Utilising bioceramics the right way in endodontics

01 October 2023

We talked to Josette Camilleri about the importance of understanding your materials.

We talked to Josette Camilleri about the importance of understanding your materials.

Josette Camilleri is a clinical professor of endodontics and applied materials and honorary specialty dentist at the School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham. After qualifying as a dentist from the University of Malta, she completed her doctoral degree supervised by Professor Tom Pitt Ford at Guy’s Hospital, King’s College London. Then, she returned to the University of Malta to fulfil roles undertaking research and teaching in civil and structural engineering and restorative dentistry departments.

Having published more than 160 papers in peer-reviewed international journals, Josette focuses her research on the field of endodontic materials. About the topic, she says, “I have researched extensively hydraulic cements collectively known as bioceramics, which are not new in dentistry. They first entered the dental market back in 1993, but for many years there were few materials on the market that were used mostly as reparative materials. Currently, many companies have produced their own bioceramics, increasing their availability to dental professionals.

“Although they are all put into the same category of ‘bioceramics’, it is essential that clinicians realise how different the materials can be. This means that they all interact with their environments differently and therefore produce varying results. Every patient’s treatment is unique – details like the amount of blood present or the irrigation method implemented will affect how the material reacts. Given the growing trend for bioceramics in practice over the past decade, I have been lecturing more and more on the topic due to the increased interest in these materials and the clinical challenges being faced.” 

Considering why these challenges occur, Josette continues, “We can’t apply the same clinical techniques to different materials and expect the same results. Biomaterials are water-based while the rest of the endodontic materials have different chemistries.

“Other factors like the irrigation solution used, the flow properties of the bioceramics being placed and how it interacts with the dentine all need to be considered to avoid challenges.”

So, how can these issues be avoided in order to achieve the best endodontic outcomes? Josette suggests that clinicians need to better understand the materials they are using. The protocols for using bioceramics and the way the materials are developed in the lab also need to change.

“Clinicians need improved access to education about the materials on the market,” she says. “It is crucial to really understand bioceramics and how they work. This training and sharing of information must come from independent sources – individuals, training providers or academics who are not affiliated with a particular company. This is why it’s so important to hear from people in the field at conferences.

“Further still, unless the standards and protocols are rewritten, we will continue to have issues in practice when bioceramics are applied. Current techniques are not suitable for the chemistry of the materials.

“There is also still plenty of development needed with bioceramics. We have spent too long testing the materials in the wrong way, treating them as if they are the same as each other. Clinical techniques can’t be enhanced until the testing methodologies in the lab are updated – they need to be clinically translatable from lab to practice for the best results. Material science in endodontics is not very advanced and we have been doing the same thing for the last 50 years. This needs to change. There needs to be more collaboration between industry and profession to ensure the right materials are created.”

Josette will be among the highly-esteemed speakers to present at the BDIA Dental Showcase next year, where she will be sharing some of her extensive expertise to help dental professionals improve their understanding of the endodontic materials they use in practice every day. About her session and the event in general, Josette adds, “I’ll be reviewing bioceramics from a clinical perspective, exploring the challenges and providing some guidance for clinicians to avoid common complications. We will cover material selection, as well as discussing their properties in detail, how to use them effectively and where to find out more. Products will be good for one patient but not another, so familiarity with the materials is key.

“I attended BDIA Showcase last year as a speaker. It was very well set out and extremely well organised with everything running smoothly. A lot of people attended and there was a very good company turn out to ensure a vibrant event.”


Registrations for the BDIA Dental Showcase open in November. For more information visit https://dentalshowcase.com/register-interest-pr