Magnesium phosphate cements for endodontic applications with improved long-term sealing ability

Value-added utilization of electric furnace nickel-iron slag to enhance the performance of magnesium sodium phosphate cement

Electric furnace nickel-iron slag is an industrial solid waste obtained by cooling the molten slag after the production of nickel and iron. Its main chemical components are SiO2, Fe2O3, and MgO. This study explores the impact of nickel-iron slag on the properties of magnesium sodium phosphate cement (MNPC), with the objective of addressing the environmental pollution caused by nickel-iron slag and reducing the cost of MNPC. Through experimentation, it has been found that as the content of nickel-iron slag increases, the volume deformation of MNPC is improved. When 30 % nickel-iron slag is added, the water resistance of the cement paste is significantly enhanced, and the porosity after 28 days of air curing is the lowest. Moreover, the compressive strength of all experimental groups gradually increases with the extension of water curing time. Specifically, MNPC with 30 % nickel-iron slag exhibits the highest compressive strength, the lowest strength loss rate, and the smallest porosity at 1 day, 3 days, and 28 days under both air and water curing conditions. The hydration products of MNPC are amorphous MgNaPO4・7H2O, while distinct crystalline peaks of MgNaPO4・7H2O are observed in MNPC containing nickel-iron slag, and the intensity of these peaks gradually increases with the curing time. The compressive strength of water - cured MNPC progressively increases with the curing duration, without any strength decline, and the intensity of the crystalline peaks of the hydration products also continues to strengthen. The innovation of this study lies in the effective utilization of nickel-iron slag in MNPC, which not only enhances the performance of MNPC but also provides a novel solution for the treatment of industrial waste and the development of sustainable materials.

Novel Foamed Magnesium Phosphate Antimicrobial Bone Cement for Bone Augmentation

In dental implant surgery, infection is identified as the primary factor contributing to the failure of bone grafts. There is an urgent need to develop bone graft materials possessing antibacterial characteristics to facilitate bone regeneration. Magnesium phosphate bone cement (MPC) is highly desirable for bone regeneration due to its favorable biocompatibility, plasticity, and osteogenic capabilities. However, the limited porosity of conventional MPC hinders the nutrient supply, gas diffusion, and cell infiltration, thereby compromising its osteogenic efficacy. This research focused on the fabrication of a highly porous MPC (CaCO3/CA-MPC) by incorporating citric acid (CA) and calcium carbonate (CaCO3) as foaming agents. The resulting material demonstrated enhanced physicochemical properties, bioactivity, and antimicrobial effects. When compared with conventional MPC, human periodontal ligament stem cells (hPDLSCs) showed improved osteogenic differentiation when cultured with CaCO3/CA-MPC. The inclusion of foaming agents significantly enhanced the antimicrobial efficacy of MPC against both Gram-positive bacteria (Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli). The results of in vivo anti-infection experiments in rats revealed that 3%CaCO3/CA-MPC displayed superior bactericidal activity compared with Bio-Oss and control groups (p < 0.05), thereby enhancing the anti-infective outcomes post-bone grafting and stimulating osteogenesis in the infected bone defect region. The study demonstrated that MPC containing 3%CaCO3/CA exhibited excellent antimicrobial and osteogenic properties both in vitro and in vivo, suggesting its potential as a promising candidate as bone graft material for dental implant surgeries.

Calcium silicate cements endowing bioactivity and sustaining mechanical strength of low-heat-releasing and fast-curing magnesium phosphate cements

It is known that magnesium phosphate cements (MPCs) show appreciable mechanical strength and biocompatibility, but the hydration reaction processes often lead to intense heat release while the hydration products present weak resistance to mechanical decay and low bioactivity. Herein we developed an MPC-based system, which was low-heat-releasing and fast-curing in this study, by compounding with self-curing calcium silicate cements (CSCs). The MPC composed of magnesium oxide (MgO), potassium dihydrogen phosphate (KH2PO4), disodium hydrogen phosphate (Na2HPO4), magnesium hydrogen phosphate trihydrate (MgHPO4·3H2O) and chitosan were weakly basic, which would be more stable in vivo. The physicochemical properties indicated that the addition of CSCs could increase the final setting time while decrease the heat release. Meanwhile, the CSCs could endow MPC substrate with apatite re-mineralization reactivity, especially, which add 25 wt.% CSCs showed the most significant apatite deposition. What's more, the mechanical evolution in buffer demonstrated CSCs could enhance and sustain the mechanical strength during degradation, and the internal constructs of cement implants could still be reconstructed by μCT analysis in rabbit femoral bone defect model in vivo. Particularly, appropriate CSCs adjusted the biodegradation and promoted new bone tissue regeneration in vivo. Totally, the MPC/CSCs composite system endows bioactivity and sustains mechanical strength of the MPC, which may be promising for expending the clinical applications of MPC-based bone cements.

