Modern endodontic principles part 8: the future of endodontics

Although the basic principles of endodontics have remained unchanged for nearly a century, there have been significant improvements in the materials and instruments used. The introduction of bioactive materials has been a major step forward and, recently, endodontic regeneration is changing shape from myth to reality. This paper will begin by focusing on the latest information on available bioactive materials and will continue by discussing our current understanding of endodontic regeneration and intentional replantation.

The term ‘bioactive materials’ covers a range of similar calcium silicate-based materials that are not only biocompatible but promote healing and regeneration of tissues. The most notable examples of these are ProRoot MTA (Tulsa Dental Products, USA) and MTA Angelus (Angelus, Brazil). MTA is hydrophilic and when mixed with water the powder forms a colloidal gel and sets via a hydration reaction. The setting time is approximately 2 hours 45 minutes.¹

Set MTA contains calcium hydroxide in a silicate matrix. The pH of MTA is 10.2–12.5. The material is regarded as bioactive as it triggers the precipitation of hydroxyapatite crystals through the interaction of calcium and phosphate ions forming a ‘dentine bridge’. This hydroxyapatite layer not only forms a seal at the interface with dentine but is both osteoconductive and osteogenic at the interface with vital tissues. There is therefore the capacity for new cementum to form on the surface of MTA.² This sets MTA apart from all other traditional restorative materials and has become a significant step forward in the goal of tissue regeneration.³ These bioactive properties and excellent sealing abilities of MTA result in a variety of clinical uses in the field of endodontics:⁴