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Elias VV, Lima RB, Lucisano MP, Araujo LDC, Pucinelli CM, Nelson-Filho P, da Silva RAB, da Silva LAB. Inflammatory response to bioceramic and epoxy resin-based endodontic sealers implanted in mice subcutaneous tissue: An in vivo study. Microsc Res Tech 2024. [PMID: 38853352 DOI: 10.1002/jemt.24631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/23/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
To evaluate the inflammatory tissue response to BioRoot™ RCS (BR) and AH Plus Jet (AHPJ) sealers implanted in mice subcutaneous tissue. It was hypothesized that the inflammatory tissue response to BR would be milder than to AHPJ. An in vivo study was carried out using isogenic mice. The sealers were implanted during standardized surgical procedures. The inflammatory response was evaluated by microscopic analysis and von Kossa reaction in the reactionary tissue around the specimens after 7, 21, and 63 days. For comparisons, a zinc oxide and eugenol sealer (ZOE) was used as a positive control, in addition to a negative control without a sealer (n = 10 per group/period). All statistical analyses considered a significance level of 5%. All endodontic sealers triggered an inflammatory tissue response after 7 days. BR had a higher inflammatory cell count and a thicker fibrous capsule when compared with AHPJ, but both were less inflammatory than ZOE (p < .001). After 21 days, BR continued to trigger an intense inflammatory tissue response, higher in both microscopic parameters compared to AHPJ, and a thicker fibrous capsule than ZOE (p < .001). After 63 days, the inflammatory tissue response decreased in BR, matching the fibrous capsule thickness with AHPJ and ZOE. BR promoted intense calcium precipitation in all study periods. After 63 days, AHPJ and BR sealers were more biocompatible to subcutaneous mice tissue, but AHPJ present better early inflammatory response, as well as BR showed potential bioactivity. RESEARCH HIGHLIGHTS: The inflammatory tissue response triggered by a bioceramic endodontic sealer (BR) was not milder than that triggered by an epoxy-resin based endodontic sealer (AHPJ) during the first 3 weeks, considering the microscopic analysis of the reactionary tissue.
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Affiliation(s)
- Vanessa Valente Elias
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ricardo Barbosa Lima
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marília Pacífico Lucisano
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lisa Danielly Curcino Araujo
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carolina Maschietto Pucinelli
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Raquel Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Léa Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Graduate Program in Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Abu-Zeid ST, Alamoudi RA. Comparative Analysis of Interfacial Adaptation and Depth Penetration of Recent HiFlow versus Regular Bioceramic Sealers in Conjunction with BC Gutta-Percha Points Using Two Different Obturation Techniques-A Preliminary Report of an Ex Vivo Study. J Funct Biomater 2024; 15:134. [PMID: 38786645 PMCID: PMC11122194 DOI: 10.3390/jfb15050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to assess the adaptability and penetration depth capacity of recent bioceramic systems, including regular EndoSequence (BC) versus HiFlow (BCH) sealers in the presence of BC points. A total of 54 single-rooted teeth were instrumented and obturated with either the cold or warm compaction technique (n = 9), using either BC, BCH, or AH Plus (AHP) combined with BC points. The adaptation, film thickness, and gaps/voids were evaluated by scanning electron microscopy. The sealer/dentin interface was evaluated by Raman spectroscopy, and depth penetration was evaluated by a confocal laser scanning microscope. According to the normality test, the data were statistically analyzed by ANOVA or Kruskal-Wallis and Mann-Whitney U tests at p < 0.05. BCH sealer showed the significantly thinnest film with the greatest flow (p > 0.001), with further improvement when subjected to the warm compaction technique. Moreover, it exhibited close adaptation with deep penetration into radicular dentin, forming a tag-like structure. The Raman spectra also indicated close contact with the dentin surface. The use of BC sealer with BC points exhibited homogenous, single-unit obturation, either with a cold or warm technique. Furthermore, the use of the warm compaction technique with BCH sealer achieved a gap-free interface associated with tag-like structures, which exhibit the monoblock phenomenon.