Exploring the potential of magnesium oxychloride, an amorphous magnesium phosphate, and newberyite as possible bone cement candidates

Magnesium phosphate-based bone cements, particularly struvite (MgNH4PO4∙6H2O)-forming cements, have attracted increased scientific interest in recent years because they exhibit similar biocompatibility to hydroxyapatite while degrading much more rapidly in vivo. However, other magnesium-based minerals which might be promising are, to date, little studied. Therefore, in this study, we investigated three magnesium-based bone cements: a magnesium oxychloride cement (Mg3(OH)5Cl∙4H2O), an amorphous magnesium phosphate cement based on Mg3(PO4)2, MgO, and NaH2PO4, and a newberyite cement (MgHPO4·3H2O). Because it is not sufficiently clear from the literature to what extent these cements are suitable for clinical use, all of them were characterized and optimized regarding setting time, setting temperature, compressive strength and passive degradation in phosphate-buffered saline. Because the in vitro properties of the newberyite cement were most promising, it was orthotopically implanted into a partially weight-bearing tibial bone defect in sheep. The cement exhibited excellent biocompatibility and degraded more rapidly compared to a hydroxyapatite reference cement; after 4 months, 18% of the cement was degraded. We conclude that the newberyite cement was the most promising candidate of the investigated cements and has clear advantages over calcium phosphate cements, especially in terms of setting time and degradation behavior.

An Overview of Magnesium-Phosphate-Based Cements as Bone Repair Materials

In the search for effective biomaterials for bone repair, magnesium phosphate cements (MPCs) are nowadays gaining importance as bone void fillers thanks to their many attractive features that overcome some of the limitations of the well-investigated calcium-phosphate-based cements. The goal of this review was to highlight the main properties and applications of MPCs in the orthopedic field, focusing on the different types of formulations that have been described in the literature, their main features, and the in vivo and in vitro response towards them. The presented results will be useful to showcase the potential of MPCs in the orthopedic field and will suggest novel strategies to further boost their clinical application.

Physicochemical, Biological, and Antibacterial Properties of Four Bioactive Calcium Silicate-Based Cements

Calcium silicate-based cement (CSC) is a pharmaceutical agent that is widely used in dentistry. This bioactive material is used for vital pulp treatment due to its excellent biocompatibility, sealing ability, and antibacterial activity. Its drawbacks include a long setting time and poor maneuverability. Hence, the clinical properties of CSC have recently been improved to decrease its setting time. Despite the widespread clinical usage of CSC, there is no research comparing recently developed CSCs. Therefore, the purpose of this study is to compare the physicochemical, biological, and antibacterial properties of four commercial CSCs: two powder-liquid mix types (RetroMTA^® [RETM]; Endocem^® MTA Zr [ECZR]) and two premixed types (Well-Root™ PT [WRPT]; Endocem^® MTA premixed [ECPR]). Each sample was prepared using circular Teflon molds, and tests were conducted after 24 h of setting. The premixed CSCs exhibited a more uniform and less rough surface, higher flowability, and lower film thickness than the powder-liquid mix CSCs. In the pH test, all CSCs showed values between 11.5 and 12.5. In the biological test, cells exposed to ECZR at a concentration of 25% showed greater cell viability, but none of the samples showed a significant difference at low concentration (p > 0.05). Alkaline phosphatase staining revealed that cells exposed to ECZR underwent more odontoblast differentiation than the cells exposed to the other materials; however, no significant difference was observed at a concentration of 12.5% (p > 0.05). In the antibacterial test, the premixed CSCs showed better results than the powder-liquid mix CSCs, and ECPR yielded the best results, followed by WRPT. In conclusion, the premixed CSCs showed improved physical properties, and of the premixed types, ECPR exhibited the highest antibacterial properties. For biological properties, none of these materials showed significant differences at 12.5% dilution. Therefore, ECPR may be a promising material with high antibacterial activity among the four CSCs, but further investigation is needed for clinical situations.

