Bioceramics in Endodontics

List of Contributors xv

Foreword by Professor Nutayla Said Al Harthy xix

Foreword by Stephen Cohen xxi

Preface xxiii

Acknowledgments xxv

About the Companion Website xxvii

1 Bioceramics in Dentistry 1
Vineeta Nikhil, Sachin Gupta, Shikha Jaiswal, and Padmanabh Jha

1.1 Introduction 2

1.2 History and Evolution of Bioceramics 3

1.3 Classification of Bioceramics 4

1.3.1 Based on Generations 4

1.3.2 Based on Tissue Interaction 5

1.3.3 Based on Structure 5

1.3.4 Based on Composition 6

1.3.5 Based on Resorbability 6

1.3.6 Based on Their Location-Specific Use in Endodontology 7

1.4 Forms of Bioceramics 7

1.4.1 Alumina 7

1.4.2 Zirconia 7

1.4.3 Hydroxyapatite (HA) 8

1.4.4 Calcium Phosphate 8

1.4.5 Mineral Trioxide Aggregate 8

1.4.6 Biodentine 9

1.5 Physicochemical Properties of Bioceramics 9

1.5.1 Portland Cement 9

1.5.2 ProRoot MTA 10

1.5.3 MTA Angelus 12

1.5.4 Biodentine 12

1.5.5 BioAggregate 14

1.5.6 Ceramicrete 14

1.5.7 Calcium-Enriched Mixture Cement 15

1.5.7.1 Physical Properties 15

1.5.7.2 Antibacterial Activity 16

1.5.7.3 Sealing Ability 16

1.5.8 EndoSequence Root Repair Material 16

1.5.8.1 Setting and Working Time 16

1.5.8.2 pH Value 16

1.5.8.3 Microhardness 17

1.5.8.4 Bioactivity 17

1.5.8.5 Sealing Ability 17

1.5.8.6 Antibacterial Activity 17

1.5.9 iROOT 17

1.5.9.1 Physical Properties 18

1.5.10 Endo-CPM 18

1.5.10.1 Physical Properties 18

1.6 Physicochemical Properties of Some Bioinert Bioceramics 20

1.6.1 Alumina (High Purity Dense Alumina/Al2O3) 20

1.6.2 Zirconia 20

1.7 Biological Properties of Bioceramics 21

1.7.1 Cytological Investigation of Biocompatibility 21

1.7.2 Subcutaneous and Intraosseous Implantation 23

1.7.3 Periradicular Tissue Reactions 23

1.7.4 Pulpal Reactions 24

1.7.5 Antibacterial Properties 26

1.8 Application of Bioceramics in Dentistry 26

1.9 Advantages of Bioceramics 28

1.9.1 Regenerative Endodontic Therapy 29

1.9.2 Advantages of BCs When Used as a Sealer/Obturating Material 29

1.10 Limitations 30

1.11 Future Trends 30

1.12 Conclusion 32

References 32

2 Calcium Silicate-Based Dental Bioceramics: History, Status, and Future 43
Abubaker Qutieshat, Shahab Javanmardi, and Gurdeep Singh

