SpringerLink
Log in

Clinical Application of BiodentineTM in Regenerative Endodontics/Revitalization

  • Chapter
  • First Online:
Biodentine™

  • 744 Accesses

Abstract

A regenerative endodontic procedure or revitalization is a biology-based treatment alternative to the apexification and apical plug in immature teeth with pulp necrosis. Although a fairly new approach, sound evidence has been generated in in vitro, in vivo and clinical studies, and recommendations have been published from the leading endodontic societies. After thorough disinfection, a blood clot is induced inside the root canal, which can support new tissue formation and healing. Whereas the treatment does not generally result in regeneration of the dentine-pulp complex, repair can take place via ectopic tissue formation where apposition of mineral and strengthening of fracture-prone dentine walls are possible outcomes. The current treatment protocols recommend to cover the blood clot with a hydraulic calcium silicate cement, followed by an adhesive restoration. Whereas mineral trioxide aggregate (MTA) has been widely used for this application, Biodentine offers advantages both from a handling perspective and minimal discolouration potential. This chapter describes the indication and procedural details of revitalization, expected outcome and potential benefits for the patient along with the materials that are used during treatment with a particular focus on hydraulic calcium silicate cements as cap** material.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (Canada)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (Canada)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (Canada)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (Canada)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: revitalization procedures. Int Endod J. 2016;49:717–23.

    Article  PubMed  Google Scholar 

  2. Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51:1367–88.

    Article  PubMed  Google Scholar 

  3. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010;36:536–41.

    Article  PubMed  Google Scholar 

  4. Jung IY, Lee SJ, Hargreaves KM. Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series. J Endod. 2008;34:876–87.

    Article  PubMed  Google Scholar 

  5. Shin SY, Albert JS, Mortman RE. One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report. Int Endod J. 2009;42:1118–26.

    Article  PubMed  Google Scholar 

  6. Topçuoğlu G, Topçuoğlu HS. Regenerative endodontic therapy in a single visit using platelet-rich plasma and Biodentine in necrotic and asymptomatic immature molar teeth: a report of 3 cases. J Endod. 2016;42:1344–6.

    Article  PubMed  Google Scholar 

  7. Botero TM, Tang X, Gardner R, Hu JCC, Boynton JR, Holland GR. Clinical evidence for regenerative endodontic procedures: immediate versus delayed induction? J Endod. 2017;43:S75–81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, Lu J, Yang M, Ling J. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. J Endod. 2017;43:1821–7.

    Article  PubMed  Google Scholar 

  9. Arslan H, Ahmed HMA, Şahin Y, Doğanay Yıldız E, Gündoğdu EC, Güven Y, Khalilov R. Regenerative endodontic procedures in necrotic mature teeth with periapical radiolucencies: a preliminary randomized clinical study. J Endod. 2019;45:863–72.

    Article  PubMed  Google Scholar 

  10. Jiang X, Liu H, Peng C. Clinical and radiographic assessment of the efficacy of a collagen membrane in regenerative endodontics: a randomized, controlled clinical trial. J Endod. 2017;43:1465–71.

    Article  PubMed  Google Scholar 

  11. Santos LGPD, Chisini LA, Springmann CG, Souza BDM, Pappen FG, Demarco FF, Felippe MCS, Felippe WT. Alternative to avoid tooth discoloration after regenerative endodontic procedure: a systematic review. Braz Dent J. 2018;29:409–18.

    Article  PubMed  Google Scholar 

  12. Tong HJ, Rajan S, Bhujel N, Kang J, Duggal M, Nazzal H. Regenerative endodontic therapy in the management of nonvital immature permanent teeth: a systematic review-outcome evaluation and meta-analysis. J Endod. 2017;43:1453–64.

    Article  PubMed  Google Scholar 

  13. Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod. 2017;43:1806–20.

    Article  PubMed  Google Scholar 

  14. Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017;18:139–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17:185–7.

    Article  PubMed  Google Scholar 

  16. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30:196–200.

    Article  PubMed  Google Scholar 

  17. Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010;36:56–63.

    Article  PubMed  Google Scholar 

  18. da Silva LA, Nelson-Filho P, da Silva RA, Flores DS, Heilborn C, Johnson JD, Cohenca N. Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs’ teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:779–87.

