Article

Ion Release, Porosity, Solubility, and Bioactivity of MTA Plus Tricalcium Silicate

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Abstract

Objective: The aim was to evaluate MTA PlusTM material’s properties, namely calcium release, the pH change, solubility, water sorption, porosity, surface morphology and apatite-forming ability after immersion in simulated body fluid. Method: Two tricalcium silicate powders (MTA PlusTM, ProRoot® MTA) and Dycal® were tested. After incubation at 37°C and 99% relative humidity the calcium and hydroxyl ion release were tested up to 28 days in deionized water at 37°C. Water absorption, interconnected pores, apparent porosity and solubility were measured after 24 hr immersion in deionized water at 37°C. The morphological and elemental analysis of the materials’ surfaces were examined using ESEM/EDX after storage at 37°C for 1 to 28 days in simulated body fluid (SBF) using the ISO 23317 method. Results: All 3 materials created an alkaline pH within 3 hours, which continued for 28 days. MTA Plus had higher ion release than ProRoot MTA and Dycal; the use of the MTA Plus gel enhanced the initial calcium release and the increase of the pH. Both MTA materials were more porous, water-soluble and water-sorptive than Dycal, but also more bioactive. After aging in SBF, MTA Plus material caused precipitation of an apparent calcium phosphate layer. Conclusions: MTA Plus showed an improved reactivity and prolonged capability to release calcium and increase the local pH to alkaline values in comparison with ProRoot MTA. These pronounced ion-releasing properties are interlinked with its noticeable porosity, water sorption and solubility and with the formation of CaP minerals. The finer calcium silicate powder may explain the higher ion release, water sorption, porosity and solubility of MTA Plus compared to ProRoot MTA.For clinicians MTA Plus represents a lower cost bioactive tricalcium silicate material with interesting chemical-physical properties that could be a convenient alternative to the conventional calcium silicate MTA-like cements.

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... It is proposed for treating dental pulp (pulp capping liner, pulpotomy) and root canals (root-end filling, perforation repair, root resorption, apexification, pulpectomy). Different setting times and physical-rheologic properties can be obtained using the gel and varying the powder to gel ratio [7,[22][23][24][25]. MTA Plus represents a lower-cost, bioactive calcium silicate-based material as a convenient alternative to the conventional calcium silicate MTAlike cements [22]. ...
... Different setting times and physical-rheologic properties can be obtained using the gel and varying the powder to gel ratio [7,[22][23][24][25]. MTA Plus represents a lower-cost, bioactive calcium silicate-based material as a convenient alternative to the conventional calcium silicate MTAlike cements [22]. MTA Plus presents no cytotoxicity, increases mineralization processes in vitro, and induces the expression of osteogenic markers [24]. ...
... The released hydroxyl ions during the hydration reaction turn the pH environment into alkaline, which inhibits the proliferation of bacteria [4,21,39]. The nature of the mineral particles and cement network structure determinate ion release [8,22]. In the present study, the alkalinizing properties of TheraCal LC (Bisco Inc., Schaumburg, IL, USA), MTA Plus (Avalon Biomed Inc., Bradenton, FL), Biodentine (Septodont, Saint-Maurdes-Fossés, France), RetroMTA (BioMTA, Seoul, Korea), MTA Flow (Ultradent Products, Inc., South Jordan, UT, USA), and OrthoMTA (BioMTA, Seoul, Korea) were evaluated. ...
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Introduction: Calcium silicate-based cements (CSC), are self-setting hydraulic biomaterials widely used for reparative procedures in dentistry and endodontics. These materials possess physical properties, such as ion release, porosity, solubility, and radiopacity. Their biological properties are connected to their alkalizing activity and calcium release capacity. Materials and methods: Six calcium silicate-based materials were selected for this study: TheraCal LC (Bisco Inc., Schaumburg, IL, USA), MTA Plus (PrevestDenpro, Jammu, India Avalon Biomed Inc., Bradenton, FL, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), RetroMTA (BioMTA, Seoul, Korea), MTA Flow (Ultradent Products, Inc., South Jordan, UT, USA), and OrthoMTA (BioMTA, Seoul, Korea). The pH was analyzed immediately after immersion (baseline) and after 1 h, 3 h, 1 day, 2 days, 3 days, 1 week, 2 weeks, 3 weeks, and 1 year with a pH meter, previously calibrated with solutions of known pH. All testing materials had alkaline pH. Results: Analysis of the tested materials showed statistically significant differences in terms of pH changes as a function of the time showed a gradual rise in the pH of all materials. Conclusions: All tested materials exhibited continuous hydroxyl ion release resulting in a rise in pH until the end of time of experience.
... Bioactivity is the ability to form apatite of calcium phosphate deposits after soaking in simulated body fluids; such ability presents the ground for the biocompatibility of inorganic biomaterials. Bioactive materials create an environment that can enhance osteogenesis, mostly through bonding to living bone tissue using the apatite layer formed on its surface once introduced into the living body (17)(18)(19)(20) deposits since the electron beam penetration at 20-keV acceleration was 2.98 μm. A low Ca/P ratio of about 1.49 was also observed. ...
... The obvious variability in outcome among bioactivity studies could be explained by differences in experimental designs and lack of technique standardisation. For example, in some studies, soaking solutions were refreshed daily (41,42), or every three days (43)(44)(45), or even every seven days (19,39) or soaked for 21 days without refreshing (46). Finally, the detection of apatite crystals in in-vitro models for the bioactivity assessment is still questionable, and the role of environmental factors, such as temperature, pH, carbon dioxide partial pressure, and agitation, has often been overlooked as reported by several authors (47,48). ...
... The Ca/P ratio could act as an indicator of the precipitation phase. The formation of carbonated apatite correlates with increased Ca/P ratios (26,35), therefore, calcium carbonate formation can be presumed when the Ca/P ratio exceeded 1.67 (19). ...
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Objective: The bioactivities of TotalFill BC and the MTA Fillapex sealers were evaluated. Methods: Sixty horizontal root sections were enlarged to size 5 Gates Glidden and randomly divided into six groups (n=10 in each group). In Groups 1–3, sections were filled with TFBCS, while sections in groups 4–6 were filled with MTAFS. Specimens from groups 1 and 4 were soaked in simulated body fluid (SBF) for one day, those from groups 2 and 5 for one week, and those from groups 3 and 6 for two months. All specimens were processed for scanning electron microscope (SEM) examination. Apatite precipitation on sealer and sealer–dentine interfaces was quantified using image analysis software (ImageJ). Energy dispersive X-ray (EDX) was used to analyse calcium (Ca) and phosphate (P) contents of surface precipitation on which calculation of the calcium phosphate (Ca/P) ratio was based. Results: TFBCS samples, regardless of the duration of SBF soaking, yielded a significantly higher surface area of precipitation compared to MTAFS (P<0.05); such precipitation increased over time, and the differences among the three time-points were also statistically significant. Following one day of SBF soaking, MTAFS samples showed only limited precipitation that started to appear after one week. EDX showed that Ca content and the Ca/P ratio of surface deposits on TFBCS samples increased over time with no difference between one week and two months of SBF soaking. The Ca content and Ca/P ratio of surface deposits on MTAFS were significantly lower than that of TFBCS samples regardless of the SBF soaking time. Conclusion: Ageing TotalFill BC sealer in SPF can induce considerable apatite formation. In addition, the TotalFill BC sealer surface showed high Ca2+ ion release as reflected by the formation of apatite with a high Ca/P ratio. These bioactivity features increased over time. In comparison, the MTAFS appears to have lower and delayed bioactivity. Keywords: Bioactivity, bioceramic sealer, calcium phosphate ratio, MTA Fillapex, TotalFill BC sealer
... Bioactivity is the ability to form apatite of calcium phosphate deposits after soaking in simulated body fluids; such ability presents the ground for the biocompatibility of inorganic biomaterials. Bioactive materials create an environment that can enhance osteogenesis, mostly through bonding to living bone tissue using the apatite layer formed on its surface once introduced into the living body (17)(18)(19)(20) deposits since the electron beam penetration at 20-keV acceleration was 2.98 μm. A low Ca/P ratio of about 1.49 was also observed. ...
... The obvious variability in outcome among bioactivity studies could be explained by differences in experimental designs and lack of technique standardisation. For example, in some studies, soaking solutions were refreshed daily (41,42), or every three days (43)(44)(45), or even every seven days (19,39) or soaked for 21 days without refreshing (46). Finally, the detection of apatite crystals in in-vitro models for the bioactivity assessment is still questionable, and the role of environmental factors, such as temperature, pH, carbon dioxide partial pressure, and agitation, has often been overlooked as reported by several authors (47,48). ...
... The Ca/P ratio could act as an indicator of the precipitation phase. The formation of carbonated apatite correlates with increased Ca/P ratios (26,35), therefore, calcium carbonate formation can be presumed when the Ca/P ratio exceeded 1.67 (19). ...
... Fizikokimyasal Özellikler MTA Plus (Avalon Biomed Inc., Bradenton, FL, ABD), diş renginde ProRoot MTA'ya benzer bir bileşime sahip daha ince toz ve bir sıvı veya jel ile karıştırılabilir kalsiyum silikat esaslı bir materyaldir. 88 Bu trikalsiyum ve dikalsiyum silikat esaslı malzeme, jel ile karıştırıldığında kök kanal patı olarak kullanılabilir, bu da kullanım özelliklerini geliştirir ve yıkama direncini arttırır. 89 Bir jel kullanarak ve toz/jel oranını değiştirerek, farklı sertleşme süreleri ve farklı fiziksel özellikler elde edilebilir. ...
... 89 Bir jel kullanarak ve toz/jel oranını değiştirerek, farklı sertleşme süreleri ve farklı fiziksel özellikler elde edilebilir. 88 MTA Plus, ProRoot MTA'ya kıyasla daha uzun süre kalsiyum iyonu salar ve lokal pH'ı yükseltebilir. 88 İyon salma özelliği; ince toz yapısına sahip olması, gözenekliliği, su emilimi, çözünürlüğü ve kalsiyum fosfat minerallerinin oluşumu ile ilişkilidir. ...
... 88 MTA Plus, ProRoot MTA'ya kıyasla daha uzun süre kalsiyum iyonu salar ve lokal pH'ı yükseltebilir. 88 İyon salma özelliği; ince toz yapısına sahip olması, gözenekliliği, su emilimi, çözünürlüğü ve kalsiyum fosfat minerallerinin oluşumu ile ilişkilidir. ...
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Son yıllarda endodonti alanında çok sayıda olumlu özelliği nedeniyle kalsiyum silikat esaslı materyaller kullanılmaya başlanmıştır. Bağ dokusu ile direkt teması olan materyallerin kullanımı söz konusu olduğunda materyalin biyouyumluluğu o maddede aranan en önemli özelliktir. Ayrıca kullanılan ideal tamir materyali toksik olmamalı, nemli ortamda sertleşebilmeli, kandan etkilenmemeli, bakteri ve doku sıvılarına karşı iyi bir tıkama özelliği olmalı, kalsiyum hidroksit salmalı, kemik oluşumunu indüklemeli, antibakteriyel özelliğe sahip olmalı ve yeterli oranda sertliğe sahip olmalıdır. Kalsiyum silikat esaslı materyallerin içeriğinde trikalsiyum silikat, dikalsiyum silikat gibi hidrofilik bileşikler bulunur. Kalsiyum silikat esaslı materyaller; vital pulpa tedavisinde, apeksifikasyon, perforasyon tamiri, internal rezorbsiyon tedavisi ve kök ucu dolgusu işlemlerinde kullanılmaktadır. Mineral trioxide aggregate (MTA) endodonti alanında kullanılmaya başladığından bu yana oldukça popülerlik kazanmış ve altın standart haline gelmiş kalsiyum silikat esaslı bir dolgu materyalidir. MTA’nın çok sayıdaki avantajına karşın uzun süren sertleşme zamanı, kullanımından sonra nemli pamuk yerleştirilmesi gerekliliği dolayısıyla randevu sayısının artışı, uygulama zorluğu, özellikle ön bölge dişlerde renklenmeye neden olması, bileşiminde toksik elementlerin bulunması, maliyetinin yüksek olması ve sökümünün zor olması gibi dezavantajları vardır. Bu nedenle ideal kök ucu dolgu maddesi arayışı günümüzde halen sürmektedir. Bu materyallerin bir kısmı, MTA’ya alternatif olma hatta MTA’nın yerine geçme potansiyeli taşımaktadır. Bu derlemenin amacı, güncel kalsiyum silikat esaslı materyallerin fizikokimyasal ve biyolojik özellikleri ile ilgili kapsamlı bilgi vermektir.