2.1 Introduction 44

2.2 Bioceramics: The What and the Why 45

2.3 Endodontic Repair Materials with Ideal Properties 45

2.4 Calcium Silicate-based Materials: A Look Back in History 45

2.5 Chemical Properties 48

2.5.1 Heavy Metal Contamination 52

2.5.2 Setting Reaction 53

2.6 Synthetic Calcium Silicates 55

2.6.1 Biodentine 55

2.6.2 BioAggregate 55

2.6.3 EndoSequence 56

2.6.4 iRoot BP Plus 56

2.6.5 NeoMTA Plus 57

2.6.6 BioRoot RCS 57

2.7 Technical Report 57

2.7.1 Methods 57

2.7.1.1 Flame Emission Spectroscopy 58

2.7.1.2 X-ray Diffraction 59

2.7.2 Results 60

2.8 Recommendations for Implementation 61

2.9 Conclusion 64

References 64

3 Bioceramics in Clinical Endodontics 71
Ayfer Atav, Burçin Arican, and Keziban Olcay

3.1 Introduction 72

3.2 Classification of Hydraulic Cements in Endodontics 73

3.2.1 Type 1 Hydraulic Cements 73

3.2.1.1 ProRoot MTA 73

3.2.2 Type 2 Hydraulic Cements 75

3.2.2.1 MTA Angelus 76

3.2.2.2 MTA Bio 77

3.2.2.3 MM-MTA™ 77

3.2.3 Type 3 Hydraulic Cements 78

3.2.3.1 EndoSeal MTA 78

3.2.3.2 MTA Fillapex 78

3.2.3.3 TheraCal LC 79

3.2.3.4 TheraCal PT 80

3.2.4 Type 4 Hydraulic Cements 80

3.2.4.1 BioAggregate 81

3.2.4.2 Biodentine™ 82

3.2.4.3 BioRoot RCS 83

3.2.4.4 MTA BIOREP 84

3.2.4.5 Bio-C Pulpo 84

3.2.4.6 MTA Repair HP 85

3.3 Conclusion 93

References 93

4 Bioceramics: Root-End Filling Material 105
Sanjay Miglani, Swadheena Patro, Ankita Mohanty, and Antarikshya Das

4.1 Introduction 106

4.2 Microsurgical Endodontics 106

4.3 History 107

4.4 Properties of Root-End Filling Material 108

4.5 Bioceramic Materials 108

4.5.1 Mineral Trioxide Aggregate 108

4.5.2 Bioaggregate 111

4.5.3 Biodentine 112

4.5.4 iRoot BP Plus Bioceramic Putty 112

4.5.5 Capasio 112

4.5.6 Calcium-Enriched Material 113

4.5.7 EndoSequence 114

4.5.8 EndoBinder 115

4.5.9 Generex A 116

4.5.10 Quick-Set 117

4.5.11 Ceramicrete-D 118

4.5.12 Bioglass 119

4.6 Conclusion 121

References 121

5 Bioceramics as an Apical Plug 129
Riccardo Tonini and Marilu’ Garo

5.1 Apical Plug 129

5.2 MTA Apical Plug Outcome 131

5.3 Other Apical Plug Materials 132

5.4 Apical Plug Technique 133

5.4.1 In the First Session 133

5.4.2 In the Second Session 133

5.4.3 Extra-Apical Resorbable Barriers 135

5.4.4 Apical Sounding Technique Procedure 137

5.5 Complex Clinical Cases 141

References 147

6 Regeneration in Endodontics with Clinical Cases 153
Abhishek Parolia, Maya Feghali, and Catherine Ricci

6.1 Introduction 153

6.2 Factors Affecting the Clinical Outcome of REP 155

6.2.1 Etiology 155

6.2.2 Type of the Tooth 155

6.2.3 Induction of Bleeding and Blood Clot 156

6.2.4 Disinfection of the Root Canal System 156

6.2.5 Coronal Barrier 157

6.3 Materials used for REP 157

6.4 Key Points to Remember While Performing REPs 159

References 164

7 Management of Deep Caries with Bioceramics 169
Antonis Chaniotis and Viresh Chopra

7.1 Introduction 169

7.2 Patient Information 170

7.2.1 Tooth 170

7.3 Treatment Plan 170

7.4 Learning Objectives 172

References 172

8 Regenerative Management of an Infected Pulp of a Permanent Tooth Using Bioceramics 173
Antonis Chaniotis and Viresh Chopra

