BIOGLASS IN ENDODONTICS:

ABSTRACT

Biomaterials have been extensively researched and used in the field of dentistry. They have over the
years become an indispensable part of the armamentarium. In the article, I will be discussing about
Bioglass in general and its role in the field of Endodontics

A bioactive material is one that elicits a specific biological response at the interface of materials and
it results in the formation of a bond between the tissues and the material. . Bioglass has gained so
much popularity because of its chemical composition that closely resembles the mineral
composition human bone and dentin.

INTRODUCTION

Biomaterials have been extensively researched and used in the field of dentistry. They have over the
years become an indispensable part of the armamentarium. In the article, I will be discussing about
Bioglass in general and its role in the field of Endodontics.

A bioactive material is one that elicits a specific biological response at the interface of materials and
it results in the formation of a bond between the tissues and the material.

COMPOSITION

PROPERTIES:

1.antimicrobial properties (Stoor et al. 1998): Its antibacterial action is based on its potential to raise
the pH of an aqueous suspension via an sodium and proton exchange process between the glass
matrix and the aqueous environment . The bioglass matrix does not release or uptake Ca2+. It is also
capable of efflux of silica and phosphate ions. Additionally, the substrate is capable of transforming
into inert Ca3PO4 in an environment of constant fluid exchange and thereby precipitate Ca3PO4
crystals. This ion exchange phenomenon results in an indirect increase in pH and formulation of an
antimicrobial microenvironment.

2. osteoinductive: encouraging osteogenic precursors to proliferate and differentiate into matrix-

producing osteoblasts. Entire classes of genes associated with osteoblast growth and
differentiation, maintenance of extracellular matrix, as well as promotion of cell-cell and cell-matrix
adhesion, are up-regulated by the dissolution products of BioGlass. The controlled release of soluble
ionic species promotes recruitment of mucopolysaccharides and glycoproteins from adjacent tissues
into an organic matrix rich of collagen fibers in intimate contact with newly formed crystals of HCA,
facilitating bone regeneration uniformly throughout the defect. In vitro studies have found that
dissolution of ionic species also leads to an increase of the local pH at values between 11.4 and 11.8,
which is strongly antibacterial and thus particularly beneficial for dead space management of areas
that are chronically infected.

DRAWACKS OF BIOACTIVE GLASS:

1. inferior to calcium hydroxide in disinfecting human root canals infected with Enterococcus
faecalis: to overcome this limitation is the reduction in particle size of bioactive glasses to increase
the specific surface area (SSA), and thus, the active exchange surface area for improved ion release
(Sepulveda et al. 2002).
Flame spray synthesis, a dry material preparation method, enables the rapid and flexible production

of nanoparticulate bioactive glasses (Brunner et al.2006). The reduced particle size (20–50 nm)
revealed improved antibacterial properties against different E. faecalis strains in a direct exposure
model (Waltimo et al. 2007). Furthermore, nanosized bioactive glass particles were able to kill an
adherent biofilm on dentine discs (Gubler et al. 2008)

SYNTHESIS OF BIOGLASS:

Nanosized bioactive glass particles were produced in a flame spray setup.

To introduce radiopacity, an organic bismuth precursor (Grass & Stark 2006) was added to the
starting material and yielded bioactive glass nanoparticles with 20 wt% and 50 wt% of bismuth
oxide, next to nanometric bioactive glass 45S5 (45% SiO2, 24.5% Na2O, 24.5% CaO and 6% P2O5, all
in wt%). The ratios of all constituents of bioactive glass 45S5 in the radio-opaque bioactive glass
were kept constant. The bioactivity of the novel derived bioactive glass nanoparticles incorporating
bismuth oxide was tested using simulated body fluid (SBF) Pressed bioactive glass particles were
placed up to 7 days in SBF at 37 C (Brunner et al. 2006). Raman spectra (EQUINOX 55 and FRA 160/S;
Bruker optics, Ettlingen, Germany) were recorded in backscattering mode (Notingher et al. 2002).
Surface examination of bioactive glasses before and after soaking in SBF can show the formation of
carbonated hydroxyapatite. The formation is an indicator for in vitro bioactivity of biomaterials. The
formation of a carbonated hydroxyapatite layer on the surface of bioactive glass nanoparticles after
immersion in SBF for 7 days was confirmed using Raman spectroscopy. It was observed that the
bismuth oxide-modified bioactive glasses formed a hydroxyapatite layer also. This was corroborated
by SEM images showing the typical cauliflower shape of this layer on both, the pure and the Bi-
modified bioactive glass.
ENDODONTIC MICROSURGERY

