Chemical and biological integration of a mouldable bioactive ceramic material capable of forming apatite in vivo in teeth. 
Chemically bonded ceramics have several advantages compared with conventional ceramics to be used as biomaterials.  Especially the possibilities to harden the material at room temperature and to control the rheology are very beneficial.  This paper investigates the interface formed in vivo between a calcium aluminate based dental filling material and teeth.  Class 1 occlusal fillings were made in wisdom teeth and extracted after up to four weeks.  Polished cross-sections of the teeth were studied with scanning electron microscopy (SEM), focused ion beam microscopy (FIB) and transmission electron microscopy (TEM).  In order to analyse the distribution of elements at the interface elemental mapping was performed using STEM and EDX.  The results showed that a tight bond forms between the filling material and tooth and no gap could be found even at high magnification.  A 100-200 nm wide zone with an increase in oxygen was detected in the enamel next to the filling.  The zone was denser than the rest of the enamel.  Elemental mapping indicated an increase of silicon and a decrease of Ca at the interface.  Dark field imaging and EDX mapping showed that the calcium aluminate system formed apatite in situ during hardening through precipitation.