Biodentine^®: All-In-One Dentine Substitute

Biodentine® is a dentine substitute with multiple clinical applications. In the crown, it can be used for temporary dentine-enamel restoration for up to 6 months, restoration of deep and/or large coronal carious lesions, restoration of cervical or radicular lesions, pulp capping (direct and indirect), and pulpotomy for diagnosed symptoms of reversible or irreversible pulpitis. In the root, Biodentine® can be used for root and furcation perforations, internal/external resorptions, apexification, retrograde surgical filling, and revitalization. 

Biodentine®’s unique combination of therapeutic and restorative properties makes it adequate for filling the tooth from pulp to crown using the Bio Bulk-Fill procedure. As only one material is used, it’s not necessary to use layering and light curing. The final enamel restoration can be placed in the same session, offering greater time-efficiency for practitioners, and fewer visits and less chair time for patients.

* Properties verified by preclinical studies

Biodentine® and Biodentine® XP are both made from the same materials: ultra-pure tricalcium silicate powder, calcium carbonate, zirconium oxide, and a calcium chloride liquid with a water-soluble polymer. Therefore, there is no difference in composition, clinical applications, or benefits.

The key difference between Biodentine® and Biodentine® XP is the method of preparation and delivery. Biodentine® capsules contain the powder component, which must be mixed with the calcium chloride solution using a triturator/amalgamator machine. It creates a paste-like material that is then placed in the tooth with an applicator tool, e.g. spatula. Biodentine® XP comes in a syringe-like cartridge that contains both the Biodentine® liquid and powder components in one. The cartridge is placed in the high-speed Biodentine® XP Mixer to combine the ingredients into a smooth, flowable paste, which is then placed directly into the tooth using the Biodentine® XP Dispenser Gun for crown indications.

Alternatively, you may apply Biodentine® XP with an amalgam carrier, a spatula, or a Root Canal Messing Gun.

Although there is no difference in terms of clinical efficacy, certain applications are generally better suited to one system over the other. Specifically, Biodentine® XP simplifies daily deep cavities restorations with direct placement in the tooth thanks to the Biodentine® XP Dispenser Gun and Biodentine® XP cartridge format.

Biodentine® has an initial setting time of approximately 12 minutes after mixing. It is recommended to wait 12-15 minutes before covering with the final restoration in order for Biodentine® to fully set.

The setting time may vary (from 9 to 25 minutes) depending on certain conditions, including the storage time and storage conditions.

Yes, Biodentine^® can be placed directly over the pulp. Thanks to the high purity of the tricalcium silicate material and the absence of contaminants such as heavy metals, Biodentine^® is a biocompatible medical device, without mutagenic, irritant, or sensitizing potential. Internal studies and clinical experience highlighted that Biodentine^® is very well tolerated by the pulp tissue. Moreover, thanks to its bioactivity*, it promotes a favorable environment for angiogenesis and osteogenesis, thus stimulating the healing process³.

* properties verified by preclinical studies

The Biodentine® powder component comes in a capsule and is composed of:

• Tricalcium silicate, the main ingredient that initiates the setting reaction, releases calcium ions and stimulates dentine repair.
• Calcium oxide, a catalyst.
• Calcium carbonate as filler.
• Zirconium oxide for radiopacity.
• Iron oxides for their characteristic color.

The Biodentine® liquid component comes in an ampoule and contains:

• Calcium chloride
• Polycarboxylate
• Purified water

Biodentine® needs to be mixed at high speed and strength, and should only be mixed in a triturator/amalgamator. Mixing by hand may result in inconsistent material properties, potentially affecting setting and sealing.

Depending on the desired application, Biodentine® can be placed with an amalgam carrier, a spatula (different from the one supplied in the box) or a Messing Root Canal Gun.

Biodentine® is a unique combination of pulp therapeutic and restorative properties in one material, ideal for daily deep cavities restorations with the Bio-Bulk Fill procedures. Some of the materials commonly used for similar indications include:

• Mineral trioxide aggregate (MTA) is another biomaterial that is often used for pulp capping and perforation repairs. Although it displays good biocompatibility and sealing, it does not have the same purity as Biodentine^{® 4}. Further, it has a much longer setting time of up to four hours, is more difficult to handle, and may result in tooth discoloration, as reported in clinical use⁴.

• Calcium hydroxide was traditionally the material of choice for pulp capping. Although it is biocompatible and promotes dentine bridge formation, calcium hydroxide is vulnerable to dissolving and has limited mechanical strength, which can affect sealing⁵ and long term stability, which limit its use for permanent restorations.

• Glass ionomer cement (GIC) is often used for restorations and repairs. It offers good adhesion and resistance to leakage, and also releases fluoride for protection against caries. However, certain limitations may affect its clinical performance. Its relatively low compressive strength and hardness limit its use to lower-stress areas⁶. Additionally, the long-term sealing ability of GIC may be less predictable in some clinical scenarios. Unlike some bioactive materials, GIC does not actively promote pulp healing or dentine formation. Comparative studies have shown that alternative materials such as Biodentine® may induce superior remineralization of caries-affected dentine⁷ and promote a favorable environment for angiogenesis and osteogenesis, thus stimulating the healing process³.

In conclusion, while there are a number of restorative materials on the market, numerous clinical and preclinical studies have reported favorable outcomes with Biodentine® in terms of handling, setting, sealing⁸, biocompatibility⁹, and bioactivity^{3, 10}.