    Article  PubMed  Google Scholar 

  19. Lin LM, Shimizu E, Gibbs JL, Loghin S, Ricucci D. Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod. 2014;40:291–5.

    Article  PubMed  Google Scholar 

  20. Nikita B, Ruparel NB, Chrepa V, Gibbs J. Revascularization of immature necrotic teeth. Curr Oral Health Rep. 2017;4(4):319–29.

    Article  Google Scholar 

  21. Andreasen JO, Bakland LK. Pulp regeneration after non-infected and infected necrosis, what type of tissue do we want? A review. Dent Traumatol. 2012;28(1):13–8.

    Article  PubMed  Google Scholar 

  22. Torabinejad M, Corr R, Buhrley M, Wright K, Shabahang S. An animal model to study regenerative endodontics. J Endod. 2011;37(2):197–202.

    Article  PubMed  Google Scholar 

  23. Dissanayaka WL, Zhu X, Zhang C, ** L. Characterization of dental pulp stem cells isolated from canine premolars. J Endod. 2011;37(8):1074–80.

    Article  PubMed  Google Scholar 

  24. Yamauchi N, Nagaoka H, Yamauchi S, Teixeira FB, Miguez P, Yamauchi M. Immunohistological characterization of newly formed tissues after regenerative procedure in immature dog-teeth. J Endod. 2011;37(12):1636–41.

    Article  PubMed  Google Scholar 

  25. Shimizu E, Jong G, Partridge N, Rosenberg PA, Lin LM. Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure. J Endod. 2012;38(9):1293–7.

    Article  PubMed  Google Scholar 

  26. Martin G, Ricucci D, Gibbs JL, Lin LM. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod. 2013;39(1):138–44.

    Article  PubMed  Google Scholar 

  27. Nazzal H, Kenny K, Altimimi A, Kang J, Duggal MS. A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi-antibiotic paste. Int Endod J. 2018;51:e204–15.

    Article  PubMed  Google Scholar 

  28. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM. An update on clinical regenerative endodontics. Endod Top. 2013;28:2–23.

    Article  Google Scholar 

  29. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010;36:1086–91.

    Article  PubMed  Google Scholar 

  30. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J. 2009;42:84–92.

    Article  PubMed  Google Scholar 

  31. Kirchhoff AL, Raldi DP, Salles AC, Cunha RS, Mello I. Tooth discolouration and internal bleaching after the use of triple antibiotic paste. Int Endod J. 2015;48:1181–7.

    Article  PubMed  Google Scholar 

  32. Shimizu E, Ricucci D, Albert J, Alobaid AS, Gibbs JL, Huang GT, Lin LM. Clinical, radiographic, and histological observation of a human immature permanent tooth with chronic apical abscess after revitalization treatment. J Endod. 2013;39:1078–83.

    Article  PubMed  Google Scholar 

  33. Chaniotis A. Treatment options for failing regenerative endodontic procedures: report of 3 cases. J Endod. 2017;43:1472–8.

    Article  PubMed  Google Scholar 

  34. Fouad AF. The microbial challenge to pulp regeneration. Adv Dent Res. 2011;23:285–9.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nagata JY, Soares AJ, Souza-Filho FJ, Zaia AA, Ferraz CC, Almeida JF, Gomes BP. Microbial evaluation of traumatized teeth treated with triple antibiotic paste or calcium hydroxide with 2% chlorhexidine gel in pulp revascularization. J Endod. 2014;40:778–83.

    Article  PubMed  Google Scholar 

  36. Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative endodontics: a systematic analysis of the failed cases. J Endod. 2019;45(5):567–77.

    Article  PubMed  Google Scholar 

  37. Verma P, Nosrat A, Kim JR, Price JB, Wang P, Bair E, Xu HH, Fouad AF. Effect of residual bacteria on the outcome of pulp regeneration in vivo. J Dent Res. 2017;96:100–6.

    Article  PubMed  Google Scholar 

  38. Martin DE, De Almeida JF, Henry MA, Khaing ZZ, Schmidt CE, Teixeira FB, Diogenes A. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod. 2014;40:51–5.

    Article  PubMed  Google Scholar 

  39. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012;38:1372–5.

    Article  PubMed  Google Scholar 

  40. Galler KM, Buchalla W, Hiller KA, Federlin M, Eidt A, Schiefersteiner M, Schmalz G. Influence of root canal disinfectants on growth factor release from dentin. J Endod. 2015;41:363–8.