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Affiliation(s)
- Sawsan T. Abu-Zeid
- Endodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22252, Saudi Arabia;
- Endodontic Department, Faculty of Dentistry, Cairo University, Giza 12345, Egypt
| | - Ruaa A. Alamoudi
- Endodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22252, Saudi Arabia;
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Srivastava S. Root Canal Instrumentation: Current Trends and Future Perspectives. Cureus 2024; 16:e58045. [PMID: 38738101 PMCID: PMC11088362 DOI: 10.7759/cureus.58045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
The evolution of root canal instrumentation techniques has significantly impacted the field of endodontics, enhancing both the efficiency and outcomes of treatments. This review outlines the transition from manual to mechanical and rotary instruments, highlighting the role of nickel-titanium (NiTi) alloys and smart technologies in advancing procedural precision and reducing patient discomfort. Key historical developments and technological innovations, such as digital imaging and navigation systems, are explored for their contributions to improved clinical outcomes and patient satisfaction. Additionally, the review addresses the challenges presented by the complex anatomy of the root canal system and the advent of current instrumentation techniques. The potential of emerging trends, including artificial intelligence and advances in materials science, is discussed in the context of future endodontic practices. Despite the progress, challenges related to using advanced instrumentation methods, ethical considerations, and the cost factor of new technologies persist. The present review underscores the ongoing need for research and development to further refine root canal instrumentation techniques, ensuring that advancements in endodontic care remain patient-centered and accessible.
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Affiliation(s)
- Swati Srivastava
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, SAU
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Abdelwahab DH, Kabil NS, Badran AS, Darwish D, Abd El Geleel OM. One-year radiographic and clinical performance of bioactive materials in primary molar pulpotomy: A randomized controlled trial. J Dent 2024; 143:104864. [PMID: 38281619 DOI: 10.1016/j.jdent.2024.104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Mineral Trioxide Aggregate (MTA) is considered the gold standard material for pulpotomy procedures. However, some drawbacks such as poor handling and long setting time are challenging when it is used as pulpotomy dressing in primary molars in children. Hence, the purpose of this study was to compare the radiographic and clinical performance of a premixed, fast setting bioceramic root repair material (BC RRM-F) with MTA in vital pulpotomy procedures of primary molars, with or without the added seal of a stainless steel crown (SSC). METHODS In this double blinded, four-arm, parallel group randomized contolled trial (RCT), 64 primary molars were randomly allocated to one of the four treatment groups: MTA (PDTM MTA WHITE)+SSC, MTA+GI (bulk fill glass ionomer with glass hybrid technology GC EQUIA Forte® HT), BC RRM-F+GI and BC RRM-F+SCC. All molars were evaluated clinically and radiographically according to the modified Zurn and Seale criteria at 1, 3, 6, and 12 months follow up. Multivariate cox regression models and Kaplan-Meier curves were used for survival analysis. RESULTS There was no statistically significant difference between the success of both pulp capping materials used. Overall survival analysis showed that using GI instead of SCC as a final restorative material was significantly associated with increased risk of failure. CONCLUSIONS TotalFill® BC RRM™ Fast Set Putty can be used as an alternative to MTA in primary molar pulpotomy. Regardless of the pulp capping material, one year survival of pulpotomized primary molars restored with SSC is higher compared to those restored with GC EQUIA Forte® HT. CLINICAL SIGNIFICANCE Clinicians' preference and cost effectiveness may justify the use of either material in primary molar pulpotomy. Parents insisting on tooth-colored restorations for their children's pulpotomized teeth cannot be told that the expectation for success is the same as those restored with SSC, even if calcium silicate-based pulp capping materials are used.
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Affiliation(s)
- Dina Hisham Abdelwahab
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Egypt.
| | - Noha Samir Kabil
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Amira Saad Badran
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Dina Darwish
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Ola Mohamed Abd El Geleel
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
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Ferreira EHRG, Rosas CAP, Limoeiro AGDS, Lima SN, Silva RA, Seckler INB, De Martin AS, Nascimento WM, Bueno CEDS. Effect of obturation technique on dentinal tubule penetration of two tricalcium silicate-based sealers: Ex vivo study. AUST ENDOD J 2024; 50:148-156. [PMID: 38146083 DOI: 10.1111/aej.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
The aim of this study was to assess by confocal laser microscope the depth of dentinal tubule penetration of two tricalcium silicate-based sealers promoted by two obturation techniques in curved canals compared with AHPlus. One hundred and twenty canals were divided into six groups (n = 20): BCSC-Bio-C Sealer (BC) and single-cone technique (SC); BCCW-BC and continuous condensation wave (CW); TFSC-Total Fill (TF) and SC; TFCW-TF and CW; AHSC-AH Plus (AH) and SC; AHCW-AH and CW. Data were analysed using the three-way ANOVA and Tukey's test (α = 5%). Penetration depth was significantly greater for TFCW than TFSC and greater for AHCW than AHSC (p < 0.05). There was no significant difference between BCCW and BCSC (p > 0.05). The penetration of TF was significantly greater (p < 0.05). The CW technique promoted greater intratubular penetration, except for the BC sealer.
