Calcium silicate bioactive cements: Biological perspectives and clinical applications

To introduce and to examine the research progress and the investigation on hydraulic calcium silicate cements (HCSCs), well-known as MTA (mineral trioxide aggregate).

This review paper introduces the most important investigations of the last 20 years and analyze their impact on HCSCs use in clinical application.

HCSCs were developed more than 20 years ago. Their composition is largely based on Portland cement components (di- and tri-calcium silicate, Al- and Fe-silicate). They have important properties such as the ability to set and to seal in moist and blood-contaminated environments, biocompatibility, adequate mechanical properties, etc. Their principal limitations are long setting time, low radiopacity and difficult handling. New HCSCs-based materials containing additional components (setting modulators, radiopacifying agents, drugs, etc.) have since been introduced and have received a considerable attention from laboratory researchers for their biological and translational characteristics and from clinicians for their innovative properties. HCSCs upregulate the differentiation of osteoblast, fibroblasts, cementoblasts, odontoblasts, pulp cells and many stem cells. They can induce the chemical formation of a calcium phosphate/apatite coating when immersed in biological fluids. These properties have led to a growing series of innovative clinical applications such as root-end filling, pulp capping and scaffolds for pulp regeneration, root canal sealer, etc. The capacity of HCSCs to promote calcium-phosphate deposit suggests their use for dentin remineralization and tissue regeneration. Several in vitro studies, animal tests and clinical studies confirmed their ability to nucleate apatite and remineralize and to induce the formation of (new) mineralized tissues.

HCSCs play a critical role in developing a new approach for pulp and bone regeneration, dentin remineralization, and bone/cementum tissue healing. Investigations of the next generation HCSCs for "Regenerative Dentistry" will guide their clinical evolution.