Catapult Education Reviewers were asked to evaluate Septodont’s Biodentine® a bioactive material made from the patented ABS technology - Active Biosilicate.
With a more conservative approach to dentistry taking hold through out the industry these advancements in materials and technologies allow clinicians to save teeth with a more moderate method. When dealing with deep carious or root lesions, clinicians can now change their focus from endodontic treatment, post and cores and deep-cut full coverage restorations to, possibly, achieving pulpal health by restoring more conservatively.
When evaluating Septodont’s Biodentine® it was primarily reviewed for its use in direct pulp caps, indirect pulp caps. Additional uses include repairing root perforations, pulpotomies, root resorption and deep caries bases. Catapult reviewers overwhelmingly reported positive feedback for Biodentine. 85% would recommend Biodentine to a colleague.
In situations when dentin has been compromised, whether from decay, resorption, or mechanical perforation, or when previous restorative options have been limited; Calcium hydroxide bases have long been used to stimulate dentin formation but their weak physical properties have been a drawback. Only 60% of our evaluators report using Dycal or MTA, which begs the question how are teeth with deep carious lesions and root lesions are being treated? With more aggressive treatments options, comes the cost of loss of tooth structure and the risk of the loss of the tooth. Could we instead opt for more conservative options such as pulp caps, root repairs, or other resorption repairs? Could we be ultimately be saving many teeth that could are being put at risk?
Biodentine, by Septodont, is a calcium silicate restorative dentin substitute, and helps maintain pulpal vitality and stimulate formation of tertiary dentin. It is indicated to be used on both the crown portion of the tooth and on the roots. With its physical properties; compressive strength, elasticity and hardness, similar to dentin and with the reparative stimulation from calcium hydroxide ion release, it is an excellent choice for direct pulp capping, indirect pulp capping, pulpotomies, furcation repair and resorption repair. Biodentine’s bioactivity is what makes it a superior clinical choice over calcium hydroxides bases and glass ionomers.
Case: Indirect pulp cap on deep carious lesion.
The patient is 26-year- old female with several missing teeth and gross decay of several others. She has neglected her dental care due to limited access and financial duress. The lower right second molar had previously been restored with amalgam. The amalgam had partially fractured out and there was a deep carious lesion with close proximity to the pulp: figure 1.
The tooth was asymptomatic. The pulp tested vital with traditional pulp testing. Because of the deep decay and proximity to the pulp, I previously would have considered endodontically treating this tooth and then restoring with a passive post and core then a full coverage crown.
The patient was anesthetized with an inferior alveolar block with 4%Septocaine(1:100,000epi). Isolation with obtained with a rubber dam. The remaining amalgam restoration with removed with a highspeed and carbide bur. The deep distal caries was excavated completely with a #6 round carbide bur with low torque. A very thin layer of dentin was left remaining over the pulp: figure 2.
A traditional matrix band was placed. Biodentine was prepared, triturated and placed in a layer over the thin dentin: figure 3.
The Biodentine was allowed to set for its 12 minute set time. The preparation was then refined and cleaned. 37%phosphoric acid was applied for 15 seconds as a total etch on the enamel, dentin and Biodentine. The etchant was then rinsed off. Adhesive was applied, air thinned and cured. A low stress bulk fill flowable was placed and topped with a universal composite resin then finished and polished: figure 4.
Thus, this tooth has been restored and the pulp has been left intact and vital. The Biodentine layer acting as a indirect pulp cap and dentin replacement, will presumably stimulate tertiary dentin formation and keep this pulp healthy. Considerable tooth structure has been saved and the longterm prognosis much improved. This makes me feel like a dental hero….saving this young patient’s tooth from endodontic and crown treatment.
For use, the liquid component is added to the capsule. The capsule is then triturated for 30 seconds. The material, a malleable paste, is applied to the tooth with the supplied disposable small spatula. The set time is 12 minutes. Some evaluators cited the mixing and handling as challenging. The set time may seem little time consuming by today’s instantaneous standards but the biostimulating activity with the associated clinical benefits of dentin stimulation and maintenance of pulpal vitality warrant the clinical time.
Overall, Catapult Reviewers reported a short term success rate of 95% with direct and indirect pulp caps. Pulpal health is maintained and reparative dentine is stimulated. More conservative restorations can be placed and more natural tooth structure can be maintained. Biodentine earns the ‘Catapult Vote of Confidence’.