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Affiliation(s)
| | | | | | - Samuel Nogueira Lima
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, Brazil
| | - Rafael Amado Silva
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, Brazil
| | | | | | - Wayne Martins Nascimento
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, Brazil
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Ortega MA, Rios L, Fraile-Martinez O, Liviu Boaru D, De Leon-Oliva D, Barrena-Blázquez S, Pereda-Cerquella C, Garrido-Gil MJ, Manteca L, Buján J, García-Honduvilla N, García-Montero C, Rios-Parra A. Bioceramic versus traditional biomaterials for endodontic sealers according to the ideal properties. Histol Histopathol 2024; 39:279-292. [PMID: 37747049 DOI: 10.14670/hh-18-664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Odontology, as a scientific discipline, continuously collaborates with biomaterials engineering to enhance treatment characteristics and patients' satisfaction. Endodontics, a specialized field of dentistry, focuses on the study, diagnosis, prevention, and treatment of dental disorders affecting the dental pulp, root, and surrounding tissues. A critical aspect of endodontic treatment involves the careful selection of an appropriate endodontic sealer for clinical use, as it significantly influences treatment outcomes. Traditional sealers, such as zinc oxide-eugenol, fatty acid, salicylate, epoxy resin, silicone, and methacrylate resin systems, have been extensively used for decades. However, advancements in endodontics have given rise to bioceramic-based sealers, offering improved properties and addressing new challenges in endodontic therapy. In this review, a classification of these materials and their ideal properties are presented to provide evidence-based guidance to clinicians. Physicochemical properties, including sealing ability, stability over time and space, as well as biological properties such as biocompatibility and antibacterial characteristics, along with cost-effectiveness, are essential factors influencing clinicians' decisions based on individual patient evaluations.
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Affiliation(s)
- Miguel A Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, Alcala de Henares, Spain
| | - Laura Rios
- Universidad San Pablo CEU, Madrid, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Diego Liviu Boaru
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Diego De Leon-Oliva
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Silvestra Barrena-Blázquez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Claude Pereda-Cerquella
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Maria J Garrido-Gil
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | | | - Julia Buján
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.
| | - Antonio Rios-Parra
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
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Shancy Merlin AR, Ravindran V, Jeevanandan G, Eswaramoorthy R, Arthanari A. Comparative Evaluation of Push-Out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, a Modified Mineral Trioxide Aggregate, and Two Novel Antibacterial-Enhanced Mineral Trioxide Aggregates. Cureus 2024; 16:e56320. [PMID: 38629015 PMCID: PMC11019474 DOI: 10.7759/cureus.56320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Background The challenges associated with incorporating antimicrobial agents, such as the potential diminishment of the cement's physical properties, highlight the need for comprehensive evaluations. Balancing antimicrobial efficacy with the maintenance of structural integrity is a crucial aspect of material development. The acknowledgment of cytotoxic properties associated with tricalcium aluminate, a major constituent in conventional mineral trioxide aggregate (MTA), is critical in terms of long-term evaluation of treatment procedures. The primary focus of the push-out test is to evaluate the resistance of the tested material to dislodgement. Greater push-out strength implies stronger adhesion between the tested material and the tooth surface. Aim This study aims to evaluate the push-out bond strength of two antibacterial-enhanced MTAs with conventional MTA and Biodentine. Material and methods A total of five materials were tested: a) modified MTA, b) doxycycline-enhanced MTA, c) metronidazole-enhanced MTA, d) conventional MTA, and e) Biodentine. All the materials were mixed based on a predetermined powder:liquid ratio and then carried using a plastic instrument to the desired experimental design. Single-rooted permanent teeth, preferably incisors, were used in the present study. Teeth were embedded vertically in a rubber mold, and sectioning of the tooth was performed. A single operator instrumented the canal space in each slice using Gates-Glidden burs, and the mixed cements were placed in the respective groups and stored for 72 hours. A push-out test was carried out using a universal testing machine. Following the bond failure, the slices were examined under a stereomicroscope to determine the nature of the bond failure. The collected data was subjected to a one-way analysis of variance test, post hoc test, and chi-square test for statistical analysis. Results The mean push-out bond strength was found to be the highest for Biodentine (43.25 ± 0.62 megapascals (MPa)), followed by doxycycline- and metronidazole-enhanced MTAs (39.54 ± 0.65 MPa and 39.29 ± 0.16 MPa, respectively), modified MTA formulation (37.75 ± 0.73 MPa), and the lowest for conventional MTA (25.93 ± 0.7 MPa). Conventional MTA samples had an adhesive failure (89.4%), while Biodentine samples had a cohesive failure (80.3%). Mixed failures were noticed with the samples containing modified MTA formulation (71.3%), doxycycline-enhanced MTA (76.6%), and metronidazole-enhanced MTA (78.0%). Conclusion Despite not surpassing Biodentine in bond strength, antibacterial-enhanced MTAs are considered potential alternatives to conventional MTA in day-to-day clinical practice.
