Bioactivity of EndoSequence Root Repair Material and Bioaggregate

Comparative Analysis of Calcium Dynamics in Regular-Set versus Fast-Set Bioceramics: Impact on Cytotoxicity and Apatite Formation

INTRODUCTION

The objective of this study was to assess the calcium ions (Ca2+) release, pH shift, bioactivity, and cytotoxicity of both forms of EndoSequence Root Repair Material: regular set (ES) and fast set (ESF).

METHODS

ES (n = 10) and ESF (n = 10) forms were tested for their bioactivity. Elemental analysis was done on the fresh material and material immersed in phosphate-buffered saline (PBS) for 30 days. The surface crystal formation was studied. Cytotoxicity was evaluated at different material concentrations using a human hepatocellular cancer cell line (Huh-7).

RESULTS

Both materials contain Ca, P, Ta, Zr, and Si as major elements. Both ES and ESF have a limited percentage of ytterbium and neodymium. In the fresh material, compared with the ESF, the ES had a higher Ca2+ concentration with a homogeneous surface distribution. However, the ESF released significantly more Ca2+ (P < .05) and had a higher pH over the 7-day course. When the material was immersed in PBS, the ESF exhibited a significantly higher Ca/P ratio of 2.95, while ES had 2.16 Ca/P ratio (P < .05). The ESF had a greater capacity to precipitate and grow hydroxyapatite (HA) than ES, resulting in more mature crystals forming on the surface. Both SE and ESF demonstrated low cytotoxicity against Huh-7 cells.

CONCLUSIONS

When ES and ESF were submerged in simulated bodily fluid, both forms produced apatite crystals at the dentin material interface, releasing high Ca2+ and displaying a prolonged high pH with high bioactivity potential. Both forms had comparable low cytotoxicity. A higher Ca2+ release in ESF indicates dynamic bioactivity, which should be aligned with the clinical requirements.

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials

PURPOSE

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes.

METHODS

This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression).

RESULTS

At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome.

CONCLUSIONS

MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Ex-vivo evaluation of clinically-set hydraulic sealers used with different canal dryness protocols and obturation techniques: a randomized clinical trial

OBJECTIVES

This 2-part randomized parallel triple-blind clinical trial adopts a unique model assessing clinically-set hydraulic calcium silicate-based sealers (HCSBS) after different root canal dryness protocols and obturation techniques.

METHODS

For the first phase of the study, 24 teeth scheduled for orthodontic extractions were allocated into four groups according to the canal dryness protocol and the obturation technique. G1 (CLC-AHP): cold lateral compaction (CLC) with AH Plus sealer, G2 (CLC-ES-SD): CLC with Endosequence (ES) after standard canal(s) dryness (SD); G3 (SC-ES-SD): matching single-cone (SC) with ES after SD; G4 (SC-ES-PD): as G3 but after partial canal(s) dryness (PD). Teeth were extracted after one month of clinical service and examined for intracanal voids by micro-CT (2D & 3D). For the 2nd phase, another 24 teeth were allocated into four groups according to the root canal dryness protocol and the HCSBS used (ES or CeraSeal (CeS)). Teeth were extracted after one month and sectioned vertically for energy dispersive X-ray (EDX)/scanning electron microscope (SEM) examination. One-way ANOVA with Games-Howell post-hoc test and Chi-square test with multiple z-tests were used for statistical analysis.

RESULTS

SC-PD showed the highest percentage of voids (p < 0.05). MicroCT scans as well as EDX/SEM examination showed that PD resulted in significantly larger interfacial gaps (p < 0.001) with more hydration products at the sealer/dentin interface than SD.

CONCLUSIONS

Both tested dryness protocols allowed the hydration of HCSBS and the formation of hydration products, thus standard dryness is recommended to reduce the incidence of intracanal voids.

CLINICAL RELEVANCE

When using the single-cone obturation technique, intentional root canal moisture negatively affects the performance of HCSBS.

PROTOCOL REGISTRATION

http://www.

CLINICALTRIALS

gov, ID: NCT05808062.

Osteoinductive and regenerative potential of premixed calcium-silicate bioceramic sealers on vascular wall mesenchymal stem cells

AIM

The osteogenic potential of new premixed calcium-silicate-containing bioceramic sealers (Ca-Si sealers) was tested with porcine vascular wall-mesenchymal stem cells (pVW-MSCs).

METHODOLOGY

Two Ca-Si-containing sealers: Ceraseal (MetaBiomed, Cheong-si, South Korea) and AH Plus Bioceramic (Maruchi, Wonju-si, South Korea), and an epoxy resin sealer (AH Plus; Dentsply, Konstanz, Germany) as a control, were prepared according to the manufacturers' indications. All samples were allowed to set for 100% of their setting time in a sterile humid cabinet at 37°C and 95% relative humidity. pVW-MSC seeding efficiency and osteogenic differentiation were analysed as marker of gene/protein expression for up to 12 days. Mineralization assay and immunofluorescence staining were performed and evaluated over a period of 21 days. Statistical analyses were conducted using one-way analysis of variance (p < .05). Additional samples were prepared and stored under the same conditions and inspected using an environmental scanning electron microscope equipped with an energy dispersive X-ray spectroscopy system.

RESULTS

Significantly higher cell seeding efficiency (p < .05) was observed for both Ca-Si sealers from day 8. pVW-MSCs showed a significant shift towards the osteogenic lineage only when seeded in contact with Ca-Si sealers. Gene expression of osteopontin was upregulated significantly. Collagen I and osteocalcin were clearly expressed by cells in contact with Ca-Si sealers. Mineralization granules were observed in Alizarin red assays and confocal laser scanning microscopy analysis of both Ca-Si sealers. No gene expression or granule mineralization were observed on the epoxy resin sealer.

CONCLUSIONS

Premixed Ca-Si sealers displayed a higher potential for osteogenic activity on pVW-MSCs. Epoxy resin sealer was unable to induce any osteogenic activity. The properties of both Ca-Si sealers suggest their potential as osteoinductive platforms for vascular MSCs in periapical bone.

Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial

Aim

The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth.

Materials and Methods

This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison.

Results

Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods.

Conclusions

Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.

