Effect of titanium tetrafluoride addition on the physicochemical and antibacterial properties of Biodentine as intraorfice barrier

Antibacterial activity of biodentine against Enterococcus faecalis: a systematic review

Introduction

Biodentine is a well-known endodontic material that is applied in various endodontic therapies. Enterococcus faecalis (E. faecalis) is associated with endodontic failure and persistent periapical infection. The purpose of this systematic review was to summarize the available evidence regarding the antibacterial activity of Biodentine against E. faecalis and to compare it to other commercial endodontic materials.

Methods

An electronic search of literature was conducted in PubMed, Scopus, Web of Science, and Google Scholar in addition to a manual search in specialized journals up to May 2024. The eligibility criteria, data extraction, and evaluation of risk of bias were assessed by two independent authors. The risk of bias was evaluated in accordance with Modified CONSORT checklist items for pre-clinical in vitro studies on dental materials.

Results

Out of 343 studies, thirty-seven fulfilled the inclusion criteria and were included in this review. Thirty studies reported a good antibacterial efficacy of Biodentine against E. faecalis. Biodentine was superior to or, at least, as efficacious as MTA, MTA Angelus, GIC, RMGIC, DiaRoot BioAggregate, NeoPutty, iRoot FS, MTA Repair HP, MTA Biorep, Well-Root PT, Activa, NeoMTA 2, Calcimol LC, TotalFill, and IRM. The findings were supported by studies with medium to high risk of bias (low quality).

Conclusions

Considering the limitations of this systematic review, there is accumulating evidence on the antibacterial activity of Biodentine against E. faecalis in context of endodontics. However, randomized clinical trials with well-designed and robust methodologies are required in order to provide information about its clinical behaviour.

Sol-gel-derived calcium silicate cement incorporating collagen and mesoporous bioglass nanoparticles for dental pulp therapy

OBJECTIVE

Calcium silicate cements (CSCs) are often used in endodontics despite some limitations related to their physical properties and antibacterial efficacy. This study aimed to develop and demonstrate the viability of a series of CSCs that were produced by sol-gel method and further modified with mesoporous bioactive glass nanoparticles (MBGNs) and collagen, for endodontic therapy.

METHODS

Calcium silicate (CS) particles and MBGNs were synthesized by the sol-gel method, and their elemental, molecular, and physical microstructure was characterized. Three CSCs were developed by mixing the CS with distilled water (CS+H2O), 10 mg/mL collagen solution (CS+colH2O), and MBGNs (10 %) (CSmbgn+colH2O). The mixing (MT) and setting (ST) times of the CSCs were determined, while the setting reaction was monitored in real-time. Antibacterial efficacy against Enterococcus faecalis (E. faecalis) and regenerative potential on dental pulp stem cells (DPSCs) were also analyzed.

RESULTS

The CS+H2O displayed a ST comparable to commercial products, while CSmbgn+colH2O achieved the longest MT of 68 s and the shortest ST of 8 min. All the experimental CSCs inhibited the growth of E. faecalis. Additionally, compared to the control group, CSCs supported cell proliferation and spreading and mineralized matrix production, regardless of their composition.

SIGNIFICANCE

Tested CSCs presented potential as candidates for pulp therapy procedures. Future research should investigate the pulp regeneration mechanisms alongside rigorous antibacterial evaluations, preferably with multi-organism biofilms, executed over extended periods.

