ISSN: 2320-5407 Int. J. Adv. Res.

11(10), 114-117

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/17684

DOI URL: http://dx.doi.org/10.21474/IJAR01/17684

RESEARCH ARTICLE
BIODENTINE V/S BIOSTRUCTURE MTA- THE BETTER ROOT END FILLING MATERIAL- CLINICAL
CASE REPORT

Sandeep Rudranaik, Sahadev Chickmagravalli Krishnegowda, Bharath Makonahalli Jaganath and Amritha
Bhat Harnad
Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India.
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Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History An ideal root end filling material is the one which is biocompatible,
Received: 05 August 2023 easy to handle, dimensionally stable ,radio opaque, set in the presence
Final Accepted: 09 September 2023 of wet environment, have good compressive strength, non staining,
Published: October 2023 have adequate working time and must be antibacterial in nature. Newer
materials have been introduced over the years and two such materials
Key words:-
Biostructure MTA, Biodentine, Root are Biostructure MTA and Biodentine. Both of them fulfil the criteria
End Filling Material, Post Operative of an ideal root end filling material. So this case report compares the
Healing, Biocompatible two materials and the post operative healing following the placement of
the material.

Copy Right, IJAR, 2023,. All rights reserved.

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Introduction:-
The goal of a successful periapical surgery is to completely enucleate the cystic lesion and provide a good periapical
seal that will accentuate the periapical healing, which mainly depends on the retrograde materials used and the
procedural protocols followed.1 An ideal retrograde material is the one which is biocompatible, easy to handle,
dimensionally stable ,radio opaque, set in the presence of wet environment, have good compressive strength, non
staining, have adequate working time and must be antibacterial in nature etc.2,3

Various materials have been used for the root end filling such as amalgam, glass ionomer, Zinc oxide eugenol,
Biodentine, MTA, Bio aggregate etc. Among the above materials, Biodentine and MTA are suggested to be the best
because of their biocompatibility and the hermetic seal. However the gold standard for the root end material is still
debatable.4.5

Biodentine, also known as the dentin substitute is composed of pure Tricalcium silicate, which regulates the setting
reaction. It also contains calcium carbonate (filler) and zirconium dioxide (radiopacifier). The liquid contains
calcium chloride (accelerator), reducing agent and water. 6, 7 It can be used for direct or indirect pulp capping,
pulpotomy, apexification, and root perforation, internal and external resorption and also as a effective root end
filling material following periapical surgery. 8,9 The advantage of Biodentine over other calcium silicate based
materials is the reduced setting time, better handling and mechanical properties. 10, 11,12

Bio structure MTA, introduced as a root repair material has been suggested to be used for perforation repair, root
end filling, cavity liners in case of recurrent caries etc. 13, 14 It has a reduced setting time of 16 minutes as
recommended by manufacture and has an added advantage of excellent biocompatibility, sets in the presence of
moisture and blood, high mechanical resistance, low solubility and high alkalinity. 15

Corresponding Author:- Amritha Bhat Harnad 114

Address:- Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India. 573202.
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Hence this case report compares two clinical cases with Biodentine and Biostructre MTA being used as root end
filling material with the 1 and 6 months follow up.

Case 1: Biostructure MTA As Root End Filling Material

An 18 year old healthy female patient reported to the department of conservative dentistry and endodontics with a
chief complaint of pain in her upper front tooth region since 2 weeks. Patient presented a history of trauma on her
front tooth region by hitting on to a metal rod 8 years back following which she had consulted a dentist and had
undergone restoration for the same. On clinical examination, 11 and 21 was tender on percussion and found to be
non vital. A pre-operative radiograph revealed an incomplete root canal treatment w.r.t 11 and 21, and there was loss
of lamina dura. With respect to 11, a hazy radiolucency suggestive of periapical abscess was noted and with respect
to 21 a large periapical radiolucency of approximately 2.5 cm x 2 cm was seen suggestive of periapical cyst. Hence
root canal treatment was completed with respect to 11 and 21 following standard protocols, followed by periapical
surgery and apicectomy with respect to 21. Mucoperisoteal flap was elevated and cystic enucleation was done. Root
end resection of 3 mm was done followed by 2 mm of root end preparation and the retrograde filling was done using
Biostructure MTA. Mucoperiosteal flap was placed back and sutured. Patient was recalled after 1 month and 6
month for follow up and the periapical healing and apical seal was found to be satisfactory. The clinical pictures
have been depicted in figure 1.

