Bioceramics in Endodontics

Abstract

One of the advances in the field of Endodontics in recent years is the introduction of Bioceramic Technology. There are many advantages of Bioceramics in Endodontics and these are principally a result of their physical properties. Bioceramics are exceedingly biocompatible and non toxic. They are chemically stable within the biological environment. The aim of this article is to explore the potential applications of Bioceramics in Endodontics.

Keywords: Bioactive glass, Biocompatible ceramics, Biocompatible glass ceramics, Calcium Silicates.

INTRODUCTION

The field of dentistry is constantly changing and so is the case with Endodontics. New techniques and technological advances have enabled majority of dentists to produce excellent endodontic results. Among these developments, the introduction of advanced material science is particularly significant. In the past few years we have witnessed significant changes in Endodontic material science. The scenario has now been enriched with the increased use of Bioceramic technology in Endodontics. The aim of this paper is to assess the potential application of Bioceramic technology in Endodontics.

BIOCERAMIC TECHNOLOGY

The term “Bioceramics” refers to biocompatible ceramic materials, applicable for biomedical or dental use.1 “Bioceramics” include Alumina and Zirconia, bioactive glass, glass ceramics, calcium silicates, coatings and composites, hydroxyapatite and resorbable calcium phosphates, and radiotherapy glasses.2 Bioceramics are widely used for Orthopedic applications such as joint or tissue replacements and for coatings to improve the biocompatibility of metal implants.3 Additionally, porous ceramics such as calcium phosphate based materials have been used for filling bone defects.2 Even some basic calcium silicates such as ProRoot MTA (Dentsply) have been used in dentistry as root repair materials and for apical retrofills.2

The Importance of Physical properties of Bioceramics in dental applications:

Bioceramics are exceedingly biocompatible and nontoxic. They are chemically stable within the biological environment. They do not shrink. In fact, upon completion of the setting process, they expand slightly. Another important factor is that if overfill occurs during the obturation process or in a root repair, Bioceramics will produce little, if any, inflammatory response. Furthermore, the material has the ability (during the setting process) to form hydroxyapatite and form a chemical bond between dentin and the appropriate filling materials.

APPLICATION OF BIOCERAMIC TECHNOLOGY IN ENDODONTICS

1. Bioceramic Sealer: Bioceramics are exceedingly being used as root canal sealers. Some of the Bioceramic sealers introduced are Endosequence BC Sealer (Brasseler USA, Savannah, Georgia), iRoot SP and iRoot BP (IBC, Canada).

Some of the specific advantages of a Bioceramic if used as an endodontic sealer are:

• All Bioceramic sealers have enhanced biocompatibility and are insoluble in tissue fluids.
• They do not shrink.
• They do not resorb.
• Achieve extremely good hermetic seal.
• Ease of use. (The particle size is so small that it can be used in a syringe).
• High pH (12.9) during the setting process which is strongly antibacterial.3 The antibacterial effect might be a combination of high pH, hydrophilicity, and active calcium hydroxide diffusion.4
• Following obturation, potential increased strength of the root.

The Bioceramic sealer is Calcium phosphate silicate based cement. It utilizes the water inherent in the dentinal tubules to drive the hydration reaction of the material, thereby shortening the setting time.3 Dentine is composed of approximately 20% (by volume) water (Pashley, 1996).5 It is this water which initiates the setting of the material thus forming hydroxyapatite. Furthermore, Kossev and Stefanov in their article note “The use of bioceramic -based sealers with their features-osseoconductivity, hydrophylity, adhesiveness and chemical bonding to root canal dentinal walls-appears to be an effective approach to eliminate on long term, the microspace, otherwise remaining between the root canal walls and the materials filling the root canal. Such microspace is a potential place for possible microbial growth, because of microleakage observed with other kind of sealers.”6

2. Bioceramic coated Gutta Percha cones: Bioceramic coated Gutta Percha cones (BC gutta percha) are now available. Used along with Bioceramic sealer the bioceramic glass particles create a good bond. That does not mean that retreatment is not possible with bioceramic technology. The key is using bioceramics as a sealer, not a filler.7 The real asset in retreating Bioceramic cases is to use an ultrasonic with a copious amount of water.8 On reaching half the canal length add a solvent to the canal. Then hand files can be used followed by rotary file for Gutta Percha removal.

3. As root repair material: New root repair material like EndoSequence Root Repair material comes premixed and thus is easy to use. It is an insoluble, radiopaque and aluminium-free material based on a Calcium Phosphate Silicate composition.7

Its advantages are:

• High pH (> 12.5)
• Excellent biocompatibility.
• High resistance to washout.
• It has a compressive strength of 50-70 MPa, which is similar to that of current root canal repair materials, Pro Root MTA (Dentsply) and Bio Aggregate (Diadent).7 However a significant advantage of this material is that it comes premixed in a syringe and thus is easy to use.

4. As Pulp Capping Material: Bioceramic material is available in the following forms: as a sealer in a premixed syringe, as a root repair material also in a premixed syringe and as pre mixed putty in a glass jar.9 Direct pulp caps can be done by premixed putty.

Technique for a direct pulp cap with the bioceramic putty is as follows:

• Isolate the tooth under rubber dam.
• Place the bioceramic putty over the exposure site.
• Place a thin layer of GIC over the pulp cap.
• Restore it with composite material (conventional Sandwich technique).

5. In Apexifications: Bioceramic root repair material can be used for performing apexifications. Syringeable root repair material is used to fill the apical portion of the root canal first. Then X ray verification is done followed by complete filling of the canal with the same material.

6. Surgical applications of Bioceramics: As previously mentioned the Bioceramic root repair material is available in two different modes: one is syringeable root repair material and the other is premixed putty. Both can be used for perforation repairs, resorption defects and for apical retrofills. When using the putty, simply remove a small amount from the room temperature jar and knead it for a few seconds with a spatula or in your gloved hands.8 Then create an oblong shape and place a section of it with a sterile instrument where needed. After placing the putty into the apical preparation (or defect), simply wipe with a moist cotton ball and finish the procedure.8 The syringeable root repair material is delivered by the syringe.

CONCLUSION

For a skilled practitioner, focus should be on retaining the natural dentition whenever possible. Saving teeth is now more feasible with the introduction of Bioceramic technology in Endodontics. Moreover the use of Bioceramics in Endodontics significantly helps us perform better quality Endodontics than ever before.

REFERENCES