Recent Research in Science and Technology 2012, 4(6): 25-27

ISSN: 2076-5061
Available Online: http://recent-science.com/

Bioactive materials used in endodontics

Deeksha Grotra* and C V Subbarao**
Department of Conservative Dentistry and Endodontics, Saveetha University,Chennai, India.
Abstract
The field of biocompatibility is interdisciplinary and draws all knowledge from material science, bioengineering, biochemistry
and other fields. Dentistry shares concern about biocompatibility with other fields of medicine. In the development of any
biomaterial one must consider strength, aesthetics and functional aspects of the material as well as biocompatibility. Various
materials are being used in endodontic therapy in clinical practice which include calcium hydroxide, zinc oxide eugenol, resin
sealers, glass ionomer cement, composite resins, amalgam etc. These materials are widely accepted as biomaterials and
each has got special properties which makes it an effective material of choice in root canal therapy. Various new bioactive
materials are available in todays time like mineral trioxide aggregate, bioactive glass, bioaggregate etc. This paper highlights
the properties and clinical application of the new biomaterials in endodontic therapy.
Keywords: Mineral trioxide aggregate, Bioactive glass, Bioaggregate, Bioceramics, Endodontic therapy
The basic principle of endodontic treatment is to preserve,
restore and retain the teeth for esthetic and functional purpose in the
dental arch.
For the past few decades there has been an tremendous
improvement in the field of biomatierials and their application in
endodontic treatment. Various materials have been tried for root
canal filling but none of them fulfiled the properties as an ideal root
filling material.
Bioactivity is defined as the ability of a material to elicit a
response in a living tissue. Various bioactive materials tried in
endodontics are: Mineral trioxide aggregate, Bioactive glass,
Bioaggregate. Recent research in biomaterials on Mineral Trioxide
Aggregate, Bioactive glass and bioaggregate has shown promising
results in clinical practice.
Mineral trioxide aggregate
Mineral Trioxide Aggregate was introduced by Dr Torabinajed
in 1993. It is established as osseo conductive, inductive, and
biocompatible. This material was developed and recommended
initially as a root-end filling material and subsequently has been used
for pulp capping, pulpotomy, apexogenesis, apical barrier formation
in teeth with open apexes, repair of root perforations, and as a root
canal filling material.23
Mineral Trioxide Aggregate powder contains fine hydrophilic
particles that set in the presence of moisture. It is currently marketed
in two forms: gray and white. Because of its discoloration white
mineral trioxide aggregate was developed. The primary differences
between both types of mineral trioxide aggregate and Portland
cement are a lack of potassium and the presence of bismuth oxide.
Received: April 17, 2012; Revised: May 19, 2012; Accepted: June 25, 2012.
*Corresponding Author
Deeksha Grotra
Department of Conservative Dentistry and Endodontics, Saveetha
University,Chennai, India.
Tel: +91-9840213779
Email: deeksha9@hotmail.com

Gray mineral trioxide aggregate basically consists of dicalcium and

tricalcium silicate and bismuth oxide, whereas white mineral trioxide
aggregate is primarily composed of tricalcium silicate and bismuth
oxide3.
When mineral trioxide aggregate powder is mixed with water,
calcium hydroxide (CH) and calcium silicate hydrate are initially
formed and eventually transform into a poorly crystallized and porous
solid gel. The precipitated calcium produces calcium hydroxide,
which is the cause of mineral trioxide aggregates high alkalinity after
hydration24.
It is an active biomaterial with the potential to interact with the
natural fluids present in tissues2. Bismuth oxide provides radiopacity.
It is present in both hydrated and nonhydrated Mineral trioxide
aggregate and is also a part of calcium silicate hydrate3. The mean
setting time of mineral trioxide aggregate is 1655 minutes, which is
longer than amalgam, Super EBA, and intermediate restorative
material (IRM)24. The long setting time is one of the major drawbacks
of the material. The compressive strength of mineral trioxide
aggregate is significantly less than that of amalgam, IRM, and Super
EBA after 24 hours19, 24. However, after three weeks, there is no
significant difference between Super EBA, IRM, and mineral trioxide
aggregate in terms of compressive strength24.
The hydration rate of dicalcium silicate is slower than that of
tricalcium silicate, hence the compressive strength and push-out
bond strength of mineral trioxide aggregate reach their maximum
several days after mixing24. The degree of solubility of mineral
trioxide aggregate is a matter of debate among investigators, most
investigations reported low or no solubility for mineral trioxide
aggregate. However, increased solubility is reported in a long-term
study24. The pH value of Mineral trioxide aggregate is 10.2 after
mixing and it rises to 12.5 at 3 hours24.
A number of biocompatible and mutagenicity studies have
confirmed that Mineral trioxide aggregate is a biocompatible
material2. In fact, the results of a meta-analysis on Mineral trioxide
aggregate showed that Mineral trioxide aggregate is more
biocompatible than Super EBA, IRM, and silver amalgam.

