Biodentine by Septodont: Comprehensive Clinical Review and Application Guide

Biodentine is a tricalcium silicate-based restorative and liner material developed by Septodont. It was introduced as an active dentin substitute, meaning it is engineered to mimic and interact with dentin biology rather than simply protect it passively. Since its commercial launch in 2011, it has become one of the most studied calcium silicate materials in restorative and endodontic dentistry, with a clinical evidence base that now spans over a decade of controlled trials and clinical case series.

This review covers the material science, clinical indications, step-by-step placement protocol, procurement considerations, and how Biodentine compares to the other major liner options available to restorative practices. For a side-by-side comparison of all major cavity liners, see our top cavity liner brands compared for dental practices.

Material Science: Pure Calcium Silicate Without a Resin Matrix

Biodentine's formulation consists of a powder and liquid system. The powder is primarily tricalcium silicate, the same active phase found in MTA (Mineral Trioxide Aggregate), with added calcium carbonate as filler and zirconium oxide for radiopacity. The liquid is an aqueous solution of calcium chloride, which acts as an accelerator, combined with a hydrosoluble polymer that improves the material's consistency and workability.

When mixed, the calcium silicate powder undergoes hydraulic hydration, forming calcium silicate hydrate as the primary reaction product. This process releases calcium ions and establishes a strongly alkaline pH, creating conditions that promote odontoblast differentiation, tertiary dentin formation, and a sustained antimicrobial effect in the surrounding tissue. Unlike resin-modified calcium silicate materials such as TheraCal LC, Biodentine contains no resin phase. This is both its primary distinction and the source of its main handling limitation.

Three material properties make Biodentine relevant in a modern liner and base workflow:

1. High compressive strength. Biodentine achieves compressive strength values of approximately 300 MPa after 1 month, which is within the range of dentin itself. This makes it the only liner-class material that can also function as a dentinal replacement for a transitional period of up to 6 months, before placement of the definitive restoration.
2. Bioactivity and dentin bridge induction. Multiple in vivo studies have confirmed that Biodentine stimulates the secretion of transforming growth factor beta-1 (TGF-beta-1) from pulp fibroblasts, triggering the differentiation of odontoblast-like cells and the formation of reactionary and reparative dentin bridges. This mechanism has been documented through histological analysis in animal models and in human clinical specimens.
3. Setting behavior compatible with moisture. Biodentine is hydrophilic by nature and performs reliably in the presence of moisture. Unlike resin-based materials, which require a dry field for adequate polymerization, Biodentine's hydraulic set is not compromised by residual moisture from dentinal tubules or minor hemorrhage control challenges in pulp capping scenarios.

Clinical Indications for Biodentine

Septodont positions Biodentine across a broader range of indications than most liner materials, spanning restorative, endodontic, and surgical applications. In a general restorative practice context, the relevant indications are the following:

1. Deep caries management and indirect pulp capping. In deep lesions with residual carious dentin close to the pulp, Biodentine is placed as a protective base, sealing the lesion and stimulating the formation of reactionary dentin over the subsequent months. It is one of the few materials for which this mechanism has been verified histologically in clinical specimens.
2. Direct pulp capping (DPC) in vital, non-infected pulps. Biodentine is among the most evidence-supported materials for DPC in the presence of mechanical or small carious exposures, with studies reporting success rates comparable to or exceeding those of MTA at 12- and 24-month follow-up. The key patient selection criterion is confirmed pulp vitality and the absence of spontaneous pain before the procedure.
3. Temporary full-coverage restorative base. In the step-wise excavation approach, Biodentine is placed as a full-cavity temporary restoration following the initial excavation session. It provides adequate sealing and mechanical resistance for up to 6 months, after which it is partially removed and overlaid with the definitive composite restoration. This eliminates the need for a separate interim restoration material.
4. Cervical and root dentin defect repair. Biodentine's moisture tolerance and biocompatibility make it a viable material for cervical resorption repair and root perforation sealing, indications that are less common in general restorative practice but relevant to clinicians who manage moderate complexity endodontic cases.

