International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 340115, 4 Pages

REVIEW ARTICLE

Bioactive materials in conservative dentistry

Snehal Sonarkar1, Rucheet Purba2
Department of Conservative Dentistry and Endodontics, VSPM’s Dental College and Research Centre, Nagpur, Maharashtra, India, 2Private Practioner, Mumbai,
1

Maharashtra, India

Correspondence
Dr. Snehal Sonarkar, Department of
Conservative Dentistry and Endodontics,
VSPM’s Dental College and Research
Center, Digdoh Hills, Hingna Road,
Nagpur – 440 019, Maharashtra, India.
E-mail: snehalsonarkar@gmail.com
Received 26 January 2015;
Accepted 28 February 2015
doi: 10.15713/ins.ijcdmr.47
Abstract
Bioactive materials have been used in every field of dentistry and medicine. These
materials are broadly used in the field of conservative dentistry for regeneration, repair
and reconstruction. These materials are available in different form and composition
that acts directly on vital tissue inducing its healing and repair. These materials directly
function because of induction of various growth factors and different cells. Thus, this
article describes various bioactive materials, the form in which they are available and its
uses.
Keywords: Bioactive materials, biomimetic substances, conservative dentistry, repair/regeneration

How to cite the article:

Snehal Sonarkar, Rucheet Purba,
“Bioactive materials in conservative
dentistry,” Int J Contemp Dent Med
Rev, vol.2015, Article ID: 340115, 2015.
doi: 10.15713/ins.ijcdmr.47

Introduction ActiveTM BioACTIVE restorative material, Pulpdent (composite

Recently introduced materials mainly concentrate on the
bioinductive activity. The terms bioactive, bioinductive,
biomaterial and biomimetic are different and have been defined
separately. Bioactive material is defined as a material that has
the effect on or eliciting a response from living tissue, organisms
or cell such as inducing the formation of hydroxyapatite. The
bioinductive property is defined as the capability of a material for
inducing a response in a biological system. Biomaterial is defined
as any matter, surface or construct that interacts with biological
systems. Biomimetics is the study of formation, structure or
function of biologically produced substances and materials
(such as silk or conch shells) and biological mechanisms and
processes (such as protein synthesis or mineralization) for the
purpose of synthesizing similar products by artificial mechanisms
that mimic natural structures. These definitions thus describe
the difference between each term.[1]
The ideal properties of bioactive material are; bactericidal and
bacteriostatic, sterile, stimulate reparative dentine formation,
sterile and maintain pulp vitality.
The various bioactive materials are calcium
hydroxide, mineral trioxide aggregate (MTA), calcium-
enriched mixture (CEM), Biodentine, Inert material
(isobutyl cyanoacrylate and tricalcium phosphate ceramic),[2,3]
resin that are more bioactive and release more fluoride
than glass ionomers),[4] MTYA1-Ca filler,[5] tetracalcium
phosphate (TTCP),[6] sol-gel-derived bioactive glass (BAG)
ceramic containing silver ions (Ag-BG),[7] calcium phosphate,
novel endodontic cement (NEC),[8] endo sequence root repair
material.
Uses of bioactive material
1. It can be used as pulp capping material
2. Used for permanent restorations
3. It can be used for dentinal tubule occlusion. Huaxi-BAG-
ceramic (HX-BGC) a BAG ceramic material can be an
effective material for reducing dentine permeability and thus
can be used for the treatment of dentinal hypersensitivity[9]
4. Bioactive materials such as BAG act as scaffold and helps
in regeneration of bone tissue.[10] The other material that is
advanced composite modified with Ag-BG and natural ECM
have improved properties for tooth regeneration[7]
5. It promotes tooth remineralization[11] and has been found
that both BAG and casein phosphopeptide-amorphous
calcium phosphate are effective in remineralizing.[12]

