In dental medicine, the concept of biomimetic material is an increasingly applicable word
especially in restorative dentistry
Low transient inflammatory response Enamel, dentin and
Magne P, Douglas WH. Rationalization of esthetic restorative dentistry based on biomimetics. Journal of Esthetic and Restorative Dentistry. 1999
The physiological performance of intact teeth is the result of intimate and balanced
relationships between biological, mechanical, functional and aesthetic parameters.
Natural tooth through the optical combination of enamel and dentin constitute the
perfect and unmatched compromise between rigidity, strength and resilience.
Prepared tissues full
Passage of functional
Hard tissue bond
Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Quintessence publishing company; 2002 May.
Magne P, Douglas WH. Rationalization of esthetic restorative dentistry based on biomimetics. Journal of Esthetic and Restorative Dentistry.61999
Biomimetics, term was coined by
Otto Schmitt in the 1950s .
Biomimetic is defined as the
study of the structure and
function of biological systems as
models for the design and
engineering of materials and
• Karma M, et al. Biomimetics in dentistry. Indian J
A bioactive material is one that
elicits a specific biological
response at the interface of the
material which results in the
formation of a bond between
the tissues and the material.
Hench LL, Splinter RJ, Allen WC, Greenlee TK Jr.;Bonding
mechanisms at the
interface of ceramic prosthetic materials. J Biomed Mater Res.,
• Bactericidal And Bacteriostatic
• Stimulate Reparative Dentine
• Sterile And Maintain Pulp
• Should be synthetic in origin
• Should mimic biology
• Should bond with natural
• Should not elicit any biological
Caries free peripheral seal
Deactivation of MMP
Immediate dentine sealing
Gold standard bonding systems
Resin coating after IDS
Deep margin elevation
Alleman DS, Nejad MA, Alleman CD. The Protocols of Biomimetic Restorative Dentistry: 2002 to 2017. Inside Dentistry. 2017 Jun;13(6).
• Mineral Trioxide Aggregate (MTA)
• Calcium Aluminate Cement
• Bioaggregate (BA)
• Endosequence Root Repair Material (ERRM) putty, ERRM paste RRM putty
fast set (FS) and iroot FS
• Bioceramic Sealers
• Bioceramic Gutta-Percha
• Bioactive Glass (BAG)
• Remineralizing Agents
i. Casein phosphopeptide amorphous calcium phosphate (CPP-
ii. Demineralized dentin (dDM)
iii. Enamel matrix derivative (EMD)
iv. Growth Factors
v. Bone Morphgenic Proteins (BMP)
• Platelet Concentrates
• Polyhedral Oligomeric Silsesquioxanes (POSS)
• Metallic Biomaterials
• Implant Biomaterials/Biomimetic Coatings on Implants
• Root Canal Revascularization via Blood Clot
• Smart Materials
• Smart pressure bandages
i. Smart suture
iii. Smart composites containing amorphous calcium phosphate (ACP)-
GLASS IONOMER CEMENT(GIC)
• Glass ionomer cement (GIC) which was invented in 1969 is composed
of fluoroaluminosilicate glass powder and water soluble polymer
• When powder and liquid is blended, it undergoes hardening reaction
that involves neutralization of the acidic group together with
significant release of fluorides.
Enamel ~82 ~10 ~384 350-430
~40-105 ~297 ~68
GIC ~4-10 ~10-11
~4.5 196-251 87-177
GIC PROPERTIES SUPPORTING AND AGAINST
ITS BIOMIMITIC BEHAVIOUR
1. It is synthetic
2. It does not form any natural tooth
3. It’s similar mechanical properties to
4. Adheres chemically to the tooth
4. Less shrinkage, so less microleakage
5. Dimensional stability at high humidity
1. Low Tensile strength
2. High opacity (Contrast
ratio- 0.9 )
3. Less Wear Resistance
BIOMIMETIC BEHAVIOUR NON- BIOMIMETIC BEHAVIOUR
• Bioactive formulation (such as 45S5, S53P4) has bioactive glass
• The mechanical properties of GIC have been improved with
incorporation of metals such as stainless steel and bio inert ceramics
• KT-308 (GC Corporation Company, Tokyo, Japan) a GIC sealers,
provides more resistance to coronal ingress of bacteria into the root
ALTERATION OF BIOMIMETIC PROPERTIES IN
CASE OF RGIC
• Optical properties- Improved from conventional GIC, as translucency
• Strength- The diametral tensile strength is much higher but compressive
strength and hardness is lesser.
