Shear bond strength of Biodentine, ProRoot MTA, glass ionomer cement and composite resin on human dentine ex vivo

Evaluation of the effects of traditional irrigation solutions and etidronic acid on the bond strength of endodontic sealers

BACKGROUND

Endodontic sealers are expected to provide a favorable adhesion for a successful seal. This study aimed to evaluate the effect of ethylenediaminetetraacetic acid (EDTA) and Hydroxyethylidene Diphosphonic acid (HEDP) on bond strength of AH Plus and EndoSequence BC HiFlow sealers to root canal walls.

METHODS

This study utilized 144 mandibular human premolars. Root canals were shaped using ProTaper Next system. Teeth were divided into 4 groups of 36 according to final irrigation: Group 1: NaOCl, EDTA; Group 2: NaOCl, HEDP (mixed with distilled water); Group 3: HEDP (mixed with NaOCl); Group 4: NaOCl only. Teeth were then divided into 2 subgroups (n = 18) and filled by AH Plus or BC Sealer HiFlow using warm vertical compaction. Teeth were kept at 37 °C with 100% humidity for 7 days. Using the IsoMet device, horizontal sections with a thickness of approximately 1 mm were taken from each sample from the apical, middle and coronal third of the root. Bond strength was tested using an Instron universal testing device at a constant speed of 1 mm/min until failure. Statistical analysis was performed using Shapiro-Wilk normality test, one-way analysis of variance and Three-Way ANOVA for intergroup comparisons.

RESULTS

Statistically significant differences were observed between all groups (p = 0,0001). Push-out averages of NaOCl, EDTA group were significantly higher than NaOCl, HEDP; HEDP (NaOCl) and NaOCl groups (p = 0,0001). Push-out averages of NaOCl group were significantly lower than NaOCl, HEDP and HEDP (NaOCl) groups (p = 0,0001). No significant difference was observed between AH Plus and BC Sealer HiFlow (p = 0,883). Push out averages of the apical region were significantly higher than others and those of middle region were significantly higher than coronal (p = 0,0001). Cohesive failure was prevalent in NaOCl, EDTA, NaOCl, HEDP and HEDP (NaOCl) groups and mixed failure was prevalent in NaOCl group.

CONCLUSIONS

Irrigation using chelating agents such as EDTA and HEDP mixed with NaOCl gave higher adhesion compared to teeth where only NaOCl was used. EDTA and HEDP mixed with NaOCl can be advocated both for resin based and calcium silicate based sealers.

Effect of Irrigation Solution Temperature on Bioceramic Sealer Bond Strength

BACKGROUND Different temperature conditions can affect the efficiency of irrigation solutions and consequently the ability of canal sealers to bond to root canal walls. The aim of this endodontic study was to evaluate the effect of irrigation solutions at different temperatures on the bond strength of a bioceramic-based root canal sealer. MATERIAL AND METHODS Root canal preparations were completed through irrigation with the following solutions: Group 1 was irrigated with 5 ml NaOCl (sodium hypochlorite) +5 ml EDTA (Ethylenediamine tetra-acetic acid) (22°C); Group 2 was irrigated with 5 ml NaOCl +5 ml EDTA (37°C); Group 3 was irrigated with 5 ml NaOCl +5 ml GA (Glycolic acid) (22°C); Group 4 was irrigated with 5 ml NaOCl +5 ml GA (37°C), Group 5 was irrigated with 20 ml Dual Rinse® HEDP (Etidronate) - NaOCl mixture (22°C); and Group 6 was irrigated with 20 ml of Dual Rinse® HEDP mixture (37°C). Obtained test specimens were subjected to the push-out test. Three-way ANOVA was used to compare bond strength values. RESULTS The main effect of temperature (P<0.05), the main effect of the solution (P<0.05), and the main effect of the section (P<0.05) were significantly associated with the mean values of the bond strength. Heating irrigation solutions increased the bond strength of bioceramic-based canal sealers. CONCLUSIONS The bond strengths of the solutions increased as the temperature increased. EDTA solution significantly increased the bond strength compared to Dual Rinse® HEDP solution. Meanwhile, the bond strengths in the apical region were lower than those in the middle region.

Can flowable short-fiber-reinforced resins achieve a strong adhesion to bioceramics?

This study compared the microshear bond strength (μSBS) of four calcium silicate-based cements (CSCs), TheraCal PT (TPT), TheraCal LC (TLC), Biodentine (BD), and Dia-Root Bio MTA (DR), with a short fiber-reinforced composite resin (SFRC). Forty cylindrical acrylic blocks were used, each with a center hole (diameter 5 mm, depth 2 mm). CSCs were placed in the holes (n = 10/group), and the blocks were incubated for 48 h. G-Premio BOND, a self-etching adhesive, was applied to the CSCs surfaces using a micro-applicator for 10 s and then air-dried for 5 s, followed by light curing for 20 s. SFRC materials placed in cylindrical polyethylene capsules (diameter 2 mm, height 2 mm) were polymerized for 20 s and placed over the CSCs. The samples were then incubated at 37°C and 100% humidity for 24 h, and their μSBSs were tested using an "Instron Universal Testing Machine." Data were statistically analyzed using chi-square and Kruskal-Wallis tests. Statistically significant differences were observed between the tested CSCs. The μSBS of TPT (45.17 ± 4.56 MPa) was significantly higher (p < .05) than that of the other materials: BD, TLC, and DR had μSBSs of 29.18 ± 2.86 MPa (p < .05), 23.86 ± 2.84 MPa (p > .05), and 18.08 ± 2.69 MPa (p < .05), respectively. Considering the importance of bond strength for CSC sealing with restorative material, using SFRC over CSC was promising for improving the μSBS, adhesion, and sealing of the material. RESEARCH HIGHLIGHTS: Adhesion is critical to the success of vital pulp restorations. To achieve strong adhesion, the bioceramic material and the resin composite to which it is bonded are very important. In our study, short fiber-reinforced composite resin, which is gaining popularity, was used and found to be a promising material for improved adhesion.

Effects of ethylenediaminetetraacetic acid, citric acid, and etidronic acid on root dentin mineral content and bond strength of a bioceramic-based sealer: A scanning electron microscopy-energy dispersive spectroscopy study

Background

This study assessed the impact of chelating agents, 17% ethylenediaminetetraacetic acid (EDTA), 10% citric acid (CA), and 18% etidronic acid (HEDP), on root dentin mineral content. Scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) was applied to analyze changes, and the push-out bond strength test was used to measure dentin adhesion of Well-Root ST, a bioceramic root canal sealer.

Methods

A total of 80 extracted single-rooted lower premolar teeth were included in this study and randomly divided into four groups (n=20): group 1 (17% EDTA), group 2 (10% CA), group 3 (18% HEDP), and group 4 (distilled water, control). After irrigation and drying, SEM-EDS was applied to analyze eight samples from each group at coronal, middle, and apical root regions for mineral content and SEM images. The remaining 12 samples underwent a push-out bond strength test using Well-Root ST sealer and gutta-percha. Kruskal-Wallis and Dunn's tests were used for statistical analyses.

