BIOCERAMICS MATERIALS IN

ENDODONTICS

Dr. DEREK S

2ndyr MDS

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

 CONTENTS

• Introduction
• History
• Classification
• Properties
• Bioceramic cements
• Recent developments
• Clinical application
• Conclusion
• References
 INTRODUCTION

• Bioceramics are defined as a type of biomaterial with optimal biocompatibility for

use for medical and dental purposes.
• In Dentistry, Bioceramic materials were introduced in the 1990’s , first as
retrograde filling materials , then as root repair cements.
• Bioceramics are biocompatible, nontoxic, non-shrinking and usually chemically
stable within the biological environment.
• This development of bioceramic based materials has greatly improved the dentist’s
possibilities to successfully treat cases such as pulp capping, pulpotomy,
apexification, apicoectomy and repair of defects caused by accidental perforation
and resorption

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
 HISTORY OF BIOCERAMICS

They are
During the 1960s chemically stable,
and 1970s, these non-corrosive, and
materials were interact well with
developed for use organic tissue Calcium
in the human
L.L Hench et al, in phosphate was
body such as joint
1969, had first used as
replacement,
introduced a new Bioceramics
bone plates, bone
material called restorative dental
cement, artificial
Bio glass and had cement by
ligaments and
observed that LeGeros et al.
tendons, blood
vessel prostheses, several glasses
heart valves, skin and ceramics
repair devices. could bond to
living bone.

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
• In the 1990s, endodontists began using bioceramic-based materials as
retrograde fillings, root canal sealers, and coatings for gutta-percha cones.
• Bioceramics materials also have the benefit of forming hydroxyapatite,
which leads to a connection between the substance and the dentin.
• Mineral trioxide aggregate (MTA) has been acknowledged as the gold-
standard material for a variety of clinical situations since the introduction of
bioceramic materials into clinical endodontics. Because of its exceptional
physico-chemical and biological properties.

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
 CLASSIFICATION

Bioceramics can be classified as:

1. Bio inert: Non interactive with biological systems.

2. Bioactive: Durable tissues that can undergo interfacial
interactions with surrounding tissue.
3. Biodegradable, soluble or resorbable: Eventually
replaces or incorporated into tissue. This is particularly
important with lattice frameworks.

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
 D E S I R A B L E P R O P E RT I E S O F B I O C E R A M I C M AT E R I A L S

Physico-chemical properties

-Short setting time

• The presence of moisture is usually required for bioceramic materials to set. A short setting time can help
facilitate a tight seal between the root canal system and the periodontium, while a long setting time may
result in difficulties with maintaining consistency of the mixture.
-High mechanical strength
• It has been reported that high compressive strength of a root repair material could enable it to withstand
loads tending to deformation and shrinkage.
-High alkaline pH and calcium ion release
• It has been suggested, by both in vitro and in vivo studies, that the mechanism of pulp wound healing by the
deposition of mineralized apatite depends on pH and the ability of calcium ion-release. Moisture facilitates
the hydration reactions of calcium silicates to produce calcium silicate hydrogel and calcium hydroxide,
which partially react with the phosphate to form hydroxyapatite and water .
Atav A, Arıcan B, Olcay K. Bioceramics in Clinical Endodontics. Bioceramics in Endodontics. 2024 Mar 11:71-103.
• Biological properties

• Biocompatibility and Bioactivity

• Materials used in endodontics are frequently placed in intimate contact with the pulp or
periodontium and thus must be non-toxic and biocompatible with host tissues. There are
different in vitro and in vivo tests to evaluate the biocompatibility of dental materials.
• The in vitro tests include evaluating the cytotoxicity profile of potential materials using different
cell lines (DC-27, MDPC-23, Od-21 etc.) and the 3-2,5 diphenyltetrazolium bromide (MTT) assay ,
flow cytometry using cell viability staining , and tests for the ability of cells to grow and
populate on the surface of a material.
• The in vivo tests comprises of usage tests in experimental animals, according to accepted
clinical protocols, followed by histological examination .