Dexamethasone and zinc loaded polymeric nanoparticles reinforce and remineralize coronal dentin. A morpho-histological and dynamic-biomechanical study

OBJECTIVE

To investigate the effect of novel polymeric nanoparticles (NPs) doped with dexamethasone (Dex) on viscoelasticity, crystallinity and ultra-nanostructure of the formed hydroxyapatite after NPs dentin infiltration.

METHODS

Undoped-NPs, Dex-doped NPs (Dex-NPs) and zinc-doped-Dex-NPs (Zn-Dex-NPs) were tested at dentin, after 24 h and 21 d. A control group without NPs was included. Coronal dentin surfaces were studied by nano-dynamic mechanical analysis measurements, atomic force microscopy, X-ray diffraction and transmission electron microscopy. Mean and standard deviation were analyzed by ANOVA and Student-Newman-Keuls multiple comparisons (p < 0.05).

RESULTS

At 21 d of storage time, both groups doped with Dex exhibited the highest complex, storage and loss moduli among groups. Zn-Dex-NPs and Dex-NPs promoted the highest and lowest tan delta values, respectively. Dex-NPs contributed to increase the fibril diameters of dentin collagen over time. Dentin surfaces treated with Zn-Dex-NPs attained the lowest nano-roughness values, provoked the highest crystallinity, and produced the longest and shortest crystallite and grain size. These new crystals organized with randomly oriented lattices. Dex-NPs induced the highest microstrain. Crystalline and amorphous matter was present in the mineral precipitates of all groups, but Zn and Dex loaded NPs helped to increase crystallinity.

SIGNIFICANCE

Dentin treated with Zn-Dex-NPs improved crystallographic and atomic order, providing structural stability, high mechanical performance and tissue maturation. Amorphous content was also present, so high hydroxyapatite solubility, bioactivity and remineralizing activity due to the high ion-rich environment took place in the infiltrated dentin.

The Corrosion Resistance of Reinforced Magnesium Phosphate Cement Reactive Powder Concrete

Magnesium phosphate cement-based reactive powder concrete (MPC-RPC) is a cement-based material with early strength, high strength and excellent durability. The slump flow and setting time of steel fibers reinforced MPC-RPC are investigated. Meanwhile, the flexural strength, the compressive strength, the ultrasonic velocity and the electrical resistivity of specimens cured for 3 h, 1 day, 3 days and 28 days are determined. Moreover, the corresponding corrosion resistance reinforced MPC-RPC exposing to NaCl freeze-thaw (F-T) cycles and dry-wet (D-W) alternations is researched. In this study, the steel fibers used are 0%, 0.5%, 1.0%, 1.5%, 2.0%, 2.5% and 3.0% by the volume of MPC-RPC. The corrosion of the inner reinforcement is reflected using the mass loss, electrical resistivity, ultrasonic velocity, and the AC impedance spectrum. Researching findings show that the steel fibers lead to decreasing the slump flow and setting time. The flexural strength, the compressive strength and ultrasonic velocity of MPC-RPC cured for 3 h are higher than 45% of the MPC-RPC cured for 28 days. Moreover, when the MPC-RPC is cured for 7 days, the flexural strength, the compressive strength and ultrasonic velocity of MPC-RPC are higher than 85% of the specimens cured for 28 days. The electrical resistance decreases in a quadratic function as the volume ratio of steel fibers increases. The corrosion resistance of the internal reinforcement can be improved by adding steel fibers at appropriate dosages. The reinforcement inner MPC-RPC corrodes more seriously under the NaCl D-W alternations than NaCl F-T cycles.

Characterization of Tetracalcium Phosphate/Monetite Biocement Modified by Magnesium Pyrophosphate

Magnesium pyrophosphate modified tetracalcium phosphate/monetite cement mixtures (MgTTCPM) were prepared by simple mechanical homogenization of compounds in a ball mill. The MgP2O7 was chosen due to the suitable setting properties of the final cements, in contrast to cements with the addition of amorphous (Ca, Mg) CO3 or newberite, which significantly extended the setting time even in small amounts (corresponding ~to 1 wt% of Mg in final cements). The results showed the gradual dissolution of the same amount of Mg2P2O7 phase, regardless of its content in the cement mixtures, and the refinement of formed HAP nanoparticles, which were joined into weakly and mutually bound spherical agglomerates. The compressive strength of composite cements was reduced to 14 MPa and the setting time was 5-10 min depending on the composition. Cytotoxicity of cements or their extracts was not detected and increased proliferative activity of mesenchymal stem cells with upregulation of osteopontin and osteonectin genes was verified in cells cultured for 7 and 15 days in cement extracts. The above facts, including insignificant changes in the pH of simulated body fluid solution and mechanical strength close to cancellous bone, indicate that MgTTCPM cement mixtures could be suitable biomaterials for use in the treatment of bone defects.

