International Journal of Applied Dental Sciences 2021; 7(1): 345-351

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2021; 7(1): 345-351 Bio active materials in pediatric dentistry: A review
© 2021 IJADS
www.oraljournal.com
Received: 16-11-2020 S Srikanth Raju, Srujana MP, M Kiranmayi, E Rajendra Reddy, S Sai
Accepted: 20-12-2020
Divya and P Gowtham
S. Srikanth Raju
Assistant Professor, Department
DOI: https://doi.org/10.22271/oral.2021.v7.i1e.1153
of Pedodontics, Kamineni
Institute of Dental Sciences, Abstract
Narketpally, Telangana, India Remineralization, a natural repair process of carious tooth, is widely followed treatment strategy and
requires action of specific agents, which may further assist in preventing formation of newer lesions in
Srujana MP the oral cavity. Materials which promote the remineralization are extensively researched and
Associate Professor, Department understanding the action of these materials and their dynamics is utmost important.
of Pedodontics, Kamineni These bioactive and biomimetic materials have evolved over a period of four decades and have become
Institute of Dental Sciences, specialized, easier to manipulate with better properties. A continuous research for further betterment of
Narketpally, Telangana, India these materials to meet the increasing clinical and restorative needs should be promoted. The future of
dentistry shifts towards use of these biomimetic materials and the aim is to provide the tooth with
Dr. M Kiranmayi minerals rather than using chemicals to restore. This article focuses about various bio active materials
Associate Professor, Department and their applications in pediatric dentistry.
of Pedodontics, Kamineni
Institute of Dental Sciences,
Keywords: Remineralization, bio active materials, pediatric dentistry
Narketpally, Telangana, India

E Rajendra Reddy 1. Introduction

Professor and HOD, Department Dentistry is an ever evolving branch with continuous stipulation for advancements in dental
of Pedodontics, Kamineni materials. From the dawn of history, dental practitioners have been in the quest of ideal
Institute of Dental Sciences, restorative dental materials. Initially ideal restorative materials were thought to be biologically
Narketpally, Telangana, India
inert and biocompatible but in the last two decades bioactive materials seem to be alternative
S Sai Divya to these inert biocompatible materials [1]. The teeth undergo a constant cycle of
Consultant Pedodontist, demineralization and re-mineralization, but this natural re-mineralization process is inadequate
Hyderabad, Telangana, India to prevent progression of dental caries. Hence there is a need to supplement the tooth with a
biomaterial which is bioactive in nature to re-mineralize, repair or regenerate the tissues of
P Gowtham tooth [2]. The term ‘Bioactivity’ is defined as the ability of a material to elicit a response in a
Consultant Pedodontist,
Hyderabad, Telangana, India living tissue [3]. Bioactive Material is a material that has the effect on or eliciting a response
from living tissue, organisms or cell such as inducing the formation of hydroxyapatite [4]. The
ideal properties of bioactive materials are bactericidal and bacteriostatic, sterile, stimulate
reparative dentine formation and maintain pulp vitality [5].
Restoratively we use these bio active materials to prevent pulpal death and initiate the
formation of a dentinal bridge during direct or indirect pulp capping. Alkalinity is a critical
factor that contributes to the effectiveness of bio active materials. The bio active material
contributes to pulpal repair not only by stimulating two proteins i.e bone morphogenic protein
[BMP] and transforming growth factor–beta [TBF BETA] from the surrounding dentin but
also by forming an anti-bacterial seal over the pulp exposure [6].

