
 Low compressive strength incompatible with restorative indications
*Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications,
Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413

23. Gray MTA White MTA
First types to be introduced Introduced 2002
Has discoloration potential due to presence of
FeO
Little discoloration potential due very low
amount of FeO
Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive
Literature Review—Part III: Clinical Applications, Drawbacks, and
Mechanism of Action. J Endod 2010; 36: 400-413

24.  Fast setting MTA
 By mixing MTA powder with hydration accelerator like: citric acid,
CaCl2 or lactic acid gluconate
Lee BN et al, . Improvement of the properties of mineral trioxide aggregate by mixing with hydration accelerators.
J Endod.2011;37:1433–1436.

25. Bioactive Materials
Biodentine

26.  Calcium-silicate based
 Supplied in form of powder and liquid:
 Powder: (highly purified particles)
1.Tricalcium silicate
2.Dicalcium silicate
3.Calcium carbonate and oxide (Filler)
4. Iron oxide
5.Zirconium oxide (radio-opacifier)
*Biodentine Scientific File. Active Biosilicate Technology. Saint-Maur-des-fosses, France:
R&D Department, Septodont; 2010. Available at: www.septodont.fr. Accessed 16-1-2015

27.  Liquid:
1.Calcium chloride hydration accelerator
2.Water-soluble polymer water reducing agent

29.  Bioactive and biocompatible material
 Dentine substitute material
 Specific feature:
Compressive strength of Biodentine continue improving with time until it
reaches 300 Mpa similar to that of the dentine (297Mpa)
(the company claims)
Biodentine Scientific File. Active Biosilicate Technology. Saint-Maur-des-fosses, France:
R&D Department, Septodont; 2010. Available at: www.septodont.fr. Accessed 16-1-2015

30.  Setting Time:
1. Initial setting 9-12 minutes
2. Final setting 45 minutes
L. Grech, B. Mallia, and J. Camilleri, Investigation of the physical properties of tricalciumsilicate cement-based root-end
filling materials. Dental Materials, 2013;29 (2):20–28.
 Hard tissue inductive and conductive
Perard M, et al. Spheroid model study comparing the biocompatibility of Biodentine and MTA.
J Mater Sci Mater Med 2013;24:1527–34.

31. Advantages over MTA:
 Ease of handling
 Shorter setting time
 Highly purified ingredients
Nowicka A, Lipski M, Parafiniuk M, et al. Response of human dental pulp capped
with biodentine and mineral trioxide aggregate. J Endod 2013;39:743–7.
 It can set either in dry or wet condition
Caronna V et al,. Comparison of the Surface Hardness among 3 Materials Used in an Experimental Apexification Model under Moist
and Dry Environments. J Endod 2014;39 :986-9

33. Can be used under composite restoration

36.  “weak restorative material in its early setting phase”. So the
placement of the overlying resin composite must be delayed for more
than 2 weeks”
Hashem DF, et al., The physical characteristics of resin composite calcium silicate interface as part of a layered/laminate adhesive
restoration. Dent Mater, 2014; 30(3): 343–349.

37. Bioactive Materials
EndoSequence Root Repair
Material
RRM

38.  Calcium-silicate based
 Supplied in premixed syringe/ moldable putty form:
 Composed of:
1.Tricalcium silicate
2.Dicalcium silicate
3.Zirconium oxide (radio-opacifier)
4.Tantalum pentoxide
5.Calcium sulfate
*Hansen S, Marshall G, Sedgley C. Comparison of intracanal Endosequence root repair material and ProRoot MTA to induce pH
changes in simulated root resorption defects over 4 weeks in matched pairs of human teeth. J Endod 2011;37:502–6.

39. Damas B et al. Cytotoxicity comparison of mineral trioxide aggregates and Endosequence bioceramic root repair materials.
J Endod 2011; 37:372–5.
Naonosphere
1*10-3 µ
Better
Penetration into
the dentinal
tubules
Micromechanical
bonding upon
setting

40.  Setting time:
Initial: 30 min.
Final : 4 hours in wet conditions
12 hours in dry conditions
 The manufacturer recommends placing a moist cotton pellet in
direct contact with the material.(minimum 4 hours)
Hansen S, Marshall G, Sedgley C. Comparison of intracanal Endosequence root repair material and ProRoot MTA to induce pH
changes in simulated root resorption defects over 4 weeks in matched pairs of human teeth. J Endod 2011;37:502–6.
 pH, biocompatibility and other properties : similar to MTA

41. Similar to MTA and Biodentine
 Vital pulp therapy (Pulp capping & Pulpotomy)
 Root-end filling material
 Perforation repair
 Repairing external and internal resorption
 Apical plug in teeth with open apices
 Revascularization

42. Bioactive Materials
Bioaggregate

43.  Calcium-silicate based
 Nanoparticles
 Composed of:
1.Calcium silicate
2.Calcium Hydroxide
3.Hydroxyapatite (strengthen the calcium-silicate hydro gel)
4.Tantalum pentoxide (radiopacifier)
Zhang H, Pappen FG, Haapasalo M. Dentin enhances the antibacterial effect of mineral trioxide aggregate and bioaggregate.
J Endod 2009;35:221–4.

44.  Similar to MTA and Biodentine

45.  With the advancement in technology, we expect to see materials that overcome the
obstacles which the endodontic community faces.
 Further investigations should be done on the newly introduced bioactive materials
in order to obtain a satisfactory knowledge about it.