... TheraCal has very favorable effects on the pulp, since, if it could be observed that it induced dentin formation, which is one of the main outcomes sought in indirect and direct pulp capping, however, these effects are to some extent limited. Gandolfi et al. (2014). Reported that the material showed lower solubility and higher calcium ion release. ...
... MTA Plus showed enhanced reactivity and prolonged ability to release calcium. These pronounced ion releasing properties are related to its remarkable porosity, water absorption and solubility and to the formation of calcium and phosphorus minerals [35] . The radiopacity of the three new MTAs was considerably lower than that of PR [36] . ...
... Previous studies have placed the specimens in the desiccant only after the immersion period-which could overestimate the sealer solubility. This occurs because the water that is not incorporated into the specimen during the immersion period (hydration of the solid) evaporates into the desiccator, increasing the values of mass loss [27]. ...
... SEM analysis for BioRoot expressed evident formation of very defined and diverse precipitates (needle-like + spherical) when incubated pbs; and a little less defined and uniform (spherical) when incubated in sbf. The elemental analysis (SEM/EDS) confirmed the higher concentration of calcium and phosphate in the precipitates, according to the literature [8,27,[33][34][35]. Under FTIR/ATR and XRD analyses, BioRoot presented expressive peaks of calcium carbonate and carbonated hydroxyapatite when incubated in pbs and sbf; endorsing the findings from SEM analysis. ...
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This study assessed the effects of immersion media [distilled water (dw), phosphate buffered saline (pbs) and simulated body fluid (sbf)] in the physical properties [fluid uptake/sorption/solubility and alkalinization activity (pH)] and bioactivity of a bioceramic sealer: the BioRoot RCS (BioRoot) (Septodont). The epoxy-resin sealer AH Plus (Dentsply) was used as comparison. Sealers were immersed in dw, pbs and sbf to evaluate the fluid uptake/sorption/solubility and pH’s media. Bioactivity was assessed with SEM/EDS, FTIR-ATR and XRD. BioRoot solubility was as follows: sbf > pbs = dw. BioRoot had alkaline pH, and AH Plus had neutral pH, regardless of the medium. BioRoot presented mineral precipitates and peaks indicating hydroxyapatite-precursors in pbs and sbf. AH Plus physical properties were not affected by immersion media and it had no bioactivity. pbs and sbf should be preferred to investigate bioceramic sealers over distilled water, because they were able to highlight the sealer properties. BioRoot maintained the alkaline environment and favored hard tissue deposition.
... The hydration reaction of NMP also produces CH in the initial phase of its setting reaction, which further reacts with phosphate ions when in contact with tissue fluids to form calcium phosphate hydroxyapatite (Camilleri, 2015). On the other hand, Gandolfi et al. (2014) observed an increase in solubility, water sorption and porosity in MTA Plus, which has a similar basic chemical composition to NMP, resulting in voids formation. This difference can be explained due to the samples of MTA Plus were immersed in distilled water; not in direct contact with tissue fluids as in the current study. ...
... The only statistically significant difference between the two groups in the current study was related to the dentin bridge thickness in the TF group after three months, which was greater than the NMP group. This result may be due to the high calcium leaching amount and the potent alkalizing effect of TF (Zamparini et al., 2018), which were more pronounced than NMP, thus producing more favorable conditions for pulp repair (Gandolfi et al., 2014). The ability to release calcium Fig. 1 Photomicrographs of pulp tissue response after three weeks, at low magnification (Â40), H&E-stained sections showed superficial pulp tissue necrosis and edema, with dilated and congested blood vessels for TF and NMP groups (1-a and 1-c, respectively). ...
Article
Objectives: The purpose of this study was to evaluate the pulpal response of dogs’ teeth after direct pulp capping using Biodentine (BD) and compared it with Mineral Trioxide Aggregate (MTA). Materials and Methods: Following the splitmouth design, forty intact teeth in two healthy Mongrel dogs were randomly assigned to two experimental groups; group I: BD and group II: MTA. Standardized Class V cavities were prepared on the vestibular surface of each tooth where the pulp exposure was performed with a dental explorer. The pulp-exposed teeth were immediately capped with one of the tested materials. The prepared cavities were then finally restored with glass-ionomer cement. After termination of the observation periods (one week and three months), the animals were euthanized. Then, teeth were extracted for histopathological evaluations. Data collected and statistically analyzed by using Fisher’s exact test. The significance level was set at P ≤ 0.05. Results: Histopathological analysis showed complete dentin bridge formation and an absence of inflammatory pulp response. Statistical analysis showed no significant differences between the BD and MTA experimental groups during the observation periods. However, a significantly higher thickness of the dentin bridge was found in the group of teeth treated with BD at three months. Conclusion: BD may be considered an interesting alternative to MTA. Both materials produced favorable pulpal responses that were similar in nature. KEYWORDS: Direct pulp capping; Dogs; Biodentine; MTA
... Recently, several new MTA-based endodontic treatment materials were introduced to improve clinical practice [9,13,17,[29][30][31]. We evaluated the physicochemical and mechanical properties and cell cytotoxicity of three new commercial MTAs in comparison with conventional MTA (PR). ...
... Consequently, the deposition of calcium and phosphate apatite into voids and spaces between the dentin, root canal systems, and root filling material enables MTA to encourage regeneration and remineralization of adjacent hard tissues while also improving its sealing capacity [50,53,54]. Thus, apatite-forming ability may provide clinical advantages by improving the sealing via the deposition of apatite at the interface and inside the dentinal tubules of the root canal when MTA is used as a root canal filling material [13,50,54]. HBSS solution was used in the present study as a storage solution to simulate the clinical environment. ...
Article
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Commercial mineral trioxide aggregate (MTA) materials such as Endocem MTA (EC), Dia-Root Bio MTA (DR), RetroMTA (RM), and ProRoot MTA (PR) are increasingly used as root-end filling materials. The aim of this study was to assess and compare the physicochemical and mechanical properties and cytotoxicity of these MTAs. The film thicknesses of EC and DR were considerably less than that of PR; however, RM’s film thickness was greater than that of PR. In addition, the setting times of EC, DR, and RM were shorter than that of PR (p < 0.05). The solubility was not significantly different among all groups. The three relatively new MTA groups (EC, DR, and RM) exhibited a significant difference in pH variation and calcium ion release relative to the PR group (p < 0.05). The radiopacity of the three new MTAs was considerably less than that of PR. The mechanical strength of RM was not significantly different from that of PR (p > 0.05); however, the EC and DR groups were not as strong as PR (p < 0.05). All MTA groups revealed cytocompatibility. In conclusion, the results of this study confirmed that EC, RM, DR, and PR exhibit clinically acceptable physicochemical and mechanical properties and cell cytotoxicity.
... Although tissue necrosis is in general, considered to be an initiator of mineralization processes [28], some studies suggested that repair processes could commence even without necrosis or acute inflammation [29]. The amount of released calcium hydroxide from calcium silicate cements decreases over time [30], along with material setting, creating favorable conditions for the start of the repair processes. Although no statistically significant differences between CS, HA-CS and MTA were found with respect to inflammatory response, tissue conditions in the samples with HA-CS were rated the best. ...
... As mentioned, the major soluble fraction of these cements is calcium hydroxide, released during material setting. Since calcium silicates are slow setting materials, they release calcium hydroxide over several weeks [30]. In contact with tissue and tissue fluids, calcium hydroxide dissolve to calcium and hydroxyl ions. ...
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The aim of the study was to evaluate inflammatory tissue reactions and the formation of calcified tissue after implantation of experimental nanostructured calcium silicate cement (CS) and hydroxyapatite with calcium silicate cement (HA-CS) into root canals of rabbits' teeth. The study was conducted on four rabbits of the genus Oryctolagus cuniculus. After instrumentation and irrigation, the root canals of the central incisors were dried and filled with CS, HA-CS and control material (MTA Angelus). The animals were sacrificed after 28 days. After histological preparation and hematoxylin-eosin staining, tissue samples were evaluated for the intensity and extension of inflammatory tissue reaction; continuity, morphology and thickness of the newly formed calcified tissue; and presence of giant cells, materials particles and microorganisms. Kruskal Wallis and Dunn's post hoc test were used for data analysis (α=0.05). There were no significant differences in the intensity of inflammatory reactions between CS, HA-CS and MTA control. HA-CS showed significantly better results than MTA and CS with respect to continuity of the newly formed calcified tissue (P=0.003 and P=0.010, respectively). Significant differences in thickness of the calcified tissue existed between CS and MTA (P=0.004) and between HA-CS and MTA (P=0.012). Application of CS and HA-CS resulted in minimal inflammatory tissue response, similar to the MTA control. CS and HA-CS were more efficient than MTA in supporting hard tissue formation. The best organized newly formed calcified tissue was seen after HA-CS application.
... MTA Plus was used in this study as it has a setting time significantly shorter than ProRoot MTA. [24] According to Gandolfi et al., [25] MTA Plus showed improved reactivity and prolonged capability to release calcium ions compared to ProRoot MTA. MTA Plus also showed a more alkaline local pH in comparison with ProRoot MTA. ...
... MTA Plus also showed a more alkaline local pH in comparison with ProRoot MTA. [25] MTA Plus was chosen in this study, considering its availability and lower setting time, and thus was a suitable replacement to conventional bioactive calcium silicate MTA-like cements. ...
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Aim: The sealing ability of the retrograde material is greatly affected by the technique used for root end preparation. Advances in retrograde preparation techniques such as lasers has shown to provide an efficient outcome. The study was to evaluate and compare the effect of various techniques of retrograde cavity preparation on apical microleakage. Materials and methods: Forty-five single rooted teeth were decoronated. Biomechanical preparation was carried out up to size F2 ProTaper system and obturated. Glass-ionomer cement was used as an access restorative material. The apical root resection was done at 3 mm from the apex at angulation of 90° to the long axis of the root. The allocation of the samples was done into three groups of 15 each. Group A: Retrograde cavities prepared using conventional round bur; Group B: Retrograde cavities prepared using ultrasonic retro preparation diamond tip; and Group C: Retrograde cavities prepared using "Erbium, chromium: yttrium, scandium, gallium, garnet" (Er,Cr:YSGG). The retrograde cavities hence prepared were filled with MTA Plus. Nail varnish was used to coat the samples except at the apical end. Samples were immersed in methylene blue for 24h. Stereomicroscope was used for examination of the sectioned teeth. The data were analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey test. Results: Results showed very highly significant difference between laser and bur (P value = 0.001). Conclusion: Retrograde preparation with Er,Cr:YSGG showed significantly less microleakage when compared to the use of ultrasonic retrotip and burs.
... Among the 4 capping agents used in our study, TheraCal and Dycal showed the highest (9.79 ± 2.52) and lowest (1.07 ± 0.54) SBS, respectively. A significant factor contributing to successful pulp therapy is the ability of the material to release and diffuse calcium ions into the dentin and surrounding structures [3]. The lower SBS of Dycal can be explained by its tendency to release fewer calcium ions than calcium silicate-based materials [2,3]. ...