The Effect of Magnesium Chloride on the Macroscopic and MI-Croscopic Properties of Phosphate Cement-Based Materials

Phosphate cement-based materials are fast-hardening cement materials, which have been applied to the rapid repair of concrete structures. However, the excessive setting rate could lead to initial cracks in the cement-based matrix. Therefore, a proper retarder is required to reduce the setting rate, thus improving the strength of structures. In this study, a magnesium chloride retarder was selected, and its influence on the setting time, slump flow, and the mechanical strengths (flexural strength, compressive strength, and bond strength) of phosphate cement paste curing for 3 h~28 d was investigated. Scanning electron microscopy, X-ray diffraction, and thermal analysis were used to analyze the mechanism of the properties of phosphate cement paste. Results showed that the setting time increased exponentially with the mass ratio of magnesium chloride by the total mass of magnesium oxide. Meanwhile, the slump flow increased linearly with the increasing dosage of magnesium chloride, and the drying shrinkage rate exhibited a quadratic function with the curing age. The addition of magnesium chloride decreased the mechanical strengths of phosphate cement paste at earlier curing age (lower than 3 d) and effectively improved the mechanical strengths at a later curing age (equal to or higher than 3 d). Moreover, magnesium chloride could also decrease the drying shrinkage rate. It can be obtained from the microcosmic researching results that magnesium chloride can inhibit the hydration of phosphate cement and reduce cracks induced by drying shrinkage at later curing age (higher than 3 d).

Biodegradable magnesium phosphates in biomedical applications

As an essential element, magnesium is involved in a variety of physiological processes. Magnesium is the second most abundant cation in cells and the fourth most abundant cation in living...

Melatonin-doped polymeric nanoparticles induce high crystalline apatite formation in root dentin

OBJECTIVE

To investigate the effect of novel polymeric nanoparticles (NPs) doped with melatonin (ML) on nano-hardness, crystallinity and ultrastructure of the formed hydroxyapatite after endodontic treatment.

METHODS

Undoped-NPs and ML-doped NPs (ML-NPs) were tested at radicular dentin, after 24 h and 6 m. A control group without NPs was included. Radicular cervical and apical dentin surfaces were studied by nano-hardness measurements, X-ray diffraction and transmission electron microscopy. Mean and standard deviation were analyzed by ANOVA and Student-Newman-Keuls multiple comparisons (p < 0.05).

RESULTS

Cervical dentin treated with undoped NPs maintained its nano-hardness values after 6 m of storage being [24 h: 0.29 (0.01); 6 m: 0.30 (0.02) GPa], but it decreased at apical dentin [24 h: 0.36 (0.01); 6 m: 0.28 (0.02) GPa]. When ML-NPs were used, nano-hardness was similar over time [24h: 0.31 (0.02); 6 m: 0.28 (0.03) GPa], at apical dentin. Root dentin treated with ML-NPs produced, in general, high crystallinity of new minerals and thicker crystals than those produced in the rest of the groups. After 6 m, crystals became organized in randomly oriented polyhedral, square polygonal block-like apatite or drop-like apatite polycrystalline lattices when ML-NPs were used. Undoped NPs generated poor crystallinity, with preferred orientation of small crystallite and increased microstrain.

SIGNIFICANCE

New polycrystalline formations encountered in dentin treated with ML-NPs may produce structural dentin stability and high mechanical performance at the root. The decrease of mechanical properties over time in dentin treated without NPs indicates scarce remineralization potential, dentin demineralization and further potential degradation. The amorphous stage may provide high hydroxyapatite solubility and remineralizing activity.