Evaluation of the pH and Antibacterial Efficacy of Mineral Trioxide Aggregate With and Without the Incorporation of Titanium Tetrafluoride

Introduction Microorganisms play an important role in causing inflammation in the pulp and periapical regions. Even after undergoing chemo-mechanical procedures during root canal treatment, bacteria may persist within dentinal tubules, posing a risk of disease recurrence. Mineral trioxide aggregate (MTA), introduced as a dental material, has been investigated as a potential antibacterial agent since its early use. Calcium and phosphorus are the primary ions in MTA, and their antibacterial characteristics are attributed to the release of calcium hydroxide through surface hydrolysis of calcium silicate components. Previous studies have shown that MTA has limited antimicrobial properties. Several alterations have been made to enhance the biological properties of MTA, such as incorporating nanoparticles made from silver, zinc, gold, and titanium. Therefore, in this study, titanium tetrafluoride (TiF4) was added to MTA in an effort to enhance its antimicrobial properties. Aim To compare and evaluate the antibacterial efficacy of MTA after the incorporation of TiF4. Materials and methods A total of 56 samples were made by mixing MTA with different weight proportions of TiF4 (1 wt%, 2 wt%, and 3 wt%). Out of these, 28 samples were taken to test each of the following properties: antibacterial efficacy and pH. The specimens were prepared using stainless steel molds of recommended dimensions for testing the pH. The pH was evaluated using a pH meter, and the antibacterial efficacy was assessed using the direct contact test. Data regarding the antibacterial efficacy and pH of MTA with various proportions of TiF4 were investigated for normality using the Kolmogorov-Smirnov test and assessed for normal distribution. The antibacterial properties among the four groups were analyzed using one-way analysis of variance (ANOVA), followed by pairwise multiple comparisons using Tukey's Honest Significant Difference test. The level of statistical significance was determined at p ≤ 0.05. MTA, when incorporated with TiF4, showed enhanced antibacterial properties. Results On day 1, the group treated with MTA containing 3% TiF4 demonstrated the strongest antibacterial effectiveness, with a mean of 4.67 ± 0.04 colony-forming units (CFU)/mL × 10^8. However, the group treated with plain MTA had the lowest mean values, at 5.67 ± 0.25 CFU/mL × 10^8. On day 1, the MTA group with 3% TiF4 also had the highest mean pH values (11.90 ± 0.05), while the plain MTA group had the lowest mean pH values (11.64 ± 0.78). On day 7, the MTA group with 3% TiF4 had the highest pH value (12.85 ± 0.08), whereas the plain MTA group had the lowest pH value (11.92 ± 0.09). Conclusion The inclusion of TiF4 resulted in an augmentation of the antibacterial efficacy of MTA against Enterococcus faecalis (E. faecalis). Hence, the integration of TiF4 into MTA can be considered a promising development against E. faecalis during endodontic procedures.

The Effect of Chitosan Incorporation on Physico-Mechanical and Biological Characteristics of a Calcium Silicate Filling Material

OBJECTIVES

A tricalcium silicate-based cement, Biodentine™, has displayed antibiofilm activity when mixed with chitosan powder. This study aimed to assess the effect of chitosan incorporation on the physico-mechanical and biological properties of Biodentine™.

METHODS

In this study, medium molecular weight chitosan powder was incorporated into Biodentine™ in varying proportions (2.5 wt%, 5 wt%, 10 wt%, and 20 wt%). The setting time was determined using a Vicat apparatus, solubility was assessed by calculating weight variation after water immersion, radiopacity was evaluated and expressed in millimeters of aluminum, the compressive strength was evaluated using an Instron testing machine, and the microhardness was measured with a Vickers microhardness tester. In addition, surface topography of specimens was analyzed using scanning electron microscopy, and the effect of chitosan on the viability of human embryonic kidney (HEK 293) cells was measured by a colorimetric MTT assay.

RESULTS

Incorporation of 2.5 wt% and 5 wt% chitosan powder delivered an advantage by speeding up the setting time of Biodentine material. However, the incorporation of chitosan compromised all other material properties and the crystalline structure in a dose-dependent manner. The chitosan-modified material also showed significant decreases in the proliferation of the HEK 293 cells, signifying decreased biocompatibility.

SIGNIFICANCE

Chitosan incorporation into calcium silicate materials adversely affects the physical and biological properties of the material. Despite the increased antimicrobial activity of the modified material, the diminution in these properties is likely to reduce its clinical value.

