Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates. Used in dentistry for Filling up bony defects Root repair materials Apical fill materials Aids in regeneration etc. Bioinert: non-interactive with biological systems (Alumina, zirconia) Bioactive: durable tissues that can undergo interfacial interactions with surrounding tissue (bioactive glasses, bioactive glass ceramics, hydroxyapatite, calcium silicates) Biodegradable: soluble or resorbable, eventually replaced or incorporated into tissue (Tricalcium phosphate, Bioactive glasses).

1. BIOCERAMIC IN DENTISTRY
PRESENTED BY-
DR. NAKUL PATIDAR
DEPT. OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
SARVAPALLI RADHAKRISHNAN UNIVERSITY
BHOPAL, MADHYA PARADESH

2. CONTENTS
 Introduction
 Classification
 Bioceramic in endodontics
 Calcium silicate based
 Portland
 MTA
 Biodentine
 Mixuture of calcium silicate and phosphate
 Calcium enriched mixture
 Endosequence
 Conclusion

3. INTRODUCTION
 Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics,
Hydroxyapatite, resorbable Calcium phosphates.
 Used in dentistry for
 Filling up bony defects
 Root repair materials
 Apical fill materials
 Aids in regeneration etc.

4. CLASSIFICATION
 Bioinert: non-interactive with biological systems (Alumina, zirconia)
 Bioactive: durable tissues that can undergo interfacial interactions with
surrounding tissue (bioactive glasses, bioactive glass ceramics,
hydroxyapatite, calcium silicates)
 Biodegradable: soluble or resorbable, eventually replaced or
incorporated into tissue (Tricalcium phosphate, Bioactive glasses).

5. ADVANTAGES
 Excellent biocompatibility
 Intrinsic osteoinductive capacity
 Function as a regenerative scaffold
 Excellent hermetic seal
 Good radiopacity
 Antibacterial properties

6. BIOCERAMIC IN ENDODONTICS
 CALCIUM SILICATE BASED –
 CEMENTS-
 Portland Cement,
 Mineral trioxide aggregate (MTA),
 Biodentine (Septodont, France)
 SEALERS –
 Endo CPM Sealer (EGO SRL, Buenos Aires, Argentina)
 MTA Fillapex (Angelus, Brazil),
 BioRoot RCS (Septodont, France)
 TechBiosealer (Profident, Kielce, Poland).

7. BIOCERAMIC IN ENDODONTICS
 CALCIUM PHOSPHATES/ TRICALCIUM PHOSPHATE/ HYDROXYAPATITE
BASED
 Mixture of calcium silicates and calcium phosphates –
 i-Root SP (Innovative Bioceramix Inc., Vancouver, Canada),
 EndoSequence BC Sealer (Brasseler, Savannah, GA, USA)/
 Bioaggregate (Innovative Bioceramix Inc., Vancouver, Canada)
 Capseal I and II

8. CALCIUM SILICATE BASED BIOCERAMICS
Portland Cement
 In 1824, Joseph Aspdin patented - Portland cement (PC) obtained from
the calcination of the mixture of lime stones.
 Inexpensive
Limitation:-
 PC released- Higher amount of lead and arsenic released
 Higher solubility
 Excessive setting expansion

9. PORTLAND VS MTA
PORTLAND CEMENT MTA
Discoloration Higher
Solubility Higher
Bioactivity Higher
Particle size Larger Smaller
Antibacterial
properties
Similar Similar
Sealing ability Similar Similar
Biocompatibility Similar Similar
Biomineralization Better

10. MTA
 Dr.Torabinejad in 1993.
 Osseoconductive , inductive and biocompatible
 Types-
 White MTA
 Grey MTA
 Composition
 Indication

11. MTA
Physical properties:-
Compressive strength- 40-65 Mpa (24 hr – 21 days)
Setting reaction-
Exothermic reaction
Tricalcium silicate & Dicalcium silicate + Water
Calcium silicate hydrates (C-S-H) & calcium hydroxide [Ca (OH) 2]

12. MTA
Powder Liquid ratio- 3:1
Setting time:-
Initial setting time- 165 min (Pathways of pulp; cohen’s 11 th edition)
Final setting time- less than 6 hours (Pathways of pulp; cohen’s 11 th edition)
pH-
Initial-10.2
Final-12.5
References- Parirokh M, Torabinejad M. Calcium silicate–based cements in mineral trioxide aggregate: Properties and clinical applications. Hoboken,
NJ, USA: John Wiley & Sons, 2014.

13. Push bond strength:-
5.2-9.0 Mpa (24 hr- 7 days) {Aggarwal V et al.)
Sufficient thickness (4 mm) offer more resistance than lesser one (1mm)
Flexural strength:-
14.26 Mpa (Walker et al)
Microleakage:-
Good sealing ability
Reference- Walker MP, Diliberto A, Lee C. Effect of setting conditions on mineral trioxide aggregate flexural strength. J Endod
2006;32(4):334-336.

