Biological Effects of New Hydraulic Materials on Human Periodontal Ligament Stem Cells

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.

Examining the Physicochemical Composition of Three Bioceramic Putties for Endodontic Use

OBJECTIVE

This study aimed to address the lack of comparative analyses of newly developed bioceramic materials by examining the chemical composition, thermodynamic profile, and microscopic surface features of three bioceramic putties: EndoSequence BC Root Repair Material Fast Set Putty (ESRRM-FS), BIO-C Repair (BCR), and Cera Putty (CP).

METHODS

Samples of each of the three bioceramic putty obtained directly from manufacturers were prepared for analysis of physicochemical composition and microscopic features by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) imagery, and energy-disper-sive X-ray spectroscopy (EDS). The data obtained was qualitatively and statistically analysed. Statistical signif-icance was determined at p≤0.05.

RESULTS

DSC analysis indicated a standard polymeric vehicle for BCR and CP, coinciding with the polyethene glycol (PEG) thermal profile; the polymeric vehicle in ESRRM-FS remains to be identified. The material with the highest heat capacity was CP (p<0.05), followed by ESRRM-FS and BCR. TGA revealed an inflexion point at 394.12 ºC for ESRRM-FS, which may correspond to the mass loss of dihydroxylation of calcium hydroxide. A more homogenous structure was observed in scanning electron microscopy (SEM) images for ESRRM-FS. EDS analysis indicated BCR had minimal amounts of aluminium (2.06+-0.44%) and a lower percentage of cal-cium than ESRRM-FS (9.11+-1.38% vs. 11.3+-0.87%). CP was composed of aluminium (49.35+-7.01%), carbon (30.65+-5.62%), and oxygen (16.75+-2.44%); no silicon was identified. ESRRM-FS had no aluminium present and the highest calcium percentage (11.3+-0.87%) (p<0.05).

CONCLUSION

BCR is a Portland cement-derived material with a lower percentage of calcium than ESRRM-FS and minimal amounts of aluminium. CP is a monocalcium aluminate cement, mainly composed of aluminium, carbon, and oxygen. ESRRM-FS is a biphasic material with the highest calcium percentage among all materials studied and no aluminium.

Biocompatibility, bioactivity, porosity, and sealer/dentin interface of bioceramic ready-to-use sealers using a dentin-tube model

This study evaluated the biocompatibility, bioactivity, porosity, and sealer/dentin interface of Sealer Plus BC (SP), Bio-C Sealer (BIOC), TotalFill BC Sealer (TF), and AH Plus (AHP). Dentin tubes filled with the sealers and empty tubes (control group) were implanted in the subcutaneous tissue of rats for different periods (n = 6 per group/period). Number of inflammatory cells (ICs), capsule thickness, von Kossa reaction, interleukin-6 (IL-6) and osteocalcin (OCN) were evaluated. Porosity and voids in the interface dentin/sealers were assessed by micro-computed tomography. The data were submitted to ANOVA/Tukey's tests (α = 0.05). Greater capsule thickness, ICs and IL-6 immunolabeling cells were observed in AHP. No significant difference in thickness of capsule, ICs, and IL-6- immunolabeling cells was detected between SP and TF, in all periods, and after 30 and 60 days between all groups. At 60 days all groups had reduction in capsule thickness, ICs and IL-6 immunolabeling cells. Von Kossa-positive and birefringent structures were observed in the capsules around the sealers. BIOC, SP, and TF exhibited OCN-immunolabeling cells. All sealers had porosity values below 5%, besides low and similar interface voids. BIOC, SP and TF are biocompatible, bioactive, and have low porosity and voids. The dentin-tube model used is an alternative for evaluating bioceramic materials.

Stereomicroscopic evaluation of sealing ability of four different root canal sealers: an in-vitro study

AIM

To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study.

MATERIAL/METHOD

80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey's test.

RESULT

The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey's test reveals that the difference was statistically non-significant between group III and group IV.

CONCLUSION

It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C).

