Review Article
Histopathological Evaluation of Periodontium after Repairing Furcation Perforation with MTA and Biodentine
Nehal Y. Abdelati*, Hanaa M. Shalan, Salwa M. Awad and Ibrahim H. Elkalla
Corresponding Author: Dr. Nehal Y. Abdelati, Faculty of Dentistry, Postgraduate student, Department of pediatric dentistry and dental public health, faculty of dentistry, Mansoura University;
Received: April 5, 2018; Revised: June 29, 2018; Accepted: June 28, 2018
Citation: Abdelati N Y, Shalan H M, Awad S M &Elkalla I H.(2018)Histopathological Evaluation of Periodontium after Repairing Furcation Perforation with MTA and Biodentine. J Oral Health Dent, 1(1): 30-33.
Copyrights: ©2018Abdelati N Y, Shalan H M, Awad S M &Elkalla I H.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Primary teeth are involved in mastication, speaking, esthetics and preserving space for the erupting permanent teeth therefore, keeping them till permanent teeth eruption is unavoidable [1]. Technical problems occur occasionally during endodontic treatment, among which furcal perforations have the worst prognosis [2].

Perforations are pathologic or iatrogenic communications between the root canal system and the attachment apparatus. If a perforation occurs, the tooth will not necessarily lost, in fact, it can be treated successfully in a conservative manner and continue to function as it did before the perforation till the time of shedding [3].

Despite the numerous favorable properties of MTA that support its clinical use when compared with the traditional materials, there are several critical drawbacks such as the prolonged setting time, difficult handling characteristics, high cost, and potential of tooth discoloration [4].

A variety of new calcium silicate–based materials have been developed aiming to improve MTA shortcomings. BiodentineTM is a high-purity calcium silicate based dental material that is recommended for use as a dentine substitute under resin composite restorations and an endodontic repair material because of its good sealing ability, high compressive strengths, short setting time, and biocompatibility, bioactivity, and biomineralization properties [4].

The aim of this study was to investigate the histopathology of periodontium to experimentally induced furcal perforations in dogs’ primary teeth repaired by Mineral Trioxide Aggregate (MTA) and Biodentine.


Experimental animals

A total of 96 primary molars teeth from 12 healthy dogs approximately 2 months age were used. Bilateral sides of both maxillary and mandibular second and third primary premolars were used. The teeth were randomly divided into 2 experimental groups of 24 teeth each, and 2 control groups with 24 teeth each.


Anesthesia administered by respiratory anesthetics. Then, a bite block had been fitted on the molars opposite to the working site.

After preparing the access cavity, furcal perforations were created one millimeter in diameter using a round bur.

The samples were randomly divided into two experimental groups (n=24 each) and two control groups (24 each).

Group A: MTA

Group B: Biodentine

Group C,D: The second and third mandibular left primary molars and the second and third maxillary left primary molars were not repaired with any material as they were used as control for the MTA group and Biodentine group respectively.

Finally the tooth was sealed with IRM restoration.

Histopathological Examination


1-The animals were divided into three groups and sacrificed with vital perfusion at one,

two, and three months intervals

2-The healing process, presence of inflammatory cells, vasodilatation and abscess

formation were assessed by a pathologist.



The results showed that no statistically significant difference was observed between MTA and Biodentine group regarding tissue inflammation, where in MTA group at one, two and three months intervals no abscess or bone resorption were observed, also bone apposition was observed in all teeth at two months interval and epithelium and granulation tissue were formed in all teeth at three months interval, on the other hand in Biodentine group no abscess was found in the three time intervals, however one tooth showed bone resorption at two months interval, bone and cementum was observed in 7 teeth at the three time intervals, and epithelium and granulation tissue were found in all teeth at three months interval.


However there was a significant different between the two groups and their control, where in both control groups there was abscess formation and bone resorption in addition to moderate to severe inflammation that was observed in the furcation area as shown in Figure 3.


Materials used in endodontics should preferably be biocompatible when they are placed in direct contact with living tissue such as in pulp capping, perforation repair, or when used as a retrograde filling [5].


Dogs were used in this study because dog is a demanding experimental model, having primary molars that have successors, also having two rooted lower molars that often furcate as close as 1 to 2 mm from the cemento enamel junction. As a result, epithelialization and the formation of connective tissue at a furcation perforation should be more likely than in humans, where the furcation lies deeper within the alveolus [6]. The size of perforations in this investigation was standardized at 1.4 mm, which is similar to several previous studies [6-9]. The bur was allowed to penetrate 2 mm into the alveolar bone to enhance the inflammatory response [9].

