Biodentine

Biodentine Tricalcium-Silicate Cement
Howard E. Strassler, Dmd | Robert Levin, Dds

Material is an active biosilicate technology for direct and indirect pulp-capping.

There is generally little agreement on the treatment of a carious exposed pulp for a vital permanent tooth.1,2 A recent systematic review of vital pulp therapy in vital permanent teeth with cariously exposed pulps reviewedsuccess rates of direct pulp-capping.3 In this review, the success rate of direct pulpcapping was reported as > 6 months to 1 year, 87.5%; > 1 to 2 years, 95.4%; > 2 to 3 years, 87.7%; and > 3 years, 72.9%. Partial and full pulpotomy sustained high success rates up to > 3 years (partial pulpotomy, 99.4%; full pulpotomy, 99. 3%). The conclusion of this review was that vital permanent teeth withcarious pulpal exposures can be treated successfully with vital pulp therapy. A retrospective study of direct pulpcapping by dental students evaluating radiographic outcomes reviewed cases that were pulp-capped at least 3 years previously both from mechanical pulpal exposures and carious exposures.4 The treatment for pulpal exposures was the use of a calcium-hydroxide liner for pulp-capping coveredwith a thicker base and a definitive restorative material. The results indicated a success rate for mechanical exposures of 92.2% and for carious exposed pulps, 33.3%. Larger preparations had less success, Class II (56. 1%) than Class I (83.8%). The clinical implications of this study was that direct pulp-capping was recommended after mechanical exposure with immediate placement of a definitiverestoration while endodontic therapy was the choice of treatment if the pulp exposure was due to caries. Of interest, direct pulp-capping of carious exposures did have some level of success.

There are many factors that can guide the clinician in making the decision to pulp cap or not. First and foremost, the type of pulp exposure plays a critical role in the potential for success—is it a cariousexposure or is it a mechanical or trauma-injury pulp exposure. For each clinical situation, clinical data needs to be collected and evaluated when making a decision, which includes past history of pain, radiographic evaluation, pulp-vitality testing data, what restoration is treatment planned for the tooth, will adjunctive measures be necessary to salvage the tooth (endodontic treatment, crownlengthening, crown vs. an implant) and financial considerations. The goal is to keep the tooth. Pulpcapping of vital mechanical and traumatic exposure of the pulp if the field is kept aseptic can have a reasonable chance of success. To these authors, the choice of direct pulp-capping of carious exposures in vital, asymptomatic permanent teeth and restoring a tooth is a better choice than extraction.Today, finances are a considerable driving force for patients’ treatment decisions. If the patient for financial reasons cannot aff ord endodontic therapy, consideration should be given for vital pulp therapy to retain the tooth. Vital pulp therapy can include direct pulp-capping or performing a pulpotomy covering the root canal orifices with bioactive pulp-capping materials. Successful vitalpulp therapy is dependent on dentin–pulp engineering strategies using materials that have progenitor cell potentials and also interact with other non-progenitor, or “supportive,” cells.5 Under severe caries lesions, progenitor cells may be activated by growth factors released after the acidic dissolution of carious dentin.5 These strategies can lead to dentin regeneration.

Recent studiesevaluating a medicalgrade, calcium-silicate–based material (Biodentine™, Septodont USA, www.Septodontusa.com) and techniques for vital pulp therapy have been very positive. As part of the chemical setting reaction of Biodentine, calcium hydroxide is formed. These studies have evaluated this bioengineered anti-inflammatory direct pulp-capping material histologically. Biodentine demonstrated the ability to...