The osteoinductive potential of different root-filling materials in a rat femur model

In pediatric dentistry, the enduring success of root-end filling materials employed for the establishment of apical plugs in immature teeth undergoing endodontic intervention is contingent upon their possessing a robust osteoinductive capacity. Hence, the primary objective of this study was to histologically assess the osteoinductive potential of four distinct dental materials, specifically recommended for retrograde filling applications, utilizing an animal hard tissue model. Within the designed experimental model, two bone defects measuring 2 mm in diameter and 2 mm in depth were created in both femurs of a cohort comprising 21 male Wistar albino rats. The first defect in the right femur was left blank as the control group, and Neo MTA Plus was placed in the second defect. The EndoSequence BCRRM Fast Set Putty was placed in the first of the defects on the left femur, and Endo Repair was placed in the second defect. Subjects were sacrificed after 7, 14, and 28 days of follow-up, and sections were examined to assess the degree of inflammation, connective tissue formation, and new bone formation. The data were statistically evaluated with Kruskal‒Wallis and post hoc Dunn's tests using SPSS 12 software. The bone healing levels of the Neo MTA Plus group were significantly higher than those of the other groups in all periods (p < 0.05). Bone organization in all groups decreased over time, and fibrous tissue was enriched. The results of this study demonstrate that NeoMta Plus has superior osteoinductive properties compared to other materials but that EndoSequence and Endo Repair have the potential to be developed.

In Vitro Assessment of Sealing Ability of Various Materials Used for Repair of Furcal Perforation: A SEM Study

AIM

The aim of the current in vitro research was to evaluate the sealing capacity of three different agents employed for the repair of perforations at the furcation area.

MATERIALS AND METHODS

Recently 60 extracted human mandibular permanent molars having well apart plus fully formed roots, and intact furcation were chosen. The 60 samples were allocated at random to three groups of 20 samples: Group I: Furcation perforation repair by means of mineral trioxide aggregate (MTA)-Angelus, Group II: Furcal perforation repair using Biodentine, Group III: Furcal perforation repair by EndoSequence. The specimens were subjected to sectioning with a hard tissue microtome and the sectioned parts of the samples were then examined. The specimens were subjected to gold sputtering and visualizing beneath scanning electron microscope (SEM) at 2000× magnification for assessing the sealing capacity of the agents.

RESULTS

The highest sealing capacity was noted with the use of Biodentine at 0.96 ± 0.10, in pursuit by EndoSequence use at 1.18 ± 0.14 and MTA-Angelus use at 1.74 ± 0.08. The disparity amid the three groups was statistically significant with p < 0.001.

CONCLUSION

In conclusion, it may be inferred that Biodentine exhibited the finest sealing capacity than EndoSequence and MTA- Angelus. It may thus be given consideration as a substance of preference for the repair of furcal perforation.

CLINICAL SIGNIFICANCE

Using biologically compatible substances may be suggested to amend perforations thereby decreasing the occurrence of inflammatory response in the neighboring tissues. The sealing capacity is a significant feature in supporting the result of a root canal treatment of a tooth.

Microstructure and color stability of calcium silicate-based dental materials exposed to blood or platelet-rich fibrin

OBJECTIVES

To investigate the effects of blood and platelet-rich fibrin (PRF), commonly used scaffolds in regenerative endodontic treatment (RET), on the hydration, microstructure, and color stability of three hydraulic calcium silicate cements (HCSCs), OrthoMTA, RetroMTA, and TotalFill-BC-RRM.

MATERIALS AND METHODS

The HCSCs were prepared and placed into polyethylene molds and transferred to Eppendorf tubes containing PRF, blood, or PBS and then incubated for 1 week or 1 month. The microstructure and hydration of the cements were studied by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD). The chromatic alteration of materials was also measured using a spectrophotometer. The data for color stability were analyzed using 2-way analysis of variance and Tukey post hoc tests.

RESULTS

There was no significant difference between the color stability of cements exposed to PBS (p > 0.05). The chromatic alteration of cements exposed to blood was significantly greater than those exposed to PRF and PBS (p < 0.001). In the presence of blood and PRF, the color change of OrthoMTA was significantly greater than that of RetroMTA and TotalFill (p < 0.05), with no significant difference between RetroMTA and TotalFill (p > 0.05). XRD analysis of all cements revealed a calcium hydroxide peak after 1-week and 1-month exposure to the media; however, OrthoMTA and TotalFill exposed to blood and PRF for 1 month showed weaker calcium hydroxide peaks. SEM images revealed cements exposed to PBS had a different surface microstructure compared to those exposed to blood and PRF. Furthermore, the surface microstructure of HCSCs was influenced by the type of cement radiopacifier (bismuth oxide or zirconium oxide). EDS analysis of the elemental composition in all groups displayed peaks of Ca, O, C, Si, P, and Al.

CONCLUSIONS

Color stability, hydration behavior, and microstructure of HCSCs were affected by exposure to PRF and blood and the type of cement radiopacifier.

CLINICAL RELEVANCE

As some important physicochemical properties of HCSCs could be influenced by the environmental conditions and the type of radiopacifier, alternatives to blood clot and HCSCs containing substitutes for bismuth oxide might be more suitable in RETs.

Evaluation of the penetration of intracoronal bleaching agents into the cervical region using different intraorifice barriers

Background

The present study aimed to make a comparison between the effects of 35% hydrogen peroxide gel (HP) and sodium perborate with distilled water (SP) bleaching agents on the sealing characteristics of glass ionomer cement (GIC), TheraBase, ProRoot MTA and Biodentine intraorifice barriers.

Methods

One hundred and twelve single-rooted mandibular human premolar teeth extracted from young patients (14–25 years) were chosen. Root cement and cementoenamel junction (CEJ) of teeth were examined under a stereomicroscope at 10 × magnification to ensure there was no cement defect or dentin gap in CEJ. After the endodontic access cavities were opened on the occlusal surfaces of the teeth, the working length was determined. Instrumentation of each root canal was performed with a ProTaper Gold rotary system in the determined working length and filled with gutta-percha + AH Plus with a single cone technique using. Root fillings were removed 3 mm short of the CEJ and sealed with one of the following intraorifice barrier materials (n = 30/group): 1. GIC; 2. TheraBase; 3. ProProot-MTA; 4. Biodentine. In each of the sub-groups, either HP or SP was used to perform intracoronal bleaching on days 1, 4, and 7. All outer surfaces of the specimens except the 3 mm cervical region were covered with nail polish and modeling wax layers. Specimens were immersed in a 5 ml Eppendorf tube that contained 2 mL of distilled water. The penetration of peroxide release was measured using the colorimetric ferric thiocyanate method. Statistical analysis of the data was performed with Three-way ANOVA and Tukey’s test (P = 0.05).

Results

In the HP groups, GIC showed the greatest peroxide release when compared with other tested groups on day 1 (P < 0.05). Biodentine and ProRoot MTA displayed a significantly lower peroxide leakage when compared to GIC and TheraBase on days 1 and 4 (P < 0.05). While GIC and TheraBase were used, HP observed higher peroxide penetration when compared with SP on days 1 and 4 (P < 0.05).