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Affiliation(s)
- Arokia Rajkumar Shancy Merlin
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vignesh Ravindran
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Ganesh Jeevanandan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Rajalakshmanan Eswaramoorthy
- Center of Molecular Medicine and Diagnostics, Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Abirami Arthanari
- Department of Forensic Odontology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Surana P, Singh Dhull K, Arya A, Samreen S, Rajan M, Parihar AS. Bio-ceramics application in Dentistry. Bioinformation 2024; 20:136-139. [PMID: 38497078 PMCID: PMC10941772 DOI: 10.6026/973206300200136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Bioceramics have gained significant attention in dentistry due to their unique properties, including biocompatibility, osseointegration, and tissue regeneration. Therefore, it is of interest to report the various applications of bioceramics in dentistry, their advantages, limitations, and future considerations. Bio-ceramics such as zirconia and hydroxyapatite offer high biocompatibility and durability for dental application. They support bone integration for implants, resist wear, and mimic natural tooth aesthetics. Used in crowns, bridges, and fillings, bio-ceramics enhance healing and are pivotal in restorative and reconstructive dental procedures.
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Affiliation(s)
- Pratik Surana
- Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India
| | - Kanika Singh Dhull
- Department of Pedodontics & Preventive Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, India
| | - Ashtha Arya
- Departmentof Conservative Dentistry and Endodontics, SGT Dental College, Hospital and Research Institute, SGT University, Gurugram, Haryana - 122505, India
| | - Sara Samreen
- Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India
| | - Milind Rajan
- Department of Pedodontics and Preventive Dentistry, MA Rangoonwala Dental College, Pune - 411001, Maharashtra, India
| | - Anuj Singh Parihar
- Department of Periodontology, People's Dental Academy, Bhopal, Madhya Pradesh, 462037, India
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Esen M, Guven Y, Seyhan MF, Ersev H, Tuna-Ince EB. Evaluation of the genotoxicity, cytotoxicity, and bioactivity of calcium silicate-based cements. BMC Oral Health 2024; 24:119. [PMID: 38245737 PMCID: PMC10799466 DOI: 10.1186/s12903-024-03891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND As calcium silicate-based cements (CSCs) have found success in various vital pulp therapy applications, several new CSC products have emerged. This study aimed to assess the genotoxicity, cytotoxicity, and bioactivity of four CSCs by comparing the newly introduced materials Bio MTA+ and MTA Cem with previously studied materials, Biodentine and NeoMTA. METHODS Genotoxicity was evaluated using the micronucleus (MN) assay in human peripheral blood lymphocyte cells, measuring MN frequency and nuclear division index (NDI). Cytotoxicity was assessed in human dental pulp stem cells through the Water-Soluble Tetrazolium Salt-1 (WST-1) colorimetric assay. Bioactivity was determined by ELISA, measuring the levels of angiogenic and odontogenic markers (BMP-2, FGF-2, VEGF, and ALP). Statistical analyses included ANOVA, Dunnet and Sidak tests, and Wald chi-square test. (p < .05). RESULTS The MN frequency in the groups was significantly lower than that in the positive control group (tetraconazole) (p < .05). NDI values decreased with increasing concentration (p < .05). Bio MTA+ and NeoMTA showed decreased cell viability at all concentrations in 7-day cultures (p < .01). All materials increased BMP-2, FGF-2, and VEGF levels, with Biodentine and NeoMTA showing the highest levels of BMP-2 and FGF-2 on day 7. Biodentine displayed the highest VEGF levels on day 7. Biodentine and NeoMTA groups exhibited significantly higher ALP activity than the Bio MTA+ and MTA Cem groups by day 7. CONCLUSION Bio MTA+ and MTA Cem demonstrated no genotoxic or cytotoxic effects. Moreover, this study revealed bioactive potentials of Bio MTA+ and MTA Cem by enhancing the expression of angiogenic and osteogenic growth factors.
