Physicochemical properties, cytotoxicity and bioactivity of a ready-to-use bioceramic repair material

Biocompatibility and Bioactivity Evaluation of Novel Calcium Silicate-Based Sealer: In Vitro Study on Human Dental Pulp Stem Cells

OBJECTIVE

 This article evaluates the biocompatibility and bioactivity of a novel calcium silicate-based sealer by assessing its impact on the viability, mineral deposition, wound closure, and migration activity of human dental pulp stem cells (hDPSCs).

MATERIAL AND METHODS

 AH Plus and AH Plus Bioceramic were pulverized and sterilized according to International Organization for Standardization 10993-5:2009. The hDPSCs were stored raw materials, reaching 80% confluence after passing stem cell marker tests (CD90 98%, CD105 99.7%, CD73 94%, and LinNeg 0.5%) and were at passage 5 to 6 after serum starvation for 24 hours. The study consisted of four groups: AH Plus at concentrations of 1:1 and 1:4, and AH Plus Bioceramic at concentrations of 1:1 and 1:4. Viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay by measuring optical density values, while mineral deposition was evaluated through Alizarin red staining and analyzed with ImageJ software. Migration activity was measured by calculating migration speed and wound closure percentage using a scratch assay at 24 and 72 hours, with results analyzed by ImageJ.

STATISTICAL ANALYSIS

 Viability, migration, and wound closure results were analyzed using one-way analysis of variance. Mineral deposition was analyzed descriptively.

RESULTS

 There were significant differences in the viability and mineral deposition of hDPSCs between calcium silicate-based sealers and epoxy resin-based sealers. Calcium silicate-based sealers showed higher viability and better mineral deposition. The migration speed rate of hDPSCs at 24 hours and wound closure at 24 and 72 hours were significantly greater with the novel calcium silicate-based sealer compared with the epoxy resin-based sealer.

CONCLUSION

 This study suggests that calcium silicate-based sealers offer advantages over traditional epoxy resin-based sealers, demonstrating superior biocompatibility and bioactivity. These properties may lead to improved clinical outcomes, such as faster healing and fewer posttreatment complications. Further research is needed to explore the full potential of these materials in endodontics.

Physicochemical and Biological Properties of Biodentine XP, Endosequence RRM, and Bio-C Repair Cements

INTRODUCTION

This study evaluated the physicochemical and biological properties of calcium silicate-based cements used in vital pulp therapy (VPT).

METHODS

Setting time, solubility, and pH of Biodentine XP (BD-XP), Bio-C Repair (BC), and Endosequence RRM Fast Set Putty (ES) were evaluated following ISO guidelines. Human dental pulp stem cells were challenged with lipoteichoic acid and then exposed to the cement's eluates. Cell viability was evaluated with XTT assay and messenger RNA (mRNA) expression analysis of relevant genes using quantitative reverse-transcript polymerase chain reaction. Statistical significance levels were set at 5%.

RESULTS

The initial and final setting time of BD-XP was shorter than BC (P ≤ .0005), and ES and BC (P ≤ .0001), respectively. BD-XP and ES showed significantly lower solubility levels in comparison to BC (P ≤ .05). All materials were alkaline for up to 7 days and exhibited significantly higher cell viability than the positive control (P ≤ .0001). RANKL mRNA expression was higher at 6 hours in the ES and BD-XP groups when compared to BC, however it decreased to low levels at 24h. ES and BD-XP groups exhibited a significant upregulation of COL1A1 mRNA expression. ALP expression was significantly higher in all tested groups, with the BD-XP group exhibiting the highest levels. BC and BD-XP groups had significantly increased RUNX2 expression after 24 hours.

CONCLUSION

BD-XP, ES, and BC appear suitable materials for VPT, despite higher solubility. The gene expression pattern may suggest a potential pathway for pulp healing.