Results

Statistically significant differences were found between groups (P<0.05). SEM-EDS showed significant differences in C, O, Ca, P, and Ca/P content, with no significant differences in Na and Mg. Push-out bond strength was significantly higher in the 17% EDTA, 10% CA, and 18% HEDP groups compared to the control group, with no significant differences between chelating agents.

Conclusion

Chelating agents altered root dentin mineral content and improved the adhesive properties of the bioceramic sealer. These findings highlight the importance of considering the selection and use of chelating agents in the clinical practice for root canal treatment.

Shear bond strength of calcium silicate-based cements to glass ionomers

BACKGROUND

A shear bond strength between the biomaterial and restorative material is crucial for minimizing bacterial microleakage and ensuring a favorable long-term prognosis for vital pulp therapy. This study aimed to conduct a comparative evaluation of the shear bond strength between calcium silicate-based biomaterials utilized in vital pulp treatment and various glass ionomer cement materials, both with and without the application of adhesive agents.

METHODS

A total of 270 acrylic blocks, each featuring cavities measuring 4 mm in diameter and 2 mm in depth, were prepared. Calcium silicate-containing biomaterials (ProRoot MTA, Medcem Pure Portland Cement, and Medcem MTA), following manufacturers' instructions, were placed within the voids in the acrylic blocks and allowed to set for the recommended durations. The biomaterial samples were randomly categorized into three groups based on the restorative material to be applied: conventional glass ionomer cement, resin-modified glass ionomer cement, and bioactive restorative material. Using cylindrical molds with a diameter of 3.2 mm and a height of 3 mm, restorative materials were applied to the biomaterials in two different methods, contingent on whether adhesive was administered. After all samples were incubated in an oven at 37 °C for 24 h, shear bond strength values were measured utilizing a universal testing device. The obtained data were statistically evaluated using ANOVA and post-hoc Tukey tests.

RESULTS

The highest shear bond strength value was noted in the Medcem MTA + ACTIVA bioactive restorative material group with adhesive application, while the lowest shear bond strength value was observed in the ProRoot MTA White + Equia Forte HT Fil group without adhesive application (P < 0.05).

CONCLUSION

Activa Bioactive Restorative may be considered a suitable restorative material in combination with calcium silicate-based biomaterials for vital pulp treatment. The application of adhesives to calcium silicate-based biomaterials can effectively address the technical limitations.

Comparative Evaluation of Shear Bond Strength of Resin-modified Glass Ionomer Cement with ProRoot MTA and MTA Angelus

AIM

The aim of the present study was to evaluate the shear bond strength of resin-modified glass ionomer cement with two different types of mineral trioxide aggregate at different time intervals.

MATERIALS AND METHODS

A total of 80 cylindrical blocks were prepared using a self-cure acrylic resin with a central cavity of 4 mm internal diameter and 2 mm height. The prepared samples were randomly divided into two groups (n = 40 each) according to the type of MTA cements used (ProRoot MTA and MTA Angelus). Two groups were further sub-divided into four sub-groups of 10 samples each according to the different time intervals. ProRoot MTA and MTA Angelus were placed in the prepared cavity and a wet cotton pellet was placed over the filled cavity. A hollow plastic tube was placed over the MTA surface and resin-modified glass ionomer cement (RMGIC) was placed into the hollow plastic tube and light-cured (Spectrum 800, Dentsply Caulk Milford, DE, USA) according to the time intervals decided. After light curing the plastic tubes were removed carefully and the specimens were stored at 37°C and 100% humidity for 24 hours to encourage setting of MTA. The specimens were mounted in a universal testing machine (ADMET) and a crosshead speed of 0.5 mm/min was applied to each specimen by using a knife-edge blade until the bond between the MTA and RMGIC failed. The data were statistically analyzed using ANOVA, post hoc Tukey's t-test and Fisher's t-test and p-value ≤ 0.5 was considered significant.

RESULTS

For both ProRoot MTA and MTA Angelus there was no statistically significant difference between 45 minutes and 24 hours (p-value ≥ 0.8). For ProRoot MTA, shear bond strength value at 10 minutes were significantly lower than 45 minutes and 24 hours group. However, for MTA Angelus, shear bond strength value at 10 minute was not significantly different from 45 minutes group (p-value ≥ 0.3). For both ProRoot MTA and MTA Angelus shear bond strength value at 0 minute were the least and were significantly lower than 10 minutes, 45 minutes, and 24 hours, respectively (p-value ≥ 0.000).

CONCLUSION

Resin-modified glass ionomer cement can be layered over MTA Angelus after it is allowed to set for 10 minutes. However, ProRoot MTA should be allowed to set for at least 45 minutes before the placement of RMGIC to achieve better shear bond strength.

CLINICAL SIGNIFICANCE

Due to the variety of types of mineral trioxide aggregate cements available in dentistry, it is justifiable to emphasize on different time intervals as it may affect the shear bond strength of restorative cements. Such information is pivotal for the clinicians while using mineral aggregate-based cements that receive forces from the condensation of restorative materials or occlusion, as the compressive strength may be affected due to different time intervals. How to cite this article: Tyagi N, Chaman C, Anand S, et al. Comparative Evaluation of Shear Bond Strength of Resin-modified Glass Ionomer Cement with ProRoot MTA and MTA Angelus. J Contemp Dent Pract 2024;25(1):35-40.

Evaluation of removal efficiency of capping materials used in pulp revascularization in vitro

BACKGROUND

This study aimed to evaluate the removal efficiency of different capping materials used in pulp revascularization (PR) in a failure scenario.

METHODS

The apices of freshly extracted 30 maxillary incisors were cut to mimic the immature teeth; then, root canals were shaped up to #6 Peeso reamers. The regeneration steps of the American Association of Endodontists (AAE) were followed to simulate PR treatment in vitro. The canals were dressed with the Ciprofloxacin and Metronidazole medicament mixture for 2 weeks. Then capping material groups were created: BioDentine (BD), ProRootMTA (PMTA), and RetroMTA (RMTA) (n = 10). The sealed specimens were stored for 2 weeks at 37 ºC in phosphate-buffered saline then the samples were examined by micro-computed tomography (µ-CT) analysis. Set capping materials were retrieved using a specific cement removal kit by a single blind operator. The residue materials were examined again by µCT. Kruskal-Wallis and Mann-Whitney U tests sought the significance for residue volumes. One-way ANOVA and Tukey post hoc tests with the Bonferroni corrections sought significance for the duration (p = 0.05).

RESULTS

In the first examined µCT data, the mean (SD) capping material volumes of the PMTA, BD, and RMTA were 6.447 µm3 (1.086), 8.771 µm3 (0.491), and 8.114 µm3 (2.447), respectively. In the last examined µCT data, the median (IQR) residual volumes of the PMTA, BD, and RMTA were 0.051 µm3 (0.1), 0.313 µm3 (0.5), and 0.124 µm3 (0.1), respectively. A significant difference was found between BD and PMTA in the residual volumes (p < 0.05). The mean (SD) durations of the retrieving procedures of PMTA, BD, and RMTA were 19.83 min (2.34), 19.24 (3.60), and 22.04 (1.68), respectively (p = 0.063).

CONCLUSIONS

Within the limitations of the presented study, it was concluded that the capping materials were largely removed from the root canals using a non-invasive approach. Nevertheless, this duration of the retrieving could be described as long.