Biological considerations of dental materials as orifice barriers for restoring root-filled teeth

There is ample published literature regarding the technical aspects of restoring root-filled teeth, but little concerning the biological impacts, consequences, and criteria for the selection of direct restorative materials following endodontic treatment. The provision of an effective coronal seal in addition to a sound root filling is known to be important in the prevention of root canal infection. This review seeks to explore the evidence concerning the selection of dental materials in the restoration of root-filled teeth, specifically with a close examination of the properties of commonly used materials as orifice barriers. © 2023 Australian Dental Association.

Effect of nanosized bioactive glass addition on some physical properties of biodentine

The aim of this in vitro study was to investigate some physical properties of Biodentine (BD) (Septodont, France) that has been modified by adding nanosized bioactive glass (nBG) particles to it in different ratios. The cement was modified by adding 1% (7 mg) and 2% (14 mg) nBG powder to BD. BD was used as the control group in its commercial form. A total of 240 cement samples (n = 80) were prepared according to the standard measurements for each test. Subsequently, tests to determine compressive strength, microhardness, initial setting time, and solubility of the samples were performed. The obtained data were statistically analyzed using one-way ANOVA and Tukey's HDS tests, and the significance level was found to be 0.05. The compressive strength values of the samples modified with 1% and 2% nBG were higher than those of the unmodified BD; however, no statistically significant difference was found between them [BD + nBG (2 wt%) ⩾ BD+nBG (1 wt%) ⩾ control BD], (p > 0.05). The microhardness values of the samples modified with 1% and 2% nBG were found to be significantly higher than those of the control group [BD + nBG (2 wt%) > BD+nBG (1 wt%) > control BD], p < 0.05. Initial setting times were determined as 14 min for unmodified BD, 13 min for BD + nBG (1 wt%), and 12 min for BD + nBG (2 wt%). The addition of nBG to BD significantly reduced the initial setting time of BD (p < 0.05). A significant decrease was observed in the solubility of the BD modified with nBG samples compared to that of the control group [control BD > BD+nBG (1 wt%) >BD+nBG (2 wt%)], p < 0.05. Within the limitations of this study, it was found that the addition of certain amounts of nBG to BD positively affected some physical properties of the cement. Future in vitro and in vivo studies should be performed to prove the clinical applicability of the cements used in this study.

Current status on antimicrobial activity of a tricalcium silicate cement

Biodentine (BD) is a bioactive material with many indications in endodontic therapy. The purpose of this study was to compile and review the outcomes of in vitro and in vivo studies of BD in terms of antimicrobial effectiveness. An electronic search was carried out in PubMed, from January 2009-April 2021 using the keywords: (Biodentine or dentine substitute or "Ca₃SiO₅" or tricalcium silicate cement or bioceramic cement) and (antimicrobial activity or antimicrobial effect or antimicrobial effectiveness or antibacterial activity or antibacterial effect or antibacterial effectiveness or antibiofilm activity or antibiofilm effectiveness). Two independent reviewers evaluated the studies for eligibility. All studies that did not include BD or its antimicrobial properties, as well as abstracts not written in English, were excluded. This review identified the need to develop standardized methods to evaluate antimicrobial activity in vitro. Most of the studies were against planktonic bacteria and gave conflicting results. Studies ex vivo and in vivo against biofilm are required to elucidate the antimicrobial activity of BD.

Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics

Microbes are prevalent in the root canals of necrotic teeth, and they are the cause of primary and post-treatment apical periodontitis. Bacteria can dwell within the infected root canal system as surface-adherent biofilm structures, which exhibit high resistance to antimicrobial agents. Bioceramic materials, with their biocompatible nature and excellent physico-chemical properties, have been widely used in dental applications, including endodontics. This review focuses on the application of bioceramic technology in endodontic disinfection and the antibiofilm effects of endodontic bioceramic materials. Different bioceramic materials have shown different levels of antibiofilm effects. New supplements have emerged to potentially enhance the antibiofilm properties of bioceramics aiming to achieve the goal of microbial elimination in the root canal system.

