Biodentine for Direct and Indirect Restorations

The scientific community, supported by both in vitro and in vivo clinical studies, confirms that Biodentine™ is biocompatible, possesses strong mechanical properties, and is safe for use in restorative dentistry. Additionally, Biodentine™ does not require surface conditioning and can be easily cut and shaped like natural dentine. Its unique properties allow it to serve as a bulk substitute for permanent dentine, capable of replacing entire sections of damaged or lost dentine. This makes it suitable for indirect pulpal protection, extending beyond direct pulp capping alone. The surface of Biodentine™ can be bonded with various adhesives, similar to natural dentine, prior to the final placement of composite resins. This clinical case demonstrates the application of Biodentine™ in both direct and indirect restorations.

septodont biodentine XP style italiano styleitaliano
septodont biodentine XP style italiano styleitaliano
styleitaliano style italiano cavities on molars direct and indirect restorations posterior restorations

Fig.1
Initial Situation. A new patient came in urgently with a broken tooth and sensitivity to cold. During the examination, we found that the left lower second molar had an old filling that was partly broken, and the back wall of the tooth was cracked because of a deep cavity. The third molar also had a cavity on the chewing surface.

styleitaliano style italiano Septodont Biodentine direct and indirect restorations posterior restorations

Fig.2
After applying the rubber dam, the cavities were cleaned and prepared. Biodentine was then used as a temporary material to fill both cavities in the teeth. Once the material was properly packed into the cavities, the automatrix and rubber dam were removed, and the integrity of the Biodentine seal on the teeth was verified.

styleitaliano style italiano Septodont Biodentine filling direct and indirect restorations posterior restorations

Fig.3
Typically, once the material has set, preparation can proceed immediately because it can be shaped and prepared without affecting its integrity. However, in this instance, to evaluate the preservation of the second molar’s pulp vitality, the patient was scheduled for a follow-up appointment in two weeks.

styleitaliano style italiano Septodont Biodentine after one week direct and indirect restorations posterior restorations

Fig.4
Unfortunately, the patient returned to the appointment after one month. The second molar showed wear of the material at the lingual margin. However, this issue did not impact the treatment’s success because the affected margin will be cleaned and prepared for creating an overlay. The tooth maintained its pulp vitality, responding positively to vitality testing. Consequently, in the same session, a direct restoration was performed on the third molar, and preparation for the indirect restoration on the second molar was completed.

styleitaliano style italiano rubber dam isolation direct and indirect restorations posterior restorations

Fig.5
Once the rubber dam was applied, the LM Gingiva instrument was used to gently displace and push the dam apically from the lingual margin to facilitate proper preparation of the second molar. This tool allowed unrestricted movement with the turbine, essential for precise work. Using an additional clamp would have hindered the preparation process.

styleitaliano style italiano Septodont Biodentine overlay preparation direct and indirect restorations posterior restorations

Fig.6
The preparation followed the principles of the Styleitaliano philosophy, which includes features like absence of interproximal boxes, rounded edges, and cusps inclined towards the axial wall. This approach helps distribute occlusal forces within the tooth, reducing the risk of tooth fracture and aiding in the cementation of the overlay.
During the preparation, Biodentine™’s hardness allowed for precise cutting and shaping without compromising its seal or integrity. In the third molar, a Class I cavity was prepared while preserving Biodentine™ in the deepest part of the cavity, up to 1.5 mm from the occlusal surface.

styleitaliano style italiano selective enamel etching direct and indirect restorations posterior restorations

Fig.7
Selective enamel etching for 20s.

styleitaliano style italiano brushing cavity with bonding direct and indirect restorations posterior restorations

Fig.8
Scotchbond Universal Plus was applied, rubbing and scrubbing very well. After that, air-blowing was performed for 20 seconds.

styleitaliano style italiano LM posterior misura direct and indirect restorations posterior restorations

Fig.9
The LM Misura Posterior tool facilitated the assessment of sufficient space for the final enamel layer.

styleitaliano style italiano injecting bulk composite direct and indirect restorations posterior restorations

Fig.10
Therefore, a single mass of body shade composite was directly applied to complete the restoration.

styleitaliano style italiano raw composite direct and indirect restorations posterior restorations

Fig.11
The composite was adapted by removing excess material. It was then possible to shape the occlusal morphology according to the Espresso Posterior Technique concept.

styleitaliano style italiano occlusal modeling direct and indirect restorations posterior restorations

Fig.12
After shaping the occlusal morphology according to the Espresso Posterior Technique, essential lines were drawn and characterizations were added to finalize the restoration.