Atav A, Arıcan B, Olcay K. Bioceramics in Clinical Endodontics. Bioceramics in Endodontics. 2024 Mar 11:71-103.
 Bioceramics affect the
proliferation, differentiation,
migration, and apoptosis of Bioceramics significantly
stem cells, promote the attachment and
osteoblasts/osteoclasts, survival of stem cells.
dental pulp cells
(DPCs)/periodontal ligament
cells (PDLCs), and immune
cells.
Biodentine, MTA, and
TheraCal LC have good
biocompatibility and can Biodentine induces
induce odontoblastic differentiation
odontogenic/osteogenic of DPSCs through mitogen-
differentiation of MSCs. activated protein kinase
MSCs can be used in bone (MAPK) and calcium-
regeneration and tissue dependent protein kinase II
engineering when combined (CaMKII) pathways .
with calcium phosphate
bioceramics.

Atav A, Arıcan B, Olcay K. Bioceramics in Clinical Endodontics. Bioceramics in Endodontics. 2024 Mar 11:71-103.
• MTA significantly inhibits osteoclastogenesis and osteoclast activity, thereby
inhibiting bone resorption in periapical lesions.

• When a biomaterial is placed into the tissue, immune cells, such as monocytes and
macrophages, respond immediately.

• Macrophages release proinflammatory cytokines, such as TNF-α, IL-1, and IL-12, at

the onset of the acute inflammatory response; anti-inflammatory cytokines, such as
IL-4, are released during tissue regeneration and healing.

• MTA changes the secretion of inflammatory cytokines, participates in leukocyte

recruitment and extravasation, and regulates inflammatory control and tissue
healing in pulpitis and periapical diseases.

Atav A, Arıcan B, Olcay K. Bioceramics in Clinical Endodontics. Bioceramics in Endodontics. 2024 Mar 11:71-103.
 BIOCERAMICS IN ENDODONTICS
C A L C I U M S I L I C AT E B A S E D B I O C E R A M I C S
 PORTLAND CEMENT

• In 1824, Joseph Aspdin patented a product called Portland

cement (PC) obtained from the calcination of the mixture of
limestones coming from Portland in England and silicon-
argillaceous materials. PC is an inexpensive material and
except for the absence of bismuth oxide and higher levels of
calcium aluminate and calcium sulfate, PC and MTA have a
similar main composition
• Particle size- The particle size of white ProRoot MTA is
significantly smaller than white PC both before and after
hydration.
• Bioactivity- Maturation of MTA after hydration is more
structured than PC hence the former displays better bioactivity.
• Antibacterial properties- PC shows antibacterial and
antifungal properties Tomer
similar
AK, Kumarito MTA
S, Rastogi against
D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
• Biocompatibility -Cell culture studies have showed MTA displayed greater

proliferation and migration of stem cells compared to PC .

• Limitations-Higher amount of lead and arsenic released from PC along with

reports of its high solubility compared to MTA has raised questions regarding its

safety with respect to the surrounding tissues .

• Higher solubility may jeopardise the long term seal of the restoration.

• Excessive setting expansion with PC may lead to crack formation with the

tooth. Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
 MINERAL TRIOXIDE AGGREGATE
(MTA)

• Mineral trioxide aggregate (MTA) was first described

in the scientific literature in 1993 as an aggregate of
mineral oxides added to “trioxides” of tricalcium silicate,
tricalcium aluminate, and tricalcium oxide, silicate oxide.
• Dr. Mahmoud Torabinejad at Loma Linda University and his
co-inventor Dean White obtained two US patents for a
Portland cement-based endodontic material, which came
to be known as Mineral Trioxide Aggregate (MTA)

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Mta composition
MTA is comprised primarily of Portland cement

There was just one MTA material made of grey coloured powder (GMTA) available until
2002.
In order to remedy the tooth discolouration brought on by GMTA, white MTA (WMTA) was
released as
Pro Root MTA (Dentsply Endodontics, Tulsa, OK, USA) in that year.
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Setting reaction
MTA sets through an exothermic reaction, requiring
hydration of its powder to produce the cement
paste that matures over time

Most important reactions are tricalcium silicate and

dicalcium silicate reacting with water to produce
calcium silicate hydrates (C-S-H) and calcium
hydroxide [Ca (OH)2].