Several studies have reported the ability of MTA to prevent leakage in a variety of applications [10,11]. Moreover, they reported its superiority compared to other dental materials. For this reason, we included MTA as a standard perforation repair material for better comparison with Biodentine.

In our study Biodentine showed comparable favorable results in repairing furcal perforation compared to MTA without showing any statistically significant differences and this was in agreement with an in vivo study performed by De Rossi et al. [12]. 

Deposition of hard tissue over MTA was observed in 87.5% at one and three months and 100% at two months, also was observed in 87.5% at the three time follow up over Biodentine. In addition, new cementum was fused to the original cementum on the root surface. This supports earlier reports of repair when using MTA [6,13,14].

In clinical situations of perforations caused by caries, the pulp tissue is likely to be infected with bacteria at the moment of the treatment, which may lead to predominance of degenerative inflammatory response and affect the reparative response [15]. However, the present study used sound teeth to avoid the interference of confounding factors.

The high success rates observed with Biodentine and MTA could be attributed to several factors related to the host, the capping material, and the mechanism of operation. Also including the initial condition of the pulp tissue, the absence of microbial contamination, the only source of infection would be bacterial infiltration through the access cavity margins.



Due to major advantages and appreciable properties and ability to achieve biomimetic mineralization and give successful outcomes of treatment of Furcal perforation, biodentine has great potential to revolutionize the management of affected tooth in endodontics. The easy handling and fast setting time are the major advantages incomparison to other similar materials available commercially. So Biodentine can be used as a potential alternative for the repair of furcation perforations due to its biocompatibility.


1.       Fuks AB (2005) Pulp therapy for the primary dentition. In: Pinkham JR, Casamassimo, Field jr, editors. Pediatric dentistry infancy through adolescence. (4thedn), Elsevier: Saunders.

  1. Sanghvi T, Shah N, Shah R (2013) Comparative analysis of sealing ability of Biodentine and Calcium Phosphate cement against Mineral Trioxide Aggregate as a furcal perforation repair material (an in vitro study). Natl J Integr Res Med 4: 56-60.
  2. Castellucci (2008) Dentistry Today. Department of Continuing Education.
  3. Guneser MB, Akbulut MB, Eldeniz AU (2013) Effect of various endodontic irrigants on the push-out bond strength of biodentine and conventional root perforation repair materials. J Endod 39:  380-384.
  4. Upadhya NP, Kishore G (2005) Trends Biomaterial Artificial Organs 18: 158-165.
  5. Walton RE, Torabinejad M (2002) Principles and practice of endodontics. (3rdedn), Saunders, Philadelphia.
  6. El Deeb ME, El Deeb M, Tabibi A, Jensen JR (1982) An Evaluation of the Use of Amalgam, Cavit& Calcium Hydroxide in the Repair of Furcation Perforations. J Endod 8: 459-466.
  7. Himel VT, Brady J, Weir J Jr. (1985) Evaluation of repair of mechanical perforations of the pulp chamber floor using biodegradable tricalcium phosphate or calcium hydroxide. J Endod 11: 161-165.
  8. Rafter M, Baker M, Alves M, Daniel J, Remeikis N (2002) Evaluation of healing with use of an internal matrix to repair furcation perforations. IntEndod J 35: 775-783.
  9. Haghgoo R, Arfa S, Asgary S (2013) Microleakage of CEM Cement and ProRoot MTA as Furcal Perforation Repair Materials in Primary Teeth. Iran Endod J 8: 187-190.
  10. Chang SW (2012) Chemical characteristics of mineral trioxide aggregate and its hydration reaction. Restor Dent Endod 37: 188-193.
  11. De Rossi A, Bezerra Silva LA, Gaton-Hernandez P, SousaNeto MD, Nelson- Filho P, Bezerra Silva RA, de Queiroz AM (2014) Comparison of Pulpal Responses to Pulpotomy and Pulp Capping with Biodentine and Mineral Trioxide Aggregate in Dogs. J Endod 40: 1362-1369.
  12. Al-Daafas A, Al-Nazhan S (2007) Histological evaluation of contaminated furcal perforation in dogs’ teeth repaired by MTA with or without internal matrix. Oral Surg Oral Med Oral Pathol Oral Radio Endod 103: 92-99.
  13. Apaydin ES, Shabahang S, Torabinejad M (2004) Hard-tissue healing after application of fresh or set MTA as root end- filling material. J Endod 30: 21-24.
  14. Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, et al. (2013) Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 39: 743-747.