Conclusions

Peroxide diffusion was significantly influenced by the kind of intracoronal bleaching agents and intraorifice barrier materials used.

Progress in Niobium Oxide-Containing Coatings for Biomedical Applications: A Critical Review

Typically, pure niobium oxide coatings are deposited on metallic substrates, such as commercially pure Ti, Ti6Al4 V alloys, stainless steels, niobium, TiNb alloy, and Mg alloys using techniques such as sputter deposition, sol-gel deposition, anodizing, and wet plasma electrolytic oxidation. The relative advantages and limitations of these coating techniques are considered, with particular emphasis on biomedical applications. The properties of a wide range of pure and modified niobium oxide coatings are illustrated, including their thickness, morphology, microstructure, elemental composition, phase composition, surface roughness and hardness. The corrosion resistance, tribological characteristics and cell viability/proliferation of the coatings are illustrated using data from electrochemical, wear resistance and biological cell culture measurements. Critical R&D needs for the development of improved future niobium oxide coatings, in the laboratory and in practice, are highlighted.

Evaluation of pH, Calcium Ion Release, and Dimensional Stability of an Experimental Silver Nanoparticle-Incorporated Calcium Silicate-Based Cement

An experimental calcium silicate-based root-end filling material incorporated with silver nanoparticles intended for use in periapical surgeries was developed with the purpose to overcome the drawbacks of existing materials and to satisfy the ideal requirements of root-end filling materials. This study was designed to evaluate the physicochemical properties, pH, calcium ion release, and dimensional stability of the experimental cement, and compare the results with commercially available ProRoot MTA (Dentsply). An independent sample test was used to analyze the data. Mean initial pH (immediately after mixing) of the experimental cement was 10.42 ± 0.04 which was higher than that of MTA. However, there was a significant increase in pH of MTA at 1 day, 2 days, and 7 days. Presence of calcium chloride favored the release of calcium ions which was significantly increased in the experimental group at 24 hours. At the end of 30 days, MTA showed a significant expansion when compared to the experimental cement (p < 0.001). In conclusion, the experimental nanoparticle-incorporated calcium silicate-based cement showed clinically acceptable physicochemical properties.

Synthesis and characterization of experimental endodontic sealers containing bioactive glasses particles of NbG or 45S5

OBJECTIVE

This study evaluated the influence of adding bioactive glasses particles [Niobophosphate (NbG) or bioglass (45S5)] into endodontic cements in relation to physical, chemical and biological properties.

METHODS

The following commercial cements were used as comparison: AH Plus (Dentsply), Endofill (Dentsply), MTA Fillapex (Angelus) and EndoSequence (BC Sealer, Brasseler). Setting time, radiopacity, flow rate, weight loss/variation, alkaline capacity (pH) at different time-intervals (24h/48h/7d/14d/28d), bioactivity (assessed under SEM/EDS, FTIR/ATR and XDR) and cell viability were measured. Data were analyzed by One-way ANOVA/Holm-Sidak post-test (α = 5%) (normal distribution) and Kruskal-Wallis/Students-Newman-Keuls post-test (α = 5%) (non-normal distribution).

RESULTS

Bioactive endodontic experimental cements (containing NbG or 45S5) had high alkalinization capacity. The experimental cements presented high weight loss/variation (p < 0.001). 45S5 experimental cement did not present radiopacity (p < 0.001). AH Plus had the lowest cell cytotoxicity when compared to the other tested cements (p < 0.001). Regarding bioactivity, SEM/EDS analyses showed precipitates with high concentrations of Ca/P for 45S5 and NbG, as well as for MTA Fillapex and BC Sealer. AH plus and Endofill did not present bioactive precipitates. FTIR/ATR and XDR analyses found hydroxyapatite precursors for NbG, 45S5, MTA Fillapex and BC Sealer.

SIGNIFICANCE

The incorporation of bioactive particles (NbG or 45S5) into endodontic cements had potential to neutralize acidic environments and induced formation of hydroxyapatite precursors. Clinically, these would produce a cement that is bactericidal and have the potential to improve tissue healing. The improved radiopacity and flowability would facilitate the visualization of the material in the radiograph and the filling of anatomical complexities during root canal obturation. As drawbacks, the excessive weight loss and post-setting cytotoxicity could result in clinical degradation of the cement and adjacent tissue irritation for the patient.

Apical Sealing Ability of Two Calcium Silicate-Based Sealers Using a Radioactive Isotope Method: An In Vitro Apexification Model

The aim of this study was to evaluate and compare the sealing ability of two calcium silicate-based sealers (TotalFill BC RRM Fast Set Putty and White ProRoot MTA) when used as apical plugs in immature teeth through nuclear medicine. Single-rooted extracted teeth (n = 34) had their crowns and root tip sectioned to obtain 14 mm long root segments to simulate an in vitro apexification model. Were created two experimental groups, namely MTA (n = 12) and BC (n = 12), and two control groups, PG (positive group, n = 5) and NG (negative group, n = 5). On the 4th day after placing the respective apical plug, the apical portions of the teeth were submerged in a solution of sodium pertechnetate (^99mTcNaO₄) for 3 h. Statistical analysis showed a significant difference between the MTA group and the controls (p < 0.05). The BC group had a significant difference regarding the negative control (p < 0.001) but showed no statistical significance regarding the positive control (p = 0.168). There was a statistically significant difference (p = 0.009) between the BC group (7335.8 ± 2755.5) and the MTA group (4059.1 ± 1231.1), where the last showed less infiltration. Within the limitations of this study, White ProRoot MTA had a significantly better sealing ability than TotalFill BC RRM Fast Set Putty.

An In Vitro Stereomicroscopic Evaluation of Bioactivity between Neo MTA Plus, Pro Root MTA, BIODENTINE & Glass Ionomer Cement Using Dye Penetration Method

The ideal root end filling material should form a tight seal in the root canal by adhering to the cavity walls. Several materials have been used for root end filling. The present study aims to find out and compare the bioactivity of Neo MTA Plus, Pro Root MTA White, BIODENTINE & glass ionomer cement as root end filling materials using 1% methylene blue as tracer. Materials and methods: 80 extracted human permanent maxillary anterior teeth were used in the study. They were divided into four groups. Specimens were sectioned transversely in the cervical area to separate the crown from the root. The root canal was obturated with gutta percha and zinc oxide eugenol sealers. Thereafter, each sample was resected apically by removing 3 mm of the apex and filled with different materials. Samples were kept in buffering solution at 37 °C until the recommended evaluation periods. The specimens were then suspended in 1% methylene blue for 24 h, prior to the analysis. The teeth were then sectioned, and dye penetration was examined, photographed, and evaluated under a stereomicroscope. Results: Vertical dye penetration showed significant differences across different groups. The minimum dye penetration was seen in Neo MTA plus followed by BIODENTINE, Pro Root MTA and maximum in GIC. There was no significant difference in dye penetration between Neo MTA plus and BIODENTINE both at fifteen days and one-month intervals. Conclusion: The present study suggests Neo MTA plus and BIODENTINE should be the preferred material for root end filling.