1.1 Uses of bioactive materials in pediatric dentistry

 Promotes tooth re-mineralization
 As pulp capping material
 For permanent restorations
Corresponding Author:  In apexification procedure
Dr. M Kiranmayi  Act as scaffold and helps in regeneration of bone tissue.
Associate Professor, Department
of Pedodontics, Kamineni
Institute of Dental Sciences, These bio active materials play a very important role in pediatric dentistry and hence this article
Narketpally, Telangana, India emphasize on various bioactive materials and their importance in pediatric dentistry.
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1.2 Bio active materials in pediatric dentistry 3.1 Biological Action of MTA
Bio-active materials used in pediatric dentistry are calcium The mechanism of action of MTA is very similar to the effect
hydroxide, Mineral tri oxide aggregate (MTA), Bio dentine, of Calcium Hydroxide [14].
Bio glass, Bio-ionomer, Calcium enriched mixture (CEM), According to Parirokh and Torabinejad et al. when MTA is
Amorphous calcium phosphate (ACP), Bio aggregate, placed in direct contact with human tissues, material does the
TheraCal LC, Endo sequence root repair material (ERRM). following [13]:
1. Forms Calcium hydroxide that releases calcium ions for
2. Calcium hydroxide cell attachment and proliferation
HERMAN introduced calcium hydroxide to dentistry in 1990 2. Creates an antibacterial environment by its alkaline pH
[7]
. Calcium hydroxide has been included in several materials 3. Modulates cytokine production.
and antimicrobial formulations that are used in various 4. Encourages differentiation and migration of hard tissue-
treatment modalities. When used as a pulp-capping agent and producing cells
in apexification cases, a calcified barrier may be induced by 5. Forms Hydroxyapatite on the MTA surface and provides
calcium hydroxide [8]. a biologic seal

2.1 Biological action 3.2 Applications in Pediatric Dentistry

The hydroxyl group of Ca(OH)2 provides an alkaline  Pulp capping agent,
environment, which encourages repair and active  Pulpotomy agent,
calcification. The alkaline pH induced not only neutralizes  Apexification procedure and
lactic acid from osteoclasts, thus preventing dissolution of the  Obturation of retained primary tooth where the
mineral components of dentine, but could also activate succedaneous permanent tooth is absent.
alkaline phosphatases that play an important role in hard-
tissue formation [9]. Alkaline phosphatase, a hydrolytic 3.3 Limitations
enzyme acts by liberation of inorganic phosphatase from the The drawbacks of MTA include its discoloration potential,
esters of phosphate, which then react with calcium ions from presence of toxic elements in the material composition,
the bloodstream to form a precipitate, calcium phosphate, in difficult handling characteristics, long setting time, high
the organic matrix. This precipitate is the molecular unit of material cost, an absence of a known solvent for this material,
hydroxyapatite, which is believed to be intimately related to and the difficulty of its removal after curing [15].
the process of mineralization [10].
4. Biodentine
2.2 Applications in pediatric dentistry Biodentine is a calcium silicate-based material introduced in
 Pulp capping agent, 2010 by Gilles and Olivier. It is in effect a dentin substitute
 Pulpotomy agent and that can be used as a coronal restoration material (for indirect
 In apexification procedure. pulp capping), but can also be placed in contact with the pulp.
Its faster setting time allows either immediate crown
2.3 Limitations of calcium hydroxide [11] restoration or to make it directly intraorally “functional”
 Length of time for induction of coronal or apical hard without fear of the material deteriorating [16].
tissue barriers. This ranges from 2–3 months in the case
of pulp capping and 6–18 months in the case of 4.1 Biological Action
apexification. Biodentine induces formation of osteodentine by expressing
 Incomplete coronal and apical hard tissue barriers markers of odontoblasts & increases TGF-Beta1 secretion
because of vascular inclusions, which may allow from pulpal cells enabling early mineralization. During the
bacterial invasion. setting of the cement, calcium hydroxide is formed. Due to its
 Changes in the physical structure of dentin related to the high pH, Calcium hydroxide causes irritation at the area of
loss of inorganic and organic components which exposure. This zone of coagulation necrosis has been
frequently leads to cervical root fractures. suggested to cause division and migration of precursor cells to
 Induction of initial zones of sterile pulp necrosis. These substrate surface, addition and cytodifferentiation into
zones represent the contact area between calcium odontoblast like cells. Thereby Biodentine induces apposition
hydroxide and vital pulp tissue; they may become of reactionary dentine by odontoblast stimulation and
infected at a later time through microleakage under reparative dentin by cell differentiation. Because of its high
restorations, leading to pulpitis and subsequent pulp alkalinity it has inhibitory effects on microorganisms [17].
necrosis.
4.2 Applications in Pediatric Dentistry
3. Mineral trioxide aggregate  Dentine substitute under a composite restoration:
Mineral Trioxide Aggregate (MTA) is a bio active material,  Pulp capping
which was introduced by Mahmoud Torabinejad at Loma  Pulpotomy
Linda University, California, USA. MTA was first described  Apexification
in the dental scientific literature in 1993 [12]. Studies on MTA
reveal that it not only exhibits good sealing ability, excellent 5. Amorphous calcium phosphate
long term prognosis, has relative ease of manipulation and Amorphous calcium phosphate (ACP) is the initial solid phase
good biocompatibility but favors tissue regeneration as well12. that precipitates from a highly supersaturated calcium
MTA was developed and recommended for endodontic phosphate solution, and can convert readily to stable
procedures because of it is nontoxic, non-carcinogenic, non- crystalline phases such as octacalcium phosphate or apatitic
genotoxic, biocompatible, insoluble in tissue fluids and products.
dimensionally stable nature [13].
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5.1 Biological Action a three-day period [24].

