Biodentine is a dental material, not a treatment that can bring a tooth back to life. It can help a pulp that is still alive to heal under a deep filling or after a pulpotomy. It cannot rescue a nerve that has already died, and it does not replace the cleaning of an infected root canal. Whether it suits your tooth is worked out from your symptoms, tests and X-rays, and sometimes from what the pulp looks like during treatment, not from the material itself.
We are asked about Biodentine often, sometimes by people hoping it will let them avoid root canal treatment. This article sets out plainly where it fits and where it does not.
What Biodentine actually is
Biodentine is a brand of calcium silicate cement. It is placed against tooth tissue, and as it sets it releases calcium hydroxide. Calcium silicate cements such as Biodentine can encourage a living pulp to form new hard tissue, called reparative dentine. Our Biodentine explainer covers what is in it and how it compares with MTA, an older material in the same family. At Lumi Dental we use bioceramic materials, including Biodentine, for pulp protection and root repair where they suit the tooth.
The important word is "living". New hard tissue is laid down by cells in the pulp, so the healing response depends on pulp tissue that is still alive. The material supports that response. It does not create it.
When it can help a tooth
Biodentine is used in vital pulp therapy, a group of treatments that aim to keep some or all of the pulp alive. A 2026 consensus from the International Association of Paediatric Dentistry (IAPD), which covered permanent as well as baby teeth, recommends calcium silicate cements for vital pulp therapy in permanent teeth with deep decay. It also states that a full pulpotomy with these materials can be an alternative to root canal treatment in mature permanent teeth (adult teeth whose roots have finished forming) where decay has reached the pulp and there are symptoms of irreversible pulpitis, such as spontaneous or lingering pain, provided that there are no signs or symptoms of pulp necrosis.
Typical situations where it may be considered include:
- a deep cavity close to a nerve that still responds normally
- an exposure of the pulp during decay removal, where the pulp still looks healthy
- a painful tooth where the pulp is inflamed but still alive, treated with a partial or full pulpotomy
Our article on vital pulp therapy explains these procedures step by step.
When it cannot save the nerve
If the pulp has died or the infection has spread into the bone around the root, there is no living pulp left to protect. In that situation no material placed over the pulp can bring it back to life. The signs that point this way include:
- no response to hot or cold testing
- a dark area at the root tip on an X-ray, which can show that inflammation has spread beyond the end of the root
- swelling, or a pimple-like bump of pus on the gum near the tooth
- no bleeding from the pulp when it is opened, or pus inside the tooth
Our articles on the signs a root canal is needed and on a dark area at the root tip explain these findings in more detail. Healthdirect notes that root canal treatment aims to clean, disinfect and seal the root canal system, that antibiotics alone do not work to cure root canal infections, and that without treatment the infection may get worse and the tooth may need to be removed.
| Finding | What it usually means | Where Biodentine fits |
|---|---|---|
| Deep decay, tooth responds normally to cold | Pulp alive | May be used to protect the pulp |
| Spontaneous or lingering pain, no signs of a dead nerve | Pulp inflamed but alive | May be used in a pulpotomy, with root canal treatment as the alternative |
| No response to cold, dark area at the root tip, swelling or a bump of pus on the gum | Pulp dead or infected | Cannot save the nerve; root canal treatment or removal is usually needed |
| Hole in the root wall or floor, or certain types of resorption | Damage to the root itself | May be used as a repair material, often alongside root canal treatment |
Used in a dead tooth, but not instead of a root canal
Biodentine does appear in the treatment of some teeth whose pulp has died, which can be confusing. In those cases it is used as part of root canal type treatment, after the canal has been cleaned, and not as a way of avoiding it.
One example is a young permanent tooth whose nerve died before the root finished forming. The IAPD consensus states that both apexification and regenerative treatment are options for these teeth, and that after an injury they can be managed with regenerative treatment or with a barrier of calcium silicate cement at the open root end. A 2025 scoping review by Gerard and Gaur found that in three clinical trials in children, Biodentine and MTA both produced satisfactory healing, while some laboratory studies favoured MTA; the authors concluded that MTA was superior overall and that longer clinical trials are needed. Another example is sealing a perforation, an opening through the floor of the pulp chamber into the bone. A 2022 systematic review by Al-Nazhan and colleagues, based on eight mostly animal studies and five case reports with a high risk of bias, found that both materials gave good results and that Biodentine performed better than MTA at 12 months.
In each of these uses, the canal is cleaned as part of the treatment. The material seals and repairs. It is not a substitute for cleaning the canal and it does not restore a dead nerve.
