BIOACTIVE MATERIALS FOR ROOT PERFORATION REPAIR: A COMPREHENSIVE REVIEW OF MINERAL TRIOXIDE AGGREGATE, BIODENTINE, BIO-C REPAIR, AND ENDOSEQUENCE BC ROOT REPAIR MATERIAL
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6477Keywords:
Root Perforation, Mineral Trioxide Aggregate, MTA, Biodentine, Bio-C Repair, EndoSequence BC RRM, Bioceramics, Calcium Silicate Cement, Endodontics, Bioactive MaterialsAbstract
Background: Root perforation is a significant complication in endodontic treatment that may adversely affect the long-term prognosis of the affected tooth if not managed promptly and appropriately. The development of bioactive calcium silicate-based materials has substantially improved treatment outcomes by providing excellent sealing ability, biocompatibility, and bioactivity. Mineral Trioxide Aggregate (MTA) has long been regarded as the gold standard for perforation repair; however, newer biomaterials such as Biodentine, Bio-C Repair, and EndoSequence BC Root Repair Material (BC RRM) have been introduced to overcome several of its limitations.
Objective: This narrative review aims to compare the physicochemical properties, biological characteristics, handling properties, clinical performance, advantages, disadvantages, and available scientific evidence regarding MTA, Biodentine, Bio-C Repair, and EndoSequence BC RRM in the management of root perforations.
Methods: A comprehensive literature review was conducted using peer-reviewed articles indexed in PubMed, Scopus, and Web of Science. Publications evaluating calcium silicate-based materials used for perforation repair, including systematic reviews, meta-analyses, randomized clinical studies, observational studies, and in vitro investigations, were analyzed.
Results: Current evidence indicates that all four materials demonstrate excellent biocompatibility and favorable clinical outcomes. MTA remains the reference material because of its extensive scientific documentation and predictable long-term performance. Biodentine offers improved handling characteristics, shorter setting time, and a lower risk of tooth discoloration. Bio-C Repair and EndoSequence BC RRM represent next-generation premixed bioceramic materials with excellent sealing ability, high bioactivity, and simplified clinical application. Although laboratory and preliminary clinical studies suggest comparable or even superior physicochemical properties of newer materials, high-quality long-term randomized clinical trials remain limited.
Conclusions: Calcium silicate-based bioactive materials have significantly advanced the management of root perforations. Material selection should be individualized according to the clinical situation, perforation characteristics, operator experience, and material properties. While MTA continues to serve as the benchmark material, Biodentine, Bio-C Repair, and EndoSequence BC RRM constitute reliable alternatives with several practical and biological advantages. Further well-designed long-term clinical studies are required to establish definitive evidence regarding their comparative effectiveness.
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