Antibiofilm potential over time of a tricalcium silicate material and its association with sodium diclofenac

OBJECTIVES

The objectives of this study are to investigate, over time, the antimicrobial activity against polymicrobial biofilms and ability to inhibit biofilm formation, of Biodentine (BD) alone and with 5% and 10% sodium diclofenac (DC).

MATERIAL AND METHODS

The antimicrobial activity of BD alone and modified with 5% and 10% DC against polymicrobial biofilm growth in dentin was determined by a modified direct contact test. The study groups were (1) BD; (2) BD + 5% DC; and (3) BD + 10% DC. The viability of microorganisms after 1 and 4 weeks was quantified by means of an ATP assay and flow cytometry. The antibiofilm efficacy of the materials, preventing polymicrobial biofilm formation over time, was assessed by confocal laser scanning microscopy (CLSM).

RESULTS

The results obtained with both the ATP test and flow cytometry showed that BD alone and with 5% and 10% DC exerted antibiofilm activity with respect to the control, in the two evaluated times (p < 0.001). Comparison between groups showed a tendency of increased antimicrobial effect, both over time and depending on the DC concentration. These results coincide with those obtained in CLSM analysis, where efficacy increased with time and DC concentration.

CONCLUSIONS AND CLINICAL RELEVANCE

Biodentine, over time, showed antimicrobial and antibiofilm efficacy on polymicrobial biofilms. The addition of 5% and 10% DC to BD enhanced this effect, in a concentration- and time-dependent manner.

Microhardness and surface roughness of Biodentine exposed to mouthwashes

Aim:

This study evaluates Vickers microhardness and surface roughness in Biodentine cement (M1) and glass-ionomer cement Fuji IX (M2), both immersed in mouthwash.

Materials and Methods:

Fifty-four samples were randomly distributed in distilled water (S1), Listerine Cool Mint (S2), and Colgate Plax (S3). Each sample was put in a flask with mouthwash for 2 min, under vibration, twice a day for 21 days. Microhardness and surface roughness were assessed at 48 h (T0), 7 days (T1), 14 days (T2), and 21 days (T3).

Results:

For roughness: time (T), solution (S) and material (M), TxM, and SxM and for microhardness: M, TxS, TxM, and SxM were statistically significant. T3, M1, M1T3, and M1S1 presented the highest surface roughness. M2, M1T0, M1T1, M1T2, M1S1, and M1S2 presented higher microhardness.

Conclusion:

Biodentine showed higher surface roughness for T1, T2, and T3 and higher microhardness for T0, T1, and T2 against Fuji IX. Biodentine presented higher microhardness independently of solution.

Iodoform-Blended Portland Cement for Dentistry

Portland cement-based formulations blended with radiopacifying agents are popular endodontic materials for various root filling and pulp capping applications. Iodoform (CHI3) is an alternative candidate radiopacifier whose impact on the setting, bioactivity, antimicrobial properties and cytotoxicity of white Portland cement were evaluated in this study. Isothermal conduction calorimetry and 29Si magic angle spinning nuclear magnetic resonance spectroscopy (MAS NMR) showed that 20 wt% iodoform had no significant impact on the kinetics of cement hydration with respect to the formation of the major calcium silicate hydrate (C-S-H) gel product (throughout the 28-day observation). Conversely, transmission electron microscopy demonstrated that iodine was incorporated into the ettringite (Ca₆Al₂(SO₄)₃(OH)₁₂·26H₂O) product phase. Both iodoform-blended and pure Portland cements exhibited comparable biocompatibility with MG63 human osteosarcoma cells and similar bioactivity with respect to the formation of a hydroxyapatite layer upon immersion in simulated body fluid. By virtue of their high alkalinity, both cements inhibited the growth of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. However, in all cases, iodoform enhanced the antimicrobial effect and significantly reduced the minimum bactericidal concentration of the cement. In conclusion, iodoform offers antimicrobial advantages in Portland cement-based formulations where oral biofilm formation threatens the success of root filling materials and dentine substitutes. The reactivity with the calcium aluminosulfate components of the hydrating cement matrix warrants further research to understand the long-term stability of the cement matrix in the presence of iodoform.