Micro-shear bond strength of different calcium silicate materials to bulk-fill composite

Introduction

This study aimed to compare the micro-shear bond strength (µSBS) performances of two resin-based calcium silicate-based cement (CSC) (TheraCal PT and TheraCal LC), Biodentine, and two modified-MTA CSC materials (NeoMTA 2 and BioMTA+) to bulk-fill restorative material.

Materials and Methods

Fifty 3D printed cylindrical resin blocks with a central hole were used (2 mm in depth and 4 mm in diameter). CSCs were placed in the holes (per each group n = 10) and incubated for 24 h. Cylindrical polyethylene molds (2 mm in height and diameter) were used to place the bulk-fill restorative materials on the CSCs and polymerize for 20 s. Then, all specimens were incubated for 24 h at 37 °C at a humidity of 100%. Specimen’s µSBSs were determined with a universal testing machine. Data were analyzed with one-way ANOVA (Welch) and Tamhane test.

Results

Statistically higher µSBS was found for TheraCal PT (29.91 ± 6.13 MPa) (p < 0.05) respect to all the other materials tested. TheraCal LC (20.23 ± 6.32 MPa) (p > 0.05) reported higher µSBS than NeoMTA 2 (11.49 ± 5.78 MPa) and BioMTA+ (6.45 ± 1.89 MPa) (p < 0.05). There was no statistical difference among TheraCal LC, NeoMTA 2 and Biodentine (15.23 ± 7.37 MPa) and between NeoMTA 2 and BioMTA+ (p > 0.05).

Conclusion

Choosing TheraCal PT as the pulp capping material may increase the adhesion and µSBS to the bulk-fill composite superstructure and sealing ability.

Characterisation of the calcium silicate-based cement-composite interface and the bonding strength with total-etch or single/two-stage self-etch adhesive systems

Due to favourable biological and physical properties, calcium silicate-based cements (CSCs) are biocompatible materials used widely for vital pulp therapies. Sealing efficacy between the adhesive system and CSC determines the clinical success of treatment. This study aimed to evaluate the shear bond strength (SBS) of CSC to composite resin with different adhesive systems and to analyse the CSC-composite interface. Mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental, Tulsa, OK), Biodentine (Septodont, Saint-Maur-des-Fossés, France) and NeoMTA Plus (Avalon Biomed Inc., Bradenton, FL) samples (n = 90) were placed in the cavities and divided into three subgroups according to the adhesive family (n = 10). SBSs were measured using a universal testing machine. The interfaces were examined using a scanning electron microscope (SEM) (×1000). NeoMTA Plus showed significantly higher SBS values than MTA and Biodentine (P < 0.0001). The application of total-etch adhesive system over Biodentine and NeoMTA Plus provided the statistically highest bond strength (P < 0.05). However, when the SBS values of MTA subgroups were compared, different adhesive families applied over MTA did not make a significant difference in SBS values (P > 0.05). Based on SEM analyses, the specimens exhibit no gaps, cracks or delamination within the adhesive layer, which indicates a good adhesion between the CSC-composite interface in all subgroups. In conclusion, the different adhesive families used over CSC did not influence interfacial gap formation.

Comparative evaluation of shear bond strength of calcium silicate-based liners to resin-modified glass ionomer cement in resin composite restorations - a systematic review and meta-analysis

Purpose The aim of this systematic review was to evaluate the difference in shear bond strength between calcium silicate-based liners to resin-modified glass ionomer cement (RMGIC) in resin composite restorations.Materials and methods The protocol was registered in PROSPERO following which primary research was carried out on Medline, Scopus and Cochrane library. To assess the risk of bias, a customised tool was used. Among the 194 records retrieved from the databases, only ten articles qualified for qualitative and quantitative synthesis after meeting all the requirements of the eligibility criteria. Covidence software was used to record the decisions. Studies published until 31 March 2021 were taken up for the review. The articles showed a low-to-moderate risk of bias. I2 test was used to check the percentage variation due to heterogeneity.Results RMGIC showed a higher shear bond strength value compared to the three calcium silicate liners MTA, Biodentine and TheraCal LC. However, TheraCal LC and MTA showed better bond strength than Biodentine. Cohesive failure was seen predominantly in liners followed by adhesive failure. RMGIC shows mixed mode of failure in some studies.Conclusions RMGIC is preferred over calcium silicate-based materials as the liner to be used under resin composite restorations. Among calcium silicate-based materials, TheraCal LC showed a better bond strength value. The mode of failure was predominantly cohesive in all the liner groups in majority.

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy

Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.

Effect of Different Adhesive Strategies on the Microshear Bond Strength of Calcium-Silicate-Based Materials

Aim:

To evaluate the microshear bond strength (µSBS) of mineral trioxide aggregate and Biodentine to various resin-based materials using different adhesive strategies.

Materials and Methods:

Three resin-based materials—a self-adhering resin composite with or without acid etching (Vertise flow; Kerr, Orange, CA, USA), a conventional flowable composite with a total-etch adhesive (Filtek Ultimate Flowable; 3M ESPE, St. Paul, MN, USA), and a flowable resin-modified glass ionomer cement (RMGIC) without any surface modification (Ionoseal; VOCO GmbH, Cuxhaven, Germany)—and two calcium-silicate-based materials—Biodentine and BIOfactor mineral trioxide aggregate (MTA)—were tested. A total of 100 cylindrical acrylic molds were prepared. Biodentine and BIOfactor MTA were prepared and placed into the central holes on the molds. Specimens were divided into two main groups according to materials and into five subgroups ( n = 10). µSBS were evaluated using a µSBS testing device. The failure modes were examined under a stereomicroscope with magnification. They were categorized as adhesive, cohesive, or mixed. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey test. The significance level was taken as α = 0.05.

Results:

It was observed that both calcium-silicate-based material type and resin-based material type influenced the µSBS significantly according to two-way ANOVA. Biodentine exhibited higher bond strength values than MTA. However, no statistically significant interaction was demonstrated between these factors ( P = .396). The µSBS values of intermediate materials to Biodentine and MTA were listed from the lowest to the highest as follows: RMGIC < Acid Etch + RMGIC < SARC (self-adhering resin composite) < FC (flowable composite) < Acid Etch + SARC.

Conclusion:

Self-adhering composites can be used on calcium-silicate-based materials in vital pulp treatments because of their mechanical properties. Acid-etching ensures high µSBS values. Although the µSBS of Biodentine were higher than MTA according to this study’s results, there was no statistically significant difference in µSBS of FC and acid-etched SARC to MTA.

Does adding accelerators to Mineral Trioxide Aggregate affect the shear bond strength?