• Adhesion- Bond strength of resin modified glass ionomer with dentin is
higher than that of conventional G.I.C
• Microleakage- Increased due to polymerization shrinkage of
• Active Gutta-Percha (GP) (Brasseler USA, Savannah, GA,
USA) has GI impregnated Gutta-Percha (GP) cones that
are bondable to GIC based sealer and claims to offer
adhesive bonding of the active GP to intraradicular
• To ensure a better prognosis in cases like flared canal
where intraradicular dentin thickness is very less,
“Reinforcement Technique” should be followed.
• ZUT (University of Toronto, Ontario, Canada) a
combination of GIC and an antimicrobial silver-
containing zeolite is effective against E.faecalis and hence
can be more effective in treating teeth of persistent apical
RESIN BASED COMPOSITE
• Introduced by Bowen in 1962, offers wear resistance, color stability,
improved physical properties and radiopacity
• Smart Dentine Replacement is a
first flowable composite material.
• Its characterized by:
i. low polymerization stress
ii. low polymerization shrinkage,
iii. high depth of cure
iv. bulk-fill material in increments of
up to 4 mm in class i and ii
• In 1928, Calcium Hydroxide was introduced
by Hermann in dentistry.
• It has been widely used as a mineralizing agent
and antimicrobial agent.
• Calcium hydroxide causes release of extracellular
matrix molecules (like dentine phosphoproteins,
dentine sialoproteins), raises expression of
biomolecules, like BMP, and has antimicrobial
and anti-inflammatory action
• Formation of tunnel defects and decrease in dentine strength
following its long term use as intracanal medicament are its
• To improve its biological performance, Controlled-release Calcium
hydroxide loaded microcapsules based on polylactic acid (PLA)
and ethyl cellulose (EC) have been developed.
• These formulations prolonged ion release.
It is a resin-based direct pulp-capping agent.
Powder :89.0% microfiller, 10.0% calcium hydroxide, and 1.0% benzoyl
Liquid : 67.5% triethyleneglycol dimethacrylate, 30.0% glyceryl
methacrylate, 1.0% O-methacryloyl tyrosine amide, 1.0%
dimethylaminoethylmethacrylate, and 0.5% camphorquinone
MTYA1-Ca developed dentine bridge formation without formation of a
necrotic layer, revealed to have good physical properties, and was not inferior
to Dycal histopathologically.
Niinuma A. Int Endod J. 1999
• Calcium sulfate (CS) has been shown to be
completely bio absorbable, osteoconductive,
allow fibroblast migration, do not cause an
• It also do not elevate serum calcium levels.
• Recently, it has been shown that CS can be
manufactured into a granular composite of CS and
poly-l-lactic acid to decrease the degradation rate.
• Calcium phosphates plays important role in biological and
• Most commonly used in the form of paste, cement, ceramics and
• It helps in induction of bridge formation
with no superficial tissue necrosis and
significant absence of pulpal inflammation.
CALCIUM ENRICHEDMIXTURE (CEM)
• It contains calcium oxide, sulfur
trioxide, phosphorous pentoxide, and
• It might promote differentiation of
stem cells and cementogenesis.
• It is also known as NEC (new
endodontic cement) and was
introduced by Asgary.
• MTAwhich was developed by Mahmoud Torabinejad at Loma
Linda University, consists of 50-75 % (wt.) calcium oxide and
15-25 % silicon dioxide.
It has high pH (12.5),
• causes regeneration of the periodontal ligament (PDL)
• dentinal bridge formation
• biomineralisation and stimulation of cell differentiation
• has antimicrobial activity.