Grotra and Subbarao

26

Bioactive glass
Bioactive glasses (BIOACTIVE GLASSs), as opposed to most
technical glasses, are characterized by the materials reactivity in
water and in aqueous liquids. The bioactivity of bio active glass is
derived from their reactions with tissue fluids, resulting in the
formation of a hydroxycarbonate apatite (hydroxyapatite) layer on the
glass. When bio active glass are brought into contact with body fluids
a rapid leach of Na+ and congruent dissolution of Ca2+, PO4 3- and
Si4+ takes place at the glass surface. A polycondensated silica-rich
(Si-gel) layer is formed on the glass bulk, which then serves as a
template for the formation of a calcium phosphate (Ca/P) layer at its
outer surface. Eventually, the Ca/P crystallizes into hydroxyapatite,
the composition of which corresponds to that of bone. Because of
this phenomenon and their good biocompatibility bio active glass
were introduced in dentistry.
Bioactive glass is currently regarded as the most
biocompatible material in the bone regeneration field because of its
bioactivity, osteoconductivity (a scaffolds ability to support cell
attachment and subsequent bone matrix deposition and formation)
and even osteoinductivity (a scaffold that encourages osteogenic
precursor cells to differentiate into mature bone-forming cells).
However, the formulation of bioactive glass has been limited to bulk,
crushed powders and micronscale fibers
The application of bioactive glass and glass-ceramics has been
widely documented over the past twenty years but the high modulus
and low fracture toughness has made them less applicable for
clinical, load bearing, applications7.
There have been many variations on the original composition
which was Food and Drug Administration (FDA) approved and
termed Bioglass. Compositions are listed below.
45S5: 46.1 mol% SiO2, 26.9 mol% CaO, 24.4 mol% Na2O
and 2.5 mol% P2O5. Bioglass
58S: 60 mol% SiO2, 36 mol% CaO and 4 mol% P2O5.
S70C30: 70 mol% SiO2, 30 mol% CaO.
Recent advances in nanomaterials fabrication have given
access to complex materials such as SiO(2)-Na(2)O-CaO-P(2)O(5)
bioactive glasses in the form of amorphous nanoparticles of 20- to
60-nm size. The clinically interesting antimicrobial properties of
commercially available, micron-sized bioactive glass 45S5 have
been attributed to the continuous liberation of alkaline ions during
application8
Bioactive glass nanopowders could be considered as good
candidates for the treatment of oral bone defects and root canal
disinfection14. Antibacterial effect of the glasses increased with
increasing pH and concentration of alkali ions and thus with
increased dissolution tendency of the glasses6.
The changes in the concentrations of Silicon, Calcium,
Magnicium, Phosphorus ions did not show statistically significant
influence on the antibacterial property30. Bioactive glasses showed
strong antibacterial effects for a wide selection of aerobic bacteria at
a high sample concentration (100 mg/mL)6.
Bioactive glass exhibits antimicrobial efficacy, the addition of
powdered enamel and dentin in aqueous suspension definitely
enhanced this property. However, the addition of enamel powder
bioactive glass did not significantly alter its antimicrobial efficacy
compared to bioactive glass + dentin powder11.
Bioactive glasses have a directly and an indirectly pH-related

antibacterial effect. The effect not directly linked to pH is because of

ion release rather than mineralization26.
BioAggregate
BioAggregate Root Canal Repair Material is a biocompatible
pure white powder composed of ceramic particles. Upon mixing, the
hydrophilic BioAggregate Powder promotes cementogenesis and
forms a hermetic seal inside the root canal. It is effective in clinically
blocking the bacterial infection, its ease of manipulation and superior
quality makes bioaggregate the most innovative and unique root
canal repair material.
It is indicated in: repair of root perforation, repair of root
resorption, root end filling, apexification, pulp capping
Biocompatibility
BioAggregate is more biocompatible than any other root end
filling and repair materials. It does not produce any adverse side
effects on microcirculation of the connective tissue. It also has
excellent biocompatibility with the vital periradicular tissue.
Working Time & Setting Time
The working time is at least 5 minutes. Upon mixing a thick
paste-like mixture is formed. If additional working time is required,
simply cover the mixture with a moist gauze sponge while
unattended
Bioceramics
Bioceramics are ceramic materials specifically designed for
use in medicine and dentistry. They include alumina and zirconia,
bioactive glass, glass ceramics, coatings and composites,
hydroxyapatite and resorbable calcium phosphates, and
radiotherapy glasses.
The properties of bioceramics are very useful in both
medicine and dentistry. In addition to being non-toxic, bioceramics
are bioinert, bioactive, biodegradable, soluble or resorbable:
Bioceramics will not result in an inflammatory response if an
over fill occurs during the obturation process or in a root repair. A
further advantage is its ability to form hydroxyapatite and to create a
bond between dentin and the appropriate filling materials.
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