... A significant factor contributing to successful pulp therapy is the ability of the material to release and diffuse calcium ions into the dentin and surrounding structures [3]. The lower SBS of Dycal can be explained by its tendency to release fewer calcium ions than calcium silicate-based materials [2,3]. In the present study, Biodentine showed a higher SBS than MTA Plus. ...
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Objectives: This study aimed to compare the shear bond strength (SBS) of a self-adhering flowable composite (Dyad Flow) and a bulk-fill flowable composite (Smart Dentin Replacement [SDR]) to several pulp-capping materials, including MTA Plus, Dycal, Biodentine, and TheraCal. Materials and methods: Eighty acrylic blocks with 2-mm-deep central holes that were 4 mm in diameter were prepared and divided into 2 groups (n = 40 each) according to the composite used (Dyad Flow or SDR). They were further divided into 4 sub-groups (n = 10 each) according to the pulp-capping agent used. SBS was tested using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance. A p value of < 0.05 was considered to indicate statistical significance. Results: A statistically significant difference (p = 0.040) was found between Dyad Flow and SDR in terms of bond strength to MTA Plus, Dycal, Biodentine, and TheraCal. Conclusions: Among the 8 sub-groups, the combination of TheraCal and SDR exhibited the highest SBS.
... Therefore, determining how these cells respond to capping materials and whether they can differentiate into extracellular matrix-forming cells capable of mineralization is important. Additionally, ascertaining the fundamental physicochemical characteristics of pulp capping materials, such as dimensional stability, pH and calcium ion release, is vital, as they directly affect the pulp repair process [2][3][4] . ...
... Our results showed that CHC lost more volume (4.58%) than MTA and BD, which is likely due to high solubility of the CHC in liquid media, as has been widely reported in the literature 11,12) . MTA gained a volume of 0.24%, which may be related to its tendency to absorb water that has also been described in the literature 4,13,14) . BD lost less volume (0.58%). ...
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This study evaluated the osteogenic differentiation of human dental pulp stem cells in response to substances released by the pulp capping agents, Biodentine (BD), mineral trioxide aggregate (MTA) and two-paste calcium hydroxide cement (CHC), along with their physicochemical characteristics. The dimensional stability test showed that of the materials studied, only BD met the standards recommended by the International Organization for Standardization (ISO) for pulp capping materials and thus can be used safely. In the chemical tests, BD was the most stable material. In the Alizarin red S test, BD formed the higher amount of mineralized nodules in the mineralizing medium and also formed mineralized nodules in a non-mineralizing medium. BD releases substances that can significantly induce formation of the human dental pulp stem cell-mineralized extracellular matrix, with physicochemical characteristics that are more conducive to pulp repair than those of MTA and CHC.
... The hydration reaction of NMP also produces CH in the initial phase of its setting reaction, which further reacts with phosphate ions when in contact with tissue fluids to form calcium phosphate hydroxyapatite (Camilleri, 2015). On the other hand, Gandolfi et al. (2014) observed an increase in solubility, water sorption and porosity in MTA Plus, which has a similar basic chemical composition to NMP, resulting in voids formation. This difference can be explained due to the samples of MTA Plus were immersed in distilled water; not in direct contact with tissue fluids as in the current study. ...
... The only statistically significant difference between the two groups in the current study was related to the dentin bridge thickness in the TF group after three months, which was greater than the NMP group. This result may be due to the high calcium leaching amount and the potent alkalizing effect of TF (Zamparini et al., 2018), which were more pronounced than NMP, thus producing more favorable conditions for pulp repair (Gandolfi et al., 2014). The ability to release calcium Fig. 1 Photomicrographs of pulp tissue response after three weeks, at low magnification (Â40), H&E-stained sections showed superficial pulp tissue necrosis and edema, with dilated and congested blood vessels for TF and NMP groups (1-a and 1-c, respectively). ...
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Aim: To histopathologically evaluate the pulpal healing after direct pulp capping with TotalFill and compared it with Neo MTA Plus in human tooth cultures. Methods: Forty sound human premolars freshly extracted for orthodontic reasons were randomly assigned to two experimental groups; group I: TotalFill and group II: Neo MTA Plus. Standardized Class V cavities were prepared on the buccal surface of each tooth where the pulp exposure was performed with a dental explorer. The pulp-exposed teeth were immediately capped with one of the tested materials. The prepared cavities were then finally restored with glass-ionomer cement. Teeth were cultured for three weeks and three months. Then, the cultured teeth were demineralized, sectioned and stained for histopathological evaluation. Data collected and statistically analyzed by using Fisher's exact test. The significance level was set at P ≤ 0.05. Results: Histopathological analysis showed complete dentin bridge formation and an absence of inflammatory pulp response. Statistical analysis showed no significant differences between the TotalFill and Neo MTA Plus groups during the observation periods. However, a significantly higher thickness of the dentin bridge was found in the group of teeth treated with TotalFill at three months. Conclusions: TotalFill produced similar favorable pulp healing and repair, and were comparable to Neo MTA Plus. Furthermore, TotalFill can form a thicker dentin bridge compared with Neo MTA Plus.
... e major clinical results of MTA cements are demonstrated by the synchronization of apatite and epigenetic signals to release ions. Moreover, the presence of apatite on the cement surface is related to cell growth and cell differentiation [102][103][104]. e evaluation of ALP activity (alkaline phosphatase activity) determines the induction of mineralized tissue formation in calcium silicate-based sealers (TotalFill BC sealer) and cements (Biodentine and MTA Plus) during exposure to human osteoblast-like cells [105,106]. ...
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Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.
... MTA is the first CSB used in the dental field, and later new materials were developed to enhance the properties and overcome the shortcomings of the original cements. For example, the setting time of Biodentine is only 9 min, that is significantly fast setting compared to the original cements, MTA Plus with gel (55 min), MTA Angelus (80 min) (Gandolfi et al., 2009b;Gandolfi et al., 2011a;Gandolfi et al., 2014;Gandolfi et al., 2015). ...
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Background: Calcium silicate biomaterials (CSB) have witnessed rapid development in the past 30 years. This study aimed to accomplish a comprehensive bibliometric analysis of the published research literature on CSB for biomedical applications and explore the research hotspot and current status. Methods: Articles related to CSB published in the last three decades (1990–2020) were retrieved from Web of Science Core Collection. The R bibliometrix package and VOSviewer were used to construct publication outputs and collaborative networking among authors, their institutes, countries, journals’ matrices and keywords plus. Results: A total of 872 publications fulfilling the search criteria were included. CSB is mainly reported for bone tissues and dental applications. Among researchers, Chang J from Chinese Academy of Sciences and Gandolfi MG from the University of Bologna are the most productive author in these two fields, respectively. China was the leading contributor to the research on CSB in the medical field. A total of 130 keywords appeared more ten or more times were identified. The term “mineral trioxide aggregate” ranked first with 268 occurrences. The co-occurrence analysis identified three major clusters: CSB in dentistry, bone tissue and vitro bioactivity. Conclusion: Calcium silicate biomaterials have a promising scope for various biomedical applications ranging from regeneration of hard tissues (bone and teeth) to skin, tumor, cardiac muscle and other soft tissues. This study may help researchers further understand the frontiers of the field.
... A much lower pH value in the BGn 1% group was observed in the 168-h extract. Moreover, these results confirm that calcium silicate sealers produce hydrated calcium silicate hydrates and calcium hydroxide, which release hydroxyl ions and provide an alkaline environment [35]. All groups maintained high alkalinity to produce a hostile environment for the survival and proliferation of bacteria [36]. ...
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Recently, bioactive glass nanoparticles (BGns) have been acknowledged for their ability to promote interactions with the periapical tissue and enhance tissue regeneration by releasing therapeutic ions. However, there have been no studies on calcium silicate sealers with bioactive glass nanoparticle (BGn) additives. In the present study, a premixed calcium silicate root canal sealer reinforced with BGn (pre-mixed-RCS@BGn) was developed and its physicochemical features and biological effects were analyzed. Three specimens were in the trial: 0%, 0.5%, and 1% bioactive glass nanoparticles (BGns) were gradually added to the premixed type of calcium silicate-based sealer (pre-mixed-RCS). To elucidate the surface properties, scanning electron microscopy, X-ray diffraction, and energy-dispersive spectroscopy were used and flowability, setting time, solubility, and radiopacity were analyzed to evaluate the physical properties. Chemical properties were investigated by water contact angle, pH change, and ion release measurements. The antibacterial effects of the bioactive set sealers were tested with Enterococcus faecalis and the viability of human bone marrow-derived mesenchymal stem cells (hMSCs) with this biomaterial was examined. In addition, osteogenic differentiation was highly stimulated, which was confirmed by ALP (Alkaline phosphatase) activity and the ARS (Alizarin red S) staining of hMSCs. The pre-mixed-RCS@BGn satisfied the ISO standards for root canal sealers and maintained antimicrobial activity. Moreover, pre-mixed-RCS@BGn with more BGns turned out to have less cytotoxicity than pre-mixed-RCS without BGns while promoting osteogenic differentiation, mainly due to calcium and silicon ion release. Our results suggest that BGns enhance the biological properties of this calcium silicate-based sealer and that the newly introduced pre-mixed-RCS@BGn has the capability to be applied in dental procedures as a root canal sealer. Further studies focusing more on the biocompatibility of pre-mixed-RCS@BGn should be performed to investigate in vivo systems, including pulp tissue.
... Regarding ion release, the highest values of Ca 2+ exhibited by MTA Angelus have been associated with its antimicrobial activity and mineralization potential. Since ion release depends on the material's properties in terms of solubility, setting, and permeability to water [24], the lower release of Ca 2+ from NeoMTA Plus and NeoPutty compared to MTA Angelus could be explained by existing differences in their hydration processes and setting reactions [25]. In addition, the release of calcium ions and calcium hydroxide deposition after hydration have been associated with the biological properties of VPT materials [26]. ...
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Objectives The aim of the present in vitro study is to determine the cytocompatibility of the recently introduced NeoPutty in contact with human dental pulp cells compared with its precursor NeoMTA Plus and the classic gold standard MTA Angelus. Materials and methods Sample disks were obtained for each of the tested materials (5 mm diameter; 2 mm thickness; n = 30), along with 1:1, 1:2, and 1:4 material eluents. HDPCs were extracted and cultured with the tested materials (test groups) or in unconditioned medium (control group), and the following biocompatibility assays were performed: MTT assay, scratch wound assay, cell cytoskeleton staining assays, and cell attachment assessment via SEM. Additionally, material ion release and surface element composition were evaluated via ICP-MS and SEM–EDX, respectively. Each experimental condition was carried out three times and assessed in three independent experiments. Statistical significance was established at p < 0.05. Results 1:2 dilutions of all the tested materials exhibited a comparable cell viability to that of the control group at 48 and 72 h of culture ( p < 0.05). The same was observed for 1:4 dilutions of the tested materials at 24, 48, and 72 h of culture ( p > 0.05). All the tested materials exhibited adequate cytocompatibility in the remaining biocompatibility assays. MTA exhibited a significantly higher calcium ion release compared to NeoPutty and NeoMTA Plus ( p < 0.05). Conclusion The results from the present work elucidate the adequate cytocompatibility of NeoPutty, NeoMTA Plus, and MTA Angelus towards human dental pulp cells. Clinical relevance Within the limitations of the present in vitro study, our results may act as preliminary evidence for its use in vital pulp therapy as a pulp capper. However, results need to be interpreted with caution until further clinical supporting evidence is reported.
... Therefore, the pulp-capping material should be biodegradable. Meanwhile, some physical and chemical properties of pulp-capping materials, such as the pH value and calcium ion release, are also crucial because they will have a direct impact on the repair process of dental pulp tissue [52,53]. ACP is a hydroxyapatite precursor with good biocompatibility and biodegradability [54,55]. ...