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Affiliation(s)
- Merve Esen
- Department of Pedodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Yeliz Guven
- Department of Pedodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Mehmet Fatih Seyhan
- Department of Molecular Biology and Genetics, Faculty of Art and Sciences, Istanbul Yeni Yuzyil University, Istanbul, Turkey
| | - Handan Ersev
- Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Elif Bahar Tuna-Ince
- Department of Pedodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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10
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Tao W, Tian G, Song Q, Lv Z. Application of mineral trioxide aggregate pulpotomy in the treatment of early pulpitis of primary molars. Am J Transl Res 2024; 16:285-294. [PMID: 38322556 PMCID: PMC10839389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of mineral trioxide aggregate (MTA) on pulpotomy in primary molars. METHODS Two hundred and sixty-three cases (310 teeth) of children with early pulpitis of primary molars admitted between February 2019 to February 2022 were enrolled, and their clinical data were retrospectively analyzed. Of them, 130 cases with 155 teeth treated with root canal treatment were set as the control group (CG) and 133 cases with 155 teeth receiving MTA pulpotomy were set as the observation group (OG). Clinical data such as efficacy evaluation, inflammatory factor levels, postoperative adverse reactions, and quality of life (QoL) were compared. RESULTS After surgery, the overall response rate in the OG was statistically higher than that in the CG, while the levels of inflammatory factors in the OG were significantly lower than those in the CG (all P<0.05). Moreover, the total incidence of complications was significantly lower in OG at 3, 6, and 12 months after surgery (P=0.018, P=0.007, P=0.015, respectively). The QoL of the two groups differed insignificantly before surgery; however, after the treatment, the QoL in OG was significantly higher than those in the CG at 3, 6, and 12 months after surgery (P=0.037, P=0.012, P=0.028, respectively). Moreover, the teeth location and treatment method were independent factors of efficacy (P=0.047, P=0.001, respectively). CONCLUSIONS MTA pulpotomy outperformed root canal treatment for superior efficacy in children with early pulpitis of primary molars, with a positive effect on improving QoL, and patient prognosis.
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Affiliation(s)
- Wen Tao
- Department of Dentistry, People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Guoyong Tian
- Department of Dentistry, People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Qingqing Song
- Department of Dentistry, People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Zhijun Lv
- Department of Dentistry, People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
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11
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Hamdy TM, Galal MM, Ismail AG, Saber S. Physicochemical properties of AH plus bioceramic sealer, Bio-C Sealer, and ADseal root canal sealer. Head Face Med 2024; 20:2. [PMID: 38172921 PMCID: PMC10765876 DOI: 10.1186/s13005-023-00403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the physicochemical properties of two newly introduced premixed calcium silicate-based root canal sealers (AH Plus Bioceramic Sealer and Bio-C Sealer) compared to a resin-based root canal sealer (ADseal root canal sealer). METHODS Solubility, pH analysis, calcium ion release, and film thickness of each sealer were evaluated following ISO guidelines. The data were examined using the two-way ANOVA test. Furthermore, X-ray diffraction (XRD) examination was performed to investigate the crystalline phase of each type of sealer. X-ray fluorescence (XRF) analysis was done for the chemical elemental analysis of each sealer. RESULTS The least film thickness, highest alkalinity, and highest calcium ion release were all displayed by AH Plus Bioceramic Sealer. High solubility, high alkalinity, intermediate calcium ion release, and intermediate film thickness were all displayed by Bio-C Sealer. While ADseal root canal sealer displayed the greatest film thickness, least solubility, alkalinity, and calcium ion release. CONCLUSIONS Both AH Plus Bioceramic Sealer and Bio-C Sealer represented adequate properties to be considered a good sealer that could be used as a potential alternative to resin-based root canal sealers.