ACP can increase alkaline phosphatase activity of mesoblasts,
enhance cell proliferation and promote cell adhesion. The 5.2.6 Food Products
unique role of ACP during the formation of mineralized CPP-ACP, with no adverse effect on taste, can be a selected
tissues makes it a promising material for tissue repair and for the treatment of demineralization. Recent studies have
regeneration. ACP may also be a potential remineralizing shown that application of CPP-ACP in drinks, sweets and
agent in dental applications [18]. milk products can prevent their cariogenic properties [24].

5.2 Clinical Applications in Pediatric Dentistry 5.2.7 Tooth Pastes

5.2.1 ACP in Bio-Mineralization CPP-ACP and Fluoride (F) have significant effects on
It has been stated that ACP likely plays a special role as a decreasing caries [25]. The additive anti-cariogenic effect of
precursor to bio apatite and as a transient phase in bio- CPP-ACP and F may be attributable to the localization of
mineralization. One bio-mineralization strategy that has Amorphous Calcium Fluoride Phosphate (ACFP) at the tooth
received significant attention in recent years is mineralization surface by the CPP which in effect would co-localize
via transient precursor phases. The transient ACP phase may Calcium, Phosphate and Fluoride. These results suggest that
conceivably be deposited directly inside the gap regions of CPP may be an excellent delivery vehicle to co-localize
collagen fibrils, but it may also be delivered as extra fibrillar calcium, phosphate and fluoride at the tooth surface in a slow
particles. A variety of proteins and ions have been proposed release amorphous form with superior clinical efficacy [26].
to be involved in the bio-mineralization of ACP to
Hydroxyapatite. Dentin matrix protein 1 (DMP1) is one of GC Tooth Mousse: This product is in the form of a soft,
such bio mineralization proteins [19]. sugar-free, water-based topical crème and is used for
remineralization of dentin and enamel for prevention of
5.2.2 ACP-Filled Polymeric Composites caries. In-vivo and in-vitro studies published in 2013 have
ACP has been evaluated as a filler phase in bioactive stated that CPP-ACP was more effective than sodium fluoride
polymeric composites. Skrtic has developed unique mouthwash and fluoridated toothpaste for remineralization of
biologically active restorative materials containing ACP as enamel caries [27-28].
filler encapsulated in a polymer binder, which may stimulate
the repair of tooth structure because of releasing significant 6. Bio-Ionomers
amounts of calcium and phosphate ions in a sustained manner. In recent years, the ability of glass ionomers to release ions
In addition to excellent biocompatibility, the ACP-containing apart from fluoride, notably calcium and aluminum, has been
composites release calcium and phosphate ions into saliva studied, and there is evidence to show that they promote re-
milieus, especially in the oral environment caused by bacterial mineralization of the tooth [29]. This seems to be related to
plaque or acidic foods. Then these ions can be deposited into their ability to buffer lactic acid [30], an effect that was
tooth structures as apatitite mineral, which is similar to the originally thought to be negative, because of its association
hydroxyapatite found naturally in teeth and bone [20-21]. with loss of cement by erosion [31]. However, very recently, it
has been found that lactic acid at the pH of active caries (4.5)
5.2.3 CPP-ACP can be buffered to the pH of arrested caries (5.5) within less
Casein phospho peptide (CPP) has a remarkable ability to than 30 seconds, and with negligible erosion [32]. This effect is
stabilize clusters of ACP into CPP-ACP complexes, likely to be beneficial, and would inhibit the development of
preventing their growth to the critical size required for secondary caries around a glass ionomer restoration.
nucleation, phase transformation and precipitation [22]. Bio active glass (BAG) contains silicon, sodium, calcium and
phosphorus oxides with specific weight percentages, which
5.2.4 Incorporation of CPP-ACP into Glass Ionomer was introduced by Larry Hench in 1969 as 45S5 Bioglass. In
Restorative Material some recent studies [33-37], BAG has been added to GI
Mqazzaoui et al. (2003) determined the effect of structure to improve its bioactivity and tooth regeneration
incorporation of CPP-ACP into glass ionomer cement Fuji IX capacity.
and demonstrated significant increase in micro tensile bond
strength (33%) and compressive strength (23%) and 7. Calcium enriched mixture
significantly enhanced the release of calcium, phosphate and Novel endodontic cement named calcium-enriched mixture
fluoride ions at neutral and acidic pH. This Fuji IX GIC (CEM) cement was introduced to dentistry in 2006 as an
containing CPP-ACP enhanced protection of the enamel and endodontic filling material [38]. The physical properties of this
dentin adjacent to the restoration compared with Fuji IX GIC biomaterial, such as flow, film thickness, and primary setting
alone [23]. time are favorable [39].