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Dental pulp is essential for the development and long-term preservation of teeth. Dental trauma and caries often lead to pulp inflammation. Vital pulp therapy using dental pulp-capping materials is an approach to preserving the vitality of injured dental pulp. Most pulp-capping materials used in clinics have good biocompatibility to promote mineralization, but their anti-inflammatory effect is weak. Therefore, the failure rate will increase when dental pulp inflammation is severe. The present study developed an amorphous calcium phosphate/poly (L-lactic acid)-poly (lactic-co-glycolic acid) membrane compounded with aspirin (hereafter known as ASP/PLGA-ASP/ACP/PLLA-PLGA). The composite membrane, used as a pulp-capping material, effectively achieved the rapid release of high concentrations of the anti-inflammatory drug aspirin during the early stages as well as the long-term release of low concentrations of aspirin and calcium/phosphorus ions during the later stages, which could repair inflamed dental pulp and promote mineralization. Meanwhile, the composite membrane promoted the proliferation of inflamed dental pulp stem cells, downregulated the expression of inflammatory markers, upregulated the expression of mineralization-related markers, and induced the formation of stronger reparative dentin in the rat pulpitis model. These findings indicate that this material may be suitable for use as a pulp-capping material in clinical applications.
... Such formulations release large amounts of chemical byproducts that can be toxic to cells in culture; however, in clinical settings, these by-products are likely to be diluted in interstitial tissue fluids and are eliminated through the vasculature, a biological response lacking in the cell culture model [16,17]. One of the most important considerations affecting the cytotoxicity of MTA-based cements is the release of calcium hydroxide when the material is set; initially, the speed of the setting reaction is high, and the cyto-toxic effects of the calcium hydroxide released in excess are observed [18]. As the material finishes setting, much of the alkalinity is lost, and cytotoxicity therefore decreases [19]. ...
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Objective: This study sought to evaluate the biocompatibility of Neomineral Trioxide Aggregate (Neo-MTA), MTA Repair High Plasticity (MTA-HP), and Mineral Trioxide Aggregate-Angelus white (MTA-Ang) in fibroblasts of human dental pulp. Materials and methods: Morphology was evaluated after 24 h of incubation. LIVE/DEAD assay and cell adhesion tests were performed at 24 h of treatment. Cell proliferation assays (MTSs) and Annexin V were performed at 48 h incubation with different treatments. The expression of Col-1 and TGF-β1 was tested by endpoint PCR at 5 days of treatment. Results: Morphological changes were observed in all groups. Neo-MTA and MTA-Ang were associated with increased cell viability, and all materials induced apoptosis, with a higher percentage in the MTA-HP group than in the other groups. In the LIVE/DEAD assay, there was more damage to the cell membrane in the group of cells treated with MTA-HP than in the other groups. Conclusion: Neo-MTA and MTA-Ang presented similar biocompatibility, and both showed greater biocompatibility than MTA-HP. MTA-HP and MTA-Ang increased Col-1A gene expression, and Neo-MTA and MTA-Ang increased TGF-β1 gene expression in a similar way.
... The release of calcium ions is a pivotal factor for pulp-capping therapies because of the action of calcium on the differentiation and mineralization of hDPSCs [40]. Previous studies have reported that after a few hours of preparation, TCS-based materials release a large amount of calcium ions upon hydration; however, calcium ion release is significantly higher in Ca(OH) 2 cements after 3 days [41,42]. The solubility of TCS-based cements is reduced by the precipitated calcium phosphate layer. ...
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This study aimed to evaluate the in vitro effect of the novel bioactive adhesive monomer CMET, a calcium salt of 4-methacryloxyethyl trimellitate acid (4-MET), on human dental pulp stem cells (hDPSCs) and its capacity to induce tertiary dentin formation in a rat pulp injury model. Aqueous solutions of four tested materials [4-MET, CMET, Ca(OH) 2 , and mineral trioxide aggregate (MTA)] were added to the culture medium upon confluence, and solvent (dH 2 O) was used as a control. Cell proliferation was assessed using the Cell Counting Kit-8 assay, and cell differentiation was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. The mineralization-inducing capacity was evaluated using alizarin red S staining and an alkaline phosphatase activity assay. For an in vivo experiment, a mechanical pulp exposure model was prepared on Wistar rats; damaged pulp was capped with Ca(OH) 2 or CMET. Cavities were sealed with composite resin, and specimens were assessed after 14 and 28 days. The in vitro results showed that CMET exhibited the lowest cytotoxicity and highest odontogenic differentiation capacity among all tested materials. The favorable outcome on cell mineralization after treatment with CMET involved p38 and c-Jun N-terminal kinases signaling. The nuclear factor kappa B pathway was involved in the CMET-induced mRNA expression of odontogenic markers. Similar to Ca(OH) 2 , CMET produced a continuous hard tissue bridge at the pulp exposure site, but treatment with only CMET produced a regular dentinal tubule pattern. The findings suggest that (1) the evaluated novel bioactive adhesive monomer provides favorable biocompatibility and odontogenic induction capacity and that (2) CMET might be a very promising adjunctive for pulp-capping materials.
... These ion-releasing properties are interlinked with solubility, water sorption, porosity, and formation of a calcium phosphate layer. MTA Plus is a convenient alternative to the MTA-like conventional CSCs, low-cost, bioactive tricalcium silicate material [27]. Despite the similarity in composition between the conventional MTA and MTA Repair HP (Angelus, Londrina, PR, Brazil), the former contains a mixing liquid with a plasticizer agent and calcium tungstate as a radiopacifier. ...
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Calcium silicate-based cements are biocompatible materials for vital pulp therapy. However, they discolour the tooth tissue, which is important for the aesthetics of the anterior teeth. The aim of this study was to investigate the effect of calcium silicate-based cements on tooth discolouration. The study included 70 extracted bovine incisors. The crown of the tooth was cut off from the root, 2 mm below the cement-enamel junction. The pulp tissue was removed via a cervical cut with a barbed broach. The teeth were randomly divided into five experimental, one positive, and one negative control groups. The evaluated materials included Biodentine, Ortho MTA, Retro MTA, MTA Plus, MTA Repair HP, and in the positive group, ProRoot MTA. A VITA Easyshade Compact 5.0 spectrophotometer was used before the application, after 1 week, 1 month, 3 months, and 6 months. The significance levels were set at p < 0.05. All materials significantly changed the teeth colour (p < 0.05). However, Ortho MTA, ProRoot MTA, MTA Plus, and Biodentine (ΔE > 6) caused maximum colour change after 6 months. While the ProRoot MTA, Ortho MTA, and MTA Plus caused grey discolouration, Biodentine darkened the shade of the base colour. Thus, Retro MTA and MTA Repair HP can be safely used in the aesthetic dentition zone. According to these clinical results, the possibility of using Biodentine, due to its lack of gray discoloration, can be considered.
... Regarding ion release, NeoMTA 2 was associated with the higher release of calcium ions from all of the tested materials (p < 0.05). It has been described that Ca 2+ release stimulates hydroxyl apatite formation and release of alkaline phosphatase and bone morphogenetic protein 2, which are important in the mineralization process [27]. Both SEM-EDS and ICP-MS assays exhibited Ca 2+ release and calcium content in all materials, as previously described for NeoMTA Plus and Bio C-Repair [28,29]. ...
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Objective The present study evaluated the biological effects and biomineralization potential of a new tantalum oxide (Ta 2 O 5 )–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 (Ta 2 O 5 )–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.
... The ionic release of new commercial formulations of CSCs/CSSs should be further studied in order to better understand the mechanisms behind their biological properties. By establishing the role of the different ionic interactions occurring between calcium silicate-based biomaterials and surrounding tissues, new material formulations with specific additives to enhance their performance could be developed (Gandolfi et al., 2014;Kasraei et al., 2021). ...
Article
Background: Most recently, the biological interactions, i.e. cytocompatibility, cell differentiation and mineralization potential, between calcium-silicate based biomaterials and periodontal ligament stem cells (PDLSCs) has been studied at an in vitro level, in order to predict their clinical behaviour in endodontic procedures involving direct contact with periodontal tissues, namely root canal treatment, endodontic surgery and regenerative endodontic treatment. Objective: The aim of the present systematic review was to present a qualitative synthesis of available in vitro studies assessing the biological interaction of PDLSCs and calcium silicate-based biomaterials. Methodology: The present review followed PRISMA 2020 guidelines. An advanced database search was performed in Medline, Scopus, Embase, Web of Science, and SciELO on July 1st 2020 and last updated on April 22nd, 2021. Studies assessing the biological interactions of PDLSCs with calcium silicate-based sealers (CSSs) and/or cements (CSCs) at an in vitro level were considered for inclusion. The evaluation of the 'biological interaction' was defined as any assay or test on the cytotoxicity, cytocompatibility, cell plasticity or differentiation potential, and bioactive properties of PDLSCs cultured in CSC or CSS-conditioned media. Quality (risk of bias) was assessed using a modified CONSORT checklist for in vitro studies of dental materials. Results: A total of 20 studies were included for the qualitative synthesis. CSCs and CSSs, as a group of endodontic materials, exhibit adequate cytocompatibility and favour the osteo/cementogenic differentiation and mineralization potential of PDLSCs, as evidenced from the in vitro studies included in the present systematic review. Discussion: The influence of the compositional differences, inclusion of additives, sample preparation, and varying conditions and manipulations on the biological properties of calcium-silicate based materials remain a subject for future research. Conclusions: Within the limitations of the in vitro nature of the included studies, this work supports the potential use of calcium silicate-based endodontic materials in stem cell therapy and biologically-based regenerative endodontic procedures.
... Solubility of the calcium silicate cement in water is low after setting; however, high solubility (20%), high water sorption (~12%) and high porosity (40%) have been reported for some dental calcium silicate cement products (137,138). Such porosity and solubility values doesn't correlate with the ...
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Calcium silicate cements were identified as excellent materials for dentistry, particularly for dental procedures contacting the dental pulp or root system. Both calcium silicate and calcium aluminate cements cause the biomineralization (precipitation of hydroxyapatite (HA) phenomena and shield dental tissues from the underlying cement (a foreign body material). The cements also elute ions to stimulate cytokines that contribute to healing of the dental pulp or in tissue surrounding the root of a tooth. The cements serve as a foundation for other dental restorative materials. This paper reviews the cement phases, properties, in vivo reactions, and clinical benefits from the use of the calcium silicate and calcium aluminate ceramic cements.
... Similar to these findings, Gandolfi et al. had recommended MTA Plus as a substitute for conventional calcium silicate MTA-like cements owing to its enhanced reactivity, and prolonged potential to release calcium and increase the local pH. 64 In contrast, a review by Al-Sabri had concluded calcium hydroxide as the first choice in clinical practice due to the high cost of MTA and the challenges associated with its mixing and handling. 65 ProRoot MTA and MTA Angelus were found to be inert and viable. ...
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Background: Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth. Materials and methods: This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested. Results: Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability. Conclusion: There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials. Clinical significance: The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength. How to cite this article: Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30-39.
... It has a greater surface area and less setting time than that of MTA because of its smaller particle size [13]. It is indicated as a root canal sealer as well as a root end filling material and a pulp capping cement [14]. ...
... The increase in pH values during setting and heat produced by this reaction enhance inflammatory cell recruitment and production as well as release of proinflammatory cytokines [34][35][36][37]. On the other hand, the release of calcium ions and alkalinity of the medium stimulate hydroxyl apatite formation and release of alkaline phosphatase and bone morphogenetic protein 2 that are important in the mineralization process [38]. Moreover, both NeoMTA Plus ® and MTA Angelus groups showed high inflammatory cell count initially because the time was not enough to repair the defect. ...
