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Bioactive Materials by Dentaltown staff

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Header: Bioactive Materials

The rapidly emerging and growing field of bioactive materials is as interesting as it is intriguing, which is why we enlisted the help of experts. Dr. Bruce Hamilton, assistant professor of restorative dentistry at the University of Tennessee Health Science Center, and Dr. Foroud Hakim, clinical vice chair of integrated reconstructive dental sciences at the Arthur A. Dugoni School of Dentistry in San Francisco, explain more about the field. Next, we recap some of the top companies that have bioactive materials already on the market for clinical use.

Part I: Defining the field
What are bioactive dental materials?
Hamilton: These materials induce cellular changes at a tissue interface. Dentistry's original bioactive material is calcium hydroxide, which stimulates deposition of reparative dentin. The new bioactive materials were heralded by MTA, and originally used in endodontics to induce healing in root perforations.

Portland cement is compounded with glass ionomer in the new bioactive cements. When mixed with water it releases calcium silicates, which have osteogenic, cementogenic and odontogenic potential. These silicates induce cell adherence and growth, periodontal ligament attachment, cementum growth and dentinal bridge formation. The cements set through a hydration reaction. Thus they are "hydraulic"—impervious to water.

Hydrophilicity and technical challenges limit the service life of adhesive cements. Bioactive cement addresses both of these drawbacks.

Why is this a promising new category of products?
Foroud: It's not necessarily a new category—materials used in endodontics, or others acting as sedative bases, have demonstrated bioactivity at various levels over the years. Certainly the emphasis on development and advancement of bioactive materials across broad restorative applications is an area of great focus.

The idea that a material may elicit apatite formation, provide a cariostatic effect or result in a therapeutic outcome (in lieu of cytotoxicity exhibited by certain dental materials, which the host is forced to overcome) is tremendously appealing.

How will these materials evolve?
Hamilton: Historically, progress in dental materials has been made by refining current products to improve their handling properties. (Consider the several generations of resin cements.) Researchers will look for new uses for bioactivity and new ways to provide for it. For instance, perhaps antimicrobial and anticariogenic polymers could be activated in the cement. Perhaps a bioactive material could be developed that would revitalize inflamed pulp tissue. There are potential uses in orthodontic cementation, bone grafting and periodontal bone regeneration.

Our materials have been biologically inert. Bioactive materials have novel properties that could contribute to improved clinical successes. These new bioactive materials are so different from what we're used to that we can expect a major rethinking in dental research and its clinical applications.

Foroud: The next level of evolution will include expanded application—innovation across all material classes, including cements, liners and bases, interim restoratives, long-term restoratives and patient-applied home therapies. An example: a cement that effectively adheres all restorative substrates to enamel and dentin, renders the interface resistant to caries, leads to apatite formation and also is reversible to a degree, facilitating restoration removal.

Part II: The company line(s)
A handful of dental companies are on the bioactive forefront, already offering products that present bioactive solutions.

Bisco
Product: TheraCal LC resin-modified calcium silicate pulp liner

Indications: A light-cured, resin-modified calcium silicate liner for use in direct and indirect pulp capping, and as a liner under composites, amalgams, cements and other base materials. It can be used as an alternative to calcium hydroxide, glass ionomer, RMGI, IRM/ZOE and other restorative materials. TheraCal LC's precise placement allows its use in all deep-cavity preparations. The light-cured set permits immediate placement and condensation of the restorative material. Its formulation allows for a command set with a light-curing unit while maintaining ease of placement due to thixotropic properties. The proprietary hydrophilic resin formulation creates a stable and durable liner.

Doxa
Product: Ceramir C&B Cement. Ceramir C&B QuikCap in self-activated capsules recently launched in March. Indications: For permanent cementation of full-coverage crowns and bridges of high-strength ceramics (zirconia, lithium disilicate, alumina) or metal, as well as cast or prefabricated metal posts. Ceramir C&B's calcium aluminate chemistry allows for a permanently alkaline material. The high pH allows for rapid growth of new hydroxyapatite crystals on its surface when exposed to phosphates from the saliva.

NuSmile
Products: NuSmile BioCem Universal BioActive Cement; NuSmile NeoMTA

Indications: BioCem—for cementation of preformed zirconia, stainless steel and pre-veneered stainless steel crowns, and has been optimized for use in pediatric dental applications. NuSmile NeoMTA—for pediatric pulp therapy treatments pulpotomy, pulp-capping and apexification. (Clinical studies show that NuSmile NeoMTA is as effective as, if not superior to, formocresol for these indications.)

Pulpdent
Products: Pulpdent Paste; TempCanal; Multi-Cal; Activa BioActive-Restorative; Activa BioActive-Base/Liner; Activa Kids; Activa BioActive-Cement

Indications: Activa BioActive-Restorative is a bioactive composite that chemically bonds to teeth, seals against bacterial microleakage, and releases more fluoride and is more bioactive than glass ionomers. It is also more durable and fracture-resistant than composites. Activa BioActive-Base/Liner —for indirect pulp capping or as a liner for open- and closed-sandwich techniques. Activa Kids—for Class I and II restorations. Activa BioActive-Cement—for all cementation procedures except veneers.

Septodont
Products: Biodentine dentin replacement material; BioRoot RCS Root Canal Sealer Indications: Biodentine and BioRoot RCS are two biocompatible products based on patented active biosilicate technology and the highly biocompatible chemistry of calcium silicates. These products both set in the presence of water and are resin-free.

Biodentine has indications for direct and indirect pulp capping, pulpotomies, deep caries, apexification, internal and external resorption. BioRoot RCS is indicated for permanent root-canal sealing with gutta-percha, single-cone technique or cold lateral condensation.

Part III: The future of bioactives
Advanced indications and a wider variety of clinical uses are on the horizon for these versatile materials, according to these industry experts.

Dr. David T. Evans of Pediatric Dental OKC in Oklahoma City: "The future for the use of bioactive materials in pediatric pulp therapy is very bright. For decades, the most frequently used medicament for pediatric pulp therapy has been formocresol. This therapy has helped millions of children but many clinicians have hoped for a day when MTA would be more affordable and become commonplace in their armamentarium, as well as any safety concerns some practitioners possess involving formocresol.

"While most pediatric dentists are aware that MTA is a bioactive bioceramic that contributes to pulpal regeneration, tooth mineralization and tooth viability, and its high success rate has been proven in numerous clinical studies, its cost has made MTA unaffordable for the pediatric dentist. Formocresol will likely always have its place, but with the advent of more cost-effective solutions, pediatric dentists can enjoy the combination of excellent dental outcomes and the peace of mind that MTA provides for the indications it merits."

Larry Clark, director of clinical affairs and marketing, Pulpdent: "In dentistry, we're seeing a shift from reactive treatment of dental disease to a preventive model. This includes bioactive materials that encourage remineralization of tooth structure and contribute to long-term health and well-being. It's inevitable that bioactive dental materials will become the treatment of choice, and this will apply not only to pulp therapy and restorative procedures, but also to orthodontics, periodontics, endodontics and other dental specialties."



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April 2024
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