5.2.5 Mouth Rinses 7.1 Biological Action

CPP-ACP in mouth rinses significantly increases the level of It has the ability to promote hydroxyapatite (HAP) formation
calcium and phosphate ions in supragingival plaque. The in saline solution and might promote the process of
results of a study by Rose (2000) showed CPP-ACP would differentiation in stem cells and induce hard tissue
compete with calcium for plaque Calcium binding sites. As a Formation [40-42]. It also possesses the ability to set in aqueous
result, this will reduce the amount of calcium bridging environments with shorter setting time than MTA and sealing
between the pellicle and adhering bacterial cells and between ability comparable to MTA [39-43].
bacterial cells themselves. This is likely to restrict mineral
loss during a cariogenic episode and provide a potential 7.2 Clinical Application in Pediatric Dentistry
source of calcium for the inhibition of demineralization and 7.2.1 Root End Filling Material
assist in subsequent re-mineralization after the mouthwash for The micro-leakage of CEM cement, which is comparable with
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MTA and Portland cement, indicates its good apical sealing. saliva which are available for re-mineralization of the tooth
Due to the other beneficial properties of this material such as surface. Unlike other calcium phosphate technologies, the
biocompatibility, flow ability, good clinical handling, ions that bioactive glass release form hydroxycarbonate
antibacterial and low cytotoxic effect, CEM cement is apatite (HCA) directly, without the intermediate amorphous
suggested as an appropriate root-end filling material [44]. calcium phosphate phase [53]. These particles also attach to the
tooth surface and continue to release ions and re-mineralize
7.2.2 Regenerative Endodontic Treatment with CEM the tooth surface after the initial application. These particles
Cement have been shown, in in-vitro studies, to release ions and
Revascularization is a valuable treatment in immature transform into HCA for up to two weeks [54]. Ultimately these
necrotic teeth that allows the continuation of root particles will completely transform into HCA which is the
development. Successful revascularization in necrotic mineral of our teeth. In a clinical trial on tooth
immature molars by using CEM cement as new endodontic hypersensitivity a bioactive glass containing toothpaste was
biomaterial with a modified approach have been reported by shown to decrease sensitivity significantly greater than
Nosrat et al. (2011) [42]. strontium chloride toothpaste. They have also been shown to
have significant anti microbial properties and can kill up to
7.2.3 Pulpotomy 99.99% of oral pathogens associated with periodontal disease
Studies of complete pulpotomy treatment in permanent teeth and caries [53-54].
using CEM, MTA, and Calcium Hydroxide have shown that
compared to Calcium Hydroxide, samples in the CEM group 9. Bio aggregate
exhibited lower inflammation, improved quality or thickness Bio Aggregate, new generation of bio ceramic material is
of calcified bridge, superior pulp vitality status, and developed as a result of utilizing the advanced science of
morphology of odontoblast cells [45]. A randomized clinical nano-technology to produce ceramic particles that, upon
trial study on the success rates of MTA and CEM in reaction with water produce biocompatible and aluminum-
pulpotomy of deciduous molars with a two-year follow-up free ceramic biomaterials. Bio Aggregate has excellent
period was conducted and concluded that pulpotomy handling characteristics which aids in a repair process of the
treatment of deciduous molars using CEM is a successful affected tooth. Bio Aggregate’s radiopacity properties,
treatment modality [46]. convenient setting and hardening time and easy workability
and handling properties make it an ideal root canal filling
7.2.4 Apexogenesis material. The working time of BioAggregate is around 5
A randomized clinical study of permanent molars with open minutes. Upon mixing a thick paste-like mixture is formed. If
apices showed extensive caries and signs of additional working time is required, simply cover the mixture
reversible/irreversible pulpitis. A 1-year follow-up with a moist gauze sponge [55].
randomized clinical trial concluded that complete pulpotomy
of the teeth using MTA and CEM were beneficially 9.1 Clinical Applications
successful [47-48]. Bio Aggregate promotes cementogenesis and forms a
hermetic seal inside the root canal. It is effective in clinically
7.2.5 Direct Pulp Capping blocking the bacterial infection, its ease of manipulation and
Zarrabi MH et al. concluded in his study that under superior quality makes Bio Aggregate the most innovative
immunohistochemical examinations, thickness of dentinal and unique root canal repair material. According to
bridge beneath CEM was higher than MTA at various time manufacturer, the Bio Aggregate is indicated for repair of root
intervals; pulp inflammation was also lower in the CEM perforation, repair of root resorption, root end filling,
groups [49]. In addition, expressions of fibronectin/tenascin in apexification, and pulp capping [55].
the CEM groups were higher than the MTA groups during
both time intervals; however, the above differences were not 10. Theracal LC
statistically significant [50]. TheraCal LC is a light-curable resin-modified tricalcium
There is controversy amongst pediatric dentists regarding silicate classified as a 4th generation calcium silicate material.
DPC treatment of human deciduous molars with calcium It is a single paste calcium silicate-based material promoted
hydroxide. A recent randomized clinical trial study has shown by the manufacturer for use as a pulp capping agent and as a
that CEM and MTA exhibit similar and acceptable outcomes protective liner for use with restorative materials, cement, or
in DPC treatment of human deciduous molars [51]. other base materials [56]. TheraCal LC is claimed to be a
hydraulic silicate material that sets by hydration. Hydration is
7.2.6 Indirect Pulp Capping with CEM Cement the chemical reaction that leads to the setting of hydrophilic
An interesting case report of IPC treatment with CEM of a cement. The setting starts with the contact of the material and
mature symptomatic first mandibular molar with irreversible water. TheraCal LC does not include water for material
pulpitis associated with apical periodontitis demonstrated hydration. It depends on the water taken up from the
favorable clinical and radiographic outcomes, such as environment and its diffusion within the material. Hence, the
complete resolution of symptoms and healing of the apical manufacturer instructions implement placing the material on
lesion within a 15 month follow-up period [52]. moist dentin [57].