In vitro biocompatibility and bioactivity of calcium silicate‑based bioceramics in endodontics (Review)

Calcium silicate-based bioceramics have been applied in endodontics as advantageous materials for years. In addition to excellent physical and chemical properties, the biocompatibility and bioactivity of calcium silicate-based bioceramics also serve an important role in endodontics according to previous research reports. Firstly, bioceramics affect cellular behavior of cells such as stem cells, osteoblasts, osteoclasts, fibroblasts and immune cells. On the other hand, cell reaction to bioceramics determines the effect of wound healing and tissue repair following bioceramics implantation. The aim of the present review was to provide an overview of calcium silicate-based bioceramics currently applied in endodontics, including mineral trioxide aggregate, Bioaggregate, Biodentine and iRoot, focusing on their in vitro biocompatibility and bioactivity. Understanding their underlying mechanism may help to ensure these materials are applied appropriately in endodontics.

Biomineralization of three calcium silicate-based cements after implantation in rat subcutaneous tissue

Objectives

The aim of this study was to evaluate the dystrophic mineralization deposits from 3 calcium silicate-based cements (Micro-Mega mineral trioxide aggregate [MM-MTA], Biodentine [BD], and EndoSequence Root Repair Material [ESRRM] putty) over time after subcutaneous implantation into rats.

Materials and Methods

Forty-five silicon tubes containing the tested materials and 15 empty tubes (serving as a control group) were subcutaneously implanted into the backs of 15 Wistar rats. At 1, 4, and 8 weeks after implantation, the animals were euthanized (n = 5 animals/group), and the silicon tubes were removed with the surrounding tissues. Histopathological tissue sections were stained with von Kossa stain to assess mineralization. Scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM/EDX) were also used to assess the chemical components of the surface precipitates deposited on the implant and the pattern of calcium and phosphorus distribution at the material-tissue interface. The calcium-to-phosphorus ratios were compared using the non-parametric Kruskal-Wallis test at a significance level of 5%.

Results

The von Kossa staining showed that both BD and ESRRM putty induced mineralization starting at week 1; this mineralization increased further until the end of the study. In contrast, MM-MTA induced dystrophic calcification later, from 4 weeks onward. SEM/EDX showed no statistically significant differences in the calcium- and phosphorus-rich areas among the 3 materials at any time point (p > 0.05).

Conclusions

After subcutaneous implantation, biomineralization of the 3-calcium silicate-based cements started early and increased over time, and all 3 tested cements generated calcium- and phosphorus-containing surface precipitates.

Solubility of bioceramic- and epoxy resin-based root canal sealers: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated whether epoxy resin-based root canal sealers present an increased solubility than calcium silicate-based root canal sealers. A systematic search was performed in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey. The inclusion criteria consisted of in vitro studies that compared the solubility of epoxy resin-based and calcium silicate-based sealers. The quality assessment and data extraction of the selected articles were performed. The meta-analysis of the pooled data and the subgroups according to the root thirds were carried out using the RevMan software (P < 0.05). After the duplicate removal and eligibility criteria assessment, a total of 22 studies were included all of them were considered as having a low risk of bias. The meta-analysis demonstrated overall lower solubility of AH Plus. AH Plus presented lower solubility than Bio-C Sealer, BioRoot RCS, MTA Fillapex, Sealer Plus and Total Fill BC Sealer.

Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review

Background

Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth.

Materials and methods

This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested.

Results

Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability.

Conclusion

There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials.

Clinical significance

The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength.

How to cite this article

Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30–39.

Comparative evaluation of biodentine and endosequence root repair material as direct pulp capping material: A clinical study

Aim:

The study was designed to clinically evaluate biodentine and endosequence root repair material (ERRM) as direct pulp capping agent at 3 months, 6 months, and 12 months intervals.

Materials and Methods:

Sixty permanent posterior teeth with deep caries, without any signs of irreversible pulpitis were allotted into two experimental groups: Group I -Biodentine, Group II-ERRM. Follow-up evaluations were done. Every 24 h for 7 days, the pain was assessed using visual analog scale.

Statistical Analysis:

Paired t-test along with Pearson's Chi-square test was performed.

Results:

The success rate of clinical assessment at 12 months for biodentine group is 78.60% and ERRM Group is 64.70%.

Conclusion:

Biodentine group performed superior than ERRM group clinically at all-time interval and hence it can be successfully used to restore exposed vital tooth.

Sealing ability of three different root repair materials for furcation perforation repair: An in vitro study

Aim

The present study aimed to evaluate and compare the sealing ability of mineral trioxide aggregate (MTA)-Angelus, Biodentine™, and EndoSequence cement in furcation perforations using protein leakage assessment.

Materials and Methods

The present study was conducted using seventy extracted human maxillary and mandibular molars with intact furcation. The samples were randomly allocated into three groups (n = 20) based on repair material used: Group 1 - MTA-Angelus, Group 2 - Biodentine™, and Group 3 - EndoSequence. Two additional groups served as positive and negative controls (n = 5). Using the leakage assessment apparatus, the presence of protein was detected with a reagent (Coomassive Brilliant Blue) every day for 60 days. One-way ANOVA and post hoc Tukey's test were used for statistical analysis using SPSS software.

Results

All the groups exhibited protein leakage from day 1. Biodentine showed minimum (0.1201 mg/ml), MTA showed maximum (0.3738 mg/ml), and EndoSequence had intermediate (0.2465 mg/ml) leakage. None in the negative control and all of the positive control specimens leaked during the experimental period of 60 days.

Conclusion

The newer biomaterials, Biodentine and Endosequence with better handling properties, could be used as alternatives to MTA-Angelus while repairing furcation perforations.

Analysis of the physicochemical properties, cytotoxicity and volumetric changes of AH Plus, MTA Fillapex and TotalFill BC Sealer

Background

To evaluate the physicochemical properties and cytotoxicity of AH Plus, MTA Fillapex and TotalFill BC Sealer. Volumetric changes were also evaluating using micro-computed tomography (micro-CT).