Amaç: Bu çalışmada, farklı hızlandırıcı ilave edilen Mineral Trioksit Agregat’ın (MTA) kompozite farklı sertleşme sürelerinde makaslama bağlanma dayanımının (MBD) değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Merkezi boşluklara sahip 120 adet akrilik blok 4 ana gruba ayrıldı. 1. grup (kontrol); sadece MTA, 2, 3 ve 4. grup ise sırasıyla %10 kalsiyum klorür (CaCl2), %23,1 kalsiyum laktat glokonat (CLG) ve %15 disodyum hidrojen fosfat (Na2HPO4) ile karıştırılmış MTA içermektedir. Her grup 2 saat 45 dakika , 24 saat ve 96 saat sertleşme süresine göre 3 alt gruba ayrıldı. Bekleme süreleri tamamlandıktan sonra adeziv sistem (Clearfil SE Bond, Kuraray) ve kompozit rezin (Clearfil Majesty, Kuraray) işlemleri tamamlanan örneklere evrensel test cihazında MBD testi uygulandı. Elde edilen verilerinin karşılaştırmasında, tek yönlü varyans analizi (ANOVA) ve Tukey HSD testleri kullanıldı. Bulgular: Hızlandırıcısız MTA en yüksek ortalama MBD değeri sergiledi. Hızlandırıcısız MTA, hızlandırıcı olarak CLG ve Na2HPO4 eklenen MTA ile kıyaslandığında aralarındaki fark anlamlı bulundu (p&lt;0.0001). Başlangıç sertleşme süresinde alt gruplar arasında istatistiksel olarak anlamlı farklılık gözlenmedi (p&gt;0,05), diğer sertleşme sürelerinde fark anlamlı bulundu (p&lt;0,05). MTA’ya hızlandırıcı olarak CLG ve Na2HPO4 ilavesinin tüm sürelerde MBD değerlerini azalttığı, CaCl2 ilavesinin ise 96 saatin ardından MBD değerini anlamlı olarak yükselttiği gözlendi. Sonuç: MTA içerisine hızlandırıcı eklemek MBD değerini düşürmektedir. Ancak MTA’ya hızlandırıcı olarak %10 CaCl2 eklemek 96 saatin ardından yapılacak restoratif işlemlerde pozitif bağlantı sonuçları ortaya çıkarabilir.

Evaluation of the Shear Bond Strength of Four Bioceramic Materials with Different Restorative Materials and Timings

The objectives of this study were to evaluate the shear bond strength (SBS) of a resin composite (RC) and a resin-modified glass ionomer (RMGI) to four different bioceramic materials and to compare the effects of the immediate vs. delayed placement of restoration on the SBS. A total of 160 Teflon blocks and 40 blocks/material, were randomly filled with one of the bioceramic materials (NeoPUTTY^®, NeoMTA2^®, TotalFill^® BC RRM™ Fast Set Putty, and ProRoot^® MTA). The restoration was performed immediately or in a delayed time frame (after 7 days) using a Filtek™ Z350 XT Flowable composite (bonded to the bioceramic materials using Single bond universal 3M) or GC Fuji II LC^® RMGI. The SBS test was performed at a crosshead speed of 1 mm/min, and the failure mode was evaluated under a digital microscope by one blinded examiner. One-way analysis of variance (ANOVA) with the Games–Howell post hoc test was used to compare the mean SBS between the groups. The mean SBS of the bioceramic materials to RC was significantly higher than to RMGI except for ProRoot MTA (p-value 0.65). The SBS values to RC were as follows: ProRoot MTA (7.64 MPa); NeoMTA2 (8.57 MPa) which was significantly higher than both NeoPUTTY (4.04 MPa) and TotalFill^® BC RRM™ Fast Set Putty (4.38 MPa). For RMGI groups, ProRoot MTA showed the highest SBS (7.18 MPa), followed by NeoMTA2 (4.15 MPa), NeoPUTTY (1.62 MPa), and TotalFill^® BC RRM™ Fast Set Putty (1.54 MPa). The delayed timing restoration showed a significantly higher SBS than the immediate, except for the immediate RMGI restoration with MTA. To conclude, the SBS of RC to the bioceramic materials was significantly higher than RMGI, except for ProRoot MTA. Both restorative materials had a significantly higher SBS to the MTA groups in comparison to premixed bioceramics. Delayed RC restoration had a higher SBS than immediate restoration. Similarly, delayed RMGI restoration had a higher SBS than immediate restoration with premixed bioceramic but not with MTA.

MTA Matrix Technique: Restoration of Teeth with Deep Subgingival Defects Extending Down to the Osseous Crest

PURPOSE

To present a new restorative technique for the restoration of teeth with deep subgingival hard tissue defects extending down to the osseous crest without additional surgical or orthodontic interventions by combining mineral trioxide aggregate (MTA) and composite material.

MATERIALS AND METHODS

The MTA matrix technique starts by deeply inserting a metal matrix as far down to the bone level as possible. The matrix should then be fixated with a matrix holder in its end position. If the matrix band does not seal tightly in the deepest area of the cavity, small portions of MTA are carefully applied to the lower end of the inner side of the matrix band. The MTA acts as a barrier for fluid control. Additional haemostasis is not necessary. Subsequently, the tooth is restored with an etch-and-rinse adhesive and composite resin. The clinical effects were observed in a case series of three patients over a period of 3 to 4.5 years.

RESULTS

Excellent outcomes were observed clinically and radiologically. Teeth restored with the MTA matrix technique showed no failures due to the materials used or due to secondary caries or periodontal inflammation after an observation period of 3 to 4.5 years. Probing depths ranged from 2 to 4 mm without bleeding on probing, including the subgingivally restored areas.

CONCLUSION

Although only a few casuistic observations are available to date, by using the MTA matrix technique, successful restoration of teeth with subgingival defects down to the alveolar bone crest seems possible without the need of additional surgical or orthodontic measures. Further clinical studies are necessary to confirm the feasibility of this technique.

Evaluation of Shear Bond Strength between Resin Composites and Conventional Glass Ionomer Cement in Class II Restorative Technique-An In Vitro Study

The success of dental restorations depends mainly on the ability to bond to other filling materials and tooth substances, in order to resist the multitude of forces acting on the bond within the oral cavity. Although the shortcomings of composite resins have been significantly reduced over the past three decades, microleakage due to shrinkage under masticatory loads is unavoidable. In order to overcome such problems, two materials laminated with matched properties can be used to achieve optimum results. The sandwich technique is an approach in which dentine is replaced by glass ionomer cement (GIC), and enamel is replaced by composite resin. In the past, numerous materials have been proposed with adequate properties to be used in this manner, but the results are conflicting in terms of bonding to the various forms of GIC, and the appearance of microcracks or gap formation during functional loading. This study aimed to evaluate the shear bond strength (SBS) and mode of failure between the following core materials: composite resins (CR) (Methacrylate Z350™, Ceram X™, and Spectrum™) with a base material of glass ionomer cement (GIC, Ketac Molar™). Eight samples were made with the help of polytetrafluoroethylene sheets (TEFLON, Wilmington, DE, USA). Each sheet consisted of holes which were 4 mm in diameter and 2 mm in thickness. The combination of materials was sandwiched. The samples were stored in distilled water and then placed in an incubator for 24 h in order to ensure complete polymerization. The samples were thermocycled for 500 cycles between 5–55 °C/ 30 s. Following thermocycling, SBS testing was performed using a universal testing machine. Additionally, scanning electron microscopy (SEM) was performed on representative samples for the bond failure analysis between GIC and the composite resins. The Ceram-X™ nanocomposite showed significantly higher bond strength than Methacrylate Z350™ or Spectrum™ (p = 0.002). The Methacrylate Z350™ and the Spectrum™ composite specimens demonstrated a similar SBS (p = 0.281). The SBS of the Ceram X™ to GIC was the highest compared to Methacrylate Z350™ and Spectrum™. Therefore Ceram X™ may produce a better bond with GIC, and may protect teeth against recurrent caries and failure of the restoration. Methacrylate Z350™ is comparable to Spectrum™ CR and can be used as an alternative. A combination of adhesive and mixed failure was observed in Methacrylate Z350™ CR and GIC, while adhesive failure was predominantly found in both Ceram X™ and Spectrum™ with GIC restorations.