8. Bio active glass 10.1 Biological Action

Bioactive glass is made of synthetic mineral containing TheraCal LC has displayed calcium release properties. The
sodium, calcium, phosphorous and silica (sodium calcium bioavailability of calcium ions plays a key role in the
phospho silicate) which are naturally found in the body. When material-induced proliferation and differentiation of human
these particles come in contact with saliva or water, they dental pulp cells and the new formation of mineralized hard
rapidly release sodium, calcium and phosphorous ions into the tissues. The amount of calcium ions released from TheraCal
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LC was in the concentration range with potential stimulatory (hDPSCs) were time and concentration-dependent.
activity for dental pulp and odontoblasts [57-58]. On the other Osteogenic differentiation of hDPSCs was enhanced after
hand, the release of hydroxyl ions raises the pH of the exposure to Biodentine that was depleted of its cytotoxic
surrounding environment and causes irritation of the pulp components. This effect was less readily observed in hDPSCs
tissue. This develops superficial necrosis on exposed pulp, exposed to TheraCal LC, although both cements supported
provoking mineralization directly against the necrotic zone extracelluar mineralization better than the positive control
[59]
. TheraCal LC is reported to have an apatite forming (zinc oxide-eugenol–based cement). Further investigations
ability. The resultant “apatite coating” plays a key role in with the use of in vivo animal models are required to validate
dentine repair and mineralization [60]. Its ability to induce the the potential adverse biological effects of TheraCal LC on
formation of hydroxyapatite-like crystals could contribute to hDPSCs [68].
the chemical bond to dentine and provides a biological seal
[61]
. 11. Endosequence root repair material
Endo sequence root repair material (ERRM) is composed of
10.2 Applications in pediatric dentistry tricalcium silicate, zirconium oxide, tantalum pentoxide,
10.2.1 Direct Pulp Capping dicalcium silicate, calcium sulfate, calcium phosphate
Cannon et al. compared the effectiveness of TheraCal LC, monobasic, and filler agent. Setting time is a minimum of
pure Portland cement, resin-based calcium hydroxide and 2hours, which requires the existence of water to set and
glass ionomer in the healing of bacterially contaminated harden. Setting may prolong if the application site on the
primate pulps. They found no statistical difference between tooth is arid. The moisture needed for setting depends on the
the groups in regard to pulpal inflammation. However, they moisture present within the dentin, which reaches the root
reported that the light-cured TheraCal LC groups had canal through dentinal tubules, therefore eliminating the need
significantly more frequent hard tissue bridge formation, a to add moisture before placing the material. ERRM is
greater thickness of the dentinal bridge and better dentinal biocompatible, insoluble, produce caustic calcium hydroxide
bridge qualities than the Glass ionomer and VLC Dycal when coming into contact with water, and do not shrink
groups [62]. Gopika et al. compared and evaluated the response during setting. The pH is more than 12; have an antimicrobial
of the human pulp following direct pulp capping with effect, radiopaque, have an excellent sealing ability when