However, difficulty in manipulation and longer setting time are
i) MTAangelus (Aangelus, Londrina, PR, Brazil)
is composed of 80% Portland cement and 20%
bismuth oxide and has setting time of 14
ii) MTAfillapex (angelus solutions odonatological,
Londrina, PR, Brazil) is a calcium silicate-based
bio ceramic sealer, created with an attempt to
incorporate physical and chemical properties of a
resin-based root canal sealer and the biological
properties of MTA.
• iii). MTAplus (Avalon biomed Inc.,
Bradenton, FL, USA) is a fine powder root
canal sealer with composition similar to
ProRoot MTA .
• iv). Pozzolan cement (Endocem) (Maruchi,
Wonju, Korea) is a fast setting MTAderived
material which does not contain any chemical
CALCIUM ALUMINATE CEMENT
• (Binderware, São Carlos, SP,Brazil), was developed by the Federal
University of São Carlos.
• It is composed of oxides of aluminium (Al2O3), calcium, (CaO), silicon (SiO2),
magnesium(MgO) and iron (Fe2O3).
• It allows the control of impurities such as Fe2O3(which promotes tooth darkening)
and is free of MgO and CaO which restricts the undesirable expansion of the
material upon moisture contact.
• It is a calcium aluminate product available in powder liquid form.
• It can be used as a permanent restorative material.
• It consists of alumina, calcium oxide, water, zirconium dioxide
and other alkali oxides.
• When powder and liquid are mixed water dissolves the calcium
aluminate powder leading to the formation of calcium, aluminum
and hydroxyl ions leading to the formation of katoite and gibbsite.
• It is calcium aluminate cement used as a
• It works on the principle of two cements
they are calcium aluminate and glass
• This cement helps in luting of permanent
crowns and fixed partial dentures, gold
inlays and onlays, prefabricated metal
and cast dowel and cores, and high-
strength all-zirconia or all-alumina
• (Septodont, Saint-Maur-des-Fossés, France),
introduced in 2011.
• It is a bioactive dentin replacement material
having similar properties of dentin and has a
positive effect on vital pulp cells stimulating
tertiary dentin formation
• Tri-calcium silicate
• Di-calcium silicate
• Calcium carbonate & oxide
• Iron oxide
• Zirconium oxide
• Calcium chloride
• Hydrosoluble polymer
• When biodentine comes in contact with dentine it results into formation of the tag-
like structures and iscalled‘‘Mineral Infiltration Zone,’’which may contribute to
• It has improved- physical properties,
-reduced setting time (12 min)
-induces odontoblast-like cell differentiation
• Mineralization occurs in the form of osteodentine by expressing markers of
odontoblasts & increases TGF-Beta1 secretion from pulpal cells enabling
• During the setting of the cement Calcium hydroxide is formed. Due to its high
pH, Calcium hydroxide causes irritation at the area of exposure.
• It is a light-cured, resin-modified calcium silicate–filled liner
insulating and protecting the dentin–pulp complex.
• It can be used in direct and indirect pulp capping, as a protective
base/liner under composites, amalgams, cements, and other base
• When this material was compared with ProRoot MTAand Dycal, it
was found that calcium release was higher and solubility was low.
• Innovative Bioceramix Inc.,
Vancouver, BC, Canada) introduced in
• It is delivered as powder form of
nanoparticles containing tricalcium
silicate dicalcium silicate calcium
phosphate monobasic amorphous
silicon dioxide tantalum pentoxide
(radio pacifier) while it’s liquid form
contains deionized water.
• It is aluminum free formulation, thus it stimulates proliferation of
human PDL fibroblasts and aids in periodontal regeneration.
• Used for pulp capping, apexification, root resorption, root perforation
and root end filling material.
ENDOSEQUENCE ROOT REPAIR MATERIAL (ERRM)PUTTY, ERRM
PASTE RRMPUTTY FASTSET(FS)ANDIROOTF
Endosequence root repair material
(ERRM) (Brasseler USA, Savannah,
premixed mouldable putty (iRoot BP
as a preloaded paste in a syringe
with delivery tips for intracanal
It contains calcium phosphate
monobasic, calcium silicates,
zirconium oxide and tantalum
• Inside dentinal tubules, ERRM forms tag-like structures .