Material and Methods

Radiopacity and flow were evaluated in accordance with the ISO 6876, while setting time was evaluated in accordance with the ASTM- C266-08 specifications. The release of Ca2+ ions and pH were measured with spectrophotometer and pH meter, respectively, after different time intervals (1h, 3h, 24h, 72h, 168h, and 360h). Cytotoxicity was evaluated by MTT reduction assay to check 3T3 cells viability at 24, 48 and 72 hours. Volumetric change was evaluated by micro-CT, by using 30 acrylic teeth, filled with gutta-percha cones and the tested root canal sealer. The samples were evaluated after 168h, 360h and 720h of immersion in distilled water. Data were statistically analyzed by one-way ANOVA and Tukey test or by Kruskal-Wallis and Dunn tests (P<0.05).

Results

MTA Fillapex and TotalFill BC Sealer showed lower radiopacity than AH Plus (P<0.05). The MTA Fillapex showed the highest flow, while AH Plus showed the lowest flow (P<0.05). The initial and final setting time of AH Plus were lower than MTA Fillapex and TotalFill BC Sealer (P<0.05). In general, TotalFill BC Sealer presented higher Ca2+ ion release and pH than the other tested sealers. TotalFill BC Sealer also showed overall lower cytotoxicity when compared to the other sealers. Volumetric change of AH Plus and TotalFill BC Sealer was lower than MTA Fillapex (P<0.05).

Conclusions

AH Plus, MTA Fillapex and TotalFill BC Sealer showed slight differences in the physicochemical properties and cytotoxicity, but all suitable for an endodontic sealer. However, AH Plus and TotalFill BC Sealer showed low volumetric changes when compared to MTA Fillapex.

Key words:Calcium silicate, cytotoxicity, physicochemical properties, micro computed tomography.

Quantifying Coronal Primary Tooth Discoloration Caused by Different Pulpotomy Materials

Introduction: Bioceramic materials, gray and white mineral trioxide aggregate (GMTA, WMTA), have been shown to have high rates of success in various endodontic applications. A major drawback is their tendency to discolor teeth. Biodentine (BD), a recenlty developed bioceramic material, has been claimed not to discolor teeth. The aim of this study was to compare tooth discoloration after applying different pulpotomy base materials (BD, GMTA and WMTA). Methods: Forty human fully developed primary incisors teeth were used in this study. Coronal access was achieved by a Tungsten Carbide drill, and the pulp chambers were accessed and chemo-mechanically debrided. Each material was placed in the pulp chamber, up to the cervical sectioning level. All specimens were incubated at 37°C and 100% humidity for 14 weeks and have been evaluated before the study and weekly. Color was assessed according to the CIE L*a*b* color space system. Results: The ΔE (delta E) of all experimental groups (GMTA, WMTA and BD) were significantly different from the control group at all time points. Color changes in the GMTA and WMTA groups showed significantly higher discoloration compared to BD group in the cervical part of the crown, since week 1. WMTA group showed significant discoloration in the cervical part as of week 1, and gradually increased over time. BD group showed no significant discoloration over time. GMTA group showed the most significant discoloration at week 1 and week 14 (P<0.05). Conclusions: both GMTA and WMTA pulpotomy materials may discolor tooth structure over time in an extracted primary anterior tooth model. When choosing bioceramic pulpotomy material, BD may be preferable, mainly in esthetic area.

Bioactivity and Physicochemical Properties of Three Calcium Silicate-Based Cements: An In Vitro Study

Objective

This study evaluated the bioactivity and physicochemical properties of three commercial calcium silicate-based endodontic materials (MTA, EndoSequence Root Repair Material putty, and Biodentine™). Material and Methods. Horizontal sections of 3 mm thickness from 18 root canals of human teeth were subjected to biomechanical preparation with WaveOne Gold large rotary instruments. The twelve specimens were filled with three tested materials (MM-MTA, EndoSequence Root Repair Material putty, and Biodentine™) and immersed in phosphate-buffered saline for 7 and 30 days. After this period of time, each specimen of each material was processed for morphological observation, surface precipitates, and interfacial dentin using SEM. In addition, the surface morphology of the set materials, without soaking in phosphate-buffered solution after one day and after 28 days stored in phosphate-buffered saline, was evaluated using SEM; also, the pH of the soaking water and the amount of calcium ions released from the test materials were measured by using an inductively coupled plasma-optical emission spectroscopy test. Data obtained were analyzed using one-way analysis of variance and Tukey's honest significant difference test with a significance level of 5%.

Result

The formation of precipitates was observed on the surfaces of all materials at 1 week and increased substantially over time. Interfacial layers in some areas of the dentin-cement interface were found from one week of immersion. All the analyzed materials showed alkaline pH and capacity to release calcium ions; however, the concentrations of released calcium ions were significantly more in Biodentine and ESRRM putty than MM-MTA (P < 0.05). ESRRM putty maintained a pH of around 11 after 28 days.

Conclusion

Compared with MM-MTA, Biodentine and ESRRM putty showed significantly more calcium ion release. However, exposure of three tested cements to phosphate-buffered solution resulted in precipitation of apatite crystalline structures over both cement and dentin that increased over time. This suggests that the tested materials are bioactive.

The effect of intracanal medicaments used in Endodontics on the dislocation resistance of two calcium silicate-based filling materials

Background

Intracanal medicaments can be used in various endodontic conditions including multiple visit endodontics after trauma or in regenerative endodontics. These medicaments should be removed from the root canal before the placement of the filling or repair material. The aim of the present study was to evaluate the effect of prior calcium hydroxide (Ca(OH)₂) and modified triple antibiotic paste (mTAP) placement on the push-out bond strength of TotalFill BC fast set putty (BC fast set putty) to root dentin when compared to mineral trioxide aggregate (MTA).

Methods

The root canals of 45 extracted mandibular premolars were prepared to a standardized internal diameter (1.5 mm). The specimens were randomly assigned to 3 groups according to the intracanal medicament used: mTAP (a mixture of metronidazole, ciprofloxacin, and cefaclor), Ca(OH)₂, and no intracanal medicament. After 1 week, the medicaments were removed, and the middle third of the roots were cut into two transverse sections (2.0 ± 0.05) (n = 90 slices). Thereafter, the specimens were divided into two subgroups (n = 45 each): MTA or BC putty. After 1 week, the push-out test was performed and failure mode was evaluated. The data were statistically analyzed using two-way ANOVA and Tukey’s post hoc.

Results

The application of the intracanal medicament did not significantly affect the bond strength of BC putty (p > .05). For MTA, the prior application of Ca(OH)₂ or mTAP significantly decreased the dislocation resistance (p < .05). Specimens in the MTA subgroups showed an almost equal number of cohesive and mixed types of failure while the majority of the specimens in the BC putty subgroups revealed the cohesive type.