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Background: The biocompatibility of NeoMTA Plus® (Avlon BioMed Inc., Bradenton, Fl) as a furcal perforation repair material is not fully understood. This study compares the biocompatibility of Mineral Trioxide Aggregate (MTA Angelus) and NeoMTA Plus® as delayed furcation perforation repair materials. Methods: Pulpotomy and root canal obturation were performed in 72 premolars in six mongrel dogs and then a standardized furcal perforation was performed. The coronal access was left open for three weeks. After curetting, cleaning and drying of the perforations, these teeth were divided into three equal groups (N = 24 teeth/ 2 dogs each) according to the material used for perforation repair; group I: NeoMTA Plus®, group II: MTA Angelus and group III: no material (positive control). The coronal access cavities were sealed with a filling material. The inflammatory cell count and qualitative pathology (presence of calcific bridge, configuration of fibrous tissue formed, examination of tissue surrounding the furcation area, histology of intraradicular bone and the inflammatory nature of tissues) were carried out after one week (subgroup A, N = 8 teeth), one month (subgroup B, N = 8 teeth) and three months (subgroup C, N = 8 teeth). The inflammatory cell count was expressed as mean ± SD and statistically analyzed. P-value < 0.05 was considered significant. Results: In all subgroups, the control group exhibited the highest number of inflammatory cell count, followed by MTA Angelus group and the least inflammatory cell count was shown by NeoMTA Plus® group. There was a significant difference in the inflammatory cell count between the NeoMTA Plus® and MTA Angelus after one week (P < 0.05) while no significant differences were recorded between them after one month and three months (P > 0.05). In contrast to group II, there was no significant differences in inflammatory cell count between the subgroups in groups I and III (P > 0.05). NeoMTA Plus® exhibited better qualitative pathological features than MTA Angelus after one week and nearly similar features after one month and three months of repair. Conclusion: NeoMTA Plus® has a better early biocompatibility than MTA Angelus after one week of delayed furcation perforation repair and a similar late biocompatibility after one month and three months.
... For clinicians, MTA Plus represents a lower-cost bioactive tricalcium silicate material with interesting chemical-physical properties that could be a convenient alternative to the conventional calcium silicate MTA-like cement. [13] It is marketed with an anti-washout gel [9] along with water for dispensing the material. MTA is known for its poor handling property and longer setting time and has a consistency which makes its use limited in some clinical situations. ...
Article
Background and Objectives: Mineral trioxide aggregate (MTA), being a near-ideal retrograde filling material, has the greatest disadvantage of longer setting time, which limits its use in a certain clinical situation. A novel MTA, known as MTA Plus, claims to have a finer particle size and is marketed with an additional anti-washout gel. This study was undertaken to compare the setting time and compressive strength (CS) of MTA Plus with various additives. Materials and Methodology: MTA Plus powder was mixed with following additives such as 5% CaCl2 solution, 10% CaCl2 solution, phosphate-buffered saline, 80% distilled water/20% propylene glycol, saline, lidocaine HCl, 15% sodium phosphate monobasic, 3% sodium hypochlorite gel, and proprietary gel with MTA Plus in the ratio of 3:1 by weight. Setting time was evaluated using Vicat apparatus using a brass mold with an internal diameter of 10 mm and height of two millimeters. CS was evaluated using an Instron machine using a split brass mold with an internal diameter of Four millimeters and height of Six millimeters. Results: The results showed that 15% sodium hydrogen phosphate and MTA Plus gel significantly decrease the setting time of MTA Plus. MTA Plus gel set cement gave the highest value of CS among all groups of additives studied. Interpretation and Conclusion: Additives used in the given study had an influence on physical property like setting time and mechanical property like CS of MTA Plus.
... Freshly mixed pastes were compacted into polyvinyl chloride molds (8 ± 0.1 mm diameter x 1.6 ± 0.1 mm), and the excess was removed. The exposed upper surface area of each sample was 50.24 ± 0.01 mm 2 (5). ...
Article
creative commons attribution noncommercial License. Which allows others to remix, tweak, and build upon the work non commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract Aim: The aim of the study is to evaluate the solubility, water sorption and bioactivity of conventional and modified retrograde filling materials after immersion in simulated body fluid (SBF). Methodology: Silver, Chitosan, calcium hydroxide and hydroxyapatite nanoparticles synthesized. The nanoparticles were subjected to XRD analysis and incorporated into the powder of conventional glass ionomer cement and mixed according to the manufacturer's instructions and solubility, water sorption and bioactivity of the materials were assessed. Results: The results were tabulated and subjected to statistical analysis. Kruskall wallis test is performed based on variables among all 6 groups. The Alternative hypothesis would be there is significant difference between 6 groups and the opposite would be null hypothesis. P value less than 0.05 shows that all groups are significantly different from each other based on solubility, calcium release and water sorption. Conclusion: Chitosan had the highest calcium release and biodentin had the lowest calcium release after 24 hours. Hydroxyapatite had the highest calcium release and biodentin had the lowest calcium release after 7 days. Chitosan had the highest solubility and pro root MTA had the lowest solubility after 24 hours. Chitosan had the highest solubility and pro root MTA had the lowest solubility after 7 days. Pro root MTA had the highest water sorption and Calcium hydroxide had the lowest water sorption after 24hours. Pro root MTA had the highest water sorption and Calcium hydroxide had the lowest water sorption after 7days.
... It has been shown that it is possible that the upregulation of Akt phosphorylation by Mg 2+ leads to cell adhesion, cell viability, ALP activity, extracellular matrix mineralization and enhanced expression of osteogenic related genes (24). In addition, OH − stimulate the release of bone morphogenetic protein 2 and alkaline phosphatase, which are involved in the mineralization process (49,50). Our hypothesis is that the ions released from the modified AH surface will increase the extracellular ion concentration in the medium, thereby changing the intracellular ion concentration of the cells and thus activating the key intracellular signal transduction related to osteogenic differentiation. ...
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Background: AH Plus (AH) has been widely used as a root canal sealer in the endodontic field due to its superior physicochemical properties. However, clinical application of AH is limited due to its weak bioactivity. Methods: In this study, we have developed an AH cement containing nano-magnesium hydroxide (NMH) as an additive to enhance the bioactivity of AH. The NMH can neutralize pH and facilitate bone formation. The objective of this study was to evaluate the effects of NMH and modified AH on osteoblasts behavior in vitro. The CCK-8, alkaline phosphatase (ALP) staining, and real-time polymerase chain reaction (PCR) assays were used to assess the proliferation and differentiation of MC3T3-E1 cells, respectively. The adhesion and spreading of MC3T3-E1 cells were investigated in vitro by scanning electron microscopy (SEM). Meanwhile, the flow and magnesium ion release of the modified AH was also concerned. Results: In vitro cell assays further showed that the addition of NMH into AH cement, which was denoted as modified AH (especially AH+3%NMH), could effectively improve the proliferation and osteogenic differentiation of MC3T3-E1 cells. Conclusions: Taken all together, we believe that the modified AH samples (especially AH+3%NMH) have outstanding biocompatibility and osteogenic properties and may have great potential in endodontic field.
... Nowadays, MTA has evolved as a most recommended material of choice used for several endodontic treatments such as pulp capping, root canal filling, repair of root canal perforation, and as root end filling material (Toptanci et al. 2013). This is due to its superior properties regarding biocompatibility, antibacterial activity, their ability to induce hard tissues formation through locally raising the pH to alkaline values, and the capability to release of calcium ions (Gandolfi et al. 2014;Prasad and Naik 2017). Moreover, it can set even in the presence of moisture (Nagmode et al. 2016). ...
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Background Insolubility is the main requirement for ideal root end filling material to provide perfect sealing ability. Moreover, alkalinity and bioactivity provide great chance for tissues healing and remineralization. So, the aim of this work was to evaluate the chemical composition, solubility, pH change, and calcium ion release of recently introduced commercial mineral trioxide aggregate (MTA) endodontic repair cement (Harvard, Universal HandMix MTA) compared with ProRoot MTA repair material. Methods Solubility was evaluated after 7- and 14-day immersion time of specimens in phosphate buffer saline solution (PBS); the mean weight loss was evaluated and solubility was calculated as a percentage of the weight loss. For assessment of pH change and calcium ion release polyethylene tubes filled with the materials were soaked in distilled water for 7 and 14 days. Measurement of pH change was done by analytical pH meter. Concentrations of calcium ion release were measured using inductively coupled plasma optical emission spectroscopy. Data were statistically analyzed by independent sample t test and paired sample t test at 5% significance level. Results Harvard MTA endodontic cement showed significant lower solubility and higher pH values compared with that of ProRoot MTA. ProRoot MTA exhibited significant higher calcium ion release value after 14 days ( P value ≤ 0.05). Conclusion Harvard, Universal HandMix MTA repair cement with its different chemical composition; exhibits a low solubility with enhanced alkaline pH value compared to ProRoot MTA repair material.
... EDX analysis is a semi-quantitative test that measures the atomic percentage of different elements on the material surface. Comparison of the calculated Ca/P ratio with that of normal stoichiometric hydroxyapatite allowed tracking the amount of hydroxyapatite formation with or without blood contamination (Gandolfi et al., 2013(Gandolfi et al., , 2014. Blood-set samples showed ratios further away from that of hydroxyapatite at all intervals which could be attributed to decreased hydration (Moinzadeh et al., 2016) as a result of adhesion of blood proteins to sites of crystal nucleation as explained by Nekoofar et al. (Nekoofar et al., 2011). ...
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Aim To evaluate the influence of blood contamination on the bond strength and apatite forming ability of Biodentine used as root-end filling material. Methodology Eighty (n = 80) extracted single-rooted, sound human maxillary anterior teeth were prepared and obturated. Then, the roots were resected, retrograde cavities were prepared and Biodentine was inserted as the root-end filling material. Teeth were then randomly divided into 2 equal groups (n = 40) according to the setting environment of Biodentine i.e., group A where setting took place in human blood and group B where setting took place in deionized water (control group). Teeth were incubated at 37 °C for 45 min to ensure complete setting. Root discs with the filling material in their core were prepared. Push-out bond strength test was performed using a universal testing machine and failure mode was examined. Both groups were aged in HBSS for 30 days. Apatite nucleation was evaluated at one-day, 7-days, and 30-days interval using SEM for morphological analysis and EDX for elemental analysis. Calculation of the Ca/P ratios was performed in addition to XRD for crystal phase analysis. Results Blood contamination (group A) resulted in significant reduction of bond strength values. It also affected the amount of apatite deposition on the material surface and interfacial spaces with higher Ca/P ratios than that of the normal stoichiometric hydroxyapatite. Conclusions Blood contamination during setting of Biodentine had a detrimental effect on the bond strength and reduced the nucleation of apatite in comparison to non-contaminated group.
... Its advantage is the smaller particle size, which is 50% smaller than MTA and <1 μm [3]. MTA Plus had a prolonged capability to release calcium ions and increase the local pH when compared with MTA [4]. ...
Article
Introduction: This in-vitro study aims to evaluate the effect of acidic environment and intracanal medicament on push out bond strength of Biodentine and Mineral Trioxide Aggregate Plus (MTA Plus). Method: Forty extracted single rooted teeth were sectioned below the cement-enamel junction. The root canals were instrumented using rotary files and then peeso reamer was used to obtain standardized root canal dimension. Specimens were randomly classified into following groups- Group 1: calcium hydroxide in the absence of acidic environment; Group 2: calcium hydroxide in the presence of acidic environment; Group 3: no intracanal medicament in the absence of acidic environment; Group 4: no intracanal medicament in the presence of acidic environment. Specimens were kept for 7 days at room temperature. Thereafter, specimens of each group were transversely sectioned into 1 mm thick slices and divided into 2 sub-groups according to the use of biodentine and MTA Plus. Using Universal Testing Machine, push out bond strength test was carried out and the data were analyzed statistically. Results: There was no statistically significant difference in the bond strength of biodentine and MTA Plus (P>0.05). For both MTA Plus and biodentine, with or without calcium hydroxide, the push out bond strength was less in acidic environment and this difference was more pronounced without calcium hydroxide. In all the four groups, MTA plus showed comparable bond strength to biodentine. Conclusion: MTA Plus is a viable option for apexification. The push out bond strength of Biodentine and MTA Plus is impaired by acidic environment. Prior application of calcium hydroxide slightly increased the bond strength, though the difference was statistically insignificant.
