Biodentine for Deep Cavities in Camberley - What Is It and How Does It Work?

When a cavity is deep - very close to the nerve of the tooth - the treatment decision becomes more complex. Go too far with drilling and you risk exposing the pulp, potentially triggering the need for root canal treatment. Stop too soon and leave decay in place and the cavity continues to progress. Biodentine, developed by Septodont, offers a third option that has become increasingly important in modern restorative dentistry.

What Is Biodentine?

Biodentine is a restorative material manufactured by Septodont, a French dental materials company. It is classified as a bioactive calcium silicate - a material that interacts with surrounding dental tissue rather than simply filling space.

It was developed as a superior alternative to Mineral Trioxide Aggregate (MTA) and traditional calcium hydroxide - the materials previously used for pulp protection and indirect pulp capping. Biodentine sets faster, is easier to handle, and has better mechanical properties than its predecessors.

Its composition includes tricalcium silicate, dicalcium silicate, calcium carbonate, and zirconium oxide as a radiopacifier (so it shows up clearly on X-rays). When mixed and placed, it releases calcium hydroxide which creates an alkaline environment that promotes the formation of secondary dentine - the tooth's natural protective layer over the pulp.

What Is It Used For?

Biodentine has several clinical applications in restorative dentistry:

1. Deep Cavity Restoration

When a cavity has progressed to within a very short distance of the dental pulp - but has not yet reached it - Biodentine can be placed over the remaining thin layer of dentine as a protective liner. This is called indirect pulp capping. The material seals the deep area, protects the pulp from bacterial contamination, and stimulates the pulp to lay down new secondary dentine beneath it.

The conventional approach would be to either remove all the decay (risking pulp exposure) or leave some decay in place under a temporary filling. Biodentine's bioactivity allows a more conservative approach - place the material, allow the tooth to heal, and review the situation at a subsequent appointment.

2. Direct Pulp Capping

If the pulp is accidentally exposed during cavity preparation - or if a very small, clean exposure occurs - Biodentine can be placed directly onto the exposed pulp tissue. This is called direct pulp capping. The material seals the exposure, promotes the formation of a dentine bridge over the pulp, and in many cases allows the tooth to remain vital (alive) without the need for root canal treatment.

Success depends on the size and nature of the exposure, the health of the surrounding pulp tissue, and the absence of infection. Direct pulp capping is not appropriate in all cases - clinical assessment is essential.

3. Children's Teeth (Pulpotomy)

In primary (baby) teeth where the pulp is affected, a pulpotomy involves removing the infected coronal portion of the pulp while preserving the healthy root portion. Biodentine is increasingly used as the material placed over the remaining healthy pulp tissue after the infected tissue has been removed. It promotes healing and allows the tooth to remain functional until it naturally exfoliates.

How Is Biodentine Different from Older Materials?

Before Biodentine, the standard materials for pulp protection were:

• Calcium hydroxide - effective at stimulating secondary dentine formation but mechanically weak, soluble over time, and prone to shrinkage which can allow bacterial recontamination
• Mineral Trioxide Aggregate (MTA) - excellent biocompatibility and sealing ability but very slow setting (up to 4 hours), difficult to handle, and expensive

Biodentine addresses the main weaknesses of both. It sets in approximately 12 minutes, has good compressive strength, excellent marginal seal, and equivalent or superior biocompatibility to MTA. Crucially, it can be used as a temporary dentine substitute - placed in the full cavity and left while the pulp recovers - then prepared conventionally for a composite or crown restoration at a follow-up appointment.

What Does the Treatment Involve?

The process for using Biodentine in a deep cavity typically follows these steps:

1. Assessment and X-ray - the depth of the cavity is assessed clinically and radiographically. Digital X-rays confirm how close the decay is to the pulp. The vitality (health) of the pulp is tested.
2. Anaesthetic - the area is numbed with local anaesthetic. The procedure should be completely comfortable.
3. Cavity preparation - decay is removed carefully. In deep areas close to the pulp, a conservative approach is taken to avoid exposure.
4. Biodentine placement - the mixed Biodentine is placed into the deep cavity, covering the thin remaining dentine layer or the exposed pulp. It is contoured and allowed to set.
5. Temporary or permanent restoration - a composite filling or temporary restoration is placed over the Biodentine. In some cases, Biodentine itself serves as a temporary dentine substitute for 6 - 12 weeks while the pulp responds.
6. Review appointment - the tooth is reassessed. If the pulp has remained healthy and the patient has no symptoms, a definitive restoration is completed.

What Are the Success Rates?

Clinical studies and systematic reviews on Biodentine show favourable outcomes for indirect and direct pulp capping. Success rates for indirect pulp capping with Biodentine in vital teeth with no pre-operative symptoms are reported at over 85% in studies with follow-up periods of 12 - 36 months.

Direct pulp capping success depends significantly on the clinical situation - in carefully selected cases with clean mechanical exposures and no signs of irreversible pulpitis, success rates are similarly high. Where the pulp is already inflamed or infected, root canal treatment remains the appropriate treatment.

Does It Replace Root Canal Treatment?

Not in all cases - and it is important to be clear about this. Biodentine is a pulp-protective material that can help avoid root canal treatment in the right circumstances. It cannot treat a tooth that already has an infected, necrotic (dead), or irreversibly inflamed pulp. In those situations, root canal treatment or extraction remains the appropriate option.

The value of Biodentine lies in expanding the range of cases where the pulp can be preserved - treating the deep cavity at the right time, before the pulp becomes irreversibly damaged, rather than waiting until root canal treatment is the only option.

Is Biodentine Available at Accord Dental Practice?

Yes. At Accord Dental Practice in Camberley, Dr. Gadde uses Biodentine as part of a minimally invasive approach to deep cavity management. With her Postgraduate Diploma in Endodontics from King's College London and experience in root canal treatment using the Labomed dental microscope, she is well placed to assess whether Biodentine pulp capping or root canal treatment is the most appropriate option for each individual tooth.

If you have a deep cavity or have been told you may need root canal treatment, we would be happy to assess the tooth and discuss all available options. Call us on 01276 984356 or book online.