The bioactivity of MTA is attributed to hydration of

the powder causing Ca+2 dissolution and diffusion,
reaction product formation (CS-H and Ca [OH]2),
and further reactions resulting in apatite formation.

Calcium chloride accelerates the setting reaction

while sodium hypochlorite hinders the formation of
calcium hydroxide.
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Setting time
• The recommended powder liquid ratio for MTA is 3:1.

• The setting time of grey ProRoot MTA was reported by

Torabinejad et al. as 2 hr and 45 min (± 5 min).

• Islam et al. reported final setting times of 140 min (2 h and

20 min) for WMTA, and 175 min (2 h and 55 min) for GMTA.

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Clinical applications

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Advantages

• Forms Calcium Hydroxide that releases calcium ions for cell attachment
and proliferation

• Creates an antibacterial environment by its alkaline pH

• Modulates cytokine production

• Encourages differentiation and migration of hard tissue–producing cells

and forms Hydroxyapatite on the MTA surface and provides a biologic
seal

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
 BIODENTINE

‘Biodentine’ is a calcium silicate based product

which became commercially available in 2009
(Septodont, Saint Maur des Fosses, France). It is a
calcium silicate based product, specifically
designed as a “dentine replacement” material.
Biodentine, known as “dentine in a capsule”,

The material is formulated using the MTA-based

cement technology and the improvement of some
properties of these types of cements, such as
physical qualities and handling.
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Setting reaction-

The setting reaction of Biodentine is similar to MTA with the formation of calcium silicate hydrate
gel(C–S–H) and calcium hydroxide. However, calcium carbonate acts as a nucleation site for
calcium-silicate-hydrate gel, thereby reducing the duration of the induction period, leading to a
faster setting time and enhancing the microstructure.

Setting time-The working time of Biodentine is up to 6 minutes with an initial setting period of 9–
12 minutes and final setting time of 45 minutes.. This is due to the addition of calcium chloride to
the mixing liquid.

Compressive strength-There is a sharp increase in the compressive strength reaching more than
100 MPa in the first hour. Biodentine has the capacity to continue improving with time over several
days until reaching 300 MPa after one month.
This value becomes quite stable and is in the range of the compressive strength of natural dentin
(297 MPa)

Antibacterial activity and pH- Calcium hydroxide ions released from cement during setting
phase of Biodentine increases pH to 12.5 which inhibits the growth of microorganisms and can
disinfect the dentin .

Biocompatibility-Biodentine is non-toxic and has no adverse effects on cell differentiation and

specific cell function. It increases TGF-B1 (growth factor) secretion from pulp cells which causes
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
angiogenesis, recruitment of
Applied progenitor
Dental Sciences. 2020;6(3). cells, cell differentiation and mineralization (42).
 Biodentine > MTA
• Consistency ensures improved handling which is better suited to
the clinical use than MTA.
• 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

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
 BIOAGGREGATE

• Bioaggregate is an endodontic repair calcium silicate

cement, which is considered as a modified version of MTA.
• BioAggregate (Verio Dental Co. Ltd., Vancouver, Canada) is
composed of nano particle sized tricalcium silicate,
tantalum oxide, calcium phosphate, silicon dioxide and
presents improved performance compared with MTA.
• Tricalcium silicate is the main component phase, tantalum
oxide is added as a radiopacifier and it is free of
aluminium.

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Setting reaction- On hydration, the tricalcium
silicate produces calcium silicate hydrate and
calcium hydroxide.

Biocompatibility-Bioactivity was demonstrated by

deposition of hydroxyapatite. The tantalum oxide as
opposed to bismuth oxide was inert, and tantalum
was not leached in solution.

Clinical applications

• Root perforation repair and root resorption repair

Root-end filling
• Apexification
• Pulp capping.

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Differences between MTA and
Bioaggregate-

• As opposed to MTA , BioAggregate does not contain aluminium

and contains additives such as calcium phosphate and silicon
dioxide.

• MTA exhibited the presence of aluminium, while BioAggregate had

phosphorus.
•
• BioAggregate exhibits high calcium ion release early, which is
maintained over the 28-day period as opposed to MTA, which
demonstrated low early calcium ion release which increased as
the material aged.