New approach for the treatment of vertical root fracture of teeth: A case report and review of literature

BACKGROUND

Vertical root fracture (VRF) is one of the most common reasons for tooth extraction, although various methods have been applied for saving teeth with VRF.

CASE SUMMARY

This case report describes a woman who had a sinus tract on the labial gingiva of the left maxillary central incisor for past two months. Periodontal probing revealed an 8–10 mm deep, narrow, isolated pocket on the palatal side of the tooth. Clinical and radiographic examination confirmed a longitudinal root fracture. A new approach using a combination of resin and iRoot BP Plus through intentional replantation was used for the treatment of the tooth. At one-year follow-up, the tooth remained asymptomatic with normal periodontal probing depth, and radiographic images showed almost normal bone and periodontal structures around the root.

CONCLUSION

This new approach may be developed as an effective method for saving teeth with VRF.

Efficacy of Mineral Trioxide Aggregate and Photobiomodulation on Pulp Capping of Dogs’ Teeth

AIM: The present study assessed the effect of mineral trioxide aggregate (MTA) and photobiomodulation (PBM) on pulp capping of exposed pulp of dogs’ teeth. METHODS: Forty-eight teeth in three mongrel dogs were randomly divided into two major study groups; Group I where MTA was used as a pulp capping agent and Group II in which both MTA+PBM were used. The groups were equally subdivided according to the observation period following completion of pulp capping into Subgroup (A) 1 week, Subgroup (B) 2, and Subgroup (C) 16 weeks. The teeth were examined for histological inflammatory response as well as dentine bridge formation. RESULTS: With regard to inflammatory response at 1 week significantly, less intense inflammation was observed in MTA+PBM (Group II) compared to the MTA (Group I) for the same time period with no significant difference for between Group I and Group II for other time intervals. As for dentin bridge formation, PBM+MTA groups showed statistically significant thicker dentine bridge formation at 16 weeks than MTA alone group for the same time period with no significant difference for between Group I and Group II for other time intervals. CONCLUSIONS: Under the conditions of this study, PBM appeared to be a beneficial adjunct in dental pulp capping procedures in which MTA was the pulp capping material.

Effect of Bioinductive Cavity Liners on Shear Bond Strength of Dental Composite to Dentin

Background

The aim of the current study was to evaluate and compare the influence of Dycal, Lime-Lite, TheraCal LC, Biodentine, resin-modified glass ionomer cement (RMGIC), and Activa BioActive as the pulp capping material on the shear bond strength of resin composite to dentin.

Methods

A total of 70 extracted caries-free molars were randomly assigned to seven groups. Six test groups were covered with various protective liners: Dycal, TheraCal LC, Lime-Lite, Activa BioActive, Biodentine, and RMGIC. The control group received no liner pretreatment. Each sample was bonded to resin composite using the total-etch Tetric N bond adhesive. The samples were then tested for shear bond strength using the universal testing machine at a cross-head speed of 1 mm/min until bond failure occurred. The data were analyzed using the one-way ANOVA test followed by the Tamhane post hoc test for pairwise comparisons of the groups.

Results

Independent of the type of the applied liner, all groups exhibited inferior SBS to dentin compared to the control group. TheraCal and RMGIC showed significantly higher shear bond strength than Biodentine and Dycal, which showed the lowest shear bond strength. Lime-Lite and Activa also had significantly lower SBS results than TheraCal. The mode of fracture was predominantly cohesive in Dycal, Biodentine, and TheraCal and adhesive in Activa.

Conclusion

This present study concludes that the bond strength of resin composite to dentin can be affected differently using various types of liners.

A comparative evaluation of microleakage and dentin shear bond strength of three restorative materials

Aim

To evaluate the microleakage and dentin shear bond strength of two glass containing restorative materials, Zirconomer and Cention N, and to compare them with a conventional glass ionomer cement (GIC) (GC Fuji II).

Materials and methods

Zirconomer (Shofu) and GC Fuji II (GC Corp.) are self-curing GICs whereas Cention N (IvoclarVivadent) also offers a self-curing option as well as the option of light-curing using an adhesive. For evaluating microleakage, standardized class V cavities were prepared on the buccal surface of 30 premolars. The cavities were restored with one of the three restorative materials (n = 10) according to manufacturers’ instructions, Cention N being used with an adhesive (Te-EconomBond, IvoclarVivadent) and in the light-curing mode. After restoration and thermocycling, the microleakage assessment was made under a stereomicroscope at 40x magnification following immersing of the teeth in 0.5% methylene blue dye and buccolingual sectioning. For evaluating dentin shear bond strength, the occlusal surface of the 30 premolars was ground flat, and cylinders of the three restorative materials (n = 10) were bonded to the occlusal surface according to manufacturers’ instructions, Cention N being used with an adhesive (Te-EconomBond, IvoclarVivadent) and in the light-curing mode. Following 24-h storage at 100% humidity, the dentin shear bond strength was measured and the fracture mode was determined under a stereomicroscope at 10× magnification. Data were statistically analyzed using Mann–Whitney and Scheffé tests (p = .05).

Results

Cention N displayed significantly less microleakage than did Zirconomer and GC Fuji II at occlusal as well as the gingival margins. Dentin shear bond strength varied significantly between 5.15 and 9.89 MPa with Cention N showing the highest bond strength and GC Fuji II the lowest.

Conclusion

In this in vitro evaluation, Cention N consistently performed better than the conventional GIC (GC Fuji II) as well as Zirconomer.

Apexification and dentinal wall reinforcement using Biodentine and glass fiber post

A 21-year-old male patient reported with chief complaint of pain in the upper front teeth. Clinical examination revealed tooth fracture in teeth # 11, 21, and prior attempted endodontic treatment. The radiographic examination revealed periapical radiolucency in relation to upper central incisors with thinning of dentinal walls. The upper left central incisor had grossly diminished root canal dentin walls with immature apex, whereas the upper right central incisor had moderate loss of dentin from the root canal wall with an open apex. Hence, it was decided to extract the upper left central incisor, whereas apexification and root canal dentin wall reinforcement with Biodentine were carried out for the upper right central incisor. The patient was asymptomatic at 1-, 4-, and 6-month follow-up visits.

Biological properties of lithium-containing surface pre-reacted glass fillers as direct pulp-capping cements

OBJECTIVE

Surface pre-reacted glass fillers (S-PRG) can release different types of ions and in our previous study, we modified these fillers with lithium chloride (S-PRG/Li-100 mM) to induce reparative dentin formation by activating the Wnt/β-catenin signaling pathway. Here, we assessed the biological performance of S-PRG/Li-100 mM and compared it with that of mineral trioxide aggregate (MTA) and S-PRG without additives.