... Its advantage is the smaller particle size, which is 50% smaller than MTA and <1 μm [3]. MTA Plus had a prolonged capability to release calcium ions and increase the local pH when compared with MTA [4]. ...
Article
Full-text available
Introduction. This in-vitro study aims to evaluate the effect of acidic environment and intracanal medicament on push out bond strength of Biodentine and Mineral Trioxide Aggregate Plus (MTA Plus) Method. Forty extracted single rooted teeth were sectioned below the cement-enamel junction. The root canals were instrumented using rotary files and then peeso reamer was used to obtain standardized root canal dimension. Specimens were randomly classified into following groups- Group 1: calcium hydroxide in the absence of acidic environment; Group 2: calcium hydroxide in the presence of acidic environment; Group 3: no intracanal medicament in the absence of acidic environment; Group 4: no intracanal medicament in the presence of acidic environment. Specimens were kept for 7 days at room temperature. Thereafter, specimens of each group were transversely sectioned into 1 mm thick slices and divided into 2 sub-groups according to the use of biodentine and MTA Plus. Using Universal Testing Machine, push out bond strength test was carried out and the data were analyzed statistically. Results. There was no statistically significant difference in the bond strength of biodentine and MTA Plus (P>0.05). For both MTA Plus and biodentine, with or without calcium hydroxide, the push out bond strength was less in acidic environment and this difference was more pronounced without calcium hydroxide. In all the four groups, MTA plus showed comparable bond strength to biodentine. Conclusion. MTA Plus is a viable option for apexification. The push out bond strength of Biodentine and MTA Plus is impaired by acidic environment. Prior application of calcium hydroxide slightly increased the bond strength, though the difference was statistically insignificant.
... The values obtained from µCT scanning depend on the resolution. Porosity values have been reported as high as 40% for the endodontic restorative materials via the Archimedes method, considerably higher than the resin-based calcium hydroxide Dycal product (~9%) [151]. Using Hg porosimetry, values of 20 to 25% were reported 28 days after setting [152]. ...
Article
Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes.
... Calcium silicates (Ca 3 SiO 5 and Ca 2 SiO 4 ) are the base compounds of BECs, together with radiopacifying additives such as bismuth, zirconia, tantalum, or tungsten oxides (2,7). Calcium silicate based cements, particularly those containing bismuth oxide as radiopacifier (8), present some disadvantages such as tooth discoloration, long setting time or difficult handling (9). Consequently, e323 new BECs have been prepared replacing bismuth oxide with alternative radiopacifier materials (9,10). ...
Article
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Background To study the mineralization capacity in vitro of the bioceramic endodontic material MTA HP Repair. Material and Methods Bioactivity evaluation in vitro was carried out, by soaking processed cement disk in simulated body fluid (SBF) during 168 h. The cement surface was studied by Fourier transform infrared spectroscopy (FT-IR), field emission gun scanning electron microscopy (FEG-SEM) and energy dispersive X-ray analysis (EDX). Release to the SBF media of ionic degradation products was monitored using inductively coupled plasma atomic emission spectroscopy (ICP-AES). Results FT-IR showed increasing formation of phosphate phase bands at 1097, 960, 607 and 570 cm-1 with prolonged SBF soaking. FEG-SEM analysis reveals that HP produces a effectively surface covering consisting in homogeneous spherical phosphate phase aggregates with an average diameter of 0.5-1.0 µm. EDX analysis comparing un-treated (hydrated), 24 h and 72 h SBF treated surfaces of MTA HP Repair revealed phosphate deposition after 24 h, with high phosphorous/silicon element ratio signal measured after 24 h, indicating a very high phosphate phase deposition for this material. Conclusions The study shows that MTA HP Repair produces a quick and effective bioactive response in vitro in terms of crystalline calcium phosphate surface coating formation. The high bioactive response of MTA HP Repair makes it an interesting candidate for endodontic use as repair cement. Key words:Bioactive endodontic cements, bioactive response, MTA HP Repair.
... MTA Plus sealer, which has particle size 50% smaller than ProRoot MTA (15), is marketed as a calcium silicate-based material that can be used during root canal filling, root-end filling, and pulp capping procedures (26). Physicochemical properties of MTA Plus sealer such as calcium ion release, hydration reaction and pH did not change when powder was mixed either with water or gel. ...
Article
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Purpose: The reinforcement effect of 3 various root canal sealers (AH 26, MTA Plus sealer and BioRoot RCS) and gutta-percha at different time periods (1 week and 1 month) were evaluated in the present study. Materials and methods: Single-rooted, single-canalled, cracks-free 80 mandibular premolars were decoronated to a length of 13mm. Group PC (positive control, n=10): samples were left unprepared and unfilled. Seventy samples were prepared by using the ProTaper Rotary System up to F4. Group NC (negative control, n=10): samples were left unfilled. Remaining 60 samples were assigned into 3 groups; Group 1: AH 26 + F4 gutta-percha (GP); Group 2: MTA Plus sealer + F4 GP and Group 3: BioRoot RCS + F4 GP. Filled samples were divided into subgroups according to storage time: Samples in Groups 1A, 2A, and 3A were stored for 1 week; while Groups 1B, 2B and 3B were stored for 1 month at 100% humidity to allow the complete setting of the sealers (n=10, for each). A universal testing machine at a crosshead speed of 1.0 mm/min was used for fracture testing. For each specimen, the force at the time of fracture was recorded and the data were analyzed statistically. Results: The highest fracture resistance values were obtained in Group PC, while the lowest values were obtained in Group NC. Groups PC and NC were statistically different from each other and from other groups, regardless of time (p<0.05). Fracture resistance values of Group AH 26/GP were statistically different from MTA Plus sealer/GP (p<0.05) and were statistically similar with BioRoot RCS/GP , irrespective of time. Within group comparisons revealed that there were no statistically differences between samples filled with same sealer at different time periods. Conclusion: Root canal preparation caused decreased fracture resistance. All sealers increased the force values needed to fracture the filled samples compared to unfilled ones. Time factor had no effect on the fracture resistance values.
... In the present study, contact with NaOCl and MTA Plus mixed with distilled water led to significantly greater discoloration than MTA Plus mixed with the gel. MTA Plus has been reported to have a finer particle size than the ProRoot MTA, which is further associated with higher ion release, porosity, solubility, and water sorption when compared to the ProRoot MTA (12,23). These properties enhance the ability of the MTA Plus to release calcium and prolong the bioactivity of the material (23). ...
Article
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Objective:This study aims to evaluate the effect of the special anti-washout gel mixing agent on the color stability of mineral trioxide aggregate (MTA) Plus and NeoMTA Plus in contact with distilled water, ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl).Materials and Methods:One set of three specimens was mixed using the antiwashout gel and the other set of three specimens was mixed using distilled water. Then, one specimen from each group was immersed in distilled water, 5% NaOCl or EDTA solutions for 24 hours. The color change of each specimen was assessed using spectrophotometer. The data were evaluated statistically with two-way ANOVA and post-hoc Tukey tests.Results:It was found that there was no statistically significant differences among the color changes of the MTA Plus and NeoMTA Plus mixed with either distilled water or gel when immersed in distilled water and EDTA (p>0.05). Immersion to NaOCl resulted in the highest discoloration in all materials compared to their immersion to distilled water and EDTA. MTA Plus mixed with distilled water showed significantly greatest discoloration after contact with NaOCl (p
... [11][12][13][14] Bioactive endodontic cements are based on tricalcium silicate and include a radiopacifying material composed of bismuth, zirconia, tantalum, or tungsten oxides, depending of the market product. 2,15 Bismuth oxide, the radiopacifier contained in the powder of MTA Plus, 16 plays a main role in cement hydration. However, it is responsible of tooth discoloration, 17 so new cements containing alternative radiopacifiers elements to replace bismuth have been prepared. ...
Article
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The aim of this study was to characterize the hydration performance and the bioactive response of the new bioactive endodontic cement MTA HP repair (HP), comparing its physicochemical parameters with those of ProRoot MTA White (Pro) and NeoMTA Plus (Neo). Un‐hydrated precursor materials were characterized by X‐ray fluorescence, laser diffraction, N2 physisorption and field emission gun scanning electron microscopy (FEG‐SEM). Setting time was assessed according to ASTM specification C 266. Hydrated materials were analyzed by X‐ray diffraction, Fourier transform infrared spectroscopy (FT‐IR) and (FEG‐SEM). Bioactivity evaluation in vitro was carried out, by soaking processed cement disk in simulated body fluid (SBF) during 168 h. The cements surface was studied by FT‐IR, FEG‐SEM, and energy dispersive X‐ray. Release to the SBF media of ionic degradation products was monitored using inductively coupled plasma atomic emission spectroscopy. HP showed shorter initial setting time compared to Pro and Neo and produce a quick and effective bioactive response in vitro in terms of phosphate phase surface coating formation. This higher bioactive response for HP is correlated with increasing calcium aluminate content, increasing surface area of un‐hydrated powder precursor and the increasing release capacity of Si ionic products of the final hydrated product. The higher bioactive response of MTA HP repair highlights this material, as very interesting to further investigate its performance to improve the outcome of vital pulp therapy procedures. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019.
Article
NeoMTA is a commercially available tricalcium silicate‐based cement intended for contact with pulp and periradicular tissues. The purpose of this study was to retrospectively evaluate the outcomes of non‐surgical root canal treatments with NeoMTA obturations. Patients were treated in a private endodontic practice between 2015 and 2018. All cases, including initial treatments and retreatments, were either fully obturated with NeoMTA, or using gutta‐percha with NeoMTA as an endodontic sealer. Outcomes were assessed using follow‐up examination data with digital periapical radiographs with a minimum of a 1‐year recall. Teeth were classified based on the clinical examination as: healed/healing (success), or non‐healed (failure). 265 teeth were included with an average follow‐up time of 1.3 years. The overall success rate was 91.7%. Only the presence of a pre‐operative periapical radiolucency was found to significantly affect success. Comparison of obturation techniques demonstrated no effect on outcomes. NeoMTA is suitable for endodontic obturation.
Article
Aim: To evaluate the tissue reaction of a tricalcium silicate-based repair material associated with 30% calcium tungstate (TCS + CaWO4 ) in comparison to Bio-C Repair (Bio-C; Angelus) and to MTA Repair HP (MTA HP; Angelus). Methodology: Polyethylene tubes filled with one of the materials or left empty (control group, CG) were implanted into the subcutaneous tissues of rats for 7, 15, 30 and 60 days (n = 32/group). The capsule thickness, number of inflammatory cells, collagen content, interleukin-6 (IL-6), osteocalcin (OCN), von Kossa reaction and analysis under polarized light were evaluated. The data were subjected to generalized linear models for repeated measures, except the OCN. OCN data were submitted to Kruskal-Wallis and Dunn's post hoc test and Friedman followed by Nemenyi's test at significance level of 5%. Results: At all time points, significant differences in the number of inflammatory cells were not observed between TCS + CaWO4 and Bio-C, whereas, at 15, 30 and 60 days, no significant difference was detected between TCS + CaWO4 and MTA HP. At all periods, significant differences were not detected in the number of fibroblasts in TCS + CaWO4 versus MTA HP, and, at 60 days, no significant difference was demonstrated between these groups and CG. Significant differences in the immunoexpression of IL-6 were not detected amongst bioceramic materials at all periods. From 7 to 60 days, significant reduction in the number of inflammatory cells, number of IL-6-immunopositive cells and in the capsule thickness was accompanied by significant increase in the collagen in all groups. OCN-immunolabelled cells, von Kossa-positive structures and amorphous calcite deposits were observed around all materials, whereas, in the CG, these structures were not seen. Conclusions: These findings indicate that the experimental material (TCS + CaWO4 ) is biocompatible and has a bioactive potential, similar to the MTA HP and Bio-C Repair, and suggest its use as a root repair material.