Conclusions

Ca(OH)₂ and mTAP promoted lower bond strength of MTA to root dentin compared to the control group. However, the BC fast set putty bond strength to dentin was not affected by prior medication with Ca(OH)₂ or mTAP.

Morphological and Spectroscopic Study of an Apatite Layer Induced by Fast-Set Versus Regular-Set EndoSequence Root Repair Materials

This study aimed to evaluate the morphology and chemistry of an apatite layer induced by fast-set versus regular-set EndoSequence root repair materials using spectroscopic analysis. Holes of a 4 mm diameter were created in the root canal dentin, which were filled with the test material. Fetal calf serum was used as the incubation medium, and the samples incubated in deionized water were used as controls. The material-surface and material-dentin interfaces were analyzed after 28 days using Raman and infrared spectroscopy, scanning electron microscopy/energy dispersive X-ray, and X-ray diffraction. After incubation in fetal calf serum, both materials formed a uniform layer of calcium phosphate precipitate on their surfaces, with the dentinal interface. This precipitated layer was a combination of hydroxyapatite and calcite or aragonite, and had a high mineral maturity with the regular-set paste. However, its crystallinity index was high with the fast-set putty. Typically, both consistencies (putty and paste) of root repair material have an apatite formation ability when they are incubated in fetal calf serum. This property could be beneficial in improving their sealing ability for root canal dentin.

Comparison between iRoot BP Plus (EndoSequence Root Repair Material) and Mineral Trioxide Aggregate as Pulp-capping Agents: A Systematic Review

INTRODUCTION

iRoot BP Plus, also known as EndoSequence root repair material (EERM) is a premixed bioceramic thick/putty. According to its instruction manual, iRoot BP Plus is composed of tricalcium silicate, zirconium oxide, tantalum pentoxide, dicalcium silicate, calcium sulfate, calcium phosphate monobasic, and filler agents. This systematic review was carried out to evaluate and present the iRoot BP Plus material as a pulp-capping agent.

MATERIALS AND METHODS

A systematic search for articles with the scope of the selection criteria undergoing for data extraction was conducted through electronic databases. Studies on evaluation of the cytotoxicity, bioactivity, and dentinal bridge formation of iRoot BP, iRoot BP Plus, ERRM putty, or ERRM paste (ERRM) on variant human cells were selected for in vitro models, and dentinal bridge formation on human and animals teeth for in vivo models were selected.

RESULTS

A total of 22 articles were discussed in the review, 14 in vitro studies, five in vivo studies, and three articles with both studies. Methyl thiazol tetrazolium was the most used method for evaluating cytotoxicity. As for dentinal bridge formation, histological assessment and micro-Computed tomography were used. Human dental pulp cells (hDPCs) were the most investigated for in vitro models and rats for in vivo models. Except for one study, all studies involved in this review were primarily examining the material and comparing it to different types of mineral trioxide aggregate.

CONCLUSION

iRoot BP, iRoot BP Plus, and ERRM are biocompatible materials that enhance hDPCs and other variant human cells proliferation, migration, attachment adhesion, mineralization, and dentinal bridge formation.

Influence of different laser-assisted retrograde cavity preparation techniques on bond strength of bioceramic-based material to root dentine

The purposes of the study were to evaluate the bond strength of bioceramic TotalFill root repair material (RRM) in retrograde cavities prepared using Er:YAG and Er,Cr:YSGG laser and steel bur, and to analyze failure modes. The root canals of 30 single-rooted teeth were endodontically treated, their root-ends were resected using a diamond bur, and the teeth were randomly divided into three groups (N = 10) according to the retrograde cavity preparation technique: (1) Er:YAG laser, (2) Er,Cr:YSGG laser, and (3) steel bur. All retrograde cavities were filled with the TotalFill RRM which was prepared according to the manufacturers' instructions. Push-out test was performed using universal testing machine, and failure mode was analyzed using a scanning electron microscope. The data were analyzed using one-way ANOVA, post hoc analysis with Bonferroni correction, and Fisher-Freeman-Halton exact test (p < 0.05). In the Er:YAG-, Er,Cr:YSGG-, and steel bur-prepared cavities, mean bond strengths (MPa) were 12.76, 8.44, and 6.01, respectively. The bond strength of the TotalFill RRM to dentin was significantly higher in the Er:YAG laser compared with the steel bur-prepared cavities (p = 0.004). The bond strength was not significantly different between the Er:YAG and Er,Cr:YSGG cavities (p = 0.074) and between the Er,Cr:YSGG and bur cavities (p = 0.648). In the cavities prepared by the Er,Cr:YSGG laser and bur, the failure mode of the TotalFill RRM was predominantly mixed, then adhesive and cohesive. In the Er:YAG laser-prepared cavities, the most common failure mode was adhesive, followed by mixed type and no cohesive failure. The bond strength of the TotalFill RRM to dentin was highest in the group of retrograde cavities prepared by the Er:YAG laser.

Effects of newly-developed retrograde filling material on osteoblastic differentiation in vitro

The aim of this study was to compare chemical properties and bioactivities of with mineral trioxide aggregate (MTA) and EndoSequence Root Repair Material (ERRM). After setting, surfaces of test materials were observed by scanning electron microscope (SEM). The pH and cell viability of materials were tested. Osteoblastic differentiation and alkaline phosphatase (ALP) activity were measured by quantitative real-time PCR and ALP staining. MTA showed spindle-shaped crystals while ERRM showed round-shaped crystals of various sizes. ERRM presented lower pH than MTA. Both materials showed good cell viabilities compared to the control. Expression levels of osteoblastic genes and ALP staining were increased significantly (p<0.05) in ERRM and MTA groups compared to those in the control group. In conclusion, ERRM and MTA both had effects on osteoblastic differentiation. Therefore, ERRM can be used as a desirable alternative to MTA for root-end filling material.

[Evaluation of bioceramic putty repairment in primary molars pulpotomy]

OBJECTIVE

To evaluate the clinical characteristics and effectiveness of bioceramic putty repairment (iroot BP Plus) used as pulp capping agents on pulpotomy in primary molars.

METHODS

Forty primary molars were treated by pulpotomy with bioceramic putty repairmen as the pulp capping agents at the Third Clinical Division of Peking University School and Hospital of Stomatology, from September 2016 to September 2017. The children who were followed up over one year were selected as the subjects of this study. The teeth were checked clinically and radiographically during fixed intervals, and classified into one of five outcomes: N, H, P0, PX, PY. N, absence of clinical symptoms, and absence of apical radiolucency; H, absence of clinical symptoms, and nonpathologic radiographic change present; P0, absence of clinical symptoms, and pathologic change present, no need for treatment; PX, present or absence of clinical symptoms, pathologic change present treatment or extract immediately; PY, premature loss of deciduous tooth. Molars classified into N and H were regarded as successful, classified into P0, PX and PY were regarded as failed.