Impact of Bi2O3 and ZrO2 Radiopacifiers on the Early Hydration and C-S-H Gel Structure of White Portland Cement

Bismuth oxide (monoclinic α-Bi₂O₃) and zirconium oxide (monoclinic ZrO₂) are the most popular radiopacifiers in commercial Portland cement-based endodontic restoratives, yet their effects on the setting and hydration reactions are not fully understood. This study compares the impact of 20 wt.% of Bi₂O₃ or ZrO₂ on the early hydration reactions and C–S–H gel structure of white Portland cement (WPC). Cement paste samples were hydrated at 37.5 °C prior to analysis by ²⁹Si and ²⁷Al magic angle spinning nuclear magnetic resonance spectroscopy at 3 h and 24 h, and transmission electron microscopy at 3 h. Initial and final setting times were determined using a Vicat apparatus and reaction kinetics were monitored by isothermal conduction calorimetry. Bi₂O₃ was found to prolong initial and final setting times and retard the degree of hydration by 32% at 24 h. Heat evolution during the acceleration and deceleration phases of the hydration process was reduced and the exotherm arising from renewed ettringite formation was delayed and diminished in the presence of Bi₂O₃. Conversely, ZrO₂ had no significant impact on either setting time; although, it accelerated hydration by 23% within 24 h. Increases in the mean silicate chain length and the extent of aluminum substitution in the C–S–H gel were observed in the presence of both radiopacifying agents after 24 h relative to those of the unblended WPC. The Bi₂O₃ and ZrO₂ particles remained intact within the cement matrix and neither bismuth nor zirconium was chemically incorporated in the hydration products.

The Application of 29Si NMR Spectroscopy to the Analysis of Calcium Silicate-Based Cement using Biodentine™ as an Example

Biodentine is one of the most successful and widely studied among the second generation of calcium silicate-based endodontic cements. Despite its popularity, the setting reactions of this cement system are not currently well understood. In particular, very little is known about the formation and structure of the major calcium silicate hydrate (C-S-H) gel phase, as it is difficult to obtain information on this poorly crystalline material by the traditional techniques of powder X-ray diffraction analysis (XRD) and Fourier transform infrared spectroscopy (FTIR). In this study, the hydration reactions of Biodentine are monitored by XRD, FTIR, isothermal conduction calorimetry and, for the first time, 29Si magic angle spinning nuclear magnetic resonance spectroscopy (29Si MAS NMR) is used to investigate the structures of the anhydrous calcium silicate phases and the early C-S-H gel product. XRD analysis indicated that the anhydrous powder comprises 73.8 wt% triclinic tricalcium silicate, 4.45 wt% monoclinic β-dicalcium silicate, 16.6 wt% calcite and 5.15 wt% zirconium oxide. Calorimetry confirmed that the induction period for hydration is short, and that the setting reactions are rapid with a maximum heat evolution of 28.4 mW g-1 at 42 min. A progressive shift in the FTIR peak maximum from 905 to 995 cm-1 for the O-Si-O stretching vibrations accompanies the formation of the C-S-H gel during 1 week. The extent of hydration was determined by 29Si MAS NMR to be 87.0%, 88.8% and 93.7% at 6 h, 1 day and 1 week, respectively, which is significantly higher than that of MTA. The mean silicate chain length (MCL) of the C-S-H gel was also estimated by this technique to be 3.7 at 6 h and 1 day, and to have increased to 4.1 after 1 week. The rapid hydration kinetics of Biodentine, arising from the predominance of the tricalcium silicate phase, small particle size, and 'filler effect' of calcite and zirconium oxide, is a favorable characteristic of an endodontic cement, and the high values of MCL are thought to promote the durability of the cement matrix.