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As the biocompatibility and bioactive potential of repair materials are desired characteristics in dentistry, the tissue response of Bio‐C Pulpo, a bioceramic material launched on the marked by Angelus (Brazil), was compared with Biodentine (Septodont, France) and White MTA (WMTA; Angelus, Brazil). In 32 rats, 148 polyethylene tubes filled with Bio‐C Pulpo, Biodentine or WMTA, and empty (CG, control group) were implanted into subcutaneous tissues for 7, 15, 30, and 60 days. The capsule thickness, numerical density of inflammatory cells (IC) and fibroblasts (Fb), amount of collagen, immunohistochemistry detection of interleukin‐6 (IL‐6) and osteocalcin (OCN), von Kossa and analysis under polarized light were performed. Data were subjected to two‐way ANOVA followed by Tukey's test (p ≤ 0.05). At 7 and 15 days, the capsules around Bio‐C Pulpo were thicker than in WMTA while, at 30 and 60 days, significant differences were not observed among the groups. Although at 7, 15, and 30 days, a greater number of IL‐6‐immunostained cells was found in Bio‐C Pulpo and Biodentine than in WMTA, no significant difference was detected among the groups at 60 days. In all groups, the number of Fb and collagen content increased significantly over time. The capsules around materials exhibited von Kossa‐positive and birefringent structures, and OCN‐immunostained cells whereas, in the CG, these structures were not observed. Bio‐C Pulpo, similarly to Biodentine and WMTA, is biocompatible, allows the connective tissue repair and presents bioactive potential in connective tissue of rats.
Article
In this research, sodium alginate-pectin composite (ALG-PEC CS) and nanocomposites (NCs) films with 0.5, 1, and 2 wt% TiO2 nanoparticles (NPs) were prepared using CaCl2 and glutaraldehyde (Glu) as cross-linkers. The cross-linking produces rigid scaffolds for sedimentation of hydroxyapatite (HA), it can also decrease solubility in water and simulated body fluid (SBF) solution to 10% or less. The increase of the adsorbed water and SBF extends the pores and consequently the surface area for HA growth. Bioactive ability was confirmed via HA's presence on the all films. It was revealed that the film containing 2 wt% TiO2 NPs had the best bioactivity without any in vitro cytotoxicity on MG-63 cell line and the best antibacterial performance against Staphylococcus aureus, and after 1 h all the bacteria were killed.
Article
Context: Microorganisms are the main cause of failure of endodontic treatment. When retreatment fails periapical surgery followed by retrograde filling is done to seal the apex. A root-end filling material should have antimicrobial property as well as bioactive properties necessary for healing, repair, and regeneration of the apex. Aims: The aim of this study was to evaluate the antibacterial and antifungal efficacy of three bioactive root-end filling materials: mineral trioxide aggregate (MTA) Plus, Biodentine, Endosequence root repair material (ERRM) against Enterococcus faecalis and Candida albicans. Subjects and methods: E. faecalis and C. albicans standard bacterial strains were used. 100 μl was taken from liquid cultures of E. faecalis and planted in Mueller-Hinton agar and the same amount of C. albicans was planted in Sabouraud dextrose agar by lawn culture. MTA Plus, Biodentine, and ERRM were aseptically filled into the opened pits. Following this, the media were kept in the drying oven at 37°C for 24, 48, and 72 h and the diameters of the inhibition zones were measured. Statistical analysis used: Statistical analysis was carried out by Kruskal-Wallis, Post hoc (Mann-Whitney), Friedman, and Post hoc (Wilcoxon-sign) test. Results: Among the three groups, the antimicrobial activity of Biodentine against E. faecalis was statistically higher than MTA Plus and ERRM (P < 0.05). Antifungal activity of MTA Plus against C. albicans was statistically higher than Biodentine and ERRM (P < 0.05). ERRM showed the smallest inhibition zone against E. faecalis and C. albicans among the three groups (P < 0.05). Conclusions: Biodentine exhibited the greatest antimicrobial activity and MTA Plus exhibited the greatest antifungal activity among the three groups. ERRM exhibited the least antibacterial and antifungal activity among the three groups.
Article
Aim and objective: To compare between mineral trioxide aggregate (MTA) mixed with water and water-based gel regarding shear bond strength with resin-modified glass ionomer cement (RMGIC) and composite. Methods and materials: In this study, 40 blocks of cylindrical shape were prepared with acrylic. These blocks were divided into four groups with each group consisting of 10 blocks: group-1A: MTA + distilled water + composite, group-1B: MTA + distilled water + RMGIC, group-2A: MTA + polymer + composite, and group-2B: RMGIC + MTA + polymer. After that, a universal testing machine was used for the measurement of shear bond strength. The acrylic blocks were placed under this machine. A blade with a knife-edge was used to provide a crosshead speed of 1 mm/minute. This was continued till bond of MTA in both forms (distilled water/gel) and restorative material failed. Results: It was observed that a statistically significant difference was found between MTAw + composite and MTAg + composite resin but no statistically significant difference between MTAw + RMGIC and MTAg + RMGIC with p ≥ 0.05. It was found that a statistically significant difference was present between the RMGIC and composite groups within the same MTA type with p ≤ 0.05. Conclusion: It was concluded from the present study that MTA with a water-based gel has a better shear bond strength than composite resin and RMGIC materials. Clinical significance: It has been found that MTA has different properties when it is mixed with polymer and water. Very few studies have been conducted in the past to compare MTA mixed with water and water-based gel regarding the shear bond strength with RMGIC and composite.
Article
Aim: To investigate the effects of a bioactive glass with a high proportion of phosphorus (BG-hP) on the repair and regeneration of dental pulps in rats under an inflammatory microenvironment. Methodology: Human dental pulp cells (hDPCs) stimulated with 1 μg/mL lipopolysaccharide (LPS) were cocultured with 0.1 mg/mL BG-hP. Cell proliferation was detected by MTT assays. The expression of inflammation-related genes and odontogenic differentiation-related genes was determined by real-time PCR. Alizarin red staining was used to detect the formation of mineralized nodules. Coronal pulp tissues of rat molars were stimulated with 10 mg/mL LPS and then treated with BG-hP. The expression of inflammation-related genes in pulp tissue was determined by real-time PCR. Haematoxylin-eosin staining and Masson staining were performed to observe the inflammatory response and mineralized matrix formation, after subcutaneous implantation in nude mice, at 3 days and 4 weeks, respectively. Analysis of variance was performed to measure statistical significance (P < 0.05). Results: BG-hP significantly reduced expression of interleukin-6 (IL-6) and IL-8 and significantly upregulated the expression of IL-10, IL-4 and transforming growth factor-β1 of the LPS-stimulated hDPCs (P < 0.05). BG-hP significantly inhibited the initial cell number (P < 0.05), but the hDPCs stimulated by LPS and cocultured with BG-hP maintained the same proliferation rate as the untreated hDPCs. BG-hP significantly promoted the expression of dentine matrix protein-1 and dentine sialophosphoprotein and the mineralization capacity of the LPS-stimulated hDPCs (P < 0.05). Furthermore, BG-hP significantly downregulated the expression of Il-6 and reduced the inflammatory response of the LPS-stimulated pulp tissue 3 days after subcutaneous implantation (P < 0.05). Four weeks after subcutaneous implantation, BG-hP induced the formation of a continuous layer of dentine-like structure with dentinal tubules and polarizing odontoblast-like cells aligned along it in the LPS-stimulated pulp tissue. Conclusion: The present preliminarily results demonstrated that the bioactive glass with a high proportion of phosphorus inhibited the inflammatory response and promoted the formation of a pulp-dentine complex in a rat experimental model. This study provides a foundation for the construction of materials with the dual functions of exerting anti-inflammatory effects and promoting tissue regeneration to meet the needs of dental pulp repair and regeneration.
Article
PurposeThis study aimed to evaluate the response of dental pulp stem cells (DPSCs) cultured with and without lipoteichoic acid (LTA) to different pulp-capping materials. Methods: The cells were cultured and seeded in 6-well plates and exposed to 1% LTA solution. Dycal, ProRoot MTA and Biodentine materials were applied on cells and all groups were evaluated by cell proliferation, viability, cell cycle and cell death signaling pathways for 24 and 72 h.ResultsLTA + Dycal treatment significantly inhibited the proliferation of DPSCs and increased the apoptosis rate of cells more than the other groups at 72 h. Compared to other groups, LTA + Dycal treatment significantly increased the levels of Caspase-3 and AKT and decreased the levels of p-AKT.Conclusions The results of this study revealed that all tested materials caused apoptosis in DPSCs via an extrinsic apoptotic pathway. The DPSCs showed an early apoptosis response to the Dycal and a late apoptosis response to the ProRoot MTA and Biodentine treatments. LTA led autophagy and inhibited the proliferation of DPSCs. ProRoot MTA and Biodentin eliminated the LTA's bioactivity with higher efficiency than Dycal.
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Aim: To assess the sealing ability of two calcium silicate-based materials in the treatment of iatrogenic furcal perforations using a dye-penetration leakage model. Materials and methods: Furcation perforations were performed using a size 12 round burr on the pulp chamber floor of 20 first mandibular molars. The teeth were then randomly divided into two groups, two additional molars served as negative controls. The defects were then filled with mineral trioxide aggregate (MTA) Angelus in the first group and Biodentine in the second group. Leakage at the repaired sites was then evaluated using the methylene blue dye penetration technique. Results: Significant differences in microleakage were found between the two groups at 72 hours (p < 0.001). MTA Angelus had greater dye penetration than Biodentine with a statistically significant difference. Subsequently, the sealing ability of Biodentine was significantly better than MTA Angelus (p < 0.001). However, the mean values of leakage and inadequate adhesion were significantly different from the theoretical value for both the MTA Angelus (p < 0.001) and Biodentine (p < 0.001). Conclusion: The current results suggested that Biodentine possesses higher sealing quality than MTA Angelus. Yet, both materials are not ideal and still need improvement to ensure perfect adhesion in case of furcal perforation. Clinical significance: This article aims to compare the sealing ability of one dental repair material over another, after iatrogenically producing a furcal perforation. Leakage resistance and sealing ability are important factors in favoring the outcome of an endodontic treatment of a tooth that could otherwise be condemned for extraction.
Chapter
Endodontic bioceramics should have trouble‐free handling properties and consider the particle size, which affects the early strength and ease of clinical manipulation. Portland cement is very common, inexpensive hydraulic cement that is obtained from a mix of lime, silica, and alumina. MTA (mineral trioxide aggregate) is a mixture of fine hydrophilic particles of tricalcium silicate, tricalcium aluminate, dicalcium silicate, tetracalcium aluminoferrite, calcium sulfate, and bismuth oxide that sets in the presence of water.
Article
Objective: To systematically review the quality of evidence of available in vitro solubility studies on endodontic sealers according to prespecified evidence criteria. Material and methods: This systematic review was based on the PRISMA guidelines and the AMSTAR measurement tool. A systematic duplicate search of the literature on endodontic sealer solubility studies was conducted in PubMed and Embase databases (until 18 October 2017). Mapping terms to subject headings and free text terms were used and combined with hand searching before exclusion of duplicates. Studies specifically dealing with endodontic sealer solubility were selected. The evidence level was graded (low, medium or high) independently by two investigators following systematic data extraction in pilot forms, which was based on prespecified evidence criteria and the modified CONSORT checklist for in vitro studies on dental materials. Results: The search retrieved 1053 articles, from which 88 were assessed in full. From the 63 articles retained in the final analysis, 11 were classified as having moderate and 52 as low quality of evidence (0 high). The studies graded as low had low sample size (n < 10) and/or insufficient details to allow replicability. Most of the studies did not conform to the modified CONSORT checklist and did not include parameters considered relevant in the prespecified criteria. Conclusions: Existing in vitro studies on the solubility of endodontic sealers do not demonstrate a high quality of evidence. Most of these studies do not present systematic reporting nor employ relevant parameters prespecified in our evidence criteria.