RESULTS

Followed up for 12-24 months (the average follow up time was 16months), thirty four children were finally included, aged from 3.1 years to 8.5 yaers (the average age was 4.3 years), forty primary molars were included. Thirty four primary molars were included into N group, with absence of clinical symptoms, absence of apical radiolucency. Two molars were included into H group with physiological root absorption. One molar was included into P0group with absence of clinical symptoms butinternal absorption of the root. Three molars were included into PX group, with gingival fistula and apical radiolucency. None was included into PY group. Thirty six teeth got successful treatment, four molars failed. One year success rate of pulpotomy of primary molars using bioceramic putty repairment was 95%.

CONCLUSION

Current evidence suggests that bioceramic putty repairment as a pulpotomy medicament showed satisfied clinical and radiographic result in pulpotomy of primary molars. Bioceramic putty repairment is an acceptable material when used in pulpotomy of primary molars.

[Recent advances in direct pulp capping materials]

The long-term effect of direct pulp capping and pulpotomy is closely related to the type of pulp capping materials. Various kinds of direct pulp capping materials are available, such as calcium hydroxide and mineral trioxide aggregates. Diverse new pulp capping materials have been reported recently. The excellent performance of calcium silicates has attracted much attention in previous studies. Moreover, enamel matrix derivative (Emdogain), which is capable of regeneration and remineralization, and other materials with similar capabilities have shown potential for use in pulp capping.

Effect of Root Repair Materials and Bioactive Glasses on Microhardness of Dentin

Introduction:

The use of bioactive glasses to re-establish or increase mechanical properties of the root dentin may be an interesting alternative. The aim of this study was to evaluate the effect of root repair materials and bioactive glasses on the microhardness of human root dentin.

Methods and Materials:

Sixty-four sectioned palatal roots of human molars were prepared and two slices were obtained of the middle third of each root (one corresponding to the control group, without treatment, and the other to the experimental group). The pairs of slices were randomly divided into four groups (n=16). The root canal of experimental slices were filled with one of the following materials: mineral trioxide aggregate (Angelus MTA, Angelus, Londrina, Paraná, Brazil), EndoSequence Root Repair Material (ERRM, Brassler, Savannah, GA, USA), Bioglass (45S5) and an experimental niobophosphate glass (NbG). The specimens were stored in an oven at 37^ºC, in an environment with 100% humidity for 60 days. The specimens were subjected to a microhardness test. Four indentations were made at a distance of 20 µm from the root canal lumen. For microhardness analysis, comparing the experimental groups and their respective controls, the Student’s-t test was applied. For comparison of the percentage increase in microhardness between the groups, the data were statistically analyzed by using One-way ANOVA and Tukey’s test. The level of significance was set at 0.05.

Results:

All the materials significantly increased the dentin microhardness values (P<0.05). MTA showed a higher increase in microhardness (94.8±42.7%), similar to that of EndoSequence (62.3±39.9%). The 45S5 (46.5±30.0%) and NbG (53.8±31.3%) showed the lowest percentages of increase in microhardness, but were statistically similar to those of EndoSequence.

Conclusion:

All the materials tested were capable of increasing root dentin microhardness.

Maturogenesis of an Immature Dens Evaginatus Nonvital Premolar with an Apically Placed Bioceramic Material (EndoSequence Root Repair Material®): An Unexpected Finding

Dens evaginatus is a dental developmental anomaly that arises due to the folding of the inner dental epithelium that leads to the formation of an additional cusp or tubercle on the occlusal surface of the affected tooth. This accessory tissue projection may carry with it a narrow and constricted pulp horn extension. Occasionally, the tubercle easily fractures, thus leading to microexposure of the pulp horn and eventual pulp necrosis. Often, the pulp necrosis occurs at a time the root development of the affected tooth is incomplete. Apexification with calcium hydroxide and mineral trioxide aggregates has been the mainstay of treatment options before root canal obturation in immature nonvital permanent teeth. Lately, regenerative endodontics (maturogenesis) is becoming one of the preferred treatment modalities to manage such teeth. The current case highlights the possibility of a bioceramic material (EndoSequence Root Repair Material, BC RRM-Fast Set Putty™, Brasseler, USA) which supposed to provide apical root closure (apexification) and could also induce continuation of root growth (maturogenesis).

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.

Effect of Sodium Hypochlorite on Push-out Bond Strength of Four Calcium Silicate-based Endodontic Materials when used for repairing Perforations on Human Dentin: An in vitro Evaluation

AIM

This study aimed to evaluate the push-out bond strength of NeoMTA Plus (NMTA), EndoSequence root repair material fast set putty (ERRMF), biodentine (BD), and ProRoot white mineral trioxide aggregate (PMTA) when used as perforation repair materials after exposure to 2.5% sodium hypochlorite (NaOCl) during the early setting phase.

MATERIALS AND METHODS

Horizontal midroot sections were prepared from single-rooted human teeth. Sections (n = 144) were randomly divided into four groups: PMTA, BD, NMTA, and ERRMF. Materials were condensed and allowed to set for 10 minutes. The groups were further divided into two subgroups. The NaOCl group included specimens that were immersed in 2.5% NaOCl for 30 minutes, and the control group included specimens on which a wet cotton pellet was placed over the test material. After 48 hours, the highest force applied to the materials at the time of dislodgement was recorded. Slices were then examined under a digital microscope to evaluate the nature of the bond failure. The surfaces of two specimens from each subgroup were observed by scanning electron microscopy. Data were statistically analyzed with two-way and one-way analysis of variances, independent t-tests, and chi-square tests. The statistical significance was set at 0.05.

RESULTS

In NaOCl-treated groups, PMTA showed a significantly higher push-out bond strength than the other three materials (p = 0.00). In the control groups, the bond strength of BD was significantly higher than that of PMTA, ERRMF, and NMTA (p < 0.05). Compared with the control group, NaOCl treatment significantly increased the push-out bond strength of PMTA (p = 0.00) and ERRMF (p = 0.00) and significantly reduced the bond strength of BD (p = 0.00) and NMTA (p = 0.03). None of the specimens showed an adhesive type of failure. The majority of the samples exhibited a cohesive failure type. Morphological observations revealed that the surfaces exhibited cubic crystals. In ERRMF, the crystals were few in number. Sodium hypochlorite enhanced the crystallization of NMTA.

CONCLUSION

The push-out bond strengths of PMTA and ERRMF were significantly increased after exposure to 2.5% NaOCl in the early setting phase, and those of BD and NMTA were significantly decreased.