In vitro evaluation of the influence of ultrasonic activation on physicochemical properties of three endodontic repair materials

The influence of ultrasonic activation (UA) on the physicochemical properties of setting time (n = 5), volumetric stability (n = 10), alkalizing activity/calcium ions release (pH/Ca2+) (n = 10) and calcium/phosphate-rich substance formation in simulated body fluid (Hank's balanced salt solution; HBSS) of three cements was evaluated: white MTA-Angelus (MTA), MTA Repair HP (MTAHP) and Biodentine (BIO). It was observed that UA influenced the setting times (min) distinctly, delaying the initial setting time of MTA (40.8/64.6) and accelerating that of BIO (35.6/22.4). The final setting time of MTAHP (154.4/114.6) and BIO (64.4/42.4) were also accelerated (p < 0.05). Volumetric reduction was observed in all groups, with MTA/UA being the most volumetrically stable (0.98%); UA did not influence volumetric stability (p > 0.05). All groups exhibited an alkaline pH, with a disadvantage for MTAHP and MTAHP/UA at 24 h, 72 h and 168 h (p < 0.05). All groups showed Ca2+ release. The tested cements exhibited a favourable Ca/P ratio on their surface after 28 days.

In vitro Analysis of DSPP and BSP Expression: Comparing the Odontogenic Influence of Bio-C Repair and Biodentine in hDPSCs

OBJECTIVES

 This study compared the ability of BIO-C Repair (BC) and Biodentine (BD) in relation to odontogenic differentiation by evaluating the dentin sialophosphoprotein (DSPP) and bone sialoprotein (BSP) expression and mineral deposition of human dental pulp stem cells (hDPSCs).

MATERIALS AND METHODS

 BC and BD were pulverized and sterilized (ISO 10993-5:2009). The hDPSCs were the result of primary cultures that were 80% confluent (having gone through the stem cell marker tests CD90 98%, CD105 99.7%, CD73 94%, and LinNeg 0.5%) and reached P2-3 by means of serum starvation for 24 hours. This study involved seven groups, in which the hDPSCs were cultured on osteogenic media with the addition of either BD (Septodont, United States) at concentrations of 1:1, 1:2, or 1:5; BC (Angelus, Brazil) at concentrations of 1:1, 1:2, or 1:5; or the negative control (Dulbecco's modified eagle medium + osteogenic media). The hDPSC differentiation was determined via enzyme-linked immunosorbent assays of DSPP and BSP expression performed on days 7 and 14 and alizarin red staining performed on day 21.

STATISTICAL ANALYSIS

 The data were analyzed using a one-way analysis of variance, followed by Tamhane's post hoc test, to compare the differences between groups. The t-test dependent was also used to identify differences between groups.

RESULTS

 BC and BD at 1:1 concentration, there was a statistically significant difference in DSPP and BSP expression. However, at concentrations of 1:2 and 1:5, there was no significant difference observed in either duration of observation (p > 0.05). The highest DSPP and BSP concentrations after 7 and 14 days of observation were observed with BD and BC at 1:5 concentration (6.6-6.71 and 13.20-13.47 ng/mL).

CONCLUSION

 The study shows that BC is as effective as BD in enhancing DSPP and BSP expression and mineral deposition in hDPSCs. The 1:5 concentration of BC showed the highest levels of DSPP and BSP expression and mineral deposition.

Biocompatibility and pro-mineralization effects of premixed calcium silicate-based materials on human dental pulp stem cells: An in vitro and in vivo study

Premixed calcium silicate-based materials have recently been developed and are recommended for a wide range of endodontic procedures, including vital pulp therapy. This study investigated the in vitro biocompatibility and pro-mineralization effect and in vivo reparative dentin formation of EndoSequence Root Repair Material, EndoSequence BCRRM, Bio-C Repair, and Well-pulp PT. Both fresh and set extracts had no detrimental effect on the growth of human dental pulp stem cells. The fresh extracts had a higher calcium concentration than the set extracts and induced considerably greater mineralized nodule formation. EndoSequence Root Repair Material had the longest setting time, whereas Bio-C Repair had the shortest. When these materials were applied to exposed rat molar pulps, mineralized tissue deposition was found at the exposure sites after 2 weeks. These results indicate that the premixed calcium silicate-based materials tested could have positive benefits for direct pulp capping procedures.

