Bioceramics in Endodontics: Updates and Future Perspectives

Abstract

Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.

Effect of obturation technique on dentinal tubule penetration of two tricalcium silicate–based sealers: Ex vivo study

“…The former has a chemical composition of calcium phosphate, tricalcium silicate, colloidal silicon dioxide, dicalcium silicate and calcium hydroxide, is highly alkaline, has antibacterial properties, no polymerisation shrinkage, is a bioactive material, insoluble to tissue body fluid after curing [8]. The latter active components are calcium silicates, calcium phosphate, zirconium oxide, tantalum oxide and thickeners [9].…”

Vital Pulp Therapy in Permanent Teeth Diagnosed with Symptomatic Irreversible Pulpitis: Reports with Long-Term Controls

“…However, recent clinical studies have shown that MTA and calcium silicate-based cements yield better results when treating deep carious lesions with exposed pulps, leading to favorable outcomes. Additionally, calcium silicate materials possess properties of cellular biocompatibility [ 13 , 14 ] and bactericidal effects [ 15 ].…”

Management of a Previously Failed Root Perforation Repair with Geristore and Deepithelialized Gingival Graft: A 5-Year Follow-Up Case Report

“…Given the severity of root perforations, the ideal repair material should excel in sealing, osteogenesis, and cementogenesis, while also being biocompatible, bacteria-resistant, and cost-effective [ 2 , 10 ]. Although no single material meets all these criteria, several bioceramics, including mineral trioxide aggregate (MTA), biodentine, EndoSequence, BioAggregate, and calcium-enriched mixture (CEM), have ushered in a transformative era in endodontics [ 10 – 13 ]. MTA, the pioneer in this field since its introduction in 1993, offers excellent sealing and biocompatibility due to its hydrophilic particles like tricalcium silicate [ 14 , 15 ].…”

“…Biodentine builds on this foundation with enhanced adaptability, particularly in challenging root conditions [ 12 ]. EndoSequence adds stability and biocompatibility with its blend of calcium silicate and calcium phosphate, while BioAggregate offers resilience under varying pH conditions [ 12 , 13 , 16 ]. CEM is notable for its calcium-rich formula, which may enhance hydroxyapatite formation near the exposed periodontium [ 13 ].…”

“…EndoSequence adds stability and biocompatibility with its blend of calcium silicate and calcium phosphate, while BioAggregate offers resilience under varying pH conditions [ 12 , 13 , 16 ]. CEM is notable for its calcium-rich formula, which may enhance hydroxyapatite formation near the exposed periodontium [ 13 ]. Amidst these repair materials, Geristore® emerges as a noteworthy addition.…”