Coupling Effect of Salt Freeze-Thaw Cycles and Carbonation on the Mechanical Performance of Quick Hardening Sulphoaluminate Cement-Based Reactive Powder Concrete with Basalt Fibers

The effect of salt freeze-thaw cycles coupled with carbonation on the mechanical performance of quick hardening sulphoaluminate cement-based reactive powder concrete combined with basalt fibers was investigated. The ratios of basalt fibers in sulphoaluminate cement-based reactive powder concrete (SAC-RPC) were 1%, 2%, 3% and 4% by the volume of concrete. The mechanical strengths (compressive strength, flexural strength and bonding strength) of SAC-RPC were investigated after curing for 5 h, 1 d, 14 d and 28 d, respectively. Meanwhile, the mechanical strengths of resultant concrete were detected, when different NaCl freeze-thaw cycles and carbonation were adopted. Results showed that the addition of basalt fibers could effectively improve the mechanical strengths, especially the flexural strength of SAC-RPC. The dosage of 3.0% was the threshold value affected mechanical strengths. The flexural, compressive and bonding strengths of SAC-RPC were higher than 8.53 MPa, 34 MPa and 3.21 MPa, respectively. The mass loss and mechanical strengths loss of SAC-RPC increased in the form of quadratic function with the increasing number of NaCl freeze-thaw cycles and varied in the form of quadratic decreasing function. Meanwhile, the effect of carbonation on the mechanical strengths of SAC-RPC can be ignored. Additionally, the coupling effect of salt freeze-thaw cycles and carbonation could accelerate the attenuation of concrete strength. The mechanical strengths loss demonstrated a decreased quadratic function with the increasing volume of basalt fibers.

A bioactive magnesium phosphate cement incorporating chondroitin sulfate for bone regeneration

Magnesium phosphate cement (MPC) has been evaluated as an inorganic bone filler due to its favorable biocompatibility, biodegradability, rapid setting, high initial strength, and osteogenic potential. However, the setting time of MPC is so rapid that it makes it difficult to use in practice, and the clinical properties of MPC could be further be improved by adding bioactive materials. Here we developed novel bioactive chondroitin sulfate (CS)-MPC composites (CS-MPCs) by incorporating different amounts of CS into MPC. The compositions, microstructures, and physiochemical properties of CS-MPCs and their inducedin vitrocellular responses andin vivobone regeneration properties were evaluated. CS-MPCs had a longer setting time, lower hydration temperature, higher compressive strength, and more neural pH than MPC. CS-MPCs demonstrated similar degradation ratios relative to MPC in Tris-HCl solution. CS-MPCs promoted pre-osteoblast cell proliferation, attachment, and differentiationin vitroand enhanced bone formation surrounding implantsin vivo. In conclusion, through CS modification, our novel CS-MPCs have improved physiochemical properties that enhance compatibilityin vitroand bone regenerationin vivo, making them attractive materials for bone regeneration.

Melatonin-doped polymeric nanoparticles reinforce and remineralize radicular dentin: Morpho-histological, chemical and biomechanical studies

OBJECTIVES

To investigate the effectiveness of novel polymeric nanoparticles (NPs) doped with melatonin (ML) in reducing dentin permeability and facilitating dentin remineralization after endodontic treatment.

METHODS

The effect of undoped NPs and ML-doped NPs (ML-NPs) was tested in radicular dentin, at 24 h and 6 m. A control group without NPs was included. ML liberation was measured. Radicular dentin was assessed for fluid filtration. Dentin remineralization was analyzed by scanning electron microscopy, AFM, Young's modulus (Ei), Nano DMA-tan delta, and Raman analysis.

RESULTS

ML release ranged from 1.85 mg/mL at 24 h to 0.033 mg/mL at 28 d. Both undoped NPs and ML-NPs treated dentin exhibited the lowest microleakage, but samples treated with ML-NPs exhibited hermetically sealed dentinal tubules and extended mineral deposits onto dentin. ML-NPs promoted higher and durable Ei, and functional remineralization at root dentin, generating differences between the values of tan delta among groups and creating zones of stress concentration. Undoped-NPs produced closure of some tubules and porosities at the expense of a relative mineral amorphization. Chemical remineralization based on mineral and organic assessments was higher in samples treated with ML-NPs. When using undoped NPs, precipitation of minerals occurred; however, radicular dentin was not mechanically reinforced but weakened over time.

SIGNIFICANCE

Application of ML-NPs in endodontically treated teeth, previous to the canal filling step, is encouraged due to occlusion of dentinal tubules and the reinforcement of the radicular dentin structure.