• They are premixed, single component materials which is ready to use
from the syringe or a tiny screw-cap box and does not requires mixing,
thus differentiating it from MTA, bioaggregate and biodentine.
• RRM putty fast set (FS) has the initial setting time of 20 min.
• iRoot FS (Brasseler USA, Savannah, GA) is iRoot series material
with improved handling properties and shorter setting time
Ceramics are nonorganic, nonmetallic, non-polymeric materials
manufactured by compacting and sintering at elevated temperatures.
They are being examined for bone tissue engineering and also have
Hydroxyapatite (HA), a major inorganic component of bone is a
calcium phosphate based ceramic.
In Novel ceramic bone replacement material Ceraball, new bone
formation first takes place on the scaffold surface.
• Ceraballs may act as a carrier for pluripotent mesenchymal stem
cells, stromal cells and bone marrow
• On the basisof tissue’s responseit canbe classified asbioactive
(bioglass/glass ceramic), bioresorbable (calcium phosphate) and bio
inert (alumina, zirconia and carbon).
• The implant coating is intended for improving implant surface
biocompatibility profiles and longevity
• Endosequence BC sealer (Brasseler
USA, Savannah, GA) or iRoot SP
root canal sealer (Innovative
Bioceramix Inc., Vancouver, BC,
Canada) is premixed bioceramic
endodontic sealer containing
tricalcium silicate, zirconium oxide,
dicalcium silicate,calcium phosphate
monobasic, colloidal silica, calcium
silicates and calcium hydroxide
• The iRoot SP possesses high
pH, hydrophilicity, and
active calcium hydroxide
• These are Gutta-Percha cones impregnated and coated with
bioceramic nanoparticles and are verified with laser for tip
and taper accuracy.
• Such coneswith BCsealers allows “three-dimensional”
• Calcium sodium phosphosilicate is used in cariology, restorative dentistry and
periodontology, air polishing procedures, desensitizing toothpastes, and as a
bonding and bone regeneration material
• Mohn et al mixed BAG particles with 50% bismuth oxide and used it as root canal
filling material. BAG has directly and indirectly pH related antibacterial effect.
• BAG can be the material of choice for pulp capping & periapical bone healing
because it is biocompatible & has antibacterial property.
Schepers et al, 1991
• BAG produce Less inflammation, dentin bridge formation & no internal
resorption, necrosis or abscess compared to Ca(OH)2
Journal of Dentistry, Tehran University of Medical
Sciences, Tehran, Iran(2007)
• Bioactive glass treatment leads to enhanced apatite formation in dentin. Size of the
bioactive glass powder particles influences the rate of apatite formation with nano
bioactive glass powders having faster apatite forming kinetics
D. Fernando, et al, (2017)
Casein phosphopeptide amorphous calcium phosphate
• Subsurface carious lesion can remineralize through diffusion of
calcium and phosphate ions into tooth structure.
• CPP stabilizes calcium and phosphate in solution state and thus acts
as calcium and phosphate reservoir.
• The incorporation of the CPP-ACP
nanoparticles into the cross-linked
matrix of the GIC aids to increase
compressive strength, microtensile
bond strength and enhances release
of calcium, phosphate and fluoride
• Tooth Mousse™ (Europe and
Australasia) or MI Paste™ (USA
and Japan) contains 10% w/w
• The dentin matrix which are used for implant biomaterial
has osteogenic and chemotactic potential.
• Demineralized bone matrix when comes in contact with
mesenchymal cells it induces chondrogenesis and osteogenesis.
• Incorporation of Galla chinensis extract into dentin matrix
may improve biochemical and biomechanical properties.
ENAMELMATRIX DERIVATIVE (EMD)
• Enamel matrix derivative is derived from
pig enamel matrix (Emdogain;
Straumann AG, Basel, Switzerland)
• It has been employed in patients with
severe attachment loss through
recruitment of cementoblasts on to the
root-surface to restore functional
periodontal ligament, cementum and
• Growth factors are considered as engines that drive wound healing.
