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 Arıcan, 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 Benyo""cs 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 Benyo""cs 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"