Experimental Drillable Magnesium Phosphate Cement Is a Promising Alternative to Conventional Bone Cements

Clinically used mineral bone cements lack high strength values, absorbability and drillability. Therefore, magnesium phosphate cements have recently received increasing attention as they unify a high mechanical performance with presumed degradation in vivo. To obtain a drillable cement formulation, farringtonite (Mg₃(PO₄)₂) and magnesium oxide (MgO) were modified with the setting retardant phytic acid (C₆H₁₈O₂₄P₆). In a pre-testing series, 13 different compositions of magnesium phosphate cements were analyzed concentrating on the clinical demands for application. Of these 13 composites, two cement formulations with different phytic acid content (22.5 wt% and 25 wt%) were identified to meet clinical demands. Both formulations were evaluated in terms of setting time, injectability, compressive strength, screw pullout tests and biomechanical tests in a clinically relevant fracture model. The cements were used as bone filler of a metaphyseal bone defect alone, and in combination with screws drilled through the cement. Both formulations achieved a setting time of 5 min 30 s and an injectability of 100%. Compressive strength was shown to be ~12–13 MPa and the overall displacement of the reduced fracture was <2 mm with and without screws. Maximum load until reduced fracture failure was ~2600 N for the cements only and ~3800 N for the combination with screws. Two new compositions of magnesium phosphate cements revealed high strength in clinically relevant biomechanical test set-ups and add clinically desired characteristics to its strength such as injectability and drillability.

Osteoclast and osteoblast response to strontium-doped struvite coatings on titanium for improved bone integration

To develop implants with improved bone ingrowth, titanium substrates were coated with homogeneous and dense struvite (MgNH4PO4·6H2O) layers by means of electrochemically assisted deposition. Strontium nitrate was added to the coating electrolyte in various concentrations, in order to fabricate Sr-doped struvite coatings with Sr loading ranging from 10.6 to 115 μg/cm2. It was expected and observed that osteoclast activity surrounding the implant was inhibited. The cytocompatibility of the coatings and the effect of Sr-ions in different concentrations on osteoclast formation were analyzed in vitro. Osteoclast differentiation was elucidated on morphological, biochemical as well as on gene expression level. It could be shown that moderate concentrations of Sr2+ had an inhibitory effect on osteoclast formation, while the growth of osteoblastic cells was not negatively influenced compared to pure struvite surfaces. In summary, the electrochemically deposited Sr-doped struvite coatings are a promising approach to improve bone implant ingrowth.

Polymeric nanoparticles for endodontic therapy

The effectiveness of novel polymeric nanoparticles (NPs) application in reducing dentin permeability and facilitating dentin remineralization after endodontic treatment was evaluated. The effect of undoped NPs, zinc, calcium and doxycycline-doped NPs (Zn-NPs, Ca-NPs and D-NPs, respectively) was tested in radicular dentin. A control group without NPs was included. Radicular dentin was assessed for fluid filtration. Dentin remineralization was analyzed by scanning and transmission electron microscopy, energy-dispersive analysis, AFM, Young's modulus (Ei), Nano DMA, Raman, and X-Ray Diffraction analysis. Ca-NPs and Zn-NPs treated dentin exhibited the lowest microleakage with hermetically sealed dentinal tubules and a zinc-based salt generation onto dentin. Zn-NPs favored crystallinity and promoted the highest Ei and functional remineralization at the apical dentin, generating differences between the values of complex modulus among groups. Ca-NPs produced closure of tubules and porosities at the expense of a relative mineral amorphization, without creating zones of stress concentration. The highest sealing efficacy was obtained in Zn-NPs-treated samples, along with the highest values of Young's modulus and dentin mineralization. These high values of Ei were obtained by closing voids, cracks, pores and tubules, and by strengthening the root dentin. When using undoped NPs or Ca-NPs, deposition of minerals occurred, but radicular dentin was not mechanically reinforced. Therefore, application of Zn-NPs in endodontically treated teeth previous to the canal filling is encouraged.

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.

Biomechanical Evaluation of Promising Different Bone Substitutes in a Clinically Relevant Test Set-Up

(1) Background: Bone substitutes are essential in orthopaedic surgery to fill up large bone defects. Thus, the aim of the study was to compare diverse bone fillers biomechanically to each other in a clinical-relevant test set-up and to detect differences in stability and handling for clinical use. (2) Methods: This study combined compressive strength tests and screw pullout-tests with dynamic tests of bone substitutes in a clinical-relevant biomechanical fracture model. Beyond well-established bone fillers (ChronOS^TM Inject and Graftys^® Quickset), two newly designed bone substitutes, a magnesium phosphate cement (MPC) and a drillable hydrogel reinforced calcium phosphate cement (CPC), were investigated. (3) Results: The drillable CPC revealed a comparable displacement of the fracture and maximum load to its commercial counterpart (Graftys^® Quickset) in the clinically relevant biomechanical model, even though compressive strength and screw pullout force were higher using Graftys^®. (4) Conclusions: The in-house-prepared cement allowed unproblematic drilling after replenishment without a negative influence on the stability. A new, promising bone substitute is the MPC, which showed the best overall results of all four cement types in the pure material tests (highest compressive strength and screw pullout force) as well as in the clinically relevant fracture model (lowest displacement and highest maximum load). The low viscosity enabled a very effective interdigitation to the spongiosa and a complete filling up of the defect, resulting in this demonstrated high stability. In conclusion, the two in-house-developed bone fillers revealed overall good results and are budding new developments for clinical use.