[Treatment tactics in children with crown-root fractures of permanent teeth]

The main principles of management of children with root fractures of permanent teeth in the coronal third are presented using two clinical cases as an example. In the treatment of root fractures in the coronal third, an important condition for success is timely flexible or semi-flexible splinting of the tooth for a sufficiently long period (up to 4 months). In the absence of splinting or significant mobility of the coronal fragment after removal of the splint the probability of pulp necrosis is very high, and the method of choice is treatment with calcium silicate cements with their introduction by orthograde or surgical access. Significant mobility of the coronal fragment excluding stable healing with the formation of a hard-tissue connection is an indication for decoronation, while orthodontic extrusion in combination with surgical lengthening makes it possible to use the preserved root as a support for the orthopedic structure.

Biological properties of Ceraputty as a retrograde filling material: an in vitro study on hPDLSCs

OBJECTIVES

To assess the cytocompatibility and bioactive potential of the new calcium silicate-based cement Ceraputty on human periodontal ligament stem cells (hPDLSCs) compared to Biodentine and Endosequence BC root repair material (ERRM).

MATERIALS AND METHODS

hPDLSCs were isolated from extracted third molars from healthy donors. Standardized sample discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following assays were performed: surface element distribution via SEM-EDX, cell attachment and morphology via SEM, cell viability via a MTT assay, osteo/cemento/odontogenic marker expression via RT-qPCR, and cell calcified nodule formation via Alizarin Red S staining. hPDLSCs cultured in unconditioned or osteogenic media were used as negative and positive control groups, respectively. Statistical analysis was performed using one-way ANOVA or two-way ANOVA and Tukey's post hoc test. Statistical significance was established at p < 0.05.

RESULTS

The highest Ca2+ peak was detected from Biodentine samples, followed by ERRM and Ceraputty. hPDLSC viability was significantly reduced in Ceraputty samples (p < 0.001), while 1:2 and 1:4 Biodentine and ERRM samples similar results to that of the negative control (p > 0.05). Biodentine and ERRM exhibited an upregulation of at least one cemento/odonto/osteogenic marker compared to the negative and positive control groups. Cells cultured with Biodentine produced a significantly higher calcified nodule formation than ERRM and Ceraputty (p < 0.001), which were also higher than the control groups (p < 0.001).

CONCLUSION

Ceraputty evidenced a reduced cytocompatibility towards hPDLSCs on its lowest dilutions compared to the other tested cements and the control group. Biodentine and ERRM promoted a significantly higher mineralization and osteo/cementogenic marker expression on hPDLSCs compared with Ceraputty. Further studies are necessary to verify the biological properties of this new material and its adequacy as a retrograde filling material.

CLINICAL RELEVANCE

This is the first study to elucidate the adequate biological properties of Ceraputty for its use as a retrograde filling material.

The effects of heating on the physicochemical properties of tricalcium silicate root canal sealers

This study evaluated the effect of heating on the physicochemical properties and surface changes of tricalcium silicate sealers. Three tricalcium silicate root canal sealers (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer), and one epoxy resin-based sealer (AH Plus; control) were tested. The effect of heating on setting time (ST) and flowability were assessed according to ANSI/ADA 57 and ISO 6876 standards. Solubility and dimensional change (DC) of the set sealers were evaluated at 24 hours and after 30 days; the pH of the water used in the DC testing was also measured. Tests were repeated with heated sealers in an oven at 100 °C for 1 min. SEM and EDS analysis were performed. Data were analyzed using One-Way ANOVA and Tukey post-hoc tests (α=5%). Heating decreased the ST for AH Plus and EndoSequence (p<0.05). Heating reduced flowability (p<0.05) and increased pH for AH Plus (p<0.05). The solubility of Bio-C (dried specimens) was not in accordance with the ANSI/ADA standard. The solubility of EndoSequence was significantly higher (p<0.05) when it was heated and dried after 30 days. DC of Bio-C (24 h and 30 days), BioRoot-RCS (30 days) and AH Plus (24 h and 30 days) were not in accordance with the standards. SEM and EDS analysis showed significant changes in sealer microstructure after heating. In conclusion, heating decreased the ST and increased the solubility of EndoSequence BC sealer. No significant changes in flowability, DC, and pH were identified for all three tricalcium silicate sealers after heat application. However, all sealers had significant surface changes.