In vivo method to evaluate volumetric changes in bioceramic repair materials

This study aimed to evaluate the effect of in vitro immersion solutions or an in vivo method on volumetric change of bioceramic root repair materials: Bio-C Repair (BCR, Angelus, Londrina, PR, Brazil) and Biodentine (BIO, Septodont, Saint-Maur-des-Fossés, France) compared to IRM (Dentsply Sirona, York, Pennsylvania, USA) by using microcomputed tomography (µCT) assessment. Tubes of polyvinyl chloride (PVC, 4 mm of length x 1.3 mm of inside diameter, n = 7) were filled with the materials for volumetric analysis in µCT. Samples were scanned after materials setting and after immersion in distilled water, PBS, or in vivo tissue fluid of subcutaneous tissue of rats for 7 days. IRM showed higher volumetric change than BCR and BIO in all immersion solutions (P<0.05). BIO and BCR presented similar volumetric changes when immersed in PBS and distilled water (P>0.05). When the in vivo method was used, BIO and BCR showed lower volumetric change (P<0.05), including an increase in volume for BCR. The immersion solutions influenced the evaluation of the volumetric change of bioceramic repair materials. Bioceramic materials show greater volumetric stability when evaluated by the in vivo method. The in vivo method in the subcutaneous tissue of rats can be an alternative for analyzing the properties of bioceramic cement, showing similarity with the clinical application.

Effect of blood and artificial saliva contamination on marginal adaptation and sealing ability of different retrograde filling materials: A comparative analysis

Objective

The objective of this study was to evaluate the effect of blood and artificial salivary contamination of different root-end filling materials on microleakage using a confocal laser scanning microscope and on marginal adaptation using a scanning electron microscope.

Materials and Methods

Eighty noncarious single-rooted teeth with mature apices were taken. After retro-cavity preparation, they were randomly assigned into two major groups (n = 40). They were contaminated with blood and artificial saliva, respectively. Each major group was divided randomly into four subgroups (n = 10) and filled as follows: Subgroup A, Biodentine; Subgroup B, bioactive bone cement; Subgroup C, Cention N; and Subgroup D, Bio-C Repair. The samples were sectioned transversely at 1 and 2 mm from the root apex and checked under a confocal laser scanning microscope for microleakage and under an scanning electron microscope for marginal adaptation. The average mean values were calculated. Independent samples t-tests, paired t-tests, and one-way analysis of variance with Tukey's post hoc tests were done to analyze the data.

Results

All the tested materials showed marginal gaps and dye leakage. The Bio-C Repair group showed the least mean marginal gap and dye leakage values, followed by bioactive bone cement, Biodentine, and Cention N, respectively, in both blood and artificial saliva contamination. However, the mean marginal gaps and dye leakage between the major groups were statistically insignificant.

Conclusion

In an overall comparison, Bio-C Repair was found to be superior in terms of marginal adaptation and sealing ability under the test conditions.

Biocompatibility and bioactive potential of NeoPUTTY calcium silicate-based cement: An in vivo study in rats

AIM

To evaluate the inflammatory reaction and the ability to induce mineralization activity of a new repair material, NeoPUTTY (NPutty; NuSmile, USA), in comparison with Bio-C Repair (BC; Angelus, Brazil) and MTA Repair HP (MTA HP; Angelus, Brazil).

METHODOLOGY

Polyethylene tubes were filled with materials or kept empty (control group, CG) and implanted in subcutaneous tissue of rats for 7, 15, 30, and 60 days (n = 6/group). Capsule thickness, number of inflammatory cells (ICs), fibroblasts, collagen content, and von Kossa analysis were performed. Unstained sections were evaluated under polarized light and by immunohistochemistry for osteocalcin (OCN). Data were submitted to two-way anova followed by Tukey's test (p ≤ .05), except for OCN. OCN data were submitted to Kruskal-Wallis and Dunn and Friedman post hoc tests followed by the Nemenyi test at a significance level of 5%.

RESULTS

At 7, 15, and 30 days, thick capsules containing numerous ICs were seen around the materials. At 60 days, a moderate inflammatory reaction was observed for NPutty, BC while MTA HP presented thin capsules with moderate inflammatory cells. In all periods, NPutty specimens contained the highest values of ICs (p < .05). From 7 to 60 days, the number of ICs reduced significantly while an increase in the number of fibroblasts and birefringent collagen content was observed. At 7 and 15 days, no significant difference was observed in the immunoexpression of OCN (p > .05). At 30 and 60 days, NPutty showed the lowest values of OCN (p < .05). At 60 days, a similar immunoexpression was observed for BC and MTA HP (p > .05). In all time intervals, capsules around NPutty, BC, and MTA HP showed von Kossa-positive and birefringent structures.

CONCLUSIONS

Despite the greater inflammatory reaction promoted by NeoPutty than BC and MTA HP, the reduction in the thickness of capsules, the increase in the number of fibroblasts, and the reduction in the number of ICs indicate that this bioceramic material is biocompatible Furthermore, NeoPutty presents the ability to induce mineralization activity.

Effect of pH on the solubility and volumetric change of ready-to-use Bio-C Repair bioceramic material

Acidic pH can modify the properties of repair cements. In this study, volumetric change and solubility of the ready-to-use bioceramic repair cement Bio-C Repair (BCR, Angelus, Londrina, PR, Brazil) were evaluated after immersion in phosphate-buffered saline (PBS) (pH 7.0) or butyric acid (pH 4.5). Solubility was determined by the difference in initial and final mass using polyethylene tubes measuring 4 mm high and 6.70 mm in internal diameter that were filled with BCR and immersed in 7.5 mL of PBS or butyric acid for 7 days. The volumetric change was established by using bovine dentin tubes measuring 4 mm long with an internal diameter of 1.5 mm. The dentin tubes were filled with BCR at 37°C for 24 hours. Scanning was performed with micro-computed tomography (micro-CT; SkyScan 1176, Bruker, Kontich, Belgium) with a voxel size of 8.74 µm. Then, the specimens were immersed in 1.5 mL of PBS or butyric acid at and 37 °C for 7 days. After this period, a new micro-CT scan was performed. Bio-C Repair showed greater mass loss after immersion in butyric acid when compared with immersion in PBS (p<0.05). Bio-C Repair showed volumetric loss after immersion in butyric acid and increase in volume after immersion in PBS (p<0.05). The acidic pH influenced the solubility and dimensional stability of the Bio-C Repair bioceramic cement, promoting a higher percentage of solubility and decrease in volumetric values.

Cell Biological and Antibacterial Evaluation of a New Approach to Zirconia Implant Surfaces Modified with MTA

Peri-implantitis continues to be one of the major reasons for implant failure. We propose a new approach to the incorporation of MTA into zirconia implant surfaces with Nd:YAG laser and investigate the biological and the microbiological responses of peri-implant cells. Discs of zirconia stabilized with yttria and titanium were produced according to the following four study groups: Nd:YAG laser-textured zirconia coated with MTA (Zr MTA), Nd:YAG laser-textured zirconia (Zr textured), polished zirconia discs, and polished titanium discs (Zr and Ti). Surface roughness was evaluated by contact profilometry. Human osteoblasts (hFOB), gingival fibroblasts (HGF hTERT) and S. oralis were cultured on discs. Cell adhesion and morphology, cell differentiation markers and bacterial growth were evaluated. Zr textured roughness was significantly higher than all other groups. SEM images reveal cellular adhesion at 1 day in all samples in both cell lines. Osteoblasts viability was lower in the Zr MTA group, unlike fibroblasts viability, which was shown to be higher in the Zr MTA group compared with the Zr textured group at 3 and 7 days. Osteocalcin and IL-8 secretion by osteoblasts were higher in Zr MTA. The Zr textured group showed higher IL-8 values released by fibroblasts. No differences in S. oralis CFUs were observed between groups. The present study suggests that zirconia implant surfaces coated with MTA induced fibroblast proliferation and osteoblast differentiation; however, they did not present antibacterial properties.

Evaluation of Different Techniques and Materials for Filling in 3-dimensional Printed Teeth Replicas with Perforating Internal Resorption by Means of Micro-Computed Tomography

INTRODUCTION

The aim of this study was to evaluate the filling ability of 2 obturation techniques in 3-dimensional (3D) printed teeth with perforating internal resorption (PIR).

METHODS

A maxillary central incisor was instrumented and scanned by micro-computed tomographic (micro-CT) imaging. The 3D model was exported in the stereolithographic format and, with the aid of OrtogOnBlender software (Cícero Moraes, Sinop, SP, Brazil), a PIR in the middle third of the root canal was designed. Thirty-two replicas were printed in surgical resin and distributed into 4 groups (n = 8) according to the obturation technique and the material used: 2 groups used the hybrid technique, 1 with Bio-C Sealer (BCS; Angelus, Londrina, PR, Brazil)/gutta-percha (GP; VDW GmbH, Munich, Germany) + Bio-C Repair (BCR; Angelus, Londrina, PR, Brazil) and the other with BioRoot (BR; Septodont, Saint Maur des Fosses, France)/gutta-percha (GP) + Biodentine (BD; Septodont, Saint Maur des Fosses, France), and 2 groups used the incremental technique, 1 with BCR and the other with BD. Postobturation micro-CT imaging was performed to measure the percentage volume of voids and laser confocal microscopy to measure the surface roughness (μm) of the repair cements. Data were compared using analysis of variance and Kruskal-Wallis tests.