CLINICAL SIGNIFICANCE

The results of the present study suggest that early exposure of NaOCl increase the push-out bond strength of PMTA and ERRMF. PMTA had the highest push-out values. Therefore, it would be a potentially useful perforation repair material for single visit endodontic treatment.

Evaluation of the Ca ion release, pH and surface apatite formation of a prototype tricalcium silicate cement

AIM

To evaluate the Ca²⁺ -releasing, alkalizing and apatite-like surface precipitate-forming abilities of a prototype tricalcium silicate cement, which was mainly composed of synthetically prepared tricalcium silicate and zirconium oxide radiopacifier.

METHODOLOGY

The prototype tricalcium silicate cement, white ProRoot MTA (WMTA) and TheraCal LC (a light-cured resin-modified calcium silicate-filled material) were examined. The chemical compositions were analysed with a wavelength-dispersive X-ray spectroscopy electron probe microanalyser with an image observation function (SEM-EPMA). The pH and Ca²⁺ concentrations of water in which the set materials had been immersed were measured, and the latter was assessed with the EDTA titration method. The surface precipitates formed on the materials immersed in phosphate-buffered saline (PBS) were analysed with SEM-EPMA and X-ray diffraction (XRD). Kruskal-Wallis tests followed by Mann-Whitney U-test with Bonferroni correction were used for statistical analysis (α = 0.05).

RESULTS

The prototype cement contained Ca, Si and Zr as major elemental constituents, whereas it did not contain some metal elements that were detected in the other materials. The Ca²⁺ concentrations and pH of the immersion water samples exhibited the following order: WMTA = prototype cement > TheraCal LC (P < 0.05). All three materials produced Ca- and P-containing surface precipitates after PBS immersion, and the precipitates produced by TheraCal LC displayed lower Ca/P ratios than those formed by the other materials. XRD peaks corresponding to hydroxyapatite were detected in the precipitates produced by the prototype cement and WMTA.

CONCLUSION

The prototype tricalcium silicate cement exhibited similar Ca²⁺ -releasing, alkalizing and apatite-like precipitate-forming abilities to WMTA. The Ca²⁺ -releasing, alkalizing and apatite-like precipitate-forming abilities of TheraCal LC were lower than those of the other materials.

Ion Release, Microstructural, and Biological Properties of iRoot BP Plus and ProRoot MTA Exposed to an Acidic Environment

INTRODUCTION

This study evaluated how exposing the novel calcium silicate nanoparticulate bioceramic iRoot BP Plus (Innovative Bioceramix, Vancouver, Canada) to an acidic environment affects ion release from this material and alters MC3T3-E1 preosteoblast viability on and attachment to this material. These factors were compared against those of ProRoot MTA under similar conditions.

METHODS

Each material was exposed to phosphate-buffered saline (pH = 7.4) or butyric acid (pH = 5.4) for 5 days. Trace metal elements within the 2 materials and released ions were identified using inductively coupled plasma optical emission spectroscopy. The microstructures and elemental compositions of MTA and iRoot BP Plus after treatment with butyric acid were determined using scanning electron microscopy with an energy-dispersive X-ray spectrometer. Furthermore, the viability of MC3T3-E1 cells on and their levels of attachment to the materials after the butyric acid treatment were compared.

RESULTS

iRoot BP Plus contained fewer toxic metal elements than MTA. Under acidic conditions, both materials displayed similar ion release abilities, with increased release of Si and Ca ions. Substantial changes in microstructure, including reduced apatite formation, were observed for both materials after exposure to acidic pH. Furthermore, exposing iRoot BP Plus and MTA to an acidic environment increased and decreased MC3T3-E1 cell viability on these materials, respectively. MC3T3-E1 cell attachment to both materials was not significantly affected by acidic pH.

CONCLUSIONS

iRoot BP Plus seems more biologically appropriate for application in an inflamed acidic environment than ProRoot MTA.

Comparison of the Potential Discoloration Effect of Bioaggregate, Biodentine, and White Mineral Trioxide Aggregate on Bovine Teeth: In Vitro Research

INTRODUCTION

Tricalcium silicate cements can be used for pulp capping, pulpotomies, apical barrier formation in teeth with open apices, repair of root perforations, regenerative endodontics, and root canal filling. The aim of this study was to evaluate and compare the discoloration potential of 3 different tricalcium cements using a bovine tooth model.

METHODS

Forty bovine anterior teeth have been used for the study. Crowns separated from the roots were randomly divided into 4 groups: the BioAggregate (IBC, Vancouver, Canada) group, the Biodentine (Septodont, Saint Maur des Fosses, France) group, the mineral trioxide aggregate Angelus (Angelus, Londrina, PR, Brazil) group, and the only blood group. Materials have been placed to the standardized cavities on the lingual surfaces of the crowns, and their contact with blood has been provided. The color values of the samples were measured with a digital tooth shade determinator (VITA Easyshade; VITA Zahnfabrik, Bad Sackingen, Germany) before the placement of the materials, after the placement of the materials, in the 24th hour, in the first week, in the first month, in the third month, and in the first year. The mean value of all groups was compared using the Tukey multiple comparison test (α = 0.05).

RESULTS

All groups displayed increasing discoloration during a period of the first year. The "only blood group" showed the highest color change values, and it was followed as BioAggregate, mineral trioxide aggregate Angelus, and Biodentine, respectively. Statistically significant differences were found for Biodentine when compared with the only blood and BioAggregate groups (P < .05).

CONCLUSIONS

Considering the results of the study, Biodentine is found to have the least discoloration potential among the tested materials.

Scanning electron microscopy (SEM) evaluation of sealing ability of MTA and EndoSequence as root-end filling materials with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents

AIM

The purpose of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA) and EndoSequence with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents using scanning electron microscopy (SEM).

MATERIALS AND METHODS

Forty human single rooted teeth were taken. Crowns were decoronated and canals were obturated. Apically roots were resected and retrograde cavities were done. Based on the type of retrograde material placed and the type of smear layer removal agent used for retrograde cavities, they were divided into four groups (N = 10): Group I chitosan with EndoSequence, group II chitosan with MTA, group III CMC with EndoSequence, and Group IV CMC with MTA. All the samples were longitudinally sectioned, and the SEM analysis was done for marginal adaptation.

STATISTICAL ANALYSIS

Kruskal-Wallis and Mann-Witney analysis tests.

RESULTS

SEM images showed the presence of less gaps in group III, i.e., CMC with EndoSequence when compared to other groups with statistically significant difference.

CONCLUSION

Within the limited scope of this study, it was concluded that EndoSequence as retrograde material showed better marginal sealing ability.