Evaluation of the Cytocompatibility of Fluoride Varnish and Its Effect on Human Gingival Fibroblasts (hGFs): An In Vitro Study

Introduction Untreated dental decay poses a significant oral health challenge, leading to pain, tooth loss, and infections. Fluoride varnishes are in prolonged contact with the tooth surface and this prevents dental decay. However, limited research has been conducted regarding the cytotoxicity and cytocompatibility of varnishes on oral cells. Recent studies have shed light on the cytotoxic effect of these varnishes on human fibroblast cells. Material and Methods The fibroblasts were isolated and cultured in 0.00001, 0.0001, 0.001, 0.01, 0.1, and 1 % fluoride concentration The cells were incubated for 72 hours at a temperature of 37°C and cell viability after the application of varnish was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide (MTT) assay. Results This study observed that fluoride varnish had a concentration dependant cytotoxic effect on human gingival fibroblasts (hGFs). As the concentration of fluoride increased, the cell viability decreased. At 1% concentration, there was maximum cell cytotoxicity. At the lowest concentration (0.00001), more than 78% of the cells were found to be viable. Conclusion Further research is necessary to develop safer and more biocompatible fluoride varnish formulations to ensure their efficacy in preventing dental caries without causing harm to oral tissues.

Response of stem cells derived from human exfoliated deciduous teeth to Bio-C Repair and Mineral Trioxide Aggregate Repair HP: Cytotoxicity and gene expression assessment

Background

The aim of this study was to investigate and compare the cytotoxicity and gene expression of Bio-C Repair, Mineral Trioxide Aggregate (MTA) HP Repair, and Biodentine on stem cells derived from exfoliated deciduous teeth.

Materials and Methods

In this in vitro study MTT assay was used to assess the cellular viability at three different dilutions. The gene expression of Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), osteocalcin [OCN], and dentin matrix protein-1 (DMP-1) was measured with real-time polymerase chain reaction after 7 days, 14 days, and 21 days of incubation. One-way analysis of variance and Bonferroni posttest were used for statistical analysis (p=o.o5).

Results

After 72 h of incubation at dilution 1:4, stem cells derived from human exfoliated deciduous teeth (SHEDs) cultivated in Biodentine, followed by Bio-C Repair and MTA Repair HP reported with highest cellular viability. The highest mRNA expression of Runx2, ALP, OCN, and DMP-1 was reported in SHEDs cultured in Biodentine (after 21 days of incubation).

Conclusion

Bio-C Repair and MTA HP Repair are biocompatible and capable of odontogenic differentiation similar to Biodentine when cultured in stem cells derived from exfoliated primary teeth.

In Vivo Assessment of the Apatite-Forming Ability of New-Generation Hydraulic Calcium Silicate Cements Using a Rat Subcutaneous Implantation Model

Hydroxyapatite formation on endodontic hydraulic calcium silicate cements (HCSCs) plays a significant role in sealing the root canal system and elevating the hard-tissue inductivity of the materials. This study evaluated the in vivo apatite-forming ability of 13 new-generation HCSCs using an original HCSC (white ProRoot MTA: PR) as a positive control. The HCSCs were loaded into polytetrafluoroethylene tubes and implanted in the subcutaneous tissue of 4-week-old male Wistar rats. At 28 days after implantation, hydroxyapatite formation on the HCSC implants was assessed with micro-Raman spectroscopy, surface ultrastructural and elemental characterization, and elemental mapping of the material-tissue interface. Seven new-generation HCSCs and PR had a Raman band for hydroxyapatite (v1 PO₄^3- band at 960 cm^-1) and hydroxyapatite-like calcium-phosphorus-rich spherical precipitates on the surfaces. The other six HCSCs with neither the hydroxyapatite Raman band nor hydroxyapatite-like spherical precipitates did not show calcium-phosphorus-rich hydroxyapatite-layer-like regions in the elemental mapping. These results indicated that 6 of the 13 new-generation HCSCs possessed little or no ability to produce hydroxyapatite in vivo, unlike PR. The weak in vivo apatite-forming ability of the six HCSCs may have a negative impact on their clinical performance.