    Article  PubMed  Google Scholar 

  41. Galler KM, Widbiller M, Buchalla W, Eidt A, Hiller KA, Hoffer PC, Schmalz G. EDTA conditioning of dentine promotes adhesion, migration and differentiation of dental pulp stem cells. Int Endod J. 2016;49:581–90.

    Article  PubMed  Google Scholar 

  42. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, Iwaku M. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29:125–30.

    Article  PubMed  Google Scholar 

  43. Takushige T, Cruz EV, Asgor Moral A, Hoshino E. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J. 2004;37:132–8.

    Article  PubMed  Google Scholar 

  44. Thibodeau B, Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent. 2007;29:47–50.

    PubMed  Google Scholar 

  45. Cehreli ZC, Isbitiren B, Sara S, Erbas G. Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series. J Endod. 2011;37:1327–30.

    Article  PubMed  Google Scholar 

  46. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45:294–305.

    Article  PubMed  Google Scholar 

  47. Chugal N, Mallya SM, Kahler B, Lin LM. Endodontic treatment outcomes. Dent Clin N Am. 2017;61(1):59–80.

    Article  PubMed  Google Scholar 

  48. Cotti E, Mereu M, Lusso D. Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case. J Endod. 2008;34:611–6.

    Article  PubMed  Google Scholar 

  49. Kontakiotis EG, Filippatos CG, Tzanetakis GN, Agrafioti A. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod. 2015;41(2):146–54.

    Article  PubMed  Google Scholar 

  50. Kim Y, Kim S, Shin YS, Jung I-Y, Lee SJ. Failure of setting of mineral trioxide aggregate in the presence of fetal bovine serum and its prevention. J Endod. 2012;38(4):536–40.

    Article  PubMed  Google Scholar 

  51. Kang JS, Rhim EM, Huh SY, Ahn SJ, Kim DS, Kim SY, et al. The effects of humidity and serum on the surface microhardness and morphology of five retrograde filling material. Scanning. 2012;34(4):207–14.

    Article  PubMed  Google Scholar 

  52. Camilleri J. Mineral trioxide aggregate: present and future developments. Endod Topics. 2015;32(1):31–46.

    Article  Google Scholar 

  53. Nekoofar MH, Oloomi K, Sheykhrezae MS, Tabor R, Stone DF, Dummer PMH. An evaluation of the effect of blood and human serum on the surface microhardness and surface microstructure of mineral trioxide aggregate. Int Endod J. 2010;43(10):849–58.

    Article  PubMed  Google Scholar 

  54. Nekoofar MH, Stone DF, Dummer PMH. The effect of blood contamination on the compressive strength and surface microstructure of mineral trioxide aggregate. Int Endod J. 2010;43(9):782–91.

    Article  PubMed  Google Scholar 

  55. Camilleri J. Color stability of white mineral trioxide aggregate in contact with hypochlorite solution. J Endod. 2014;40(3):436–40.

    Article  PubMed  Google Scholar 

  56. Marciano MA, Costa RM, Camilleri J, Mondelli RFL, Guimarães BM, Duarte MAH. Assessment of color stability of white mineral trioxide aggregate angelus and bismuth oxide in contact with tooth structure. J Endod. 2014;40(8):1235–40.

    Article  PubMed  Google Scholar 

  57. Vallés M, Mercadé M, Durán-Sindreu F, Bourdelande JL, Roig M. Color stability of white mineral trioxide aggregate. Clin Oral Investig. 2013;17(4):1155–9.

    Article  PubMed  Google Scholar 

  58. Guimarães BM, Tartari T, Marciano MA, Vivan RR, Mondeli RFL, Camilleri J, et al. Color stability, radiopacity, and chemical characteristics of white mineral trioxide aggregate associated with 2 different vehicles in contact with blood. J Endod. 2015;41(6):947–52.

    Article  PubMed  Google Scholar 

  59. Felman D, Parashos P. Coronal tooth discoloration and white mineral trioxide aggregate. J Endod. 2013;39(4):484–7.

    Article  PubMed  Google Scholar 

  60. Yoldaş SE, Bani M, Atabek D, Bodur H. Comparison of the potential discoloration effect of bioaggregate, Biodentine, and white mineral trioxide aggregate on bovine teeth: in vitro research. J Endod. 2016;42(12):1815–8.