Step-by-Step Placement Protocol

Biodentine requires a mixing step that adds approximately 60 seconds to the workflow compared to single-component syringe-dispensed liners. Consistent mixing technique directly affects the final material properties, so the protocol below should be followed precisely.

1. Preparation and isolation. Complete caries excavation to the extent indicated by your case protocol. Rubber dam isolation is required. Rinse with water and apply gentle air drying, leaving the dentin visibly moist but not pooling with water.
2. Hemostasis for DPC cases. Control pulpal bleeding with sterile cotton pellets moistened with sodium hypochlorite at 2.5%. Biodentine can be placed in a moist environment, but active, uncontrolled hemorrhage should be resolved before application to ensure clean adaptation to the exposure site.
3. Mixing. Open one capsule of Biodentine. Add the full contents of the liquid pipette to the powder in the capsule. Activate in an amalgamator at approximately 4,000 to 4,500 rpm for 30 seconds. The resulting consistency should be smooth, paste-like, and workable. Under-mixed material will appear granular and should not be used.
4. Placement. Transfer the mixed material to the preparation using a plastic instrument or a dedicated Biodentine applicator. Condense gently with a small condenser to adapt the material to the preparation floor and walls. For IPC and DPC applications, place a controlled layer over the area of pulp proximity or exposure. For a temporary full-cavity base, fill the entire preparation to the cavo-surface margin.
5. Initial set. Biodentine has an initial set time of approximately 9 to 12 minutes. During this window the material is workable and can be re-adapted if needed. After 12 minutes, it is sufficiently set to proceed with adhesive application if placing a same-session composite, or to place a temporary restoration if using the step-wise approach.
6. Final restoration. After the initial set, apply your adhesive system and place the composite restoration in standard incremental fashion. Biodentine does not require a separate bonding primer but benefits from a selective enamel etch or universal adhesive in self-etch mode for the surrounding tooth structure.

Clinical Evidence Summary

Biodentine has one of the most robust evidence bases among contemporary liner and base materials. A systematic review published in the Journal of Dentistry in 2017, analyzing 12 controlled clinical studies, reported pulp vitality preservation rates above 85 percent at 12 months for direct pulp capping with Biodentine, with histological evidence of dentin bridge formation confirmed in the majority of specimens where biopsy data was available.

A 2020 randomized controlled trial published in the International Endodontic Journal compared Biodentine to ProRoot MTA in direct pulp capping of carious exposures, reporting no statistically significant difference in clinical success at 24 months (87 percent for Biodentine vs. 89 percent for MTA), while noting a clear handling advantage for Biodentine due to its shorter working time and capsule-based delivery. A separate multicenter study with 3-year follow-up data reported sustained pulp vitality in 83 percent of Biodentine-capped cases.

The evidence for its use as a temporary restorative base in step-wise excavation is also well-established, supported by the work of Maltz et al. and replicated in subsequent European multicenter trials. In this indication, Biodentine is currently the reference material against which newer calcium silicate products are benchmarked.

Handling Advantages and Limitations

Advantages:

• Strongest clinical evidence base among calcium silicate liner materials for DPC and IPC, with multiple randomized controlled trials and systematic reviews.
• High compressive strength, allowing use as a temporary full-cavity restoration in step-wise excavation without a separate interim material.
• No resin matrix: moisture-tolerant setting, no light-curing device required, no concerns about oxygen-inhibition layer or light attenuation.
• Documented TGF-beta-1 induction and odontoblast differentiation, providing a biologically active mechanism beyond simple sealing.
• Radiopaque, verifiable on post-operative radiographs.

Limitations:

• Requires mixing with an amalgamator. Practices without an amalgamator or capsule activation unit cannot use Biodentine without adding equipment.
• Initial set time of 9 to 12 minutes adds chair time compared to light-cured alternatives. For practices with tight scheduling, this is a practical constraint in high-volume sessions.
• Higher cost per application than conventional liners such as Dycal or RMGI products when calculated on a per-capsule basis. Volume purchasing reduces but does not eliminate this gap.
• Not available as a syringe-dispensed product. Capsule waste is a minor but real inventory concern if use frequency is low.