Cytotoxicity evaluation of Bio-C, CeraSeal, MTA - Fillapex, and AH Plus root canal sealers by microscopic and 3-(4, 5 dimethythiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay

Aim

The aim of this study was to compare the cytotoxic effect of calcium silicate-based Bio-C, CeraSeal, and mineral trioxide aggregate (MTA)-based (MTA-Fillapex) sealers to a widely used resin-based sealer (AH Plus) using 3-(4, 5 dimethythiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and microscopic examination.

Materials and Methods

A total of (n = 36) samples divided into four groups with three sealer samples per time period of 0 h, 24 h, and 7 days after mixing were extracted in cell culture medium using Dulbecco's Modified Eagle's Medium. The cytotoxicity of these sealers was evaluated using an MTT assay on L929 mouse fibroblasts, and changes in the cell morphology were observed under an inverted phase-contrast microscope (×20). The values obtained were analyzed statistically using one-way ANOVA, Tukey's post hoc, and Bonferroni's test.

Results

Bio-C and CeraSeal showed a reduction in cytotoxicity from severe at 0 h to no cytotoxicity at 24 h and 7 day time period. AH Plus showed severe cytotoxicity at all time periods. MTA-Fillapex showed severe cytotoxicity at 0 h which decreased to moderate at 24 h and 7 days. The differences between groups were statistically significant (P < 0.05).

Conclusions

The sealers with resin constituents (AH Plus and MTA-Fillapex) showed severe-to-moderate cytotoxicity at different time periods, whereas calcium silicate-based sealers (Bio-C and CeraSeal) were relatively biocompatible as their cytotoxicity decreased significantly from severe initially to noncytotoxic with time.

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

The aim of this study was to evaluate the physicochemical properties, cytotoxicity and bioactivity of a ready-to-use bioceramic material, Bio-C Repair (Angelus), in comparison with White MTA (Angelus) and Biodentine (Septodont). The physicochemical properties of setting time, radiopacity, pH, solubility, dimensional and volumetric changes were evaluated. Biocompatibility and bioactivity were assessed in Saos-2 osteoblast cell cultures by the MTT assay 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), Neutral Red (NR), Alizarin Red (ARS), and cell migration tests. Statistical analysis was performed by ANOVA, Tukey or Bonferroni tests (α = 0.05). Bio-C Repair had the longest setting time (p < 0.05), but radiopacity and solubility were accordance with the ISO 6876/2012 standards, besides linear expansion. Bio-C Repair and MTA had similar volumetric change (p > 0.05); lower than Biodentine (p < 0.05). All the materials evaluated had an alkaline pH. Bio-C Repair was cytocompatible and promoted mineralized nodule deposition in 21 days and cell migration in 3 days. In conclusion, Bio-C Repair had adequate radiopacity above 3mm Al, solubility less than 3%, dimensional expansion, and low volumetric change. In addition, Bio-C Repair promoted an alkaline pH and presented bioactivity and biocompatibility similar to MTA and Biodentine, showing potential for use as a repair material.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set

Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

Cytotoxicity and bioactive potential of new root repair materials for use with BMP-2 transfected human osteoblast cells

Modified formulations of calcium silicate repair materials with additives have been developed to enhance handling, consistency, biocompatibility and bioactivity. Considering the relevance of osteoblastic cell response to mineralized tissue repair, human osteoblastic cells (Saos-2 cells overexpressing BMP-2) were exposed to mineral trioxide aggregate (MTA) (with calcium tungstate - CaWO4), MTA HP Repair, Bio-C Repair and Bio-C Pulpo. Cell viability was assessed by 3-(4,5-dimethylthiazol)-2,5-diphenyltetrazolium bromide (MTT) and neutral red (NR), and cell death, by flow cytometry. Gene expression of bone morphogenetic protein 2 (BMP-2), runt-related transcription factor 2 (RUNX-2), and alkaline phosphatase (ALP) osteogenic markers were evaluated by real-time polymerase chain reaction (RT-qPCR). ALP activity and alizarin red staining (ARS) were used to detect mineralization nodule deposition. Bioactive cements presented no cytotoxic effect, and did not induce apoptosis at the higher dilution (1:12). MTA, Bio-C Repair and Bio-C Pulpo exhibited higher ALP activity than the control group (P < 0.05) after 7 days. MTA, MTA HP and Bio-C Pulpo affected the formation of mineralized nodules (p < 0.05). Exposure to all cement extracts for 1 day increased BMP-2 gene expression. RUNX-2 mRNA was greater in MTA, MTA HP and Bio-C Repair. MTA, MTA HP and Bio-C Pulpo increased the ALP mRNA expression, compared with BMP-2 unexposed cells (P < 0.05). Calcium silicate cements showed osteogenic potential and biocompatibility in Saos-2 cells transfected BMP-2, and increased the mRNA expression of BMP-2, RUNX-2, and ALP osteogenic markers in the BMP-2 transfected system, thereby promoting a cellular response to undertake the mineralized tissue repair.

Influence of dual-cure and self-cure abutment cements for crown implants on human gingival fibroblasts biological properties

AIMS

To analyze the biological effects of the cements Relyx Unicem 2, Panavia V5, Multilink Hybrid Abutment and SoloCem on human gingival fibroblast cells (HGFs).

MATERIALS AND METHODS

HGFs were exposed to different eluates (n = 40) of the studied resin-based cements. Their cytotoxic effects and influence on cell migration were assessed using MTT and wound-healing assays, respectively. Level of HGF attachment, cell morphology and F-actin cytoskeleton content after exposition to the different eluates were analyzed by scanning electron microscopy (SEM) and confocal microscopy analysis, respectively. The levels of intracellular reactive oxygen species (ROS) produced by the eluates of the different cements were also determined by flow cytometry. Data were analyzed by one-way analysis of variance (ANOVA) followed by Tukey´s test.

RESULTS

Eluates of SoloCem significantly reduces the viability of HGFs (69% reduction compared to control at 48 h). Cell migration of HGFs in presence of undiluted SoloCem eluates was significantly lower than in the control (88% open wound area at 24 h). Contrarily, migration speed with Multilynk eluates was similar to that of the control group at all periods of time and all dilutions studied. SEM analysis showed very few cells in SoloCem group, and a moderate cell growth in Multilink, Panavia and Relyx groups were detected. Finally, ROS levels detected in HGFs treated with the more concentrated SoloCem and Relyx dilutions were significantly enhanced compared with that in the control cells or the other groups (44% and 11% ROS positive cells, respectively).

CONCLUSIONS

The results obtained in the present work suggest that Multilink hybrid abutment has better biological properties and lower cytotoxicity for cementing implant crowns on abutments.

Biological parameters, discolouration and radiopacity of calcium silicate-based materials in a simulated model of partial pulpotomy

AIM

To analyse the discolouration, radiopacity, pH and calcium ion release of Biodentine (BD), Bio-C repair (BCR) and Bio-C temp (BCT), as well as their biological effects on human dental pulp cells (hDPCs).

METHODOLOGY

Sixty-four extracted bovine incisors were prepared to simulate crown fractures with pulp exposure and open root apex. The roots were filled using a mixture of agar and blood (control), and BD, BCR or BCT were placed over this mixture. Colour assessment analyses of the samples were performed before and immediately after material insertion and repeated at 30 and 90 days, using a spectrophotometer. The colour change of each specimen was evaluated at the crown and calculated based on the CIELab colour space. Digital radiographs were acquired for radiopacity analysis. hDPCs were placed in contact with different dilutions of culture media previously exposed to such materials and tested for cell viability using the MTT assay. The pH and calcium ion release of all materials were measured after 24 h; the data were assessed using one-way analysis of variance (ANOVA). Cell viability was analysed by two-way ANOVA. Differences in colour parameters and wound-healing data were assessed by two-way repeated measures ANOVA (α = 0.05). Tukey's and Dunnett's tests were used to compare the experimental groups with the control group.

RESULTS

BCR had grater radiopacity and smaller colour alteration (ΔEab/ΔE00) than the other materials tested (p < .005; p < .001). No significant differences in pH were found amongst the tested materials (p > .05). BCT was associated with the largest release of calcium ions (p < .0001). BD had cell viability similar to that of the control at the lowest dilutions, and BCR was similar to that of the control, regardless of the dilution tested (p > .05). BCT had a lower percentage of viability than that of the control at all tested dilutions (p < .0001). Cell migration rates in BD and BCR were similar to those in the control group after 24 h and 48 h (p > .05), whilst BCT had larger voids than the control in both periods (p < .0001).

CONCLUSIONS

BCR, BCT and BD were associated with tooth discolouration. BCR had the lowest staining values, the highest radiopacity and viability greater than 80% hDPCs.

Biomineralization potential and biological properties of a new tantalum oxide (Ta2O5)-containing calcium silicate cement

Objective

The present study evaluated the biological effects and biomineralization potential of a new tantalum oxide (Ta₂O₅)–containing material designed for vital pulp therapy or perforation repair (NeoMTA 2), compared to NeoMTA Plus and Bio-C Repair.

Material and methods

Human dental pulp stem cells (hDPSCs) were exposed to different eluates from NeoMTA Plus, NeoMTA 2, and Bio-C Repair. Ion release from each material was determined using inductively coupled plasma-optical emission spectrometry (ICP-MS). The biological experiments performed were MTT assays, apoptosis/necrosis assays, adhesion assays, migration assays, morphology evaluation, and reactive oxygen species (ROS) production analysis. Biomineralization was assessed by Alizarin red S staining. Finally, osteo/odontogenic gene expression was determined by real-time quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR). Data were analyzed using one-way ANOVA followed by Tukey’s multiple comparison test.

Results

NeoMTA 2 displayed a significantly higher calcium release compared to the other materials (p < 0.05). When hDPSCs were cultured in presence of the different material eluates, all groups exhibited similar hDPSC viability and migration rates when compared to untreated cells. Substantial cell attachment and spreading were observed in all materials’ surfaces, without significant differences. hDPSCs treated with NeoMTA 2 displayed an upregulation of ALP, Col1A1, RUNX2 (p < 0.001), ON, and DSPP genes (p < 0.05), and showed the highest mineralization potential compared to other groups (p < 0.001). Finally, the more concentrated eluates from these materials, specially NeoMTA Plus and NeoMTA 2, promoted higher ROS production in hDPSCs compared to Bio-C Repair and control cells (p < 0.001), although these ROS levels did not result in increased cell death.

Conclusions

The new tantalum oxide (Ta₂O₅)–containing material shows an adequate cytocompatibility and the ability to promote biomineralization without using chemical osteogenic inducers, showing great potential as a new material for vital pulp therapy.

Clinical relevance

NeoMTA 2 seems to be a promising material for vital pulp therapy. Further studies considering its biocompatibility and biomineralization potential are necessary.

Bio-C Repair - A New Bioceramic Material for Root Perforation Management: Two Case Reports

These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up.

A micro-computed tomographic study using a novel test model to assess the filling ability and volumetric changes of bioceramic root repair materials

Objectives

New premixed bioceramic root repair materials require moisture for setting. Using micro-computed tomography (micro-CT), this study evaluated the filling ability and volumetric changes of calcium silicate-based repair materials (mineral trioxide aggregate repair high-plasticity [MTA HP] and Bio-C Repair, Angelus), in comparison with a zinc oxide and eugenol-based material (intermediate restorative material [IRM]; Dentsply DeTrey).

Materials and Methods

Gypsum models with cavities 3 mm deep and 1 mm in diameter were manufactured and scanned using micro-CT (SkyScan 1272. Bruker). The cavities were filled with the cements and scanned again to evaluate their filling capacity. Another scan was performed after immersing the samples in distilled water for 7 days to assess the volumetric changes of the cements. The statistical significance of differences in the data was evaluated using analysis of variance and the Tukey test with a 5% significance level.

Results

Bio-C Repair had a greater filling ability than MTA HP (p < 0.05). IRM was similar to Bio-C and MTA HP (p > 0.05). MTA HP presented the largest volumetric change (p < 0.05), showing more volume loss than Bio-C and IRM, which were similar (p > 0.05).

Conclusions

Bio-C Repair is a new endodontic material with excellent filling capacity and low volumetric change. The gypsum model proposed for evaluating filling ability and volumetric changes by micro-CT had appropriate and reproducible results. This model may enhance the physicochemical evaluation of premixed bioceramic materials, which need moisture for setting.

Biocompatibility of a High-Plasticity, Calcium Silicate-Based, Ready-to-Use Material

The Bio-C Sealer is a recently developed high-plasticity, calcium-silicate-based, ready-to-use material. In the present study, chemical elements of the materials were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). The biocompatibility of the Bio-C Sealer was investigated using cytotoxicity tests and histological responses in the roots of dogs’ teeth. XRD, SEM, and FTIR produced hydrated calcium silicate in the presence of water molecules. In addition, FTIR showed the formation of calcium hydroxide and polyethylene glycol, a dispersing agent. The 1:4 dilutions of Bio-C Sealer presented weaker cytotoxicity than the Calcipex II in an in vitro system using the V-79 cell line. After 90 d, the periradicular tissue response of beagle dog roots was histologically evaluated. Absence of periradicular inflammation was reported in 17 of the 18 roots assessed with the Bio-C Sealer, whereas mature vertical periodontal ligament fibers were observed in the apical root ends filled with the Bio-C Sealer. Based on these results and previous investigations, the Bio-C Sealer is recommended as an effective root-end filling material. These results are relevant for clinicians considering the use of Bio-C Sealer for treating their patients.

Comparative Surface Morphology, Chemical Composition, and Cytocompatibility of Bio-C Repair, Biodentine, and ProRoot MTA on hDPCs

Biocompatibility is an essential property for any vital pulp material that may interact with the dental pulp tissues. Accordingly, this study aimed to compare the chemical composition and ultrastructural morphology of Biodentine (Septodont, Saint Maur-des-Fosses, France), ProRoot MTA (Dentsply Tulsa Dental Specialties, Johnson City, TN, USA), and Bio-C Repair (Angelus, Londrina, PR, Brazil), as well as their biological effects on human dental pulp cells. Chemical element characterization of the materials was undertaken using scanning electron microscopy and energy dispersive X-ray analysis (SEM-EDX). The cytotoxicity was assessed by analyzing the cell viability (MTT assay), cell morphology (immunofluorescence assay), and cell attachment (flow cytometry assay). The results were statistically analyzed using ANOVA and Tukey’s test (p < 0.05). EDX revealed that ProRoot MTA and Biodentine were mostly composed of calcium, carbon, and oxygen (among others), whereas Bio-C Repair evidenced a low concentration of calcium and the highest concentration of zirconium. SEM showed adequate attachment of human dental pulp cells (hDPCS) to vital pulp materials and cytoskeletal alterations were not observed in the presence of material eluates. Remarkably, the undiluted Biodentine group showed higher viability than the control group cells (without eluates) at 24 h, 48 h, and 72 h (p < 0.001). Based on the evidence derived from an in vitro cellular study, it was concluded that Bio-C Repair showed excellent cytocompatibility that was similar to Biodentine and ProRoot MTA.