• BioAggregate is more biocompatible, has bettersealing ability,

higher fracture and acidic resistance than MTA.

• BioAggregate exerts a greater potential to induce odontoblastic

differentiation and mineralization than that of MTA in pulp
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
capping. Applied Dental Sciences. 2020;6(3).
 THERACAL

• Theracal LC is a single paste calcium silicate-based material

promoted by the manufacturer for use as a pulp capping agent
and as a protective liner for use with restorative materials,
cement, or other base materials.
• TheraCal LC in which the setting reaction of the polymerizable
component is light activated.
• TheraCal is a radiopaque light-cure, resin-modified calcium
silicate cement, promoted as a pulp-capping cement with an
ability to stimulate apatite-like precipitates and dentinal
bridging.
 CALCIUM ENRICHED CEMENT

• A novel endodontic cement named calcium-enriched mixture

(CEM) cement was introduced to dentistry in 2006 by Agsary et
al as a tooth-colored, water-based endodontic repair cement
with similar applications to MTA, but with a different chemical
composition.
• It has the ability to promote hydroxyapatite formation in saline
solution and might promote the process of differentiation in
stem cells and induce hard tissue formation.

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
Sealing ability-Its sealing ability as a root-end filling
material was comparable with MTA. However, CEM showed
superior sealing ability compared to MTA in presence of
saliva contaminations.

Antibacterial activity-Antimicrobial properties of CEM

against gram-negative, gram-positive, and cocci/ bacilli
bacteria were compared with MTA and calcium hydroxide
(CH) using agar diffusion test. Results showed comparable
antibacterial effects with CH and significantly better results
than MTA.

Biocompatibility- MTA and CEM showed similar favorable

biological outcomes, and both better than CH especially in
terms of inducing the formation of the dentinal bridge

Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
 E N D O S E Q U E N C E R O O T R E PA I R M AT E R I A L / I R O O T B P P LU S

• EndoSequence root repair material (ERRM) (Brasseler USA, Savannah, GA) is

a new bioceramic material delivered as a premixed mouldable putty (also
labeled as iRoot BP Plus) or as a preloaded paste in a syringe.
Composition
Tri and di calcium silicates (Ca2SiO4)
Monobasic calcium phosphate
(Ca[H2PO4]2)
Zirconium oxide (ZrO2)
Tantalum oxide (Ta2O5)
Proprietary fillers, and thickening agents

• Clinical applications
Perforation repair, apical surgery, apical plug, and pulp capping have been
promoted as suitable uses for ERRM.
Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
 BIOCERAMIC SEALERS

Bioceramic materials contain calcium phosphate which

enhances the setting properties of bioceramics and results in
a chemical composition and crystalline structure similar to
tooth and bone apatite materials, thereby improving sealer-
to-root dentin bonding.

One major disadvantage of these materials is in the difficulty

in removing them from the root canal once they are set for
later retreatment or post-space preparation.

Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
• Bioceramic sealers have the property of hardening only when exposed to
moist environment such as dentinal tubules
• Upon hydration, calcium silicate gel and calcium hydroxide are produced by
the calcium silicates in the powder. The calcium hydroxide reacts with
phosphate ions and produces the precipitation of hydroxyapatite and water.
• The hydroxyapatite that is produced can be used for reconstruction material
and in bone repair as is nontoxic. The continuous interaction of calcium
silicate and water leads to production of calcium silicate hydrate.

Partial reaction of phosphate with calcium silicate hydrogel and calcium hydroxide,
produced through the reaction of calcium silicates in the presence of the dentin’s
moisture, resulting in the formation of hydroxyapatite along the mineral infiltration
zone.

Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
Endosequence BC sealer / iroot SP

• EndoSequence BC Sealer (also known as iRoot

SP root canal sealer) is a premixed ready-to-use
injectable bioceramic cement paste developed
for permanent root canal filling and sealing
applications.

• EndoSequence BC Sealer is an insoluble,

radiopaque and aluminum-free material based
on a calcium silicate composition, which requires
the presence of water to set and harden.

Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
MTAfillapex
MTA Fillapex (Angelus SolucoesOdontologicas,
Londrina, PR, Brazil) is a recently introduced
calcium silicate-based bioceramicsealer .

MTA Fillapex was created in an attempt to combine

the physico-chemical properties of a resin-based
root canal sealer with the biological properties of
MTA.

Composition
The composition of MTA Fillapex after mixture is
mineral trioxide aggregate, salicylate resin, natural
resin, bismuth, and silica.

Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
BioRoot RCS
tricalcium silicate-based sealer introduced in
2015, BioRoot RCS (Septodont, SaintMaur- des-
Fosses, France). It is a water-based sealer.

Composition
Bioroot is composed of tricalcium silicate and
zirconium oxide.

• BioRoot RCS releases calcium hydroxide

after setting, which was absent in MTA
Fillapex.
• BioRoot RCS leaches high levels of calcium
exhibiting double the calcium ion leaching
compared with EndoSequence BC Sealer. It
also forms a calcium phosphate phase when
in contact with physiologic solution.
Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
Setting time:

As proposed by the manufacturer, working time is

10 mts and setting time is 4 mts.

Biological property

BioRoot RCS has less toxic effects on periodontal

ligament cells than Pulp Canal Sealer (SybronEndo,
Orange, CA, USA) and induced secretion of
angiogenic and osteogenic growth factors
indicating a higher bioactivity than Pulp Canal
Sealer.

Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal
of Oral Care and Research. 2021 Apr 1;9(2):59-62.
Ceraseal
• CeraSeal (Meta Biomed Co., Cheongju, Korea) is
a newly launched premixed endodontic sealer
containing calcium silicates, zirconium oxide,
and thickening agent.

• Moisture in the dentinal tubules and calcium

silicate’s chemical reaction produce
crystallization of calcium hydroxide.

• The material is dimensionally stable, does not

shrink or expand in the root canal. Due to the
shorter setting time, the material is highly
resistant to the washout.

• CeraSeal induce a high degree of Ca2+ release.

This product characteristically cures slowly by
absorbing the ambient water inside the root
canal.
 RECENT DEVELOPMENTS

1. The Use of hydraulic calcium silicate cements (HCSCs) for

revitalization

• MTA has been the material of choice for most cases of revitalization
in immature teeth after pulp necrosis and used to cover the blood
clot.
• Regardless of its clinical success over a long number of years, MTA
has several drawbacks
• To overcome these disadvantages, optimized formulations of HCSCs
have been introduced.

Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in
endodontics. Journal of translational medicine. 2023 Nov 25;21(1):853
2. Bioceramic-coated(bc)gutta-percha
points for root canal obturation

• There is still the lack of solid scientific evidence that BC gutta-

percha points in conjunction with hydraulic calcium silicate–
based cements ensure significantly better root canal sealing in
comparison to conventional gutta-percha and hydraulic
calcium silicate cements fillings.
• It has been claimed that standard gutta-percha points can be
used with BC Sealer or TotalFill, but for a tight, gap-free seal,
manufacturers recommend use BC Points .
• BC Points are impregnated and coated with bioceramic
nanoparticles to allow for bonding with BC Sealer producing
the uniform monoblock inside the root canal space.

Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in
endodontics. Journal of translational medicine. 2023 Nov 25;21(1):853
3. Temporary bioceramic–based root
canal dressing materials
The calcium hydroxide was the material of choice for
the interappointment root canal filling used to maximize
the root canal disinfection.

The BIO-C TEMP is the first ready-to-use bioceramic-

based paste for intracanal dressing.

The indications for use are intracanal dressing for

endodontic treatment in teeth with pulp necrosis and
retreatments—intracanal dressing in teeth with
perforations, external and internal resorptions, prior to
the use of root repair materials or the apexification
procedures.
Composition- calcium silicates,
The material is biocompatible and ready for use, has calcium aluminate, calcium oxide,
high alkalinity (pH is 12 ± 1), and radiopacity (9 mm of calcium tungstate, and titanium
the aluminum). The paste is launched in 0.5 g syringes oxide.
and can be delivered into the root canal via plastic tip
cannula, attached to the syringe.
Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in
endodontics. Journal of translational medicine. 2023 Nov 25;21(1):853
C L I N I C A L A P P L I C AT I O N O F B I O C E R A M I C S I N
ENDODONTICS
Pulp capping

