Biodentine XP application for Indirect Restoration

The enhanced physical and biological properties of Biodentine have been repeatedly emphasized in the literature. This material presents finer particle size, zirconium oxide as radiopacifier, purity of tricalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine overcomes the major drawbacks of mineral trioxide aggregate (MTA) it has great potential to revolutionize the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Thanks to its characteristics mentioned above and its ease of application, this material can also be used in restorative dentistry. Indeed, in addition to the direct and indirect capping of the dental pulp, this material is a candidate for replacing dentin, therefore it can be used both for filling cavities for direct restorations and as a build-up for the preparation of indirect restorations. This clinical case shows how Biodentine is used firstly as a temporary restoration; and secondly, to replace the dentin by including it in the preparation of the indirect restoration.

style italiano styleitaliano initial situation Biodentine XP Septodont indirect posterior restorations

Fig.1
The patient comes to the clinic urgently due to the fracture of his old amalgam restoration of the upper right first molar. The initial situation shows a great loss of coronal structure after the amalgam removal, with a cavity extending from mesial to distal. The cavity is deep even if the pulp was not exposed.

style italiano styleitaliano Biodentine placement Biodentine XP Septodont indirect posterior restorations

Fig.2
In this case, Biodentine XP was applied inside the cavity, covering all the dentin and reconstructing all the missing part. As indicated by the manufacturer, the bioceramic material was used as a temporary restoration awaiting the positive response of dental vitality. In this case the patient is sent back for a check-up after two weeks.

septodont biodentine XP style italiano styleitaliano
septodont biodentine XP style italiano styleitaliano
style italiano styleitaliano After 2 weeks Biodentine XP Septodont indirect posterior restorations

Fig.3
After two weeks the patient felt no pain and the vitality of the tooth was maintained. Therefore, the indirect restoration of the first molar was performed.

style italiano styleitaliano Cavity preparation Biodentine XP Septodont indirect posterior restorations

Fig.4
Therefore, the preparation was carried out following StyleItaliano concept for indirect posterior restoration. The preparation provides an absence of interproximal boxes, rounded edges and the cusps inclination allows the occlusal forces to be distributed within the dental element, thus avoiding fracture of the tooth. During preparation, the hardened material did not deteriorate and remained in situ. Indeed, the material was included in the preparation, considering as substitute of the dentin. After the application of the retraction wires, the impression of the dental element was taken.

style italiano styleitaliano Impression of the prepared restoration. Biodentine XP Septodont indirect posterior restorations

Fig.5
The impression displayed all the margins of the preparation, and hence, ready to be developed.

style italiano styleitaliano Cementation procedures Biodentine XP Septodont indirect posterior restorations

Fig.6
Once the prosthetic restoration has been obtained from the laboratory, the adhesion and cementation procedures were performed. After the selective enamel etching and bonding phases, it is important to note how the Biodentine XP material was not altered or modified, remaining hardened.

septodont biodentine XP style italiano styleitaliano
septodont biodentine XP style italiano styleitaliano
style italiano styleitaliano Final situation Biodentine XP Septodont indirect posterior restorations

Fig.7
Final situation after the cementation of the indirect restoration. All the preparation margins were finished and polished. After the indirect restoration on the first molar, the direct restorations on the second molar and the second premolar were performed, replacing the old amalgam restorations.

style italiano styleitaliano Radiograph evaluations Biodentine XP Septodont indirect posterior restorations

Fig.8
The radiograph evaluations display the presence of the Biodentine XP under the indirect restoration. After one-month of follow-up, the vitality of the tooth was preserved.

Conclusions

Biodentine XP results a promising material in different field of dentistry. Due to its consistency and ease of use, it can have many applications in restorative dentistry. Furthermore, thanks to its hardness, it is possible to use it as a build-up of preparations for indirect restorations. When bonding to Biodentine, the use of self-etch or total-etch strategies displayed promising results. Given the lack of evidence related to the chemical interaction of self-etch adhesive materials with the bioceramics, if self-etch adhesives are used for bonding resin-based restorations to calcium silicate-based cement, a pretreatment with phosphoric acid could be recommended.

Bibliography

  1. Rajasekharan, S., Martens, L.C., Cauwels, R.G.E.C. et al. Biodentine™ material characteristics and clinical applications: a 3 year literature review and update. Eur Arch Paediatr Dent 19, 1–22 (2018). https://doi.org/10.1007/s40368-018-0328-x.
  2. Hardan, L.; Mancino, D.; Bourgi, R.; Alvarado-Orozco, A.; Rodríguez-Vilchis, L.E.; Flores-Ledesma, A.; Cuevas-Suárez, C.E.; Lukomska-Szymanska, M.; Eid, A.; Danhache, M.-L.; et al. Bond Strength of Adhesive Systems to Calcium Silicate-Based Materials: A Systematic Review and Meta-Analysis of In Vitro Studies. Gels 2022, 8, 311. https://doi.org/10.3390/gels8050311
  3. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond Strength of Universal Adhesives to Dentin: A Systematic Review and Meta-Analysis. Polymers (Basel). 2021 Mar 7;13(5):814. doi: 10.3390/polym13050814. PMID: 33799923; PMCID: PMC7961712.
  4. Zarow M, Devoto W, Saracinelli M. Reconstruction of endodontically treated posterior teeth with or without post. Guidelines for the dental practitioner. Eur J Esthet Dent. 2009 Winter;4(4):312-27.

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Bulk&Go and BIOBulk & Body

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