RESULTS

Regarding the filling volume in the apical third, the BCS/GP + BCR (89.70 ± 5.15), BR/GP + BD (87.70 ± 8.43), and BCR (84.20 ± 9.00) groups showed the highest percentages compared with the BD group (69.70 ± 6.88) (P < .05). In the area of internal resorption, the BCS/GP + BCR (96.00 ± 2.64) and BCR (95.30 ± 2.93) groups showed the highest percentages compared with the BR/GP + BD group (91.50 ± 1.35) (P < .05). The BD group showed intermediate values that were sometimes similar to the BCS/GP + BCR and BCR groups and similar to the BR/GP + BD group (P > .05). Regarding the quality of the filling in the perforation area, the BCR group showed better results compared with the BD group (P < .001). Regarding roughness, the BCR group (1.66 ± 0.65) showed lower surface roughness compared with the BD group (2.51 ± 0.89) (P < .05).

CONCLUSIONS

The capacity and quality of the filling in teeth with PIR were superior with the incremental technique with BCR and the hybrid technique with BCS/GP + BCR.

Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells

OBJECTIVES

To investigate the effect of three different calcium silicate-based materials (CSBM) on the biological behavior of human periodontal ligament stem cells (hPDLSCs).

METHODS

Eluates of Biodentine, NeoPutty and TheraCal PT prepared at 1:1, 1:2, and 1:4 ratios were extracted under sterile conditions. The cytotoxicity of the extracts to the hPDLSCs was assessed using the MTT assay. Scratch wound healing assay was utilized for assessing cell migration. Scanning electron microscopy was used to detect cell attachment and morphology. Calcium ion release was measured using inductively coupled plasma-optical emission spectrometry; the pH-value was evaluated with a pH-meter. ANOVA with post hoc Tukey test was used for statistical analysis.

RESULTS

Cell viability was significantly higher for Biodentine and NeoPutty at day 1 with all dilutions (p < 0.05), while at day 3 and day 7 with dilutions 1:2 and 1:4; all materials showed similar behavior (p > 0.05). Biodentine had the highest percentage of cell migration into the scratched area at day 1 for all dilutions (p < 0.05). Stem cells were attached favorably on Biodentine and NeoPutty with evident spreading, and intercellular communications; however, this was not shown for TheraCal PT. Biodentine showed the highest pH values and calcium ion release (p < 0.05).

CONCLUSIONS

The resin-free CSBM showed better performance and favorable biological effects on hPDLSCs and were therefore considered promising for usage as endodontic repair materials.

CLINICAL SIGNIFICANCE

Proper selection of materials with favorable impact on the host stem cells is crucial to ensure outcome in different clinical scenarios.

The Effects of Tricalcium-Silicate-Nanoparticle-Containing Cement: In Vitro and In Vivo Studies

A tricalcium-silicate-nanoparticle-containing cement (Biodentine) was developed to overcome the disadvantages of existing mineral trioxide aggregate (MTA) dental materials. This study aimed at evaluating the effects of Biodentine on the osteogenic differentiation of human periodontal ligament fibroblasts (HPLFs) in vitro and the healing of furcal perforations created experimentally in rat molars in vivo, in comparison to MTA. The in vitro studies performed the following assays: pH measurement using a pH meter, the release of calcium ions using a calcium assay kit, cell attachment and morphology using SEM, cell proliferation using a coulter counter, marker expression using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and cell mineralized deposit formation using Alizarin Red S (ARS) staining. In the in vivo studies, MTA and Biodentine were used to fill the rat molar perforations. Rat molars were processed at 7, 14 and 28 days for analysis of inflammatory processes using hematoxylin and eosin (HE) staining, immunohistochemical staining of Runx2 and tartrate-resistant acid phosphate (TRAP) staining. The results demonstrate that the nanoparticle size distribution of Biodentine is critical for osteogenic potential at an earlier stage compared to MTA. Further studies are required to elucidate the mechanism of action of Biodentine in osteogenic differentiation.