METHODS

In vivo studies were conducted on male Wistar rats using Masson's trichrome staining in pulp-capped molars. The test materials were implanted subcutaneously to evaluate their capacity for vascularization and biocompatibility. The ability of the test materials to form apatite was tested by immersing them in simulated body fluid. Rhodamine-B staining was conducted to assess their sealing ability in bovine teeth, while their antibacterial activity was evaluated against Streptococcus mutans and Lactobacillus casei in terms of colony-forming units and by live/dead staining.

RESULTS

Masson's trichrome staining and tissue-implantation tests confirmed the biocompatibility of S-PRG/Li-100 mM and it was similar to that of MTA and S-PRG; inflammation regression was observed 14 days after operation in the subcutaneous tissues. S-PRG/Li-100 mM promoted the formation of apatite on its surface. Both the S-PRG groups showed higher sealing capability and bactericidal/bacteriostatic activity against oral bacterial biofilms than MTA.

SIGNIFICANCE

Lithium-containing surface pre-reacted glass cements exhibit better antibacterial and sealing capabilities than MTA, suggesting their potential as high-performance direct pulp-capping materials.

Pre-endodontic restoration of structurally compromised teeth: current concepts

Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart.

Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment.

Discusses restorability aspects for structurally compromised teeth.

Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.

Evaluation of the Interfaces between Restorative and Regenerative Biomaterials Used in Vital Pulp Therapy

BACKGROUND

Calcium-silicate-based cements (CSC) have gained an increasing scientific and clinical relevance, enabling more conservative approaches, namely pulp preservation and regeneration therapies. This research aims to study the influence of four clinical variables on the interfaces between CSC and composite adhesive restoration, concerning shear bond strength (SBS) and ultra-morphological patterns.

METHODS

SBS tests were performed in 320 specimens divided in 16 groups (n = 20) according to: two CSC (NuSmile^® NeoMTA, Biodentine^TM); two adhesive systems (Clearfil^TM SE Bond 2 (CSEB2), Clearfil^TM Universal Bond Quick (CUBQ)); optional application of an additional hydrophobic bonding layer (HBL); two restoration times (immediate, seven days). Scanning electron microscopy (SEM) was performed to conduct the ultra-morphology interface analysis in 32 deciduous molars prepared and randomly allocated into the 16 groups.

RESULTS

Globally, SBS tests showed higher bond strength of CUBQ compared to CSEB2 (p < 0.001), as with an additional HBL application (p = 0.014) and delayed restoration (p < 0.001). SEM showed the interpenetration between adhesive systems and CSC forming a hybrid layer, whose depth and thickness depended on the restoration time and adhesive strategy.

CONCLUSIONS

The independent clinical variables adhesive system, application of an additional HBL and restoration time affected the bond performance and ultra-morphological interface between composite adhesive restoration and CSC.

Evaluation of the bond strengths of restorative materials to primary tooth dentin treated with different pulpotomy techniques

The aim of this study was to investigate the changes of different pulpotomy techniques on the primary tooth dentin and to evaluate the effects of these pulpotomy methods on the shear bond strength of restorative materials to primary tooth dentin. Two hundred and forty dentin specimens were distributed randomly to the study groups as; control, ferric sulphate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma (APCP). After the application of pulpotomy methods, samples were again randomly divided to two restorative materials (glass hybrid and composite resin) (n = 20) and shear bond strength (SBS) test was performed. Then, 12 new dentin specimens were prepared for all groups for surface analysis. Surface examination (n = 12) and fracture analyses (n = 240) were carried out with scanning electron microscope (SEM). Statistical significance range was accepted as α <.05 for all data. A statistically significant difference was obtained among all study groups for glass hybrid material as well as composite material (p <.05). While the highest mean SBS value was obtained with Nd:YAG laser (7.58 ± 0.60 MPa), the lowest value was observed with Biodentine® (6.70 ± 0.91 MPa; p = .001) for glass hybrid material. For composite material, the highest mean SBS value was calculated for Nd:YAG laser (13.79 ± 1.24 MPa), while the lowest value was obtained with ferric sulphate (10.17 ± 1.45 MPa; p = .001). Fracture modes were mainly adhesive and mixed type according to SEM analysis. Moreover, morphological changes were observed with SEM on the dentin surfaces of ferric sulphate, Biodentine® and Nd:YAG laser. Within the limitations of this study, Nd:YAG laser increased the shear bond strength values in groups of composite resin. RESEARCH HIGHLIGHTS: In this article, we report the results of the shear bonding strength test of two restorative materials (glass-hybrid vs. composite resin) to primary tooth dentin following the application of five different pulpotomy techniques (ferric sulfate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma) were reported. This article will contribute to the literature that there are considerably limited researches concerning the bond strength of glass hybrid to primary dentin and also atmospheric pressure cold plasma in pulpotomies. The SEM examination was performed in two stages in this study; the morphological changes in both treated dentin surfaces and the surfaces of the samples subjected to the shear bond strength test.

Comparison of Obturation Quality after MTA Orthograde Filling with Various Obturation Techniques

This study aimed to quantify and compare the obturation quality after mineral trioxide aggregate (MTA) orthograde fillings with three different obturation techniques. Thirty-three extracted human maxillary molars were collected. Distobuccal and palatal canals were prepared to an apical size of #40/06 with a Profile Ni-Ti system. All 66 canals were divided into two groups according to the material (EZ-seal or OrthoMTA) and then obturated using three different techniques: manual compaction using S-kondenser (group H), compactor activation (group C), or reverse rotary motion of Ni-Ti file (group R). The obturated roots were scanned using micro-computed tomography (micro-CT). The percentage of voids located in the apical 5 mm was measured separately, that is, closed, open, and total porosity. There was no relation between the filling material and obturation technique (p > 0.05). The percentage volume of open and total porosity was higher in EZ-seal than in OrthoMTA (open: p = 0.002, total: p = 0.001). Group H showed higher open and total porosity than groups C and R. Micro-CT analysis showed that the void volume after orthograde MTA fillings significantly decreased when the additional activation was accompanied by hand condensation. Obturation with a Ni-Ti file using reverse motion could be recommended as an MTA orthograde filling technique.

Flexural properties and dentin adhesion in recently developed self-adhesive bulk-fill materials

PURPOSE

This study investigated the flexural properties, shear bond strength (SBS) and interface to dentin of three recently developed self-adhesive bulk-fill materials.

METHODS

Bars of Surefil One (SO), Cention N (CN), Activa BioActive Restorative (AB) and EQUIA Forte HT Fil (EQUIA) were tested for flexural strength and flexural modulus in self-curing and light-curing modes. In addition, SBS to dentin was tested in specimens without pretreatment and after application of universal adhesive (Scotchbond Universal). EQUIA was used as the control material.

RESULTS

The flexural properties were significantly better in light-curing mode for all materials except CN. CN had the highest SBS values after universal adhesive application (33.8 MPa), and SO had the highest SBS without pretreatment (20.9 MPa).

CONCLUSION

The mechanical and adhesive properties of these new materials varied widely.