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Affiliation(s)
- Tamer M Hamdy
- Restorative and Dental Materials Department, Oral and Dental Research Institute, National Research Centre (NRC), Giza, Dokki, 12622, Egypt.
| | - Manar M Galal
- Restorative and Dental Materials Department, Oral and Dental Research Institute, National Research Centre (NRC), Giza, Dokki, 12622, Egypt
| | - Amira Galal Ismail
- Restorative and Dental Materials Department, Oral and Dental Research Institute, National Research Centre (NRC), Giza, Dokki, 12622, Egypt
| | - Shehabeldin Saber
- Endodontic Department, Faculty of Dentistry, The British University in Egypt, Cairo, 11841, Egypt
- Center for Innovative Dental Sciences, The British University in Egypt, Cairo, 11841, Egypt
- Endodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, 11566, Egypt
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12
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Teves-Cordova A, Coloma Calle L, Mejia Rojas P, Goncalves-Pereira J, Duarte MAH. Vital Pulp Therapy in Permanent Teeth Diagnosed with Symptomatic Irreversible Pulpitis: Reports with Long-Term Controls. Case Rep Dent 2023; 2023:2694388. [PMID: 38045017 PMCID: PMC10689073 DOI: 10.1155/2023/2694388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
The aim of this study was to describe the treatment of permanent teeth diagnosed with irreversible pulpitis, which can be effectively managed with partial or total pulpotomy. This alternative approach has shown great clinical and radiographic success in the long term compared to traditional pulpectomies. In this series of clinical cases, all the teeth exhibited symptoms of intense pain upon exposure to cold and at night. The clinical examination revealed extensive caries, while radiographic imaging showed radiolucent lesions in contact with the pulp chamber, indicating symptomatic irreversible pulpitis. The chosen treatment approach was either partial or total pulpotomy. The tooth was anesthetized, and the operative field was isolated and disinfected. After removing caries with a sterile round drill, the area was rinsed with sodium hypochlorite. In some cases, a portion of the pulp tissue was removed, while in others, the entire tissue of the pulp chamber was extracted using diamond burs. Hemostasis was achieved by applying sterile cotton pellets for 2 to 6 minutes. Following that, the tissue exhibited no signs of bleeding. Bioceramic cements were used, and the tooth was definitively restored. Periodic follow-up examinations were conducted, consistently showing positive pulp responses and no evidence of periradicular radiolucent lesions on radiographs.
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Affiliation(s)
- Abel Teves-Cordova
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
| | - Luis Coloma Calle
- Faculty of Dentistry of the Catholic University of Cuenca-Azogues, Ecuador
| | - Pierre Mejia Rojas
- Department of Endodontics, School of Dentistry, Cayetano Heredia Peruvian University, Lima, Peru
| | - Juan Goncalves-Pereira
- Department of Endodontics, School of Dentistry, Central University of Venezuela, Caracas, Venezuela
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
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13
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Demircan B, Demir P. 3D finite element analysis of stress distribution as a result of oblique and horizontal forces after regenerative endodontic treatment part II: comparison of material thickness. BMC Oral Health 2023; 23:869. [PMID: 37974115 PMCID: PMC10655308 DOI: 10.1186/s12903-023-03559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
AIM This study aimed to evaluate the stress distribution caused by secondary trauma forces after regenerative endodontic treatment (RET) using different thicknesses of coronary barrier material with three-dimensional finite element analysis(FEA). METHOD A control model was created using the tomography image of the immature maxillary central tooth with computer software.Study models were created with the modulus of elasticity and Poisson's ratio of the materials used in RET.Enamel, dentin, cementum, periodontal ligament, cortical, and cancellous bone were modeled. Coronary barrier materials were applied in 3 mm and 5 mm thicknesses (Model 1: control model, model 2:3 mm/Calcium Enriched Mixture(CEM), model 3:3 mm/Mineral Trioxide Aggregate(MTA), model 4:3 mm/Biodentin, model 5:5 mm/CEM, model 6:5 mm/MTA, model 7:5 mm/Biodentin). For the trauma force simulation, 300 N force in the horizontal direction was applied to the buccal surface of the tooth in the first scenario. For the second scenario, maximum bite force simulation, a force of 240 N in the oblique direction was applied to the palatal surface of the tooth. FEA was performed with Algor Fempro. The resulting stresses were recorded as Von Mises, maximum, and minimum principal stresses. RESULTS Lower stress values were obtained in 5 mm models compared to 3 mm models. However, the difference between them was insignificant. Lower stress values were obtained in all RET models compared to the control model. The lowest stress values in dental tissues and bone tissue were obtained in the CEM models. CONCLUSION This is the first study in which the stress caused by different thicknesses of CEM on dental tissues was evaluated with FEA. RET strengthens immature teeth biomechanically. CEM and Biodentin are more successful materials in stress distribution than MTA. Considering the cost of treatment, 3 mm material thickness is ideal for RET since there is no significant difference between the stress values resulting from the use of 5 mm and 3 mm coronary barrier material.
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Affiliation(s)
- Beril Demircan
- Department of Pediatric Dentistry, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, 38170, Kocasinan, Türkiye.
| | - Pınar Demir
- Department of Pediatric Dentistry, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, 38170, Kocasinan, Türkiye
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14
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Saber SM, Gomaa SM, Elashiry MM, El-Banna A, Schäfer E. Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells. Clin Oral Investig 2023; 27:6757-6768. [PMID: 37796335 PMCID: PMC10630253 DOI: 10.1007/s00784-023-05288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
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.
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Affiliation(s)
- Shehabeldin M Saber
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt (BUE), Cairo, Egypt
- Dental Science Research Group, Health Research Centre of Excellence, The British University in Egypt (BUE), Cairo, Egypt
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Egypt, Cairo, Egypt
| | - Shaimaa M Gomaa
- Dental Science Research Group, Health Research Centre of Excellence, The British University in Egypt (BUE), Cairo, Egypt
| | - Mohamed M Elashiry
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Egypt, Cairo, Egypt
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ahmed El-Banna
- Department of Biomaterials, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany.
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15
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Zahid TM. Management of a Previously Failed Root Perforation Repair with Geristore and Deepithelialized Gingival Graft: A 5-Year Follow-Up Case Report. Case Rep Dent 2023; 2023:7335196. [PMID: 37799172 PMCID: PMC10550458 DOI: 10.1155/2023/7335196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
Iatrogenic root perforation presents a significant management challenge for clinicians as it may seriously harm the periodontium. More specifically, perforations occurring relative to the crestal bone have a poor prognosis even after repair due to their proximity to the gingival tissues. The current literature reports the use of various materials for root perforation repair including calcium hydroxide, glass ionomer cement, amalgam, and mineral trioxide aggregate (MTA), to name a few. This case report describes the clinical management of a cervical perforation that occurred on the maxillary central incisor. The perforated area was initially repaired with MTA but failed after one year, which resulted in an active lesion at the midlabial aspect of the tooth. The case was subsequently treated using a resin-modified glass ionomer cement (Geristore®) and deepithelialized free gingival graft (DGG). There were favorable clinical and radiographic outcomes at 1-, 3-, and 5-year follow-up. The use of DGG, however, led to some late complications such as gingival cul-de-sac and color discrepancy, which were later resolved with gingivoplasty and frenectomy. We thus conclude that Geristore® has the potential to be a better repair material than the existing ones for crestal and subcrestal root perforations.
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Affiliation(s)
- Talal M. Zahid
- Department of Periodontology, King Abdulaziz University, Jeddah, Saudi Arabia
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16
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Carvalho JA, Franco C, Proença L, Neves JA, Polido M, Mendes JJ, Azul AM. Spectrophotometric Analysis of Coronal Discoloration In Vitro Induced by Bioceramic Cements. Dent J (Basel) 2023; 11:180. [PMID: 37504246 PMCID: PMC10377855 DOI: 10.3390/dj11070180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
The aim of this study was to evaluate and quantify, in vitro, the extent of coronal discoloration induced by bioceramic materials over time. In total, 44 human monoradicular teeth were divided into four groups (n = 11), according to the applied material: Negative control (NC); White MTA ProRoot® (WMTAP); Biodentine™ (BD); and TotalFill® BC RRM™ Putty (TF). Teeth were immersed in saline solution and incubated at 37 °C; the following periods of time were defined: before incubation: [t0]-without bioceramic material, t1-immediately after the bioceramic material placement; after incubation: t24h-24 h, t7d-7 days, and 30d-30 days. Descriptive and inferential statistical analysis were performed. Cochran's Q test was used to evaluate coronal discoloration across the different groups, while the Kruskal-Wallis test was employed to determine differences in discoloration among the groups at each time interval. Additionally, the Friedman test was applied to analyze the variations in discoloration within each group over time. A significance level of 5% was set. All experimental groups revealed coronal discoloration over time: NC (p = 0.001), WMTAP (p < 0.001), BD (p = 0.001), and TF (p = 0.006). No significant differences were observed between groups for each time interval (p > 0.05). The WMTAP group varied the most considering the intervals [t0-t1] and [t24h-t7d] (p = 0.037) compared to the remaining experimental groups.
