Calcium silicate bioactive cements: Biologicalperspectives and clinical applications

tObjective. To introduce and to examine the research progress and the investigation onhydraulic calcium silicate cements (HCSCs), well-known as MTA (mineral trioxide aggregate).Methods. This review paper introduces the most important investigations of the last 20 yearsand analyze their impact on HCSCs use in clinical application.Results. HCSCs were developed more than 20 years ago. Their composition is largely basedon Portland cement components (di- and tri-calcium silicate, Al- and Fe-silicate). They haveimportant properties such as the ability to set and to seal in moist and blood-contaminatedenvironments, biocompatibility, adequate mechanical properties, etc. Their principal limi-tations 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 con-siderable attention from laboratory researchers for their biological and translationalcharacteristics and from clinicians for their innovative properties.HCSCs upregulate the differentiation of osteoblast, fibroblasts, cementoblasts, odonto-blasts, pulp cells and many stem cells. They can induce the chemical formation of a calciumphosphate/apatite coating when immersed in biological fluids.These properties have led to a growing series of innovative clinical applications such asroot-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 dentinremineralization and tissue regeneration. Several in vitro studies, animal tests and clini-cal studies confirmed their ability to nucleate apatite and remineralize and to induce theformation of (new) mineralized tissues.Significance. HCSCs play a critical role in developing a new approach for pulp and bone regen-eration, dentin remineralization, and bone/cementum tissue healing. Investigations of thenext generation HCSCs for “Regenerative Dentistry” will guide their clinical evolution.