Preserving pulp vitality: part two - vital pulp therapies

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

Preserving pulp vitality: part one - strategies for managing deep caries in permanent teeth

This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth.

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.

The Effect of Biodentine Maturation Time on Resin Bond Strength When Aged in Artificial Saliva

Biodentine is a calcium silicate cement (CSC) that has been broadly applied in vital pulp therapy. The quality of the Biodentine-composite bond has a significant effect on the longevity of the definitive restoration. The aim of this study is to investigate the shear bond strength (SBS) between Biodentine and composite restoration at different maturation times of Biodentine aged in artificial saliva. Fifteen Biodentine discs were allocated into three groups (n = 5) based on the timeframe of performance of composite restoration: immediate (after 12  min), after 14 days, and after 28 days of Biodentine maturation. Total etch and rinse adhesive system and bulk-fill regular resin composite were used. The shear bond strength and the failure pattern were assessed. One-way ANOVA with the Bonferroni post hoc test was applied for statistical analysis at p < 0.05. The highest (32.47 ± 8.18 MPa) and the lowest (4.08 ± 0.81 MPa) SBS values were recorded for 14 days and 12 min groups, respectively. Significant statistical differences were reported among the groups, and a high statistically significant difference was found between the immediate group and the other groups. Adhesive failure patterns were evident in all groups. More clinically acceptable bond strength between the Biodentine and overlaid composite restoration is at 14 days after Biodentine maturation. Delaying the coverage of Biodentine later than 14 days may significantly reduce the SBS. Using the artificial saliva as an aging medium may affect the SBS between Biodentine and composite material.

Bio-Inductive Materials in Direct and Indirect Pulp Capping-A Review Article

The article is aimed at analyzing the available research and comparing the properties of bio-inductive materials in direct and indirect pulp capping procedures. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured calcium silicate-based material (TheraCal LC) and an enhanced resin-modified glass-ionomer (ACTIVA BioACTIVE) are widely discussed. A correlation of in vitro and in vivo data revealed that, currently, the most validated material for pulp capping procedures is still MTA. Despite Biodentine's superiority in relatively easier manipulation, competitive pricing and predictable clinical outcome, more long-term clinical studies on Biodentine as a pulp capping agent are needed. According to available research, there is also insufficient evidence to support the use of TheraCal LC or ACTIVA BioACTIVE BASE/LINER in vital pulp therapy.

Comparison of the microleakage of mineral trioxide aggregate, calcium-enriched mixture cement, and Biodentine orthograde apical plug

BACKGROUND

One-visit apexification is a treatment of choice in necrotic immature open apex teeth. Calcium silicate base materials are suitable for this method. The purpose of this study was to investigate and compare the sealing efficiency of Biodentine, mineral trioxide aggregate (MTA) ProRoot, and calcium-enriched mixture (CEM) cement orthograde apical plug using bacterial leakage method.

MATERIALS AND METHODS

In this in vitro study a total of 70 extracted maxillary incisors were cleaned and shaped. A 1.1-mm standardized artificially open apex was created in all samples. The teeth were randomly divided into three experimental groups of 20, and two negative and positive control groups of 5. In experimental groups, 4-mm thick apical plugs of ProRoot MTA, CEM cement, or Biodentine were placed in an orthograde manner. Negative control samples were completely filled with MTA while positive control samples were left unfilled. Sealing efficiency was measured by bacterial leakage method, and results were analyzed by Kaplan-Meier and Chi-square tests. The level of significance was set at 0.05.

RESULTS

The highest number of turbidity was recorded for ProRoot MTA samples, while the lowest for Biodentine. There was a significant difference in the number of turbidity between ProRoot MTA and Biodentine groups (P < 0.001), but there was no significant difference between CEM cement and Biodentine (P = 0.133) and ProRoot MTA (P = 0.055).

CONCLUSION

Within the limitation of this in vitro study, Biodentine showed promising results as a substance with good-sealing efficiency.

Comparative evaluation of the bond strength of self-adhering and bulk-fill flowable composites to MTA Plus, Dycal, Biodentine, and TheraCal: an in vitro study

Objectives

This study aimed to compare the shear bond strength (SBS) of a self-adhering flowable composite (Dyad Flow) and a bulk-fill flowable composite (Smart Dentin Replacement [SDR]) to several pulp-capping materials, including MTA Plus, Dycal, Biodentine, and TheraCal.

Materials and Methods

Eighty acrylic blocks with 2-mm-deep central holes that were 4 mm in diameter were prepared and divided into 2 groups (n = 40 each) according to the composite used (Dyad Flow or SDR). They were further divided into 4 sub-groups (n = 10 each) according to the pulp-capping agent used. SBS was tested using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance. A p value of < 0.05 was considered to indicate statistical significance.

Results

A statistically significant difference (p = 0.040) was found between Dyad Flow and SDR in terms of bond strength to MTA Plus, Dycal, Biodentine, and TheraCal.

Conclusions

Among the 8 sub-groups, the combination of TheraCal and SDR exhibited the highest SBS.

Performance of Adhesives and Restorative Materials After Selective Removal of Carious Lesions: Restorative Materials with Anticaries Properties

Selective carious tissue-removal strategies require specific considerations in selection of restorative materials. A tight marginal seal placed over hard dentin and sound enamel is essential. For selective removal of carious tissue with permanent restoration, bioactive materials, such as high-viscosity glass-ionomer cement (HV-GIC) or calcium silicates, may be preferred over caries-affected firm or leathery dentin to improve remineralization. HV-GICs have the best clinical evidence of caries-arresting effect and demonstrate sufficient longevity as long-term provisional restorations that can later be used in open or closed sandwich restorations. As with any material, oral health maintenance remains important for long-term survival of restorations.

[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.

The push-out bond strength of calcium silicate-based endodontic sealers

Background

The aim was to compare the dislodgement resistance of calcium silicate-based sealers (Total Fill BC Sealer, Endo CPM Sealer, BioRoot RCS) with an epoxy resin-based sealer (AH Plus).

Methods

The root canals of 80 single-rooted human teeth were instrumented with F360 up to size 45.04. All canals were obturated using matching gutta-percha cones according to the single-cone technique in combination with one of the mentioned sealers (n = 20 per group). After eight weeks of incubation (37 °C, 100% humidity), the roots were embedded in resin. Starting with a distance of 7 mm from the apex, four slices of 1 mm thickness were cut. Dislodgement resistance was measured using a universal testing machine and the push-out bond strength was calculated. Specimens were examined under 4×-magnification to determine the mode of bond failure. Statistical analysis was performed using ANOVA and Student-Newman-Keuls-test.

Results

Regarding the pooled data of all sections, the push-out bond strength of AH Plus was significantly higher than the push-out bond strength of all calcium silicate-containing sealers (P < 0.05). Out of all calcium silicate-based sealers, Total Fill BC Sealer showed the highest push-out bond strength (P < 0.05). BioRoot RCS had significant higher push-out bond strength than Endo CPM Sealer (P < 0.05). Nearly the same results were found for all four sections. BioRoot RCS only differed significantly from Endo CPM Sealer in the third section (P < 0.05).