Procurement and Inventory Considerations

Biodentine is sold in unit-dose capsule format, with standard packaging of 5 or 15 capsules per box. The 15-capsule box is the standard ordering unit for most practices and is available through Patterson Dental, Henry Schein, and Benco Dental. Typical list pricing for a 15-capsule box ranges from $85 to $115 depending on distributor, equating to approximately $6 to $8 per clinical application.

Because Biodentine has a finite shelf life and the capsule format means each unit is consumed in a single use, practices with low liner volumes should monitor inventory turnover carefully to avoid expiry waste. For practices performing 3 to 5 direct or indirect pulp capping procedures per month, a 15-capsule box typically lasts 3 to 5 months, keeping inventory fresh within the product's shelf life window.

Price variance for Biodentine across major distributors follows a similar pattern to other branded dental materials: negotiated account pricing can reduce the per-box cost by 15 to 25 percent relative to list price. Practices that compare prices systematically at the time of ordering consistently find meaningful savings on this product category.

Biodentine vs. Other Cavity Liners: Quick Positioning

Understanding where Biodentine sits relative to the other liner options helps practices make a clear choice based on their clinical scenarios and workflow preferences:

1. Biodentine vs. Dycal. Dycal remains one of the most commonly stocked liners in US practices due to familiarity and low cost. However, its degradation under resin restorations and lack of dentin bridge induction evidence make it a weak alternative to Biodentine in any pulp proximity scenario. For practices seeking a clinical upgrade without complexity, Biodentine is the more defensible choice for deep cavity management.
2. Biodentine vs. TheraCal LC. TheraCal LC offers better handling convenience through its light-cured syringe format and immediate working control. Biodentine has the stronger long-term clinical evidence, particularly for DPC in carious exposures and for use as a temporary restorative base. In a rationalized armamentarium, the two materials can coexist: TheraCal LC for routine IPC and liner cases, Biodentine reserved for DPC and step-wise excavation where its evidence and mechanical properties provide a clear advantage.
3. Biodentine vs. ProRoot MTA. ProRoot MTA has the longest evidence base of any calcium silicate material but is notoriously difficult to handle, with a long set time (2 to 4 hours), poor flow control, and the need for a moist cotton pellet placement during set. Biodentine achieves comparable clinical outcomes in most restorative DPC scenarios with significantly better handling. MTA retains a role in endodontic surgery and apexification where its seal durability over extended time frames is specifically required.

Summary

Biodentine is the most evidence-backed calcium silicate liner and base material available for general restorative practice. Its combination of documented bioactivity, high compressive strength, and moisture-tolerant setting makes it the material of choice for direct pulp capping, step-wise excavation, and indirect pulp capping in cases where clinical or radiographic signs suggest pulp proximity is a genuine risk factor.

Its handling limitation, specifically the mixing requirement and the 12-minute initial set, is the main reason some practices default to light-cured alternatives for routine liner applications. Practices that accept this workflow step in exchange for a stronger biological and mechanical outcome will find Biodentine one of the most clinically justified materials in their restorative inventory.

Biodentine is a high-variance product between distributors, and the per-box price difference can be meaningful at the volume a busy restorative practice consumes. Alara's platform lets you compare Biodentine pricing across 15+ verified vendors in real time, so you always order at the best available price without changing suppliers or renegotiating contracts.

References

• Laurent P, Camps J, De Meo M, Dejou J, About I. Induction of specific cell responses to a Ca3SiO5-based posterior restorative material. Dent Mater. 2008;24(11):1486-1494.
• Nowicka A, Lipski M, Parafiniuk M, et al. Response of human dental pulp capped with Biodentine and mineral trioxide aggregate. J Endod. 2013;39(6):743-747.
• Maltz M, Jardim JJ, Mestrinho HD, et al. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res. 2013;47(2):103-109.
• Zanini M, Sautier JM, Berdal A, Simon S. Biodentine induces immortalized murine pulp cell differentiation into odontoblast-like cells and stimulates biomineralization. J Endod. 2012;38(9):1220-1226.
• Lipski M, Nowicka A, Kot K, et al. Factors affecting the outcomes of direct pulp capping using Biodentine. Clin Oral Investig. 2018;22(5):2021-2029.