Biodentine Review: The All-In-One Bioactive Dentine

Biodentine is a calcium silicate-based bioactive dental material manufactured by Septodont that has fundamentally changed how clinicians approach damaged dentine. Available since 2009, this all-in-one dentine substitute is designed for use wherever dentine is compromised, covering both restorative and endodontic indications in a single material system.

The material combines therapeutic bioactivity with restorative-grade mechanical properties, allowing dental professionals to treat everything from deep carious lesions and pulp exposures to root perforations and apexification procedures. Unlike traditional approaches that require multiple materials for different layers of a restoration, Biodentine can fill a cavity from pulp to crown in one step using the Bio Bulk-Fill technique.

This review examines Biodentine’s composition, clinical evidence, practical advantages, limitations, and real-world performance to help dental professionals make an informed decision about whether this material belongs in their operatory.

What Is Biodentine and How Does It Work?

Understanding the science behind Biodentine helps explain why this material performs so differently from conventional cements and liners. The formulation is built on Septodont’s patented Active Biosilicate Technology, which ensures an exceptionally high purity of tricalcium silicate, the material’s principal bioactive component.

Biodentine is supplied as a powder-liquid system in single-dose capsules. The powder contains tricalcium silicate as the main core material, dicalcium silicate for long-term strength, calcium carbonate as a filler, zirconium oxide for radiopacity, and iron oxide for colour. The liquid component contains calcium chloride (an accelerator), a hydrosoluble polymer (a water-reducing agent), and water.

When mixed, the tricalcium silicate reacts with water to produce calcium silicate hydrate gel and calcium hydroxide. This reaction creates a highly alkaline environment that is inherently unfavourable for bacterial growth. The calcium ions released during setting stimulate dentine repair and promote hydroxyapatite formation at the material-tissue interface, which is the foundation of the material’s bioactive behaviour.

Importantly, Biodentine does not contain bismuth oxide. This is a deliberate formulation choice that significantly reduces the risk of tooth discoloration, a well-documented drawback of MTA-based products that use bismuth oxide as their radiopacifier.

Key Properties That Matter in Clinical Practice

The clinical relevance of any dental material ultimately comes down to how its properties translate into predictable patient outcomes. Biodentine’s properties have been evaluated extensively in laboratory and clinical studies, and several characteristics stand out as particularly significant for everyday practice.

Biocompatibility and Bioactivity

Biodentine is classified as a fully biocompatible medical device with no mutagenic, irritant, or sensitising potential. When placed in direct contact with vital pulp tissue, the material is well tolerated and actively promotes healing. It induces hydroxyapatite formation, supports angiogenesis and osteogenesis, and stimulates reactionary dentine genesis for pulp vitality preservation. This bioactive behaviour sets Biodentine apart from passive restorative materials that simply fill space without engaging in biological repair.

Mechanical Strength

Biodentine achieves a compressive strength comparable to natural sound dentine, and this strength continues to increase over time after initial placement. The flexural modulus is also equivalent to natural dentine, meaning the material distributes occlusal stress in a pattern similar to the tooth structure it replaces. These properties are critical when using the Bio Bulk-Fill approach, where Biodentine may occupy a large portion of the restored cavity.

Sealing Ability and Dimensional Stability

The material develops a natural micromechanical anchorage with tooth structure without requiring surface conditioning, etching, or bonding agents. This self-adhesive property contributes to excellent marginal sealing, minimal microleakage, and elimination of post-operative sensitivity. The resin-free formulation ensures zero polymerisation shrinkage and long-lasting dimensional stability, creating a tight seal that remains reliable over time.

Setting Time and Handling

The total working time from mixing to final set is approximately 10 to 12 minutes. The capsule format allows mixing with a standard triturator or amalgamator, producing a paste-like consistency that is placed with a spatula or applicator. No layering or light curing is needed, which simplifies the clinical workflow considerably.

Clinical Indications and Applications

Biodentine’s versatility across both crown and root indications is what truly earns it the all-in-one designation. The material is suitable for a broad range of clinical scenarios that would traditionally require different products.

Crown Applications

• Temporary enamel restoration for up to six months while planning the definitive composite or indirect restoration

• Permanent dentine restoration beneath composite or indirect restorations

• Deep or large carious lesions where proximity to the pulp demands a biocompatible, bioactive base

• Deep cervical or radicular lesions

• Direct pulp capping when exposure occurs during caries excavation or mechanical preparation

• Indirect pulp capping as a protective liner that stimulates reactionary dentine formation

• Pulpotomy in both primary and permanent teeth, including cases with signs of irreversible pulpitis

Root Applications

• Root and furcation perforation repair

• Internal and external resorption management

• Apexification as an apical plug for immature non-vital teeth

• Retrograde surgical filling during endodontic microsurgery

The Bio Bulk-Fill Procedure Explained

The Bio Bulk-Fill technique is one of the most clinically significant protocols enabled by Biodentine’s combined therapeutic and restorative capabilities. This approach allows the entire cavity to be filled with Biodentine alone, from the pulp floor to the tooth surface, using a single material in a single step.