Conclusions

The push-out bond strength of the investigated calcium silicate-based sealers was lower than of AH Plus. Total Fill BC showed the highest push-out bond strength of the calcium silicate-based sealers.

Effect of the Er: YAG laser on the shear bond strength of conventional glass ionomer and Biodentine™ to dentine

OBJECTIVES

The purpose of this study was to determine if Er: YAG laser etching improves the shear bond strength (SBS) of Biodentin™ and GC Fuji IX® to dentine.

MATERIALS AND METHODS

Forty human dentine specimens were standardized and embedded in stone. The specimens were randomized into four groups (n = 10). Twenty samples were treated with the Er: YAG laser radiation and 10 of these restored with GC Fuji IX® and 10 with Biodentine™. The remaining 20 specimens acted as controls (no laser treatment); 10 were restored with GC Fuji IX® and 10 with Biodentin™. All samples were then stored in an incubator at 37.5°C and 100% humidity for 7 days. The SBS was determined using a Zwick universal testing machine. A two-way analysis of variance test was used to evaluate the statistical difference in SBS between the groups. An independent sample t-test was used to determine the statistical significance of differences between control and lased groups within the same material.

RESULTS

A highly statistically significant difference in SBS was found with the laser treatment (P = 0.0001) and material (i.e., Biodentin™ or Fuji IX® (P = 0.0001). The GC Fuji IX® group recorded the highest mean SBS required to dislodge the material from the laser-treated dentine surface (1.77 ± 0.22 Mega-Pascal [MPa]). The mean SBS of Biodentin™ to dentine following the laser radiation (1.12 ± 0.16 MPa) was significantly greater compared to the nonlased dentine (0.53 ± 0.09). Pearson Chi-square test indicated a nonsignificant relation between shear strength and mode of failure (P = 0.467).

CONCLUSION

Laser etching of the dentine surfaces yielded a significant increase in the bond strength for both GC Fuji IX® and Biodentin™. The SBS of Biodentin™ to dentine is greater than with conventional glass ionomer (Fuji IX®).

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

INTRODUCTION

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

AIM

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

STUDY DESIGN

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

CONCLUSIONS

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

Effect of Oral Tissue Fluids on Compressive Strength of MTA and Biodentine: An In vitro Study

INTRODUCTION

Over the past many years various root end filling materials have been used which have been tested for their physical properties but each of them had certain limitations. In clinical practice, root end filling materials are exposed to oral tissue fluids which may compromise their longevity.

AIM

The aim of this study was to investigate the effects of oral tissue fluids on compressive strength of Mineral Trioxide Aggregate (MTA) and biodentine.

MATERIALS AND METHODS

MTA and biodentine cylinders measuring 6 mm × 4 mm were prepared using acrylic blocks. They were divided into six groups; (Group 1) (MTA) (n=3), (Group 2) MTA contaminated with saliva, (MTA-S) (n=3), Group 3: MTA contaminated with blood, MTA-B (n=3), Group 4: Biodentine (BD), Group 5: Biodentine contaminated with saliva (BD-S) (n=5), Group 6: Biodentine contaminated with blood (BD-B) (n=5). The mould was contaminated with saliva and blood and incubated at 37°C at 100% humidity for three days and compressive strength (MPa) was measured using universal testing machine and the data was analyzed statistically using one-way ANOVA test.

RESULTS

There was no significant difference in the compressive strength between the three groups i.e., MTA, MTA-S, MTA-B (p > 0.05). However, there was higher compressive strength in the MTA-B group when compared to MTA and MTA-S. Also, there was no statistical significant difference between BD, BD-S, BD-B (p>0.05).

CONCLUSION

This study showed that the compressive strength of MTA and biodentine was not adversely affected by contamination with oral tissue fluids like blood and saliva.

Cavity Adaptation of Water-Based Restoratives Placed as Liners under a Resin Composite

Purpose. To investigate the cavity adaptation of mineral trioxide (ProRoot MTA/MT), tricalcium silicate (Biodentine/BD), and glass ionomer (Equia Fil/EF) cements used as liners and the interfacial integrity between those liners and a composite resin placed as the main restorative material. Materials and Methods. Standardized class I cavities (n: 8 per group) were prepared in upper premolars. Cavities were lined with a 1 mm thick layer of each of the tested materials and restored with Optibond FL adhesive and Herculite Precis composite resin. Cavity adaptation of the restorations was investigated by computerized X-ray microtomography. The regions of interest (ROI) were set at the cavity-liner (CL) interface and the liner-resin (LR) interface. The percentage void volume fraction (%VVF) in the ROI was calculated. The specimens were then sectioned and the interfaces were evaluated by reflection optical microscopy, to measure the % length (%LD) of the interfacial gaps. Selected samples were further evaluated by scanning electron microscopy. Statistical analysis was performed by two-way ANOVA and Student-Newman-Keuls multiple comparison test (a = 0.05). Results. MT showed significantly higher %VVF and %LD values in CL interfaces than BD and EF (p < 0.05). No significant differences were found among the materials for the same values at the LR interfaces. Conclusions. When used as a composite liner, ProRoot MTA showed inferior cavity adaptation at dentin/liner interface when compared to Biodentine and Equia Fil.

Shear bond strength of different restorative materials to mineral trioxide aggregate and Biodentine

Significance of Study:

Mineral trioxide aggregate (MTA) and Biodentine (calcium silicate-based materials) have great importance in dentistry. There is no study comparing the bond strength of Biodentine and MTA for composite, compomer, and compomer or resin-modified glass ionomer (RMGIC). Although many advantages of Biodentine over MTA; in this study, MTA has shown better shear bond strength (SBS) to restorative materials.

Aim:

Recently, a variety of calcium silicate-based materials are often used for pulp capping, perforation repair, and endodontic therapies. After those treatment procedures, teeth are commonly restored with composite resin, (RMGIC materials in pediatric dentistry. The aim of this study was to evaluate the SBS of composite resin (Filtek™ Z250; 3M ESPE, USA), compomer (Dyract XP; LD Caulk/Dentsply, USA), and resin-modified glass ionomer (Photac-Fil Quick Aplicap; 3M ESPE, USA) to white MTA and Biodentine.

Materials and Methods:

Ninety acrylic cylindrical blocks were prepared and divided into two groups (n = 45). The acrylic blocks were randomly allocated into 3 subgroups; Group-1A: MTA + composite (Filtek™ Z250), Group-1B: MTA + compomer (Dyract XP), Group-1C: MTA + RMGIC (Photac-Fil Quick Aplicap), Group-2A: Biodentine + composite, Group-2B: Biodentine + compomer, Group-2C: Biodentine + RMGIC. The specimens were mounted in Universal Testing Machine. A crosshead speed 1 mm/min was applied to each specimen using a knife-edge blade until the bond between the MTA/Biodentine and restorative material failed. Failure modes of each group were evaluated under polarized light microscope at ×40 magnification.

Results:

There was no statistically significant difference between MTA + Composite resin with MTA + Compomer; and MTA + RMGIC with Biodentine + RMGIC (P > 0.05). There were statistically significant differences between other groups (P < 0.05).

Conclusions:

The results of the present study displayed that although many advantages of Biodentine over MTA; MTA has shown better SBS to compomer and composite resin materials than Biodentine.