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
Perforation Repair

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
Regenerative Endodontic Treatment

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
Apexification

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
Root-End Filling

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
Root Canal Therapy

Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar
 CONCLUSIONS

• Bioceramics such as MTA have been demonstrated to possess excellent

bioactivity and biocompatibility, and have been widely used in the clinical
practice of endodontics.
• With the development of materials, more and more bioceramics other than MTA
have been developed, such as Biodentine, BioAggregate, CEM, and BioRoot
RCS.
• These new materials are used in root-end filling, root canal therapy, VPT,
apexification/RET, perforation repair, and root defect repair. They have been
proven to have comparable or even better clinical outcomes than MTA through
numerous clinical trials, in vitro experiments, and case reports.
 REFERENCES

• Dong X, Xu X. Bioceramics in endodontics: updates and future perspectives. Bioengineering. 2023 Mar 13;10(3):354.
• Kusek ER, Kaur R, Jacobson W, Home CE, Series CE, Receipts M, Tarquini G, Comitz E, Shows AP, Big HB, Long
Established OM. The Increased Use of Bioceramics in Endodontics. Human Resources. 2025;2:7.
• Chopra V, editor. Bioceramics in Endodontics. John Wiley & Sons; 2024 Mar 12.
• Atav A, Arıcan B, Olcay K. Bioceramics in Clinical Endodontics. Bioceramics in Endodontics. 2024 Mar 11:71-103.
• Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in
endodontics. Journal of translational medicine. 2023 Nov 25;21(1):853
• Wang X, Xiao Y, Song W, Ye L, Yang C, Xing Y, Yuan Z. Clinical application of calcium silicate-based bioceramics in
endodontics. Journal of translational medicine. 2023 Nov 25;21(1):853.
• Tomer AK, Kumari S, Rastogi D, Cecilia LL, Singh S, Tyagi A. Bioceramics in Endodontics-A Review. Int Journal of
Applied Dental Sciences. 2020;6(3).
• Raghavendra SS, Jadhav GR, Gathani KM, Kotadia P. Bioceramics in endodontics–a review. Journal of Istanbul
University Faculty of Dentistry. 2017 Dec 2;51(3 Suppl 1):128-37.
• Jitaru S, Hodisan I, Timis L, Lucian A, Bud M. The use of bioceramics in endodontics-literature review. Clujul medical.
2016 Oct 20;89(4):470.
• Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review. International Journal of
• Mangat P, Azhar S, Singh G, Masarat F, Yano N, Sah S. Bioceramics in endodontics: A review.
International Journal of Oral Care and Research. 2021 Apr 1;9(2):59-62.
• Wang Z, Shen Y, Haapasalo M. Antimicrobial and antibiofilm properties of bioceramic materials in
endodontics. Materials. 2021 Dec 10;14(24):7594.
• Alnujaym M, Almotiri A, Alsubaie A, Alradhyan N, Otain O, Rehan A. Application of bioceramic
materials in endodontic therapy: a brief review. Int. J. Med. Dev. Ctries. 2022 Jan 5;6(1):201-5.
• Chellapandian K, Reddy TV, Venkatesh V, Annapurani A. Bioceramic root canal sealers: A review.
Int J Heal Sci. 2022;6:S3.
• Darade L, Ranjan S, Singh GB, Gangadhar BV, Vandekar M, Rathi AG. Bioceramic A Futuristic
Boon in Endodontics: A Review. International Journal of Health Sciences.(I):9934-42.
• Nur Usta S, Valderrama Baca MP, Arias Moliz MT, Baca García MP. Research trends on
bioceramics in endodontics: A bibliometric analysis from 2001 to 2020.
• Joshi C. Bioceramic Materials in Endodontics: Innovations for Root Canal Filling. Endodontics
Beyond Basics: Navigating New Frontiers in Root Canal Therapy. 2022 Mar 13:20.
• Navalagunda PS, Prasad BK. Bioceramic materials: a review. Int J Sci Res (IJSR). 2023;12:1620-
5.
THANKYOU