Dental Tribune Middle East & Africa Edition | 6/2018 ◊Page A2 ENDO TRIBUNE A3 potomies. Here, the final restoration was placed 15 days after the initial procedure and the patient was com- pletely asymptomatic. Nine months later, full formation of calcified tis- sue could be seen at the level of the pulp capping, the tooth remained vital and the patient was completely asymptomatic (Fig. 16). Obtaining the right diagnosis is key to the success of conservative pulp therapy. An ideal case is a diagnosis of reversible pulpitis with no previ- ous history of spontaneous or pro- longed dental pain.9 It is generally ac- cepted that a history of spontaneous pain or pain at night is associated with the existence of an irreversible pulp inflammation process.10, 11 In these cases, the success of direct pulp capping may be questionable,12 al- though there are studies indicating that vital pulp therapy can be suc- cessful even in these situations.2, 13 –15 When it comes to the long-term success of conservative pulp proce- dures, it is extremely important to provide a final permanent restora- tion for the tooth that ensures a suit- able marginal seal. The reason is that this last factor, in conjunction with the absence of bacterial contamina- tion during the procedure, is among the most important factors to con- sider in order to avoid subsequent pulp inflammation.4, 16 The success rate reported for vital pulp therapy procedures using MTA with a follow- up period of up to ten years is greater than 80%17 — a fairly high percent- age for a dental procedure within that functional period. Editorial note: A list of references is available from the publisher. This ar- ticle was published in the 3/2018 issue of roots_international magazine of endodontics. A contemporary endodontic approach using bioceramic cement By Prof. Dr Leandro A. P. Pereira Endodontics is the specialty of den- tistry which prevents or treats pa- thologies of pulpal and periaplical origins. The ultimate goal is to cure the endodontic disease and allow the affected tooth to reestablish its aes- thetic/functional functions through a complementary restorative treat- ment. Obturation of the root canal system is an important step in endodontic treatment and its function is to fill and seal the canals to prevent their recontamination. With the evolution in intracanal microbiological knowl- edge and the impact of new canal modeling instruments with continu- ous or alternating rotation, we know that it is not possible to completely eliminate the microorganisms in- side the endodontic microanatomy. However, we also know that this is not necessary for success, and that the significant reduction in the lev- els of intracanal infection, in most cases, is sufficient to achieve success (SIQUEIRA). Thus, at the time of ob- turation, it is necessary to create an intercanal environment which is un- favourable to the population growth of the remaining bacteria. Therefore, another function of obturation is to prevent or hinder the growth of re- sidual bacteria not eliminated dur- ing the cleaning and disinfection process. To achieve the desired objectives, obturation cements must have es- sential properties in order to be used clinically. These are: capacity to fill, seal, and present dimensional stabil- ity; not being soluble in the organic tissue fluids; having a film thickness or no more than 50 micrometers; being radiopaque; having good drainage; not producing chromatic alterations; having suitable working time; to set and be easy to manipu- late and easy to remove if necessary; to promote cementogenesis; to be biocompatible and non-irritating to the tissues of the periapex (Kenneth M. Hargreaves 2001). However, with the development of new materials and rehabilita- tive concepts in the era of adhesive dentistry, the search for two other characteristics has become increas- ingly important in the development of new endodontic cements. One of them is the absence of eugenol, which interferes in the strength of the bond of the resin systems (VANO et al 2006). The other characteristic is bioactivity. Bioactivity is the ca- pacity of a material to be integrated with the tissues and structures of the organism with which it is in contact. responsible for the superior adapta- tion of this material to the dentin (Torabinejad 1995 Reyes-Carmona 2009). Bioactivity of the MTA is known as biomineralization and was first described by Reyes and Carmona in 2009. In one in vitro study, the authors used scanning electron mi- croscopy images to observe the in- tegration of the MTA with the dentin through deposition of numerous ap- atite groups on the dental collagen fi- brils throughout the dentinal tubule surface in contact with the MTA. An- other very interesting factor is that the authors observed that the more contact time the material had with the dentin, the more extensive the mineralizations were. These miner- alizations took place, integrating the material with the dentin, and may be However, the low drainage capac- ity of MTA does not allow for its use as an obturating cement. Thus, to get the benefit of this material’s biocompatibility, a new class of ob- turating endodontic cement was created, known as silicate-based ce- ments. This designation is derived from the components which make up the MTA and which are present in these cements. They are: Tricalcium silicate, Dicalcium silicate, Calcium Oxide and Tricalcium aluminate. The clinical case below shows the ÿPage A4 AD More than biocompatible, bioactive! 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