No layering, multiple material systems, or light curing is required. The final enamel restoration can be placed in the same session or deferred to a second appointment performed any time between two weeks and six months later. This protocol was developed based on recommendations from an international panel of dental practitioner experts convened by Septodont in 2023.

The clinical benefits are straightforward: fewer materials to stock, fewer technique-sensitive steps, reduced chair time, and fewer appointments for the patient. For practices looking to streamline deep caries management while maintaining biological outcomes, the Bio Bulk-Fill approach represents a meaningful workflow improvement.

Biodentine vs. MTA: A Clinical Comparison

Mineral trioxide aggregate (MTA) has been the gold standard bioactive endodontic material since the 1990s. Biodentine was developed specifically to address MTA’s known limitations while retaining its biological strengths. For clinicians choosing between these two dental materials, the practical differences are significant.

Multiple systematic reviews have concluded that Biodentine and MTA demonstrate comparable clinical success rates across shared indications (Kaur et al., 2017). However, Biodentine consistently outperforms MTA on practical measures including handling ease, setting speed, discoloration risk, and versatility as a bulk restorative. A 2025 meta-analysis found that Biodentine showed a lower failure rate and marginally better calcific bridge formation, although these differences did not reach statistical significance.

Biodentine vs. Calcium Hydroxide

Calcium hydroxide was the traditional gold standard for pulp capping for several decades. While biocompatible and capable of stimulating dentine bridge formation, calcium hydroxide has well-documented clinical limitations that Biodentine directly addresses.

Calcium hydroxide is susceptible to dissolution over time, has limited mechanical strength, and produces dentine bridges that are frequently porous with tunnel defects. These characteristics can compromise the long-term seal and leave the pulp vulnerable to bacterial contamination.

Clinical studies have shown that Biodentine produces more uniform, thick, and continuous reparative dentine bridges compared to calcium hydroxide (Nowicka et al., 2015). One randomised clinical trial in young permanent teeth reported 100% success for Biodentine versus 86.36% for calcium hydroxide at follow-up (Brizuela et al., 2017). The material’s superior mechanical properties and sealing ability provide a more reliable foundation for the overlying restoration.

Clinical Evidence and Published Success Rates

Biodentine has accumulated a substantial body of peer-reviewed evidence since its launch. The data supports its use across multiple indications with favourable short-term and medium-term outcomes.

Direct Pulp Capping Results

Published studies report overall success rates for Biodentine direct pulp capping ranging from approximately 80% to over 92%, depending on follow-up duration and patient demographics. Patient age is a significant prognostic factor: success rates reach approximately 90.9% in patients younger than 40 years compared with 73.8% in patients aged 40 and older (Lipski et al., 2018). A three-year prospective randomised trial found success rates of 91.7% for Biodentine and 96.0% for MTA, with no statistically significant difference (Awawdeh et al., 2018).

Pulpotomy Outcomes

Research on full pulpotomy with Biodentine in permanent teeth with symptoms of irreversible pulpitis reported 98.4% success at six months and 100% at 12 months (Brizuela & Daley, StatPearls 2024). A systematic review and meta-analysis evaluating Biodentine for vital pulp therapy in young permanent teeth found an overall radiographic success rate of approximately 93.87%, comparable to other bioceramic materials, with a significantly lower discoloration rate compared to MTA (Tang et al., 2025).

Apexification Evidence

In a randomised clinical trial comparing Biodentine and MTA as apical plugs in immature permanent molars, both materials demonstrated comparable periapical healing at 12 months. Biodentine cases showed apical calcified barrier formation that was not observed in the MTA group (Abuelniel et al., 2022).

Primary Teeth

A comprehensive systematic review of randomised controlled trials found comparable success rates between Biodentine and MTA for pulpotomy in primary teeth. Given Biodentine’s practical advantages, it has been identified as a suitable preferred alternative in the paediatric patient population.

Biodentine XP: The Next-Generation Delivery System

Septodont developed Biodentine XP to address the most common criticism of the original product, the mixing and delivery workflow. The XP version uses the same composition and delivers identical clinical efficacy, biocompatibility, and bioactivity. The innovation is entirely in the delivery system.

Biodentine XP comes in all-in-one syringe-like cartridges containing both powder and liquid. These are mixed in 30 seconds with a dedicated high-speed mixer and dispensed directly into the tooth using an applicator gun with an orientable nozzle. Two cartridge volumes are available: XP 200 for smaller procedures and XP 500 for larger restorations.

Clinical evaluators have consistently praised the system for eliminating guesswork, improving consistency, and simplifying the workflow. The cartridges have a 24-month shelf life when stored at 5°C to 25°C. Biodentine XP is suitable for both primary teeth (children aged 2 and older) and permanent teeth.

Bottom Line

Biodentine is a genuine all-in-one bioactive dentine substitute that simplifies clinical workflows without compromising biological outcomes. The material delivers predictable results for pulp capping, pulpotomy, dentine restoration, perforation repair, and apexification, backed by a robust body of peer-reviewed evidence. Its advantages over MTA in setting time, handling, and discoloration risk, combined with comparable clinical success rates, make it a material that belongs in every modern dental practice.