styleitaliano style italiano overlay on model direct and indirect restorations posterior restorations

Fig.13
After completing the restoration, an impression was taken to fabricate the overlay. Subsequently, the patient was scheduled for another appointment to cement the overlay.

styleitaliano style italiano Septodont Biodentine before overlay cementation direct and indirect restorations posterior restorations

Fig.14
On cementation day, after applying the rubber dam, the temporary restoration was removed, and the tooth surface was cleaned using sandblasting. It was observed that the Biodentine remained intact.

styleitaliano style italiano Septodont Biodentine direct and indirect restorations posterior restorations enamel etching

Fig.15
Beginning the cementation phase, the enamel margin was etched with 37% orthophosphoric acid for 20 seconds.

styleitaliano style italiano Septodont Biodentine direct and indirect restorations posterior restorations enamel after etching

Fig.16
The proper enamel etching appears uniform and frosty. This etching pattern ensures optimal bonding for the cementation process.

styleitaliano style italiano bonding preparation direct and indirect restorations posterior restorations

Fig.17
Scotchbond Universal Plus was applied evenly across the surface. It’s noteworthy that the Biodentine remained stable without any deterioration during the adhesive application, as evidenced by the clean brush. After air-blowing, the adhesive was then cured.

styleitaliano style italiano cementing an overlay direct and indirect restorations posterior restorations

Fig.18
The overlay was cemented into place. The LM Condensa tool helped stabilize and secure the overlay while removing excess cement.

styleitaliano style italiano after cementing overlay posterior restorations

Fig.19
The Step Luting technique, as detailed in our published work, was employed to aid in the removal of excess cement using the LM Eccesso tool. After removal, all margins were inspected to ensure they were clean and that there were no gaps in the tooth-restorative interface.

styleitaliano style italiano after direct and indirect restoration posterior restorations

Fig.20
After removing the rubber dam, all margins of the restoration were finished and polished. Subsequently, the occlusion was checked to ensure proper alignment and function.

styleitaliano style italiano direct and indirect restorations posterior restorations before and after ray

Fig.21
Radiographs were taken before and after the restorations. The pulp vitality was maintained, and no periapical lesions were observed.

styleitaliano style italiano direct and indirect restorations posterior restorations 3-month follow up

Fig.22
The final appearance of the two restorations was satisfactory, and radiographic images at the 3-month follow-up showed no issues.

Conclusions

Biodentine offers diverse applications. Recognized as a dentine substitute for its comparable physical and mechanical properties, it can be utilized in bulk to fill cavities up to 1.5mm from the occlusal surface, following the Bio-Bulk Fill technique. In direct restorations, combining Biodentine for cavity filling with the Essential Lines technique for occlusal surface modeling streamlines procedures and reduces time. For indirect restorations, once Biodentine has set, it facilitates precise tooth preparation while maintaining a protective seal, safeguarding the dental pulp.

septodont biodentine XP style italiano styleitaliano
septodont biodentine XP style italiano styleitaliano

Bibliography

  1. About I. Biodentine: from biochemical and bioactive properties to clinical applications. Giornale Italiano di Endodonzia, 2016, Volume 30, Issue 2, Pages 81-88, https://doi.org/10.1016/j.gien.2016.09.002.
  2. Falakaloğlu S, Yeniçeri Özata M, Plotino G. Microshear bond strength of different calcium silicate materials to bulk-fill composite. PeerJ. 2023 Mar 29;11:e15183. doi: 10.7717/peerj.15183.
  3. Tosco V, Monterubbianesi R, Orilisi G, Sabbatini S, Conti C, Özcan M, Putignano A, Orsini G. Comparison of two curing protocols during adhesive cementation: can the step luting technique supersede the traditional one? Odontology. 2021 Apr;109(2):433-439. doi: 10.1007/s10266-020-00558-0.
  4. Manauta J, Salat A, Devoto W, Putignano A. Layers 2. Direct composite: the StyleItaliano clinical secrets. 2022. Quintessence pub.

RELATED CASES

styleitaliano style italiano extensive cavities severe tooth decay restorations

Handling extensive cavities in cases of severe tooth decay

Discover how to handle severe tooth decay and extensive cavities effectively, restoring both function and aesthetics using advanced restorative techniques and materials.
styleitaliano style italiano proximal caries cover image snowplow technique direct posterior restoration bulk composite Kerr SimpliShade Bulk Fill composite restoration

Bulk flow for Snowplow