Case 2:- Biodentine As Root End Filling Material

A 56 year old healthy female patient reported to the department of conservative dentistry and endodontics with a
chief complaint of pain in her upper front tooth region since 5 days. Patient presented a history of trauma to her front
tooth region following a road traffic accident 15 years back following which she had consulted a dentist and had
undergone restoration for the same. On clinical examination there was composite restoration with respect to 12 and
PFM crown with respect to 11 and 21. Further, 11, 12 and 13 were tender on percussion and found to be non-vital. A
pre-operative radiograph revealed deep composite restoration approaching the pulp with respect to 12, with loss of
lamina dura and a large periapical radiolucency of approximately 2 cm x 2 cm suggestive of periapical cyst. Hence
root canal treatment was completed with respect to 11, 12 and 13. Periapical surgery followed by apicectomy was
planned with respect to 12 and executed. Root end resection of 3 mm, followed by 2 mm of root end preparation
was done and Biodentine was placed as the retrograde filling material and the mucoperiosteal flap was placed back
and sutured. Patient was recalled and reviewed after 1 month and 6 month interval and the periapical healing and
apical seal was found to be satisfactory. The clinical pictures have been depicted in figure 2.

Discussion:-
An ideal root end filling material is the one that provides a good apical seal with good handling properties. The
materials used in this case reports are Biodentine and Biostructure MTA, which is a modification of MTA with
shorter setting time. The above mentioned materials were selected as per the manufacturer’s claim that suggests
faster setting and good handling properties.

In the former case Biostructure MTA was used, which is a modified form of MTA with reduced setting time. The
study results showed good periapical healing and appreciable apical seal, which is in accordance with the studies
conducted by Saravanapriyan et al, Shetty et al, Ecnomides et al and Caliskan et al, who concluded that MTA when
used as a retrograde filling material gave good apical seal, push out bond strength and better healing. The
advantages of the Biostructure MTA include faster setting of around 15 minutes, sets in the presence of wet
environment, good apical seal and better radioopacity, lower cost compared to latter. This is in accordance wit h the
manufacturers claims. Tough there are studies where MTA has been used as retrograde filling material but not much
studies were Biostructure MTA was used. Hence, further studies are required to know about the strength and other
aspects of the material.

In the latter case, Biodentine was used as a retrograde filling material showed a good post operative healing. These
results were in accordance with the study conducted by Pawar et al, where Biodentine when used as a retrograde
filling material for the management of a large cystic lesion showed a completely healed cystic lesion within 18
months of follow up. This is also supported by studies conducted by Ahmed et al and Caron et al.

The advantage of Biodentine as found in this study are as follows, they mimic dentin radiographically, had a faster
setting of around 12- 15 minutes, good post operative healing and good apical seal. Moreover there are studies by
Aggarwal et al and Chaudhari et al where they have suggested that the push out bond strength of Biodentine was

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comparable or slightly greater than MTA. A study conducted by Biocanin et al suggested that the marginal
adaptation of Biodentine was equal to that of MTA.

But the drawbacks are that it is difficult to handle and delayed setting in presence of wet environment and requires a
triturator for mixing. This can be validated by the study conducted by Gupta et al, where it was found that
microleakage was greater during manual manipulation when compared to that of triturator. Studies by Alhodiry et
al, Moosani et al and Shalabi et al concluded that blood contamination had a detrimental effect on the push out bond
strength of Biodentine and delays the setting time. However contrary to this, the study by Paulo et al suggested that
blood contamination do not effect the setting of Biodentine.

Hence, this study would conclude that both Biodentine and Biostructure MTA have shown good periapical healing.
However the handling properties may vary and none of this can solely be considered as a gold standard for root end
filling material. The material of choice again depends on the clinician’s preference and the clinical demand.

Figure 1:- A) Pre-Operative Radiograph B) Surgical Photograph C) Post Operative Radiograph After Biostructure
MTA Placement D) 1 Month Follow Up E) 6 Month Follow Up.

Figure 2:- A) Pre-Operative Radiograph B) Surgical Photograph C) Post Operative Radiograph After Biodentine
Placement D) 1 Month Follow Up E) 6 Month Follow Up.

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