1
Bioactive materials in conservative dentistry
Materials
Calcium hydroxide
Calcium hydroxide dissociates into calcium and hydroxyl ions.
These calcium ions reduce capillary permeability thus in turn
reducing the serum flow and reducing the levels of inhibitory
pyrophosphates that cause the mineralization. The hydroxyl ions
neutralize acid produced by osteoclasts maintaining optimum
pH for pyrophospahatase activity leading to increase level of
calcium-dependent pyrophosphatase which reduced the levels
of inhibitory pyrophosphate and causing mineralization.[13]
MTA
MTA introduced by Torabinejad in 1990. It’s a bioactive material
that is mainly composed of calcium and silicate. Major content
of the mixture is dicalcium silicate, tricalcium silicate, tricalcium
aluminate, gypsum, and tetracalcium aluminoferrite.[14] These
calcium silicate containing materials have a common characteristic
of apatite formation.[15] This is a material of choice for vital pulp
therapy, apexification and apexogenesis, correcting procedural
errors as well as for root-end filling material in apicoectomy
procedures.
The exact mechanism of dentinal bridge formation when MTA is
used is not known completely and detailed research should be carried
out for understanding this mechanism. However, it was found that
when MTA was used as a pulp capping agent it induces cytologic
and functional changes within pulpal cells, resulting in formation
of fibrodentine and reparative dentin at the surface of mechanically
exposed dental pulp. When placed it causes proliferation, migration
and differentiation of odontoblast-like cells that produce a collagen
matrix. This formed umineralized matrix is then mineralized by
osteodentin initially and then by tertiary dentin formation.[15]
CEM[8]
It is also known as NEC and was introduced by Asgary.[16] It consists
of calcium oxide, whereas calcium oxide and silica in Portland
cement and calcium oxide, silica, and bismuth oxide in MTA are
the major ingredients.[17] This cement releases both calcium and
phosphorus ions leading to hydroxyapatite production.[18,19] It is also
known as CEM. It is composed of calcium oxide, calcium phosphate,
calcium carbonate, calcium silicate, calcium sulfate, and calcium
chloride.
Biodentine
It is a bioactive dentin replacemental material having similar
properties of dentin and has a positive effect on vital pulp cells
stimulating tertiary dentin formation.[20]
ActiveTM BioACTIVE restorative material[4]
It is a composite resin that is bioactive and release more fluoride than
glass ionomers. It contains bioactive resin matrix, a shock absorbing
resin component and BAG fillers that have similar properties of tooth.
2
Sonarkar and Purba
MTYA1-Ca filler[5]
It is a resinous direct pulp capping agent. It consists of
powder (89.0% microfiller, 10.0% calcium hydroxide and
1.0% benzoyl peroxide) and liquid (67.5% triethyleneglycol
dimethacrylate, 30.0% glyceryl methacrylate, 1.0% O-methacryloyl
tyrosine amide, 1.0% dimethylaminoethylmethacrylate
and 0.5% camphorquinone).[5,21]
TTCP[6]
It can be used for biomedical purpose as it contains bioresorbable
polylactide composite that was incorporated with more basic
filler for biomedical application. It was proved that it reduces
inflammation and allergic effect resulting from acidic substances.
Sol-gel-derived Ag-BG[7]
It is a Ag-BG having antibacterial and regenerative properties.
Calcium phosphate
It has properties such as good biocompatibility, superior
compressive strength, and its transformation into hydroxyapatite
over time. It induces bridge formation with no superficial tissue
necrosis and significant absence of pulpal inflammation.[22]
Endo sequence root repair material
It consists of calcium silicates, monobasic calcium phosphate,
zirconium oxide, tantalum oxide, proprietary fillers and
thickening agents.[23]
Monomers
It was found that HEMA-BisGMA-TEGDMA resin with antimicrobial
agent as quaternary ammonium salt monomer 2-methacryloxylethyl
dodecyl methyl ammonium bromide was an effective pulp capping
material for vital pulp preservation and treatment of deep caries.[24]
HX-BGC
It is novel BAG-ceramic available in powder form and containing
SiO2-P2O5-CaO-Na2O-SrO. It was used to reduce dentine
permeability and works by the property of occluding dentinal tubule.
Theracal
It is a light cured, resin modified calcium silicate filled liner
insulating and protecting dentin-pulp complex. It can be used in
direct and indirect pulp capping, as a protective base/liner under
composites, amalgams, cements, and other base materials. When
this material was compared with ProRoot MTA and Dycal, it was
found that calcium release was higher and solubility was low.[25]
Castor oil bean cement
It consists of 81-96% triglyceride of ricinoleic acid, and is
considered a natural polyol containing three hydroxyl radicals
and can be used as a pulp capping material.[26]
Sonarkar and Purba
Doxadent
It is a calcium aluminate product available in powder liquid form. It
can be used as a permanent restorative material. It consists of alumina,
calcium oxide, water, zirconium dioxide and other alkali oxides. When
powder and liquid are mixed water dissolves the calcium aluminate
powder leading to the formation of calcium, aluminum and hydroxyl
ions leading to the formation of katoite and gibbsite.[27]
Ceramir
It is calcium aluminate cement used as a luting agent. It works
on the principle of two cements they are calcium aluminate
and glass ionomer cement.[27] This cement helps in luting of
permanent crowns and fixed partial dentures, gold inlays and
onlays, prefabricated metal and cast dowel and cores, and high-
strength all-zirconia or all-alumina crowns.[28,29]
Bioaggregate
It is a calcium silicate material available in powder and liquid
form. This can be used for pulp capping, apexification, root
resorption, root perforation and root end filling material.[27]
Endosequence root repair material
It is also a calcium silicate material available in paste or putty
form. The applications are same as bioaggregate.[27]
iRoot BP
It is also a calcium silicate material available in paste or putty
form and is a injectable root repair material.[27]
Resin impregnation with titanium oxide (TiO2)
The TiO2 nanoparticles can be impregnated in dental resins such as
dental monomers and dentin bonding adhesives. It has found that with
this type of restorations hydroxyapatite formation is promoted further
enhancing the strength and bactericidal property. These nanoparticles
helps in remineralization of both enamel and dentin by restoring the
marginal gaps. Thus, because of this property it reduces the incidence
of secondary caries and other properties of implant surface.[30]
Conclusion
Bioactive materials can be considered as boon to dentistry
because of its regeneration potential.
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