TheraCal LC, Septocal LC, and Dycal. Their study found that used as root-end fillings, and known to be aluminum free [69].
TheraCal LC and Septocal LC (Calcium hydroxide with In human studies, one study concluded that there was no
hydroxyapatite) cements were as effective as Dycal in difference between ERRM and MTA in the appearance of the
inducing the formation of reparative dentin and evoking an dentinal bridge and pulp inflammation, and there was less
inflammatory response [63]. sensitivity to cold in patients treated with MTA [70].
Anujalkhur et al. performed direct pulp capping using ERRM
10.2.2 Indirect Pulp Capping and MTA found that the dentinal bridge formed with ERRM
One randomized clinical trial reported successful clinical (no showed chronic mild inflammation cells in two sample
pain and absence of sinus tract) and radiographic (no sign of specimens of five [71]. Sultana N et al. performed vital pulp
external and internal resorption and presence of bridge) therapies with ERRM, MTA, and Biodentine in 41
outcomes following the use of MTA and TheraCal LC when participants with a follow-up period of 730 average days. The
used for indirect pulp capping in primary teeth [64]. A. T. results showed that the failure of patients who get ERRM was
Gurcan, F. Seymen et al. conduted a study on ProRoot MTA, double the odds of failure when compared to patients who get
TheraCal LC, and Dycal as IPC material on primary and MTA [72]. However more clinical studies need to be done to
permanent teeth and concluded that there were no statistically evaluate the prognosis and outcomes for long-term follow-up
significant differences between the materials and success rates to assess the material as pulp-capping agent in both primary
of ProRoot MTA, TheraCal LC, and Dycal were 94.4%, and permanent teeth.
87.8%, and 84.6% in both primary and permanent teeth
according to the modified USPHS criteria (p>0.05) [65]. 12. Conclusion
In the present era of regeneration, re-mineralization of de-
10.2.3 Pulpotomy mineralized dental hard tissue is a pre eminent requisite. With
Mariem O. Wassel, Dina H. Amin and Amira S. Badran advances in technology, a ceaseless quest for bio mimetic
conduted a study on TheraCal as pulpotomy agent in primary materials which protects and maintains the health of hard and
teeth and concluded that TheraCal LC is a relatively soft tissue persists. It becomes necessary to understand the
biocompatible material with comparable clinical and properties of the current bioactive materials available to
radiographic success rates over 6 months to Formocresol66. thoroughly avail their beneficial actions. Further there is a call
Hengameh Bakhtiar et al. conducted a study on human pulp for increased research in the field to develop more materials
responses to partial pulpotomy treatment with TheraCal as based on current concepts available and create bio active
compared with Biodentine and ProRoot MTA and concluded materials which can mimic and replace the natural hard and
that Biodentine and MTA performed better than TheraCal soft tooth structure and also the surrounding bone. Newer
when used as partial pulpotomy agent and presented the best concepts for adhesion and incorporation of these materials are
clinical outcomes [67]. to be sought after which may change the approach towards
treating tooth and also the future of dentistry.
10.2.4 Revascularization
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