8.1 Introduction 173

8.2 Patient Information 174

8.2.1 Tooth 174

8.3.1 First Visit 175

8.3.2 Second Visit 176

8.3.3 Recall 177

8.4 Learning Objectives 177

References 177

9 Endodontic Management of a Necrosed Pulp with Wide Open Apex 179
Antonis Chaniotis and Viresh Chopra

9.1 Introduction 179

9.2 Patient Information 180

9.2.1 Tooth 180

9.3 Treatment Plan 180

9.4 Technical Aspects 181

9.4.1 First Visit 181

9.4.2 Second Visit 182

9.5 Learning Objectives 183

References 184

10 Clinical Application of Bioceramics as Direct Pulp Capping Material 185
Antonis Chaniotis and Viresh Chopra

10.1 Introduction 185

10.2 Patient Information 186

10.2.1 Tooth 186

10.3 Treatment Plan 187

10.4 Technical Aspects 188

10.5 Learning Objectives 188

References 188

11 Sealer-Based Obturations Using Bioceramics in Nonsurgical Root Canal Treatments 189
Garima Poddar, Ajay Bajaj, and Viresh Chopra

11.1 Introduction 190

11.2 Case 1 192

11.2.1 Patient Information 192

11.2.2 Details of the Tooth 192

11.2.3 Radiographic Evaluation of Tooth Number 35 Revealed the Following 193

11.2.4 Diagnosis 193

11.3 Treatment Plan 193

11.4 Treatment Done 194

11.4.1 Instrumentation Protocol 194

11.4.2 Irrigation Protocol 194

11.4.3 Obturation Protocol 195

11.4.4 Post Endodontic Restoration 196

11.4.5 Rationale on the Treatment Protocol and the Material Used 196

11.5 Learning Objectives for the Readers 196

11.6 Case 2 196

11.6.1 Patient Information 196

11.6.2 Details of the Tooth 197

11.6.2.1 Clinical Examination Findings 197

11.6.2.2 Preoperative Radiological Assessment 197

11.6.3 Diagnosis 198

11.7 Treatment Plan 200

11.8 Treatment Done 202

11.8.1 Instrumentation Protocol 202

11.8.2 Irrigation Protocol 203

11.8.3 Obturation Protocol 204

11.8.4 Post Endodontic Phase 205

11.8.5 Rationale on the Treatment Protocol and the Material Used 206

11.9 Learning Objectives for the Readers 206

11.10 Case 3 206

11.10.1 Patient Information 206

11.10.2 Details of the Tooth 206

11.10.3 Preoperative Radiological Assessment 207

11.10.4 Diagnosis 207

11.11 Treatment plan 207

11.12 Treatment Done 207

11.12.1 Instrumentation Protocol 207

11.12.2 Irrigation Protocol 208

11.12.3 Obturation Protocol 209

11.12.4 Post Endo Restorative Phase 211

11.12.5 Rationale on the Treatment Protocol and the Material Used 211

11.13 Learning Objectives for the Readers 211

11.14 Discussion 211

References 212

12 BioConeless Obturation 215
Francesca Cerutti and Calogero Bugea

12.1 Introduction 215

12.2 Why BioConeless? 217

12.2.1 BioConeless: Indications 221

12.2.2 BioConeless: How to Do It? 224

12.2.3 Concerns Regarding the Complete Filling of the Root Canal with the Coneless and BioConeless Techniques 231

12.2.4 Concerns Regarding the Consistency of the Obturation 234

12.2.4.1 Time Required to Complete the Obturation 234

12.3 Final Remarks 234

12.4 Learning Objectives 235

References 235

13 Primary Endodontic Treatment using ProTaper Ultimate and AH Plus Bioceramic Sealer 239
Viresh Chopra and Harneet Chopra

13.1 Introduction of the Case 239

13.1.1 Patient Information 239

13.1.2 Tooth 240

13.2 Treatment Procedure for the First Appointment 241

13.3 Treatment Procedure for the Second Appointment 242

13.3.1 Irrigation Protocol 244

13.4 Technical Aspects 244

13.4.1 Follow up 244

13.5 Learning Objectives 244

14 Management of Failed Root Canal Treatment in an Anterior Tooth Using Calcium Silicate Cement 247
Viresh Chopra and Ajinkya Pawar

