**2. Clinical properties**

Among the clinical properties of endodontic cements are the endodontic repair capacity, and for this reason, it must be biocompatible, radiopaque, antibacterial, dimensionally stable, easy to handle, and should not be affected by blood contamination [11]. Some of the favorable properties of bioceramics in endodontics are their physical chemical properties, such as the release of Ca2+, pH, and radiopacity [12]. The bioceramic sealing ability is excellent, as it promotes satisfactory sealing [13, 14], as well as the capacity to increase the resistance of the sealed teeth [15]. It shows a greater adhesion to the root canals, which can be seen when the endodontic retreatments are present in the longer residues [16], requiring longer clinical work time [17].

According to manufacturers' specifications, bioceramics have antibacterial activity, alkaline pH, radiopacity, and excellent biocompatibility. Its physical, chemical, and biological properties are the main characteristics for its application in dentistry. It is a biocompatible material, non-toxic, and chemically stable in biological environment. This material also has the advantage of bioactivity, that is, it is capable of forming hydroxyapatite during the hardening or prepping process, exerting influence on the bond between the dentin and the obturator material. Besides, it hardens when exposed to a humid environment, making the local dentinal tubules ideal, since the water from inside the tubules causes the cement to hydrate, promoting the reduction of the solidification time that results in the formation of hydroxyapatite [1].

According to Trope et al. [8], the various forms of bioceramics are similar in composition (calcium silicates, zirconium oxide, tantalum oxide, and monobasic calcium phosphate), having excellent mechanical, biological, and manipulative properties. In addition to being hydrophilic, they are also insoluble, radiopaque, and aluminum free. The working time is over 30 min and the holding time is around 4 h under normal conditions, depending on the amount of moisture available. EndoSequence BC RRM Fast Set Putty cement has been recently launched presenting all the properties of the original product, but with a formula that promotes a faster setting time (approximately 20 min).

**181**

**4. Bioactivity**

iRoot SP [24].

*Bioceramic Cements in Endodontics*

**3. Biocompatibility**

*DOI: http://dx.doi.org/10.5772/intechopen.89015*

ibility, not having induced critical cytotoxic effects [21].

ferentiation, a bioactivity not found in AH Plus and Roth cements.

[22] via deposition of hydroxyapatite on the surface of a substrate [23].

and stimulating the healing processes of damaged apical tissues [25].

According to Camps et al. [26], tricalcium silicate-based materials have a recognized bioactivity property, that is, the ability to induce hard tissue formation in both the dental pulp in the periapical region. In this regard, interactions of newly developed tricalcium silicate (BioRoot, Septodont, Saint Maur Des Fosses, France)

Bioactive materials can be used to repair diseases or damage to bone tissue and can remain in place indefinitely. An indication of bioactivity is the ability to develop a stable binding with living tissues in contact with simulated body fluid solution

The bioactivity of endodontic bioceramic materials was confirmed in the Bioaggregate [21], EndoSequence Root Repair Material [21], Pro RootMTA [21], and

After the SCR closure, direct contact between the obturator material and the periapical tissues occurs, such as the periodontal ligament (PDL) and the bone, making a three-dimensional hermetic sealing to prevent recurrent infections of the periapical space, both of endodontic or coronal origin. This seal may be mechanical with materials that provide an airtight seal, but may also be of biological origin. In this case, the filling material induces the formation of hard tissue through the cells of the periodontal ligament, isolating the root canal from the surrounding tissues

During endodontic obturation, the cements come into contact with the periradicular tissues, which lead to the risk of a possible systemic toxicity [12], hence the great importance of biocompatibility. The materials EndoSequence Root Repair Material (ERRM) [11, 12], BioAggregate and iRoot [18], ProRoot MTA and MTA-Angelus [12], and EndoSequence BC sealer [19, 20] showed acceptable biocompat-

Giacomino et al. [10] conducted a study to compare the biocompatibility and osteogenic potential of EndoSequence BC Sealer (Brasseler, Savannah, GA) and ProRoot ES (Johnson City Dental Specialties, Johnson City, TN) compared to Roth (Roth International, Chicago, IL) and AH Plus (Dentsply DeTrey). A precursor murine osteoblast lineage (IDG-SW3) was exposed to various concentrations of each of the cements for 7 days. Biocompatibility was determined by luminescence assay based on the quantification of adenosine triphosphate (Cell-Titer-Glo [Promega, Madison, Wisconsin]). The osteogenic potential was determined by fluorescence microscopy of the expression of DMP-1. Data were analyzed with bidirectional analysis of variance or univariate analysis of variance with the post hoc Bonferroni test. Both bioceramic cements have excellent biocompatibility even at high concentrations. On the other hand, cell death was detected when Roth and AH Plus were used in concentrations 100× lower than the bioceramic groups. It is important to note that both bioceramic cements significantly increased osteoblastic differentiation, although greater responses were observed with the EndoSequence BC Sealer. Concerning these results, DMP-1 expression, robust increase of osteogenic gene expression, and superior mineral deposition were shown. Osteoblastic differentiation and function were significantly impaired when Roth cement or AH Plus was used. Therefore, they concluded that the EndoSequence BC Sealer and ProRoot ES were significantly more biocompatible and promoted osteoblastic dif-