    Article  PubMed  Google Scholar 

  61. Schembri Wismayer P, Lung CYK, Rappa F, Cappello F, Camilleri J. Assessment of the interaction of Portland cement-based materials with blood and tissue fluids using an animal model. Sci Rep. 2016;6(1):34547–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Keskin C, Demiryurek EO, Ozyurek T. Color stabilities of calcium silicate-based materials in contact with different irrigation solutions. J Endod. 2015;41(3):409–11.

    Article  PubMed  Google Scholar 

  63. Camilleri J. Staining potential of Neo MTA Plus, MTA Plus, and Biodentine used for pulpotomy procedures. J Endod. 2015;41(7):1139–45.

    Article  PubMed  Google Scholar 

  64. Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview—part II: other clinical applications and complications. Int Endod J. 2018;51(3):284–317.

    Article  PubMed  Google Scholar 

  65. Meschi N, Li X, Van Gorp G, Camilleri J, Van Meerbeek B, Lambrechts P. Bioactivity potential of Portland cement in regenerative endodontic procedures: from clinic to lab. Dent Mater. 2019;35(9):1342–50.

    Article  PubMed  Google Scholar 

  66. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992;8(2):45–55.

    Article  PubMed  Google Scholar 

  67. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011;37:133–8.

    Article  PubMed  Google Scholar 

  68. Sonoyama W, Liu Y, Yamaza T, Tuan RS, Wang S, Shi S, Huang GT. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod. 2008;34:166–71.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Diogenes A, Ruparel NB, Shiloah Y, Hargreaves KM. Regenerative endodontics: a way forward. J Am Dent Assoc. 2016;147:372–80.

    Article  PubMed  Google Scholar 

  70. Nagas E, Uyanik MO, Cehreli ZC. Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report. Restor Dent Endod. 2018;43:e31.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Saoud TM, Martin G, Chen YH, Chen KL, Chen CA, Songtrakul K, Malek M, Sigurdsson A, Lin LM. Treatment of mature permanent teeth with necrotic pulps and apical periodontitis using regenerative endodontic procedures: a case series. J Endod. 2016;42:57–65.

    Article  PubMed  Google Scholar 

  72. Paryani K, Kim SG. Regenerative endodontic treatment of permanent teeth after completion of root development: a report of 2 cases. J Endod. 2013;39:929–34.

    Article  PubMed  Google Scholar 

  73. Xuan K, Li B, Guo H, Sun W, Kou X, He X, Zhang Y, Sun J, Liu A, Liao L, Liu S, Liu W, Hu C, Shi S, ** Y. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci Transl Med. 2018;10:455.

    Article  Google Scholar 

  74. Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, Matsushita K. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther. 2017;8(1):61.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Brizuela C, Meza G, Urrejola D, Quezada MA, Concha G, Ramírez V, Angelopoulos I, Cadiz MI, Tapia-Limonchi R, Khoury M. Cell-based regenerative endodontics for treatment of periapical lesions: a randomized, controlled phase I/II clinical trial. J Dent Res. 2020;99(5):523–9.

    Article  PubMed  Google Scholar 

  76. Galler KM, Widbiller M. Perspectives for cell-homing approaches to engineer dental pulp. J Endod. 2017;43:S40–5.

    Article  PubMed  Google Scholar 

  77. Widbiller M, Schweikl H, Bruckmann A, Rosendahl A, Hochmuth E, Lindner SR, Buchalla W, Galler KM. Shotgun proteomics of human dentin with different prefractionation methods. Sci Rep. 2019;9:4457.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany

    Kerstin M. Galler

  2. Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, MI, USA

    Tatiana M. Botero

Authors
  1. Kerstin M. Galler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatiana M. Botero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kerstin M. Galler .

Editor information

Editors and Affiliations

  1. Aix Marseille University, CNRS, ISM, Institute of Movement Science, Marseille, France

    Imad About

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Galler, K.M., Botero, T.M. (2022). Clinical Application of BiodentineTM in Regenerative Endodontics/Revitalization. In: About, I. (eds) Biodentine™. Springer, Cham. https://doi.org/10.1007/978-3-030-80932-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-80932-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-80931-7

  • Online ISBN: 978-3-030-80932-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation