Color Stabilities of Calcium Silicate–based Materials in Contact with Different Irrigation Solutions

Color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions

Objectives

This study aimed to evaluate the color stability and solubility of Biodentine and NeoPutty in contact with different irrigation solutions.

Materials and Methods

Biodentine and NeoPutty were set in cylindrical molds with 7 mm diameter and 1.5 mm high and immersed in distilled water, 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), 9% 1-hydroxyethylidene 1,1-diphosphonate (HEDP), and 5% sodium hypochlorite (NaOCl) solutions for 24 hours. The color change was measured with a spectrophotometer. The solubility values were calculated as the mass loss was expressed as a percentage of the original mass using an analytical balance with 10-4 g accuracy. Data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests, and 2-way analysis of variance test followed by Bonferroni corrections for pairwise comparisons for solubility and color stability with a 5% significance threshold, respectively.

Results

Biodentine exhibited higher color changes compared to the NeoPutty contact with all solutions except distilled water (p < 0.05). Both hydraulic cements (HCs) showed higher discoloration values immersion in CHX followed by NaOCl. No statistically significant difference was found between Biodentine and NeoPutty regardless of irrigation solution in terms of solubility (p > 0.05). Solubility values were lower in the distilled water group compared to EDTA and CHX (p < 0.05).

Conclusions

Tested HCs showed solubility and color changes at various rates. NeoPutty could be an appropriate material in aesthetic areas. The usage of HEDP as an irrigant solution can be considered suitable for various endodontic treatments due to its relatively lower solubility and discoloration values.

A 12-month randomized controlled trial to assess the efficacy of revitalization of retreated mature incisors with periapical radiolucency in adolescents

The use of regenrative endodontics is restoring the health status of the root canals of retreated mature teeth is a novel approach. Therefore, the current trial aimed to compare the effectiveness of regenerative endodontic procedures (REPs) to non-surgical root canal retreatment (NS-RCR) in reducing periapical radiolucency over one year for the retreatment of mature incisors with periapical periodontitis. The secondary purpose was to assess clinical success and regain pulp sensibility. A parallel randomized controlled trial, 66 mature incisors with periapical radiolucencies were randomly divided into two equal groups and retreated with either REPs or NS-RCR. At baseline and after 6 and 12 months, teeth were assessed clinically and radiographically using a periapical index (PAI). The Mann-Whitney test was used to analyze nonparametric PAI scores. The Electric pulp test readings were analyzed using the repeated measure analysis of variance (ANOVA). Over the follow-up intervals, there was no significant intergroup difference in the PAI medians, the majority of the teeth displayed a reduction in periapical radiolucency. At the end of the follow-up period, the clinical successes for the REP and NS-RCR groups were 93.9% and 97%, respectively (p = 0.555). Positive pulp sensibility was recorded in 54.54% of cases in the REPs after 12 months. Both approaches showed a comparable diminishing of periapical radiolucencies and equivalent clinical results. A conventional, non-surgical endodontic retreatment may not always be necessary.

Two-Dimensional Radiographs and Cone-beam Computed Tomography Assessment of Concentrated Growth Factor and Platelet-Rich Fibrin Scaffolds in Regenerative Endodontic Treatment of Immature Incisors with Periapical Radiolucency: A Randomized Clinical Trial

INTRODUCTION

The primary aim of this study was to compare the radiographic changes of immature incisors with periapical radiolucency after treatment with platelet-rich fibrin (PRF) and concentrated growth factor (CGF) platelet concentrate scaffolds as well as assessment of the clinical success rate over 12 months. The secondary aim was to monitor the radiographic changes in terms of reduction of periapical lesion diameter (PALD), root dentine thickness (RDT), root length (RL), and apical foramen width (AFW). The tertiary aim was to assess and pulp responses, after 12 months.

METHODS

Fifty six children with seventy necrotic, single-rooted maxillary incisors with periapical radiolucency were treated with either CGF or PRF scaffolds (35 teeth per group). Two patients with 4 teeth (2 teeth in each group) failed to attain the follow-up recalls. Radiographic changes in terms of reduction of PALD, RDT, RL, and AFW were monitored using a 2-dimensional (2D) radiograph and cone-beam computed tomography (CBCT) scan. The clinical performance of teeth receiving both scaffolds was assessed after 6 and 12 months. Categorical and continuous data were analyzed using the chi-square test and the t test, respectively. The time and group effects on the means of different radiographic dimensions were tested using the general linear model. Bland-Altman plots were used to assess the level of agreement between the 2D radiographs and CBCT. The level of significance was defined at 0.05 and a 95% confidence interval.

RESULTS

The means of PALD and RL showed significant enhancement in the CGF group compared to the PRF group (P < .05). While the difference between the 2 scaffolds in terms of RDT and AFW was not significant (P > .05). The findings of the 2D radiograph and CBCT were consistent. Clinically, both scaffold success rates were similar (93.9%) over the follow-up intervals. The influence of study independent variables had no significant effect on the success of the regenerative endodontic procedures outcome (P > .05). There was no significant difference in the positive pulp responses to the thermal and electric pulp tests after one year of treatment (P > .05).

CONCLUSIONS

According to the short-term follow-up, PRF and CGF were successful in treating immature teeth with periapical radiolucency by regenerative endodontics. Both scaffold systems induced periapical healing and root lengthening with significant superiority of CGF.

Correlation between pulp sensibility and magnetic resonance signal intensity following regenerative endodontic procedures in mature necrotic teeth- a retrospective cohort study

BACKGROUND

With increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures.

METHODOLOGY

This retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients' responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05.

RESULTS

All 18 teeth scored a baseline score of "2" for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05).

CONCLUSION

Magnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes.

CLINICAL TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov (ID: NCT03804450).

Spectrophotometric Analysis of Color Stability Induced by Various Calcium Silicate Cements in Full Pulpotomy of Permanent Molars: Theracal PT, Biodentine, and ProRoot MTA

AIM

The objective of this study was to assess the color stability induced by Theracal PT, Biodentine, and ProRoot MTA in teeth subjected to full pulpotomy, over a span of 6 months.

MATERIALS AND METHODS

The study employed a total of 48 freshly extracted intact human third molar teeth. Samples were randomly assigned into four groups (n = 12). All teeth, with the exception of the control group, underwent endodontic access. All materials were mixed in accordance with the manufacturer's guidelines and applied at a thickness of 3 mm at the orifice level before they set. The study groups were negative control (was not prepared), positive control (ProRootMTA), Biodentine, and Theracal PT. Glass ionomer and composite resin material was applied to the cavities. The color measurements were performed using the VITA Easy Shade spectrophotometer. All measurements were repeated 3 times in the determined area on the middle buccal surface of the tooth at baseline that (T0); after access preparation and material placement and setting) and then subsequently at 7 (T1), 30 (T2), 90 (T3), and T4 (180) days later. Data were statistically analyzed by using Kruskal-Wallis H at a confidence level of 95% (P < .05).

RESULTS

Compared with the negative control group, Biodentine and Theracal PT showed color stability (ΔE ≤ 3.7). The teeth treated with MTA showed clinically observable discoloration (ΔE ≥ 3.7) at T0, T1, T2, T3, and T4 intervals. At all-time intervals, the MTA group induced more discoloration than Biodentine and Theracal PT (P < .05).

CONCLUSIONS

Theracal PT and Biodentine caused least discoloration compared to PMTA even 6 months after its application in teeth undergoing pulpotomy, thereby offering clinicians a reliable alternative for use in the esthetic zone.

Push out bond strength of hydraulic cements used at different thicknesses

BACKGROUND

The aim of this study was to compare the pushout bond strength (POBS) of three hydraulic cements, when used at thicknesses of 3 and 5 mm.

METHODS

78 root slices of 3 and 5 mm of thickness were obtained from human teeth. Cylindrical cavities of 1.4 mm of diameter were drilled and filled with Biodentine (BD), Totalfill Root Repair paste (TF) or ProRoot MTA White (PMTA). Pushout tests were performed 21 days later. The fracture pattern of each sample was also analyzed. POBS data were analyzed with Welch and Brown-Forsythe and Tamhane's post hoc tests and a Weibull analysis was also performed.

RESULTS

In the 3 mm group, TF showed significantly lower bond strength than BD and PMTA. In the 5 mm group, BD showed significantly higher bond strength than TF. Both BD and TF showed higher bond strength when the thickness of the sample increased, while PMTA did not.

CONCLUSIONS

TF and BD achieve higher pushout bond strength resistance when used at a thickness of 5 mm than at 3 mm, while the mean resistance of PMTA is less influenced by the thickness. At 5 mm of thickness, BD and PMTA exhibit similar resistance to displacement. However, the behavior of BD is more predictable than that of its predecessor. BD is a reliable hydraulic cement for clinical situations where thick cavities need to be filled and displacement resistance plays an important role. Clinicians need to consider choosing specific hydraulic cements according to the thickness of material to be used.

The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review

Aim

The aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.

Method

The two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.

Conclusions

Promoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.

Present status and future directions: Hydraulic materials for endodontic use

BACKGROUND

Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic.

OBJECTIVES

Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified.

METHODS

The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated.

RESULTS

A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated.

CONCLUSIONS

The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.

Effect of irrigants on the color stability, solubility, and surface characteristics of calcium-silicate based cements

Objectives

Materials and Methods

Results

Conclusions

Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study

OBJECTIVES

To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method.

MATERIALS AND METHODS

Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro-Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05).

RESULTS

Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected.

CONCLUSIONS

Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period.

CLINICAL RELEVANCE

APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.

Discoloration Potential of Biodentine: A Systematic Review

The aim of this systematic review is to investigate the teeth discoloration potential of Biodentine. An electronic search in six databases (PubMed, Cochrane Library, LILACS, SCIELO, Web of Science, and Scopus) was conducted by three independent reviewers to identify eligible articles. The following search terms were used: ((discolo*, staining potential, color, colour, or spectrophotomet*), (teeth or tooth), and (Biodentine)). Methodology following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines was adopted for this investigation. At the end of the selection process, 30 articles were identified as eligible, of which 14 in vitro studies were included in this systematic review. Nine of the included studies evaluated the discoloration potential of Biodentine in the presence of blood. Within the limitations of this review, teeth discoloration using Biodentine is highly expected when material is placed in direct contact with blood during dental procedures. In the absence of blood, Biodentine causes less teeth color changes than MTA-based materials, but it is still unclear what clinically relevant results could be expected regarding the discoloration frequency and intensity induced by Biodentine.

Mineral trioxide aggregate immersed in sodium hypochlorite reduce the osteoblastic differentiation of human periodontal ligament stem cells

White mineral trioxide aggregate (WMTA) is a root canal treatment material, which is known to exhibit a dark brown color when in contact with sodium hypochlorite solution (NaOCl). This study aimed to investigate the effects of NaOCl on the surface properties of WMTA discs and WMTA-induced osteoblastic differentiation of periodontal ligament stem cells (PDLSCs). Mixed WMTA (ProRoot MTA) was filled into the molds to form WMTA discs. These discs were immersed in distilled water (D-WMTA) or 5% NaOCl (Na-WMTA). Their surface structures and Ca²⁺ release level was investigated. Moreover, they were cultured with a clonal human PDLSC line (line 1–17 cells). The main crystal structures of Na-WMTA were identical to the structures of D-WMTA. Globular aggregates with polygonal and needle-like crystals were found on D-WMTA and Na-WMTA, which included Ca, Si, Al, C and O. However, many amorphous structures were also identified on Na-WMTA. These structures consisted of Na and Cl, but did not include Ca. NaOCl immersion also reduced Ca²⁺ release level from whole WMTA discs. Line 1–17 cells cultured with D-WMTA formed many mineralized nodules and exhibited high expression levels of osteoblast-related genes. However, cells incubated with Na-WMTA generated a small number of nodules and showed low expression levels of osteoblast-related genes. These results indicated that NaOCl reduced Ca²⁺ release from WMTA by generating amorphous structures and changing its elemental distribution. NaOCl may also partially abolish the ability of WMTA to stimulate osteoblastic differentiation of PDLSCs.

Fabrication and Characterization of a Nanofast Cement for Dental Restorations

This study was aimed at fabricating and evaluating the physical and bioproperties of nanofast cement (NFC) as a replacement of the MTA. The cement particles were decreased in nanoscale, and zirconium oxide was used as a radiopacifier. The setting time and radiopacity were investigated according to ISO recommendations. Analysis of color, bioactivity, and cytotoxicity was performed using spectroscopy, simulated body fluid (SBF), and MTT assay. The setting time of cement pastes significantly dropped from 65 to 15 min when the particle sizes decreased from 2723 nm to 322 nm. Nanoparticles provide large surface areas and nucleation sites and thereby a higher hydration rate, so they reduced the setting time. Based on the resulting spectroscopy, the specimens did not exhibit clinically noticeable discoloration. Resistance to discoloration may be due to the resistance of zirconium oxide to decomposition. Scanning electron microscopy (SEM), X-ray diffraction (XRD), and infrared spectroscopy (FTIR) examinations of the immersed SBF samples showed apatite formation that was a reason for its suitable bioactivity. The results of cell culture revealed that NFC is nontoxic. This study showed that NFC was more beneficial than MTA in dental restorations.

Tooth Discoloration Using Calcium Silicate-Based Cements For Simulated Revascularization in Vitro

The endodontic revascularization may be an alternative treatment for necrotic immature teeth, however, several treatment steps may cause tooth discoloration. This study evaluated the use of three calcium silicate-based cements with different radiopacifying agents on the color alteration (∆E) of extracted premolars after simulation of revascularization. Forty single rooted extracted premolars were shaped with #1-6 gates Glidden drills, rinsed with sodium hypochlorite, and filled with fresh human blood. Three calcium silicate-based cements with different radiopacifying agents (bismuth oxide - CSBi, calcium tungstate - CSW, and zirconium oxide - CSZr) were applied over the blood clot (n=10). The control group received the application of a temporary zinc oxide-based cement (TFZn) (n=10). ∆E was measured with a spectrophotometer, using the L*a*b* color system of the International Commission on Illumination (CIELab), in different times: prior to the preparation of the access cavity (t0); right after treatment (t1); and after one (t2), two (t3), three (t4) and four (t5) months. The tooth site for color evaluation was standardized by silicon matrix, the color reading was performed 3 times per tooth, and the teeth were stored in 37º water between evaluations. ∆E, whiteness (WID index) and yellowness (b*) were evaluated. Data were subjected to one-way ANOVA and repeated measures ANOVA, followed by Tukey's post hoc test (α=0.05). All groups were similar in ∆E1 (t0-t1). The ∆E was the lowest and constant in the control group. In all evaluation times, CSBi presented the highest ∆E (p<0.01). CSW and CSZr were similar in all evaluated times and presented intermediate ∆E values. WID index from CSBi and CSW presented more distancing from 'white' reference. CSBi presented the greatest decrease in yellowness (b* value). The cement containing bismuth oxide presented the highest color alteration values. All tested calcium silicate-based cements presented clinically perceptible discoloration. Calcium tungstate and zirconium oxide may be used as alternative radiopacifiers to decrease tooth discoloration after endodontic tooth revascularization.

Spectrophotometric analysis of the color stability of white mineral trioxide aggregate in contact with four different irrigating solutions - An in vitro study

Aims

This study aims to compare the color stability of white mineral trioxide aggregate (wMTA) in contact with four irrigating solutions.

Settings and Design

Original research study.

Subjects and Methods

Fifty cylindrical discs of wMTA, 10 mm in diameter and 2 mm in height were prepared using a mold. Samples were incubated at a temperature of 37°C and at 100% humidity for the material to reach its optimal mechanical properties. The samples were divided into 6 groups: Group A: dry (n = 5); Group B: distilled water (DW) (n = 5); Group C: 5% sodium hypochlorite (NaOCl) (n = 10); Group D: 2% chlorhexidine gluconate (CHX) (n = 10); Group E: 17% aqueous ethylene diamine tetra-acetic acid (EDTA) (n = 10); Group F: 0.2% Chitosan (n = 10) Each disc was immersed into the irrigating solution for a period of 24 h. All the specimens were photographed using a digital camera before and after immersion. The assessment of color change of each disc of wMTA was conducted by a spectrophotometer. The Commission Internationale de l'eclairage system was used to calculate the differences in color.

Statistical Analysis Used

Statistical Package for the Social Sciences version 16.0 (Chicago, IL, USA) at a significance level of P < 0.05 was used.

Results

All groups except group A exhibited discoloration of wMTA. The mean values for change in color was highest with Group D, followed by Group C, F, E, B, and group A. Only Group B when compared to group A did not show any statistically significant difference (P = 0.948) whereas all the other four groups showed a highly statistically significant difference (P < 0.001).

Conclusions

2% CHX causes maximum discoloration of wMTA followed by 5% NaOCl, 0.2% Chitosan and least discoloration with 17% aqueous EDTA and DW.

Preserving pulp vitality: part two - vital pulp therapies

Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of Endodontology have begun a campaign to raise awareness on the efficacy of VPTs following on from the publication of their 2019 position statement, aimed at both specialists and general dental practitioners. This review examines the current evidence surrounding VPTs and provides a rational approach to the management of the exposed pulp with the aid of case studies. Success lies in accurate diagnosis and case selection, along with well-executed treatment and appropriate follow-up protocols. The introduction of calcium silicate cements has made these treatments more predictable.

In vivo Biocompatibility and Bioactivity of Calcium Silicate-Based Bioceramics in Endodontics

Endodontic therapy aims to preserve or repair the activity and function of pulp and periapical tissues. Due to their excellent biological features, a substantial number of calcium silicate-based bioceramics have been introduced into endodontics and simultaneously increased the success rate of endodontic treatment. The present manuscript describes the in vivo biocompatibility and bioactivity of four types of calcium silicate-based bioceramics in endodontics.

Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium Silicate Cements in the Presence of Blood

INTRODUCTION

New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood.

METHODS

One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis.

RESULTS

Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05).

CONCLUSIONS

Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.

Tooth Discoloration after Regenerative Endodontic Procedures with Calcium Silicate-Based Cements—An Ex Vivo Study

The aim of the present ex vivo study was to assess and compare coronal discoloration induced by four endodontic biomaterials used in regenerative endodontic procedures (REPs). Root resection was executed horizontally, 2 mm apical to the cementoenamel junction, in all fifty-four teeth. After accessing the pulp chamber, specimens were randomly divided in groups and filled with either saline solution or blood, followed by calcium silicate-based cements (CSCs) placement: ProRoot mineral trioxide aggregate (MTA) (Dentsply Sirona), Biodentine (Septodont), TotalFill BC (FKG), or pulp capping material (PCM) (Coltène). Color change (ΔE) was assessed using the L* a* b* system at five different timepoints (before and immediately after biomaterial application, 72 h, 7 days, and 6 months). The significance level for statistical analysis was set at p < 0.05. There are statistically significant differences regarding ΔE over time (p < 0.001). Statistical differences are found considering material (p < 0.001), treatment (p = 0.007), or both (p = 0.002). If solely the material or treatment is considered, regardless of time, statistically significant differences are detected (p < 0.001). After a six-month period of evaluation, blood exposure might be a critical factor in biomaterials’ color variation. Biodentine presents the lowest discoloration potential, followed by TotalFill and PCM, albeit without statistically significant differences. MTA exhibited the greatest color variation. The selection of biomaterial should consider the material’s discoloration potential.

Tooth discoloration and the effects of internal bleaching on the novel endodontic filling material SavDen® MTA

BACKGROUND/PURPOSE

Mineral trioxide aggregate (MTA) was widely used in endodontic therapy as bioceramic material. Although MTA has high biocompatibility, it may lead to tooth discoloration. The aim of this study was to investigate the discoloration of two different bioceramic materials and the effects of internal bleaching.

METHODS

Thirty single-canal mandibular premolars were extracted and randomly assigned to three groups (n = 10), white ProRoot® MTA, SavDen® MTA and a control group. Endodontic access opening, cleaning and shaping were performed, then the teeth were obturated using the two bioceramic materials. Tooth color was recorded at baseline, day 1, and 1, 2, 4, 6, 8, 12, 16, and 24 weeks after treatment. At the end of 24 weeks, sodium perborate was used to perform internal bleaching. Tooth color was recorded at 1, 2, and 6 weeks subsequently. Teeth were measured using a DeguDent® spectrophotometer, and data were transformed into Commission Internationale de l'Eclairage (CIE) L∗a∗b∗ system.

RESULTS

Teeth treated with white ProRoot® MTA showed significant color change and decrease in L∗ value. Internal bleaching leaded to decrease of the ΔE∗ value for all three groups and increase in the L∗ value. There was no difference in tooth discoloration between SavDen® MTA and the control group after obturation and internal bleaching.

CONCLUSION

In terms of visual perception, white ProRoot® MTA tends to cause black and blue discoloration. SavDen® MTA, formulated with calcium lactate gluconate, could be used to reduce tooth discoloration in endodontic treatment.

Effect of commonly used irrigants on the colour stabilities of two calcium-silicate based material

Purpose:

The aim of present study was to evaluate the color stability of calcium-silicate based cements (CSC) Mineral Trioxide Aggregate (MTA) and BiodentineTM when exposed to endodontic irrigating solutions 5% Sodium hypochlorite (NaOCl) or 2% Chlorhexidine (CHX).

Materials and methods:

A total of 60 (n=30) cylindrical samples (10 mm diameter, 2 mm height) were prepared by manipulating white MTA Angelus (Angelus, Londrina, PR, Brazil) and BiodentineTM (Septodent, Saint Maur, France) according to manufacturer's instructions. These samples were immersed in 5% sodium hypochlorite (Prime Dental Products Pvt. Ltd., Mumbai, India), 2% chlorhexidine gluconate (Dentochlor, Saronno VA, Italia), or distilled water for 24 hours. Color changes were measured using UV spectrophotometer (UV-1650, Shimadzu, Europe) and the values were tabulated.

Results:

A significant difference was observed between group I and II with respect to both parameters A & B (p<0.05). Both the calcium-silicate-based materials exhibited significant discoloration when immersed in NaOCl and CHX. Distilled water did not cause clinically perceptible discoloration of any material.

Conclusion:

A significant discoloration was observed with a specific combination of calciumsilicate- based cement and irrigant. BiodentineTM exhibited significant discoloration with CHX whereas, MTA showed more discoloration with NaOCl.

Bioactive tri/dicalcium silicate cements for treatment of pulpal and periapical tissues

Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.

The effect of bleaching agents on the compressive strength of calcium silicate-based materials

The present study aimed to evaluate the effect of sodium perborate on the compressive strength of calcium silicate-based materials. ProRoot wMTA, MTA Plus, NeoMTA Plus and Biodentine discs with 5 mm thickness and 4 mm diameter were prepared. Thirty discs from each material were used for compressive strength testing and divided into two groups: control and bleaching (n = 15). The sodium perborate was mixed with 30% hydrogen peroxide in a creamy consistency and placed on the surface of the specimens. Specimens were tested in an Instron machine, and compressive strength values were recorded and compared. The data were analysed using one-way anova and post hoc Tukey tests. Compressive strength of all tested materials significantly decreased after bleaching (P < 0.05). SEM examination revealed deterioration on materials' surfaces after bleaching. Application of sodium perborate and hydrogen peroxide reduced the compressive strength of ProRoot wMTA, MTA Plus, NeoMTA Plus and Biodentine.

Retention of BioAggregate and MTA as coronal plugs after intracanal medication for regenerative endodontic procedures: an ex vivo study

Objectives

This study compared the retention of BioAggregate (BA; Innovative BioCeramix) and mineral trioxide aggregate (MTA; Angelus) as coronal plugs after applying different intracanal medications (ICMs) used in regenerative endodontics.

Materials and Methods

One-hundred human maxillary central incisors were used. The canals were enlarged to a diameter of 1.7 mm. Specimens were divided into 5 groups (n = 20) according to the ICM used: calcium hydroxide (CH), 2% chlorhexidine (CHX), triple-antibiotic paste (TAP), double-antibiotic paste (DAP), and no ICM (control; CON). After 3 weeks of application, ICMs were removed and BA or MTA were placed as the plug material (n = 10). The push-out bond strength and the mode of failure were assessed. The data were analyzed using 2-way analysis of variance, the Tukey's test, and the χ² test; p values < 0.05 indicated statistical significance.

Results

The type of ICM and the type of plug material significantly affected bond strength (p < 0.01). Regardless of the type of ICM, BA showed a lower bond strength than MTA (p < 0.05). For MTA, CH showed a higher bond strength than CON, TAP and DAP; CHX showed a higher bond strength than DAP (p < 0.01). For BA, CH showed a higher bond strength than DAP (p < 0.05). The mode of failure was predominantly cohesive for BA (p < 0.05).

Conclusions

MTA may show better retention than BA. The mode of bond failure with BA can be predominantly cohesive. BA retention may be less affected by ICM type than MTA retention.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Biological response of commercially available different tricalcium silicate-based cements and pozzolan cement

This study evaluated four root repair materials for cytotoxicity and cell attachment in vitro. Cell viability was determined at 24 hr, 3 days and 7 days by using a 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay with material extracts. Cell adhesion was examined with a scanning electron microscope on the surface of materials at 24 and 48 hr. Angelus MTA displayed the lowest cell viabilities at all-day incubations. Endocem had high biocompatibility on the first day. After culturing for 3 days and 7 days, the cell viabilities of Biodentine, Endocem and MM-MTA had similar results, and their cell viability was significantly higher than that of Angelus. No definite relation was found between the incubation time and the relative cell viability in any group. In scanning electron micrographs, the cells were attached to the material surface for all materials, although the cells in the Biodentine group were attached better than the other groups on the second day. Cell viability and cell attachment was lower in the Angelus group. Endocem, Biodentine and MM-MTA were similar in biocompatibility and cytotoxicity.

Spectrophotometric analysis of coronal discoloration induced by white mineral trioxide aggregate and Biodentine: An in vitro study

Aims:

The aim of this study was to evaluate the specific chromatic alterations in tooth crowns induced by two different endodontic restorative materials.

Settings and Design:

This in vitro study was conducted at the Department of Conservative Dentistry, KMCT Dental College, Kozhikode, Kerala.

Subjects and Methods:

Forty-five freshly extracted, fully developed, single-rooted teeth were prepared and randomly assigned to two experimental groups (n = 15 each) and one negative control group (n = 15). Group 1 consists of white mineral trioxide aggregate (WMTA), Biodentine formed Group 2, and controls formed Group 3. Double-beam ultraviolet spectrophotometer equipment was used to assess the coronal discoloration as determined by CIE L*, a*, and b* and their corresponding total values.

Results:

At baseline, no significant difference was detected for CIE values between the groups. Group 1 showed a significant decrease in L*, a*, and b* values over time. The color change with WMTA led to clinically perceptible crown discoloration after 6 weeks which exceeded the perceptible threshold for the human eye, i.e., ΔE > 3.3. No changes were observed with Biodentine.

Conclusions:

Materials used in endodontics may stain teeth. WMTA induced clinically perceptible crown discoloration, whereas Biodentine demonstrated color stability.

Long-Term Fracture Resistance of Simulated Immature Teeth Filled with Various Calcium Silicate-Based Materials

Objective. The aim of this in vitro study was to evaluate the long-term fracture resistance of simulated human immature permanent teeth filled with BioAggregate™ (BA), mineral trioxide aggregate (MTA), and EndoSequence® Root Repair Material (ERRM). Material and Methods. 40 teeth, simulated to average root length of 13 ± 1 mm (Cvek's stage 3), were included in the study. The teeth were randomly divided into four groups: Group 1: DiaRoot® BA, Group 2: MTA-Plus™ (MTA-P), Group 3: MTA-Angelus (MTA-A), and Group 4: ERRM. The root canal filling materials were applied according to the manufacturers' instructions. After 24 months of incubation, the roots of the teeth were embedded in acrylic blocks and subjected to fracture testing. The resultant data were analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests. Results. Mean (±SD) failure loads (MPa) were 20.46 ± 2.53 for BA, 18.88 ± 5.13 for MTA-P, 14.12 ± 1.99 for MTA-A, and 17.65 ± 4.28 for ERRM groups. BA group exhibited the highest and MTA-A group showed the lowest resistance to fracture. Significant differences in fracture resistance were found between the groups of BA and MTA-A (p < 0.001), MTA-P and MTA-A (p < 0.05), and ERRM and MTA-A (p < 0.05). Conclusion. Within the limitations of this study, data suggests that BA-filled immature teeth demonstrate higher fracture resistance than other groups at 24 months appearing to be the most promising material tested.

In vitro evaluation of different dental materials used for the treatment of extensive cervical root defects using human periodontal cells

INTRODUCTION

Repair materials for extensive cervical root defects may come in direct contact with periodontal tissues. This in vitro study compared the effects of four calcium silicate cements (CSC), one resin-modified glass ionomer cement, and one glass carbomer cement on primary human gingival fibroblasts (HGF), alveolar osteoblasts (HAO), and a human osteoblast cell line (hFOB 1.19).

METHODS

HGF, HAO, and hFOB were seeded on discoid test specimens. Relative numbers of viable cells were quantitatively assessed after 1 and 24 h for cytotoxicity/adhesion assays and after 4, 24, 48, and 72 h for proliferation assays. Data were statistically analyzed using non-parametric tests (α = 0.05).

RESULTS

Relative to the control (100 %), CSC allowed for mean numbers of 71-81 % viable HGF and 80-82 % viable HAO. Then, 64 % of HGF and 56 % of HAO were assessed on GC Fuji II LC. Mean numbers of viable cells were 59-64 % HGF and 67-68 % HAO for GCP Glass Fill specimens. Cells exposed to CSC over 24 h remained viable and even increased in number. Both cell types adhered almost equally well to CSC and GC Fuji II LC. GCP Glass Fill continued to decrease cell viability and adhesion. CSC-based materials and GC Fuji II LC allowed for HGF and hFOB proliferation; however, none of the tested materials specifically stimulated cell proliferation.

CONCLUSIONS

CSC characterized by low cytotoxicity. GC Fuji II LC shows moderate cytotoxic effects. ProRoot MTA, Harvard MTA, Biodentine, EndoSequence putty, and GC Fuji II LC allow HGF and HAO to adhere and HGF and hFOB to proliferate. GCP Glass Fill decreases cell viability, adhesion, and proliferation.

CLINICAL RELEVANCE

CSC remain the paramount biologic choice for the repair of extensive cervical root defects. GC Fuji II LC might be considered in addition to CSC when the defect comprises supracrestal areas and the restoration requires superior aesthetic and mechanical characteristics.

Effects of a discoloration-resistant calcium aluminosilicate cement on the viability and proliferation of undifferentiated human dental pulp stem cells

Discoloration-resistant calcium aluminosilicate cement has been formulated to overcome the timely problem of tooth discoloration reported in the clinical application of bismuth oxide-containing hydraulic cements. The present study examined the effects of this experimental cement (Quick-Set2) on the viability and proliferation of human dental pulp stem cells (hDPSCs) by comparing the cellular responses with commercially available calcium silicate cement (white mineral trioxide aggregate; WMTA) after different aging periods. Cell viability and proliferation were examined using assays that examined plasma membrane integrity, leakage of cytosolic enzyme, caspase-3 activity for early apoptosis, oxidative stress, mitochondrial metabolic activity and intracellular DNA content. Results of the six assays indicated that both Quick-Set2 and WMTA were initially cytotoxic to hDPSCs after setting for 24 h, with Quick-Set2 being comparatively less cytotoxic than WMTA at this stage. After two aging cycles, the cytotoxicity profiles of the two hydraulic cements were not significantly different and were much less cytotoxic than the positive control (zinc oxide-eugenol cement). Based on these results, it is envisaged that any potential beneficial effect of the discoloration-resistant calcium aluminosilicate cement on osteogenesis by differentiated hDPSCs is more likely to be revealed after outward diffusion and removal of its cytotoxic components.

Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Various Bioceramic Cements and Other Endodontic Materials

INTRODUCTION

Coronal tooth discoloration induced by various endodontic materials was evaluated in vitro.

METHODS

Eighty extracted human maxillary anterior teeth were accessed, instrumented, and sectioned to standardized root lengths of 10 mm below the cementoenamel junction. Pulp chambers were cleaned chemomechanically to ensure complete tissue removal. Specimens were filled with experimental materials in 8 random groups: RRM, EndoSequence RRM putty (Brasseler, Savannah, GA); RRMF, EndoSequence RRM fast set paste (Brasseler); BD, Biodentine (Septodont, Saint-Maur-des-Fossés, France); WMTA, white MTA (Dentsply, York, PA), GMTA, gray MTA (Dentsply); AH+, AH Plus sealer (Dentsply); TAP, triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline); and NF, no filling (negative control group). After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 7, 30, 60, and 180 after material placement (T0-T180). Data were transformed into Commission International de I'Eclairage's L*a*b color values, and corresponding ΔE values were calculated. Two-way analysis of variance and the Bonferroni method were performed.

RESULTS

Visual discoloration was observed in all specimens in the GMTA, WMTA, and TAP groups at T7, increasing with time. The ΔE value between the initial color at T0 and at T7, T30, T60, and T180 was significantly different for GMTA, WMTA, and TAP (P < .001). ΔE values for the BD, RRM, RRMF, AH+, and NF groups were not statistically significantly different between T0 and T7, T30, T60, and T180, respectively, except for 3 samples below the human perceptible threshold. Values of L* dropped significantly from T0 to T180 in the TAP, GMTA, and WMTA groups.

CONCLUSIONS

Significant coronal tooth discoloration was caused by TAP, GMTA, and WMTA but not by BD, RRM, and RRMF.