Endodontic microsurgery is
indicated when an orthograde
approach is not possible or has
not yielded the desired healing
outcome, and to secure a
biopsy. The most common
endodontic surgical procedure
consists of periradicular
curettage, root-end resection,
preparation and filling with the
help of an operating
microscope.

Clinical application of B-G during

endodontic surgery. (a)
Intraradicular post protruding
through a perforation is noted
radiographically; (b) Post
reduction followed by root
repair; (c) B-G placed into the
surgical crypt prior to closure;
(d) At one-year follow-up,
resolution of furcal
radiolucency; (e) Preoperative
radiological situation; (f)
Completed root-end filling; (g)
B-G embedded in the bone
cavity; (h) Resolution of
radiolucency and reattachment
of periodontal ligament at one-
year control; (i) Preoperative
periapical x-ray; (j) Retrofilling
placed; (k) Immediate post-
operative x-ray following apicoectomy with concomitant B-G grafting; (l) One-year follow up
radiograph shows complete healing; (m) Preoperative periapical radiograph; (n) Terminated
retrograde filling; (o) Intraoperative image showing B-G in place to fill in the bony cavity; (p)
Radiological situation one year after surgery representing complete resolution of the periapical
lesion.
SOURCE: . Profeta A.C., Prucher G.M. Bioactive-glass in periodontal surgery and implant dentistry.
Dent. Mater. J. 2015;34(5):559–571. doi: 10.4012/dmj.2014-233.

ORTHOGRADE ROOT CANAL THERAPY

B-G has been successfully used in dentine remineralization procedures due to its ability to dissolve,
upon contact with physiological body fluids or human plasma, and promote mineral precipitation
with subsequent crystallization of hydroxyl carbonate apatite (HCA) on the glass/tissue interface.
The detailed analysis of the reactions involved has been presented by Hench [4]. The process
involves five stages which occur very rapidly on the surface of B-G particles because of fast ion
exchange of alkali ions with hydrogen ions from the liquid medium (stage 1), glass network
dissolution (stage 2), condensation of a silica-rich mass (stage 3), and calcium phosphate
precipitation followed by crystallisation of the HCA layer within hours (stages 4 and 5). Such a phase
is chemically and structurally similar to the mineral phase of human bone and dentine, allowing
accelerated interfacial fusion and consolidation without toxicological consequences.

1. Radio-opaque nanosized bioactive glass for potential root canal application: evaluation of
radiopacity, bioactivity and alkaline capacity, D. Mohn, M. Zehnder, T. Imfeld & W. J. Stark,
Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH
Zurich, Zurich; Department of Preventive Dentistry, Periodontology, and Cariology, University of
Zurich Center of Dental Medicine, Zurich, Switzerland, International Endodontic Journal.

Timeline of molecular and cellular B-G reactions (modified after reference [4]). The process starts
with five inorganic stages that occur very rapidly on the surface of B-G particles and lead to
formation of polycrystalline HCA. The latter fastens down rapidly with the surrounding tissue from
step 6 and acts as framework for the ingrowth of new bone. 3D architecture of mineralized bone is
created by mesenchymal stem cells in response to critical concentrations of the soluble ionic
constituents released from B-G. Mineralization of the matrix follows thereafter and mature
osteocytes, encased in a collagen-HCA matrix, are the final product by 6-8 days in vitro and in vivo.

SOURCE: Andrea Corrado Profeta* and Gian Marco Prucher, Bioactive-glass in Endodontic Therapy
and Associated Microsurgery, Open Dent J. 2017; 11: 164–170.