Platelet derived growth factor (PDGF) plays key role in chemotaxis of
neutrophils that acts with other growth factors to produce collagen.
• Keratinocyte growth factor (KGF) through keratinocyte differentiation,
plays vital role in wound re-epithelialization.
• Transforming growth factor (TGF) induces extracellular
matrix deposition and collagen formation.
• Fibroblast growth factor (FGF) plays role in fibroblast proliferation,
angiogenesis, and matrix deposition.
• Vascular endothelial growth factor (VEGF) increases
vascular permeability at the capillary level.
• Epidermal growth factors (EGF) acts in an autocrine fashion.
• Kepivance (KGF-2) is used in preventing oral mucositis. Juvista, a
recombinant TGF-b3 may be used as a growth factor enhancer for all
surgically created wounds
BONE MORPHGENIC PROTEINS(BMP)
• BMP plays a key role in dental bone grafting and implant placement,
fracture healing and spinal fusion.
• It increases alkaline phosphatase activity, stimulates proteoglycan
synthesis in chondroblasts, collagen synthesis in osteoblasts,
differentiation of neural cells and chemo taxis of monocytes.
• It was first described by Whitman et all.
• Platelet rich plasma (PRP) is generated by differential centrifugation and serves as
reservoir of critical growth factors such as platelet- derived growth factor (PDGF),
transforming growth factor-b (TGF-B) and insulin-like growth factor-1 (IGF-1) ,
thus regulates wound-healing.
• PRP requires biochemical blood handling with addition of
anticoagulants while platelet rich fibrin (PRF) does not.
• A second generation platelet concentrate, Leucocyte and platelet rich fibrin (L-
PRF) was developed by Choukroun et al in France does not contain any
anticoagulant or gellifying agents.
• Biomaterials such as polyhedral oligomeric silsesquioxanes (POSS)
and polyhedral oligomeric silicates (POS) may be fabricated by the
incorporation of POSS molecules to provide a nanoscopic topology
which favors cellular modulation, bioavailability and differentiation.
• Advent of POSS has led to formulation of dental adhesives and
composites with improved mechanical and physical properties.
• Metallic biomaterials are mainly used for fabrication of medical
devices for hard tissue replacement such as artificial hip joints,
bone plates and dental implants.
• Stainless steel, cobalt alloys, pure Ti and Ti-6al-4v are mainly
used for biomedical applications.
IMPLANT BIOMATERIALS/BIOMIMETIC COATINGS
• It includes metals and metallic alloys,
ceramics, natural materials and synthetic
• Metals and metallic alloys include titanium,
tantalum and alloy of Ti-Al-Va, Co-Cr-Mb,
Fe- Cr-Ni. Devices made from zirconium,
hafnium and tungsten have been evaluated
• Hydroxyapatite-coated metal’s coatingis
done using robotic techniques for
• Polymers like polymethylmethacrylate (PMMA), polyethylene
(PE), polyurethanes are used in dental surgery since decades.
• Polyglycolic acid (PGA), polylactide (PLA), polydioxanone (PDS)
are mainly used as resorbable bone fixation devices or as suture
• For surgical wound repair fibrin glue is used as tissue adhesive.
• Alginate can be used as growth factor delivery system.
• Dental regeneration is a process in humans by which specialized
dental tissues are replaced by the recruitment, proliferation,
migration, and differentiation of dental stem cells.
• Stem cells, scaffolds, and growth factors are 3 key elements for tissue
• Root Canal Revascularization via Blood Clot
In the Root canal revascularization via blood clot in apical region, the
bioceramic material is placed as mid-root/coronal plug, thereby
providing permanent and superior quality seal.
• Jung et al. reported that by activation of MAPK pathway biodentine,
bioaggregate and MTA causes odontoblastic differentiation and
• Postnatal stem cell therapy, pulp implantation, scaffold implantation,
injectable scaffold delivery, 3-D cell printing and gene therapy are
some regenerative approaches.
• It is defined as the class of materials that are highly responsive and
have the inherent capability to sense and react according to changes
in the environment.
• They can be classified as active and passive smart materials.