The final decision is often made during treatment
Tests before treatment give a good idea of the state of the pulp, but they are not perfect. A 2018 meta-analysis of 28 studies by Mainkar and Kim found that cold testing correctly identified about 87% of teeth with a dead pulp and about 84% of teeth with a living pulp. Once the pulp is exposed, the dentist can see how it bleeds. The IAPD consensus notes that achieving haemostasis (control of bleeding) may be viewed as important for the success of vital pulp therapy, and that if bleeding cannot be controlled during a partial pulpotomy, more tissue may need to be removed, up to a full pulpotomy. In the PROVE trials described below, root canal treatment was carried out instead if bleeding could not be controlled within 10 minutes or if no bleeding was seen when the pulp was opened.
That is why a plan for vital pulp therapy usually includes a fallback. If the pulp does not look healthy when it is opened, root canal treatment may be the better choice at that same visit or a later one.
For dentists: consent for both pathways, and screen before booking
Patients who arrive asking for a specific material often have a fixed plan in mind. Two points from the literature help set expectations early. First, the IAPD consensus limits full pulpotomy as an alternative to root canal treatment to mature permanent teeth with carious exposure and no signs or symptoms of pulp necrosis. The PROVE trials likewise required a positive response to sensibility testing and excluded teeth with an apical radiolucency, so a tooth with a periapical radiolucency or signs of infection such as swelling or a sinus tract sits outside this evidence. A single negative cold test is not conclusive on its own, since cold testing misclassifies some vital teeth; the IAPD notes that electric pulp testing can complement cold testing when results are inconclusive. Second, the final call depends partly on what the exposed pulp looks like, so consent should cover progressing from a partial to a full pulpotomy, or to root canal treatment, if haemostasis is not achieved or the pulp appears non-vital.
Short-term trial data are worth sharing as they are. The PROVE study (El Karim and colleagues, 2026) pooled linked randomised trials run to one protocol in eight countries: 410 patients aged 12 or over with symptomatic irreversible pulpitis in a mature premolar or molar were randomised and 385 were analysed, with Biodentine used for the pulpotomies. Both full pulpotomy and root canal treatment reduced pain over the first week, but root canal treatment gave greater pain relief and lower analgesic use over that week. Early failure, defined as needing further treatment within 4 weeks, occurred in 10 of 192 pulpotomy patients (5.2%) and 1 of 193 root canal patients (0.5%); the authors described the early failure rate as low in both groups. Early failure was associated with tenderness to percussion, molar teeth, sleep disturbance and prolonged bleeding after exposure. The analysis was per protocol, patients excluded during treatment were not followed, and these are one week to one month outcomes only. Recent radiographs and a description of symptoms gathered before the appointment can flag teeth with an obvious periapical radiolucency, but pulp status still needs clinical testing and examination.
Questions we are often asked about Biodentine
Can I ask for Biodentine instead of a root canal?
You can ask whether vital pulp therapy is an option, and we are happy to assess the tooth. Whether it is suitable depends on the state of the pulp, not on the request. If the nerve has died or the tooth is infected, vital pulp therapy is not an option and the realistic choices are usually root canal treatment or removing the tooth.
My tooth has stopped hurting. Does that mean it can still be saved with Biodentine?
Not necessarily. Pain can fade for a time when a nerve dies, as our article on toothache that stopped on its own explains. Testing is needed to tell the difference.
Is Biodentine more natural than a root canal?
Both treatments use manufactured materials. The difference is whether the living pulp can be kept, which depends on the tooth rather than on a preference for one material.
Having a tooth assessed
If you have a deep filling, a painful tooth or an X-ray finding and want to know whether vital pulp therapy is possible, a dentist at our general dentistry practice in Melrose Park can examine the tooth and explain the options. You will usually receive a written treatment plan after the examination, often by email. Our guide to root canal treatment covers what is involved if that turns out to be the better choice.
Sources
- Dhar V and colleagues (IAPD Porto Forum). Consensus-based recommendations on pulp therapies in primary and permanent teeth. International Journal of Paediatric Dentistry, 2026. PubMed 41622922
- El Karim IA and colleagues. Short-term outcomes of full pulpotomy compared with root canal treatment for irreversible pulpitis: the PROVE study. International Endodontic Journal, 2026. PubMed 42370524
- Mainkar A, Kim SG. Diagnostic accuracy of 5 dental pulp tests: a systematic review and meta-analysis. Journal of Endodontics, 2018. PubMed 29571914
- Gerard LM, Gaur S. Application of Biodentine for apexification of immature teeth of children: a scoping review. International Journal of Clinical Pediatric Dentistry, 2025. PubMed 41050304
- Al-Nazhan S and colleagues. Outcomes of furcal perforation management using mineral trioxide aggregate and Biodentine: a systematic review. Journal of Applied Oral Science, 2022. PubMed 36477558
- Malkondu Ö, Karapinar Kazandağ M, Kazazoğlu E. A review on Biodentine, a contemporary dentine replacement and repair material. BioMed Research International, 2014. PubMed 25025034
- MSD Manual Professional Version. Pulpitis. msdmanuals.com
- Healthdirect Australia. Root canal treatment. healthdirect.gov.au
This article is general information only and is not a substitute for an in-person assessment by a dental professional.