14.1 Introduction of the Case 247

14.1.1 Patient Information 248

14.1.2 Diagnosis (Pulpal and Periapical) 249

14.1.2.1 Advice 249

14.2 Treatment Plan 249

14.2.1 Treatment Procedure for the First Appointment 249

14.2.2 Treatment Procedure for the Second Appointment 250

14.2.3 Irrigation Protocol 252

14.2.3.1 Materials Used for Obturation 252

14.3 Technical Aspects 252

14.3.1 Follow-up 253

14.4 Learning Objectives 253

15 Apexification of a Traumatic Central Incisor with an Apical Plug Technique using Calcium Silicate Cement 255
Viresh Chopra, Harneet Chopra, and Aylin Baysan

15.1 Introduction of the Case 256

15.1.1 Patient Information 256

15.1.2 Tooth Information 256

15.1.2.1 Identification 256

15.1.2.2 Dental History 256

15.1.2.3 Clinical Examination Findings 256

15.1.2.4 Diagnosis (Pulpal and Periapical) 256

15.1.2.5 Advice 256

15.2 Treatment Plan 256

15.2.1 Treatment Procedure for the First Appointment 257

15.2.2 Treatment Procedure for the Second Appointment 258

15.2.3 Treatment Procedure for the Third Appointment 258

15.2.3.1 Irrigation Protocol 259

15.3 Technical Aspects 259

15.3.1 Follow-up 261

15.4 Learning Objectives 261

15.5 Conclusion 261

16 Coneless Obturations: Bioceramics as Obturating Materials 263
Viresh Chopra and Maryam Hasnain

16.1 Introduction 264

16.2 Introduction of the Case 264

16.2.1 Patient Information 264

16.2.2 Tooth Information 265

16.2.2.1 Identification 265

16.2.2.2 Dental History 265

16.2.2.3 Diagnosis (Pulpal and Periapical) 266

16.2.2.4 Advice 266

16.3 Treatment Plan 266

16.3.1 Treatment Procedure for the First Appointment 266

16.3.2 Treatment Procedure for the Second Appointment 268

16.3.2.1 Irrigation Protocol 269

16.4 Technical Aspects 269

16.5 Learning Objectives 270

16.6 Conclusion 271

References 271

17 Selective Management of a Case With Complicated Internal Morphology 273
Gergely Benyocs and Viresh Chopra

17.1 Introduction of the Case 273

17.1.1 Patient Information 274

17.1.2 Tooth Information 274

17.1.2.1 Identification 274

17.1.2.2 Dental History 274

17.1.2.3 Investigations 274

17.1.2.4 Diagnosis (Pulpal and Periapical) 276

17.1.2.5 Advice 276

17.2 Treatment Plan 276

17.2.1 Treatment Procedure for the First Appointment 276

17.2.2 Treatment Procedure for the Second Appointment 277

17.2.2.1 Irrigation Protocol 277

17.3 Technical Aspects 279

17.4 Learning Objectives 279

17.5 Conclusion 280

18 Retreatment of a Maxillary Molar With Complex Internal Morphology 281
Gergely Benyocs and Viresh Chopra

18.1 Introduction of the Case 282

18.2 Patient Information 282

18.2.1 Tooth Information 282

18.2.1.1 Identification 282

18.2.1.2 Dental History 282

18.2.1.3 Investigations 282

18.2.1.4 Diagnosis (Pulpal and Periapical) 282

18.2.1.5 Advice 282

18.3 Treatment Plan 282

18.3.1 Treatment Procedure for the First Appointment 283

18.3.2 Treatment Procedure for the Second Appointment 284

18.3.2.1 Irrigation Protocol 285

18.4 Technical Aspects 287

18.5 Learning Objectives 288

18.6 Conclusion 288

Index 289