14.  Particle size- White MTA finer particle
 Biocompatibility
 Non-mutagenic
 Non-neurotoxic
 Anti-inflammatory effects on pulp tissue
 Cementoconductive
 Cementoinductive
 Osteoconductive

15. DISADVANTAGE OF MTA
 Limitations-Long setting time
 Difficult handling and high cost
 Potential tooth discoloration.
 Absence of a known solvent for this material
 Difficulty of its removal after placement

16. MTA FILLAPEX
 Two paste system
 Adiitionally contain-
 Salicylate resin
 Diluent resin
 Silica
 Bismuth oxide
 Film thickness- 24 um
 Flow- 25,29 mm

17. BIODENTINE (CALCIUM SILICATE CEMENT)
Calcium silicate cement- Introduced by Septodent -2009
Setting reaction- Similar to MTA
 Calcium carbonate acts as a nucleation gel
 Hydrosoluble polymer- improve handling and decrease viscosity
 Working time- 6 min
 Setting time-
Initial – 9-12 min
Final - 45 min

18. BIODENTINE OVER MTA
 Biodentine has
 Ensures improved handling
 Exhibits better mechanical properties than MTA.
 Does not require a two-step restoration procedure as in the case of MTA.
 As the setting is faster, there is a lower risk of bacterial contamination than
with MTA.

19. CALCIUM PHOSPHATE BASED
 1971, Hench developed
 Triple calcium phosphate compound used in bony defect
 Bioglass= Calcium and phosphate + Glass ceramic
 Chemically bounded
 Classification
 Porosity- Dense/Porous
 Resorbability- Non Resorabable/ Resorabable
 Used as bone graft material and pulp capping, sealer
 Limitation- lack of strength, fracture during load bearing condition

20. CALCIUM PHOSPHATE BASED SEALER
 Capseal I
 Capseal II
 Adv-
 Less cytotoxicity and inflammatory mediators promote bone regeneration as root canal
sealers.
 Facilitate the periapical dentoalveolar and alveolar healing.
 Diadv- Capseal I is not biocompatible.

21. MIXTURE CA SILICATE & CA PHOSPHATE
 BIOAGGREGATE
 Composition-
 Nanoparticle size tricalcium silicate
 Tatalum oxide
 Calcium phosphate
 Silicon dioxide
 Biocompatibility- demonstrated by deposition of hydroxyapetidde

22. DIFFERENCE BTW MTAAND BIOAGGREGATE
MTA BIOAGGREGATE
Composition D/F Aluminium Phosphorus
Calcium ion release Low early ion release High early ion release
Reactivity Higher Slower
Biocompatibility Less More
Sealing ability Less More
Fracture resistance Less More
Acidic resistance Less More
Reference- Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P. Bioceramics in endodontics–a review. Journal of Istanbul University
Faculty of Dentistry. 2017;51(3 Suppl 1):S128.

23. ENDOSEQUENCE ROOT REPAIR MATERIAL/
i-Root SP
 i-Root SP
 Calcium silicate, monobasic calcium phosphate, zirconium oxide, tantalum oxide
and filler agents
 Working time- 30 min
 Setting time- 4 hrs
 Leakage is more than MTA (Hischberg CS et al)
 ERRM similar bacterial activity as MTA
 Its biocompatible
Reference- Hirschberg CS, Patel NS, Patel LM, Kadouri DE, Hartwell GR. Comparison of sealing ability of MTA and EndoSequence
Bioceramic Root Repair Material: a bacterial leakage study. Quintessence Int. 2013 May 1;44(5):e157-62.

24. CROSS REFERENCES
 A systematic review intended to compare the biocompatibility and sealing ability of
mineral trioxide aggregate (MTA) and biodentine as root-end filling material.
 12 In-vitro study included
 Biocompatibility- 2 article- biodentine better, 2 article- comparable
 Sealing ability- 6 article- biodentine better, 1 article MTA is better, 1 article comparable
 Conclusion- good sealing ability of biodentine along with its favorable biological
properties show that materials can be used competently in clinical practice.
Solanki NP, Venkappa KK, Shah NC. Biocompatibility and sealing ability of mineral trioxide aggregate and biodentine
as root-end filling material: A systematic review. Journal of conservative dentistry: JCD. 2018 Jan;21(1):10.

25. USE OF BIOCERAMIC
 Repair, retrograde filling, pulpotomy, resorption,
 Apexification, regenerative endodontics.
 Restorative uses- Dentin substitute, pulp capping,
 Dentin hypersensitivity, dentin remineralization.
 Prosthetic uses- Prosthetic device
 Surgical uses – joint replacements, fill surgical bone

26. CONCLUSION
 While MTA was the benchmark in bioceramic materials advances have constantly tried to
overcome disadvantages and improve its properties.
 Bioceramics now have a wide array of applications both in endodontic and restorative
dentistry.
 An up-to-date knowledge of these new bioactive materials is essential to ensure the selection
of the most suitable material in different clinical situations.

27. REFERENCES
1. Textbook of Pathways of pulp (Cohens, 11 edition)
2. Textbook of Endodontics (Ingles, 6 th edition)
3. Texbook of Endodontic practice (Grossman, 13 edition)
4. Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P. Bioceramics in endodontics–a review.
Journal of Istanbul University Faculty of Dentistry. 2017;51(3 Suppl 1):S128.
5. Parirokh M, Torabinejad M. Calcium silicate–based cements in mineral trioxide aggregate:
Properties and clinical applications. Hoboken, NJ, USA: John Wiley & Sons, 2014.
6. Tyagi S, Mishra P, Tyagi P. Evolution of root canal sealers: An insight story. European
Journal of General Dentistry. 2013 Sep 1;2(3):199.

28. 7. Solanki NP, Venkappa KK, Shah NC. Biocompatibility and sealing ability of mineral
trioxide aggregate and biodentine as root-end filling material: A systematic review.
Journal of conservative dentistry: JCD. 2018 Jan;21(1):10.

29. THANK YOU