• Passive smart materials responds to external change without any
• While active smart materials utilizes a feedback loop to enable them
to function like a cognitive response through an actuator circuit.
A) Smart pressure bandages -
Upon exposure to blood, these
bandages contracts thereby
putting pressure on a wound.
B) Smart suture - It ties itself into
the Perfect knot and possesses
C) Hydrogel - It exhibit plastic contraction
temperature, pH, magnetic or electrical field.
D) Smart composites containing amorphous calcium
Inclusion of ACP into composite resin results into release of
calcium and phosphorous for an extended period and are thus
helpful in caries prevention.
• E) Cercon - smart ceramics -
It is a metal-free
biocompatible life like
restoration that has strength
to resist crack formation.
• The drawbacks of porcelain
fused to metal like unsightly
dark margins and artificial
grey shadows from the
underlying metal are no
longer a problem with
APPLICATIONS OF BIOACTIVEMATERIALS
ANDMOLECULES IN DENTISTRY
Root Canal Therapy
• Portland cement or MTA is a bioactive material used for
maintaining pulp and periodontal tissue vitality as part of pulp-
capping and perforation repair procedures.
• Mineral trioxide aggregate is also used as an obturating material
after root canal therapy. It helps in apexification.
Tooth Repair and Regeneration
• Dentin extracellular matrix proteins (ECMPs) contain growth
factors that can promote tooth healing and pulp regeneration.
• Dentonin (peptide) can stimulate reparative mineralization
of the coronal pulp and occlusion of the lumen of the root
• A novel biomaterial (tissue regenerative gel), can
promote the regeneration of tooth tissue.
In Dental SurgeryandCraniomaxillofacial
• Biomaterials, such as Emdogain containing Porcine proteins
play an important role in periodontal regeneration after injury.
• Synthetic bone materials are used for maxillofacial and
• The ideal biomaterial for dental reconstruction should be
biocompatible and also able to maintain volume and can be
• n-Butyl-2-cyanoacrylate is widely used as a tissue adhesive.
It is also used for filling and repairing bone defects.
Coating of Implants
Dental implants are made from titanium alloys and have a
hydroxyapatite to promote osteogenesis and bone healing.
• A novel bioactive glass-ceramic (biosilicate) is
applied in hypersensitivity cases.
• It is capable of inducing HCA (hydroxyl carbonate apatite)
deposition in open dentinal tubules, and thus occluding the
• Hence, biosilicate may be a new way for treating
• Bone Graft
• Bioactive materials, such as osteoconductive matrix,
which act as scaffold to new bone growth, and
osteoinductive proteins, which support mitogenesis of
undifferentiated cells combined with osteogenic cells
(mesenchymal stem cells), are capable of forming bones.
Stem Cell Therapy
• New methods of stem cells with bioactive materials renovate the
function of injured tissue by replacing dead or damaged cells with
new and healthy cells.
• Dental Tissue Regeneration
• A combination of nanostructure materials, such as biomimetic
matrices and scaffold and stem cells, will certainly increase the
regenerative impact of dental pathological tissues
• Biomimietic materials functions as root canal sealer, filling materials,
cements and root and crown repair material and possesses features as
like strengthening the root following obturation, good sealing ability,
enhanced biocompatibility and antibacterial properties.
• Contemporary biomaterials have shown ability to overcome the
limitations of traditional materials.
• However, there exists limitations when considering criteria for
categorizing them as ideal materials.
• Several in vitro and in vivo studies have demonstrated good results,
however randomized and double blind studies of sufficient duration
with biomimetic materials have been needed to confirm long term
• Cohen's Pathways of the Pulp, 11th Edition
• Sonarkar S, Purba R. Bioactive materials in conservative dentistry. Int J
Contemp Dent Med Rev. 2015;2015:4.
• Bhushan M, Tyagi S, Nigam M, Choudhary A, Khurana N, Dwivedi V.
Bioactive materials: A short review. J. Orofac. Res. 2015 Oct;5:138-
• Jefferies S. Bioactive and biomimetic restorative materials: a
comprehensive review. Part II. Journal of Esthetic and Restorative
Dentistry. 2014 Jan 1;26(1):27-39.