Halloysite nanotubes loaded with alkyl trimethyl ammonium bromide as antibacterial agent for root canal sealers

OBJECTIVE

This study aimed at evaluating the effects of experimental endodontic sealers containing halloysite nanotubes (HNT) doped with alkyl trimethyl ammonium bromide (ATAB).

METHODS

An experimental dual-cure resin sealer was formulated and used as control material. This resin was also filled with ATAB and HNT at different ratios (GATAB:HNT 1:1; 1:2; 2:1) generate three experimental resin sealers. The ATAB:HNT filler was characterized through transmission electron microscopy (TEM). While, the experimental and control sealers were evaluated for degree of conversion, softening ration, radiopacity, flow, film thickness, antibacterial activity for biofilm and planktonic bacteria and cytotoxicity in human pulpal cells.

RESULTS

GATAB:HNT _(1:1) significantly increased the immediate DC (p < 0.05), although no difference was encountered between the groups after 24 h (p > 0.05). All the experimental cements (ATAB/HNT) showed relatively low initial Knoop hardness (p < 0.05), but with no significant reduction (p > 0.05) after storage in ethanol (softening ratio). The radiopacity of all groups achieved at least 3 mm of aluminum. All groups showed more than 17 mm of flow, with a film thickness lower than 50 μm (ISO 6876:2012). All the experimental ATAB:HNT cements showed antibacterial activity against E. faecalis; the higher the ATAB ratio, the greater the antibacterial activity (p < 0.05). Cell viability was higher than 70% with no significant difference between the groups (p > 0.05).

SIGNIFICANCE

The incorporation of ATAB/HNT into the experimental resin sealers induced antibacterial activity against biofilm and planktonic E. faecalis without affecting the pulp cell viability or the chemo-mechanical properties.

Bone regeneration capacity of magnesium phosphate cements in a large animal model

Magnesium phosphate minerals have captured increasing attention during the past years as suitable alternatives for calcium phosphate bone replacement materials. Here, we investigated the degradation and bone regeneration capacity of experimental struvite (MgNH₄PO₄·6H₂O) forming magnesium phosphate cements in two different orthotopic ovine implantation models. Cements formed at powder to liquid ratios (PLR) of 2.0 and 3.0 g ml^-1 were implanted into trabecular bone using a non-load-bearing femoral drill-hole model and a load-bearing tibial defect model. After 4, 7 and 10 months the implants were retrieved and cement degradation and new bone formation was analyzed by micro-computed tomography (µCT) and histomorphometry. The results showed cement degradation in concert with new bone formation at both defect locations. Both cements were almost completely degraded after 10 months. The struvite cement formed with a PLR of 2.0 g ml^-1 exhibited a slightly accelerated degradation kinetics compared to the cement with a PLR of 3.0 g ml^-1. Tartrat-resistant acid phosphatase (TRAP) staining indicated osteoclastic resorption at the cement surface. Energy dispersive X-ray analysis (EDX) revealed that small residual cement particles were mostly accumulated in the bone marrow in between newly formed bone trabeculae. Mechanical loading did not significantly increase bone formation associated with cement degradation. Concluding, struvite-forming cements might be promising bone replacement materials due to their good degradation which is coupled with new bone formation.

STATEMENT OF SIGNIFICANCE

Recently, the interest in magnesium phosphate cements (MPC) for bone substitution increased, as they exhibit high initial strength, comparably elevated degradation potential and the release of valuable magnesium ions. However, only few in vivo studies, mostly including non-load-bearing defects in small animals, have been performed to analyze the degradation and regeneration capability of MPC derived compounds. The present study examined the in vivo behavior of magnesiumammoniumphosphate hexahydrate (struvite) implants with different porosity in both mechanically loaded and non-loaded defects of merino sheep. For the first time, the effect of mechanical stimuli on the biological outcome of this clinically relevant replacement material is shown and directly compared to the conventional unloaded defect situation in a large animal model.