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Affiliation(s)
- Joana A Carvalho
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
| | - Carlos Franco
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
| | - Luís Proença
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
| | - João Albernaz Neves
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
| | - Mário Polido
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
| | - José João Mendes
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
| | - Ana Mano Azul
- Egas Moniz School of Health and Science, Monte de Caparica, 2829-511 Almada, Portugal
- Egas Moniz Center for Interdisciplinary Center (CiiEM), Monte de Caparica, 2829-511 Almada, Portugal
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17
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Iandolo A. Modern Advances in Microendodontics: The State of the Art. Bioengineering (Basel) 2023; 10:789. [PMID: 37508816 PMCID: PMC10376487 DOI: 10.3390/bioengineering10070789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
The concept of "minimally invasive" advances is becoming increasingly popular in the endodontic field [...].
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
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18
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Joshi S, Gandage D, Thakare E, Mahagaonkar PA, Gadda R, Palekar AU. A Comparative Evaluation of the Fracture Resistance of Mineral Trioxide Aggregate (MTA) Plus and MTA Angelus: An In Vitro Study. Cureus 2023; 15:e40385. [PMID: 37456459 PMCID: PMC10344682 DOI: 10.7759/cureus.40385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/18/2023] Open
Abstract
Background Mineral trioxide aggregate (MTA) is a biocompatible dental material used for root-end filling in endodontics. A wide variety of literature has been published on the assessment of fracture resistance of MTA. However, the results were conflicting in the reported studies, and the sample size used was insufficient to conclude the efficacy of materials such as MTA Plus and MTA Angelus. Therefore, this study was designed to compare and evaluate the effectiveness of two commercially available MTAs, namely, MTA Plus (Avalon Biomed Inc. by Prevest Denpro Ltd, Jammu, India) and MTA Angelus (Angelus Dental Solutions, Brazil) in terms of fracture resistance. Methodology To determine fracture resistance, 300 freshly extracted healthy human teeth with single roots and canals were collected by simple random sampling. Teeth were decoronated, the apical third was enlarged, and root canals were prepared to receive MTA as a 5 mm apical filling. The root segments were randomly categorized into two experimental groups of 100 samples each, namely, group A (MTA Plus) and group B (MTA Angelus), and the remaining 100 root segments were used as control (unfilled). Fracture resistance was determined using the Instron Universal testing machine. Results The results of our study showed statistically significant increased fracture resistance for MTA Plus (532.14 ± 5.19 N) than MTA Angelus (540.81 ± 3.56 N) and the control group (460.63 ± 7.91 N). Conclusions The control group showed the least fracture resistance. The composition and structure of MTA Angelus (group B) containing Portland cement, with a 4:1 addition of bismuth oxide, make it more fracture resistant than MTA Plus (group A).
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Affiliation(s)
- Saurabh Joshi
- Department of Pediatric Dentistry, Rural Dental College, Pravara Institute of Medical Sciences, Loni, IND
| | - Dhananjay Gandage
- Department of Prosthodontics, Dr D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, IND
| | - Esha Thakare
- Department of Oral Pathology and Microbiology, SGP Nanded Rural Dental College and Research Centre, Nanded, IND
| | | | - Rohit Gadda
- Department of Oral Medicine and Radiology, Mahatma Gandhi Mission Dental College and Hospital, Navi Mumbai, IND
| | - Aparna U Palekar
- Department of Conservative Dentistry and Endodontics, Rural Dental College, Pravara Institute of Medical Sciences, Loni, IND
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