**3. Biocompatibility**

*Oral Diseases*

of deciduous teeth, specification, and repair of surgically and non-surgically root perforations. In addition to these indications, MTA can be applied in other clinical situations such as the coronal plug after endodontic obturation; in the repair of vertical root fractures; prior to the internal bleaching of the dental element, as temporary restorative material; repair of root perforations. Its properties have been modified in order to obtain the excellent properties already well established of the MTA such as biocompatibility, high pH, no reabsorption, increase of root resistance, low cytotoxicity, non-contracting, and chemical stability in an endodontic sealant cement of root

Bioceramics are currently represented through restorative materials in the field of oral health, more precisely in endodontics. These bioceramic nanoparticulate cements have three presentations: the EndoSequence Root Putty Putty (ERRM Putty), in dense form; EndoSequence Root Repair Material Paste (ERRM Paste), which comes arranged in a syringe by having fluid constitution; and more recently,

For the closure of dentinal tubules, the use of bioceramic cements has been widely indicated. This material homogeneously seals the voids between the obturator material and the dentin walls. Its bioactivity favors bone repair and neoforma-

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

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

canal that is easy to work inside the root canals [5].

EndoSequence Root Repair Material [6–9].

tion by interacting with periapical tissues.

**2. Clinical properties**

formation of hydroxyapatite [1].

faster setting time (approximately 20 min).

**180**

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

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