Magnesium-based bioceramics in orthopedic applications

Magnesium ions are directly involved in numerous biological mechanisms; for example, they play an important part in the regulation of ion channels, DNA stabilization, enzyme activation and stimulation of cell growth and proliferation. This alkaline earth metal has gained great popularity in orthopedic applications in recent years. Magnesium-based bioceramics include a large group of magnesium containing compounds such as oxides, phosphates and silicates, that are involved in orthopedic applications like bone cements, bone scaffolds or implant coatings. This article aims to give a comprehensive review on different magnesium-based bioceramics, e.g. magnesium phosphates (MgO-P₂O₅), calcium magnesium phosphates (CaO-MgO-P₂O₅), and magnesium glasses (SiO₂-MgO) with a strong focus on the chemistry and properties of magnesium phosphate containing cements as the main application form. In addition, the processing of magnesium phosphate minerals into macroporous scaffolds for tissue engineering applications by either using traditional porogens or by additive manufacturing approaches are reflected. Finally, the biological in vitro and in vivo properties of magnesium phosphates for bone regeneration are summarized, which show promising results regarding the application as bone replacement material, but still lack in terms of testing in large animal models, load-bearing application sites and clinical data.

STATEMENT OF SIGNIFICANCE

Though bone substitutes from calcium phosphates have been investigated for a long time, a new trend is visible in the biomaterials sector: magnesium based bioceramics from magnesium phosphates and silicates due to the special biological significance of magnesium ions in enzymatic activation, cell growth and proliferation, etc. In contrast to pure magnesium implants, such formulations do not release hydrogen during degradation. As with calcium based bioceramics, magnesium based bioceramics are used for the development of diverse applications such as cements, macroporous scaffolds and coatings. From this perspective, we present a systematic overview on diverse kinds of magnesium based bioceramics, their processing regimes for different clinical purposes and their behavior both in vitro and in vivo.

Innovative root-end filling materials based on calcium-silicates and calcium-phosphates

This in vitro study evaluated the apical sealing ability, bioactivity and biocompatibility of an experimental calcium silicate-based and two light-curing calcium silicate/calcium-phosphate cements as potential root end filling materials. A calcium silicate Portland-based (Control PC), an experimental calcium silicate (Exp. PC) and two light-curing cements (LC-CaP; LC-Si/CaP) were assessed for their alkalinising activity (pH) and biocompatibility. Single-rooted human canines were endodontically treated, filled with gutta-percha and finally submitted to apicoectomy. Root end fillings were performed using all tested cements, and their apical sealing ability was evaluated up to 4 weeks of immersion in simulated body fluid (SBF). The mineral precipitation at the apical region and the cement adaptation to root dentine were also evaluated through non-destructive optical microscopy both at 24 h and after prolonged water storage (four week). LC-CaP and LC-Si/CaP had neutral pH, the greatest sealing ability (24 h) and excellent cytocompatibility. The Exp. PC cement presented sealing ability after two and four weeks, as well as biocompatibility after four and seven days, similar to LC-CaP and LC-Si/CaP. The control PC cement showed the lowest sealing ability and the greatest cytotoxicity. Mineral precipitation was observed in all groups, while some differences were seen in terms of cement adaptation along the root canal dentine walls. The experimental light-curable cements as well as the experimental PC might be suitable root end filling materials with appropriate (in vitro) sealing ability, biocompatibility and aptitude to induce mineral precipitation.

Magnesium Phosphate Cement Systems for Hard Tissue Applications: A Review

In the search for more ideal bone graft materials for clinical application, the investigation into ceramic bone cements or bone void filler is ongoing. Calcium phosphate-based materials have been widely explored and implemented for medical use in bone defect repair. Such materials are an excellent choice because the implant mimics the natural chemistry of mineralized bone matrix and in injectable cement form, can be implemented with relative ease. However, of the available calcium phosphate cements, none fully meet the ideal standard, displaying low strengths and acidic setting reactions or slow setting times, and are often very slow to resorb in vivo. The study of magnesium phosphates for bone cements is a relatively new field compared to traditional calcium phosphate bone cements. Although reports are more limited, preliminary studies have shown that magnesium phosphate cements (MPC) may be a strong alternative to calcium phosphates for certain applications. The goal of the present publication is to review the history and achievements of magnesium phosphate-based cements or bone void fillers to date, assess how these cements compare with calcium phosphate competitors and to analyze the future directions and outlook for the research, development, and clinical implementation of these cements.