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Ca(OH)(2)-containing/forming materials are conventionally used for indirect pulp-capping and are theoretically able to release Ca(2+) and OH(-) ions for hydrolytic dissociation. However, no evidence exists for ion diffusion through the remaining coronal dentin. The aim of this study was to design an innovative experimental set-up to test the ability of Ca(OH)(2)-containing and Ca(OH)(2)-forming pulp-capping materials to generate pulpward Ca(2) and OH(-) ion fluxes through coronal dentin after indirect pulp-capping in vitro. Standardized class 1 cavities were prepared in erupted sound human molars. Pulp tissue was excised. A coronal Remaining Dentin Thickness (RTD) (1±0.2 mm thick) was prepared within an occlusal-to-pulp cavity system (coronal RD system). The whole system/sample was treated with 17% EDTA to remove the smear layer and the external surface was covered by nail varnish. Indirect pulp-capping was performed on coronal RDT using a conventional pulp-capping material covered by a glass ionomer cement, a composite and nail varnish. Chemically different Ca(OH)(2) materials were used to test the reliability of the set-up. The leached Ca(2+) and OH(-) ions were measured using ion-selective electrodes after soaking for 3 hours, 24 hours, and 7 days in deionized water (10 mL, 37°C). Calcium ions were detected and a rise in pH was observed in the treated water after a few hours for all tested materials. The experimental set-up proved to be an easy and effective method for testing the different Ca(OH)(2)-containing and Ca(OH)(2)-forming materials ability to induce a pulpward flux of calcium and hydroxyl ions through coronal remaining dentin after indirect pulp-capping. The new system will allow the screening of current pulp-capping materials.
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Solubility of root filling materials is heavily influenced by the environment they are in contact with. This study compared the solubility of ProRoot MTA in deionized water and synthetic tissue fluid. Forty specimens of prepared MTA were immersed in deionized water and synthetic tissue fluid (20 samples each). The solubility was assessed after 7 and 28 days. Scanning electron microscope observation was also performed. The mean weight loss was evaluated using a digital scale. Data were analyzed using one-way ANOVA. Tukey test was performed for multiple comparisons. MTA solubility in synthetic tissue fluid was significantly lower than deionized water after 7 and 28 days (P<0.05). Secondary electron detectors revealed the presence of lumps and platelets on the surfaces of both specimens. Also, more voids were observed in specimen stored in deionized water. MTA dissolved faster in deionized water than synthetic tissue fluid. Despite this, the solubility of this material in both media was acceptable.
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Fluoride-releasing restorative materials are available for remineralization of enamel and root caries. However, remineralization of dentin is more difficult than remineralization of enamel due to the paucity of apatite seed crystallites along the lesion surface for heterogeneous crystal growth. Extracellular matrix proteins play critical roles in controlling apatite nucleation/growth in collagenous tissues. This study examined the remineralization efficacy of mineral trioxide aggregate (MTA) in phosphate-containing simulated body fluid (SBF) by incorporating polyacrylic acid and sodium tripolyphosphate as biomimetic analogs of matrix proteins for remineralizing caries-like dentin. Artificial caries-like dentin lesions incubated in SBF were remineralized over a 6 week period using MTA alone or MTA containing biomimetic analogs in the absence or presence of dentin adhesive application. Lesion depths and integrated mineral loss were monitored with microcomputed tomography. The ultrastructure of baseline and remineralized lesions was examined by transmission electron microscopy. Dentin remineralization was best achieved using MTA containing biomimetic analogs regardless of whether an adhesive was applied; dentinal tubules within the remineralized dentin were occluded by apatite. It is concluded that the version of MTA employed in this study may be doped with biomimetic analogs for remineralization of unbonded and bonded artificial caries-like lesions in the presence of SBF.
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Calcium hydroxide cements have been largely used in deep cavities due to their abilities to stimulate dentin formation. However, their resistance can be relatively low and their solubility relatively high, in many instances. This study evaluated water sorption and solubility of different calcium hydroxide cements, in order to show alterations that may reduce their effectiveness. Five discs (20 mm in diameter and 1.5 mm thick) of three different materials (Biocal, Dycal and Hidro C) were prepared with the aid of a ring-shaped metallic matrix. After being stored at 37 degrees C for 24 h, the discs were weighed on a precision weight scale, dehydrated and weighed again. Immediately after weighing, discs were stored for a week in 50 mL of distilled water at 37 degrees C and, then, weighed again, dehydrated and submitted to a new weighing. The loss of soluble material and its water sorption was obtained from the difference between the initial and the final dry mass of each disc, after 1 week of immersion in water. Data were analyzed for significant differences by two-way ANOVA and Tukey's test (p<0.05). Mean water sorption values (g) +/- standard deviation and percentage (%), for each evaluated cement, were: Biocal (0.006 +/- 0.001 / 2.15); Dycal (0.016 +/- 0.004 / 5.49); and Hidro C (0.025 +/- 0.003 / 8.27). Mean solubility values (g) +/- standard deviation and percentage (%), for each evaluated cement, were: Biocal (0.002 +/- 0.001 / 0.72); Dycal (0.013 +/- 0.004 / 4.21); and Hidro C (0.023 +/- 0.004 / 7.65). Biocal absorbed less water and was less soluble than the other evaluated cements; Hidro C exhibited the highest water sorption and solubility values; and there were significant differences among all evaluated experimental groups.
Article
The retreatability of recent calcium silicate or mineral trioxide aggregate (MTA) sealers has not yet been assessed. The aim of this study was to evaluate the removal of 2 MTA-based sealers (MTA Fillapex [Angelus Soluções Odontológicas, Londrina, PR, Brazil] and MTA Plus [Prevest-Denpro, Jammu City, India]) using a rotary retreatment system, considering an epoxy resin sealer (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland]) as the standard for comparison. Root canals in 45 single-rooted teeth were instrumented using a rotary nickel-titanium system (MTwo; VDW GmbH, Munich, Germany) and obturated with gutta-percha using one of the following sealers (n = 15): group 1, MTA Fillapex; group 2, MTA Plus; and group 3, AH Plus. The teeth were scanned using a cone-beam computed tomography scanner. After 2 months, the root canals were retreated with a rotary retreatment system (ProTaper Universal Retreatment; Dentsply Maillefer, Ballaigues, Switzerland) and a second cone-beam computed tomography scan was performed to assess the amount of remaining root filling material (in percentage) and dentin removal (in cubic millimeters). The time taken to reach the working length was calculated in minutes. Group comparisons were performed using 1-way analysis of variance and the Student-Newman-Keuls post hoc test (P = .05). There was a significant difference in the amount of remaining root filling material between the 3 groups (P < .05), with group 1 showing the least amount of root filling material (1.8% ± 0.22%) and group 3 showing the highest (10.4% ± 0.71%). The amount of dentin removal and the time taken to reach the working length was significantly higher in group 3 than in groups 1 and 2 (P < .05). There was no significant difference between groups 1 and 2 in these outcome variables (P > .05). The rotary retreatment system evaluated was not able to completely remove any of the sealers. MTA Fillapex showed less remaining root filling material than MTA Plus.
Article
Commercial root end filling materials, namely two zinc oxide eugenol-based cements [intermediate restorative material (IRM), Superseal], a glass ionomer cement (Vitrebond) and three calcium-silicate mineral trioxide aggregate (MTA)-based cements (ProRoot MTA, MTA Angelus, and Tech Biosealer root end), were examined for their ability to: (a) release calcium (Ca(2+) ) and hydroxyl (OH(-) ) ions (biointeractivity) and (b) form apatite (Ap) and/or calcium phosphate (CaP) precursors. Materials were immersed in Hank's balanced salt solution (HBSS) for 1-28 days. Ca(2+) and OH(-) release were measured by ion selective probes, surface analysis was performed by environmental scanning electron microscopy/energy dispersive X-ray analysis, micro-Raman, and Fourier transform infrared spectroscopy. IRM and Superseal released small quantities of Ca(2+) and no OH(-) ions. Uneven sparse nonapatitic Ca-poor amorphous CaP (ACP) deposits were observed after 24 h soaking. Vitrebond did not release either Ca(2+) or OH(-) ions, but uneven nonapatitic Ca-poor CaP deposits were detected after 7 days soaking. ProRoot MTA, MTA Angelus, and Tech Biosealer root end released significant amounts of Ca(2+) and OH(-) ions throughout the experiment. After 1 day soaking, nanospherulites of CaP deposits formed by amorphous calcium/magnesium phosphate (ACP) Ap precursors were detected. A more mature ACP phase was present on ProRoot MTA and on Tech Biosealer root end at all times. In conclusion, zinc oxide and glass ionomer cements had little or no ability to release mineralizing ions: they simply act as substrates for the possible chemical bonding/adsorption of environmental ions and precipitation of nonapatitic Ca-poor ACP deposits. On the contrary, calcium-silicate cements showed a high calcium release and basifying effect and generally a pronounced formation of more mature ACP apatitic precursors correlated with their higher ion-releasing ability.
Article
The purpose of this study was to examine the effect of mineral trioxide aggregate (MTA) on pluripotent-mesenchymal cell differentiation. The pluripotent-mesenchymal cell line C2C12 was cultured in a 5% serum medium to induce cell differentiation with or without MTA. The differentiation to myoblasts was analyzed by the immunocytochemical staining of myosin heavy chains. The cellular phenotype-specific markers characterizing the osteoblasts (Runx2 and osterix), chondroblasts (Sox9), myoblasts (MyoD), and adipocytes (LPL) were estimated with mRNA and protein levels by using real-time polymerase chain reaction and Western blot analysis, respectively. To verify that the effect of MTA was caused by the released calcium ions, the mRNA levels were analyzed in the presence or absence of MTA with ethylene glycol tetraacetic acid, calcium chloride, or verapamil. C2C12 cells cultured without MTA altered their phenotype to myoblasts, exhibiting positive reactions to myosin heavy chains. However, the cells cultured with MTA were strongly inhibited from developing into myoblasts. The mRNA and protein expressions of Runx2, osterix, and Sox9 significantly increased with MTA; the expressions of MyoD and LPL decreased significantly. Calcium chloride addition without MTA presented a significant increase of mRNA levels of Runx2, osterix, and Sox9; ethylene glycol tetraacetic acid addition with MTA presented a significant increase of mRNA levels of MyoD and LPL. Verapamil blocked the stimulating or suppressing effect of MTA on these transcription factors. Our study showed that MTA converted the differentiation pathway of C2C12 cells into osteoblast and/or chondroblast lineages as a result of elution components such as calcium ions from MTA.
Article
Aim: To investigate nondestructively the percentage of 3D voids and marginal gaps in a pre-defined interface volume of interest (VOI) within root fillings produced by Thermafil Obturators with either a hydrophobic epoxy-resin-based sealer (AH Plus) or a hydrophilic flowable calcium-silicate sealer [mineral trioxide aggregate (MTA) Flow]. Methodology: Sixteen single root canals from extracted premolar teeth were prepared with ProTaper rotary instruments, randomly allocated into two groups (n = 8) and filled with size 30 Thermafil Obturators in association with AH Plus or MTA Flow sealers. The filled roots were stored at 37 °C in 5 mL of Hank's balanced salt solution (HBSS) used to represent body fluids and scanned after 7 days and 6 months using a high-resolution micro-CT. From each root, images of 3000 sections were analysed in 3D and binarized using a high-resolution micro-CT (4-μ resolution). The 3D distribution of voids (porosity and marginal gaps) at the gutta-percha-sealer-dentine interface was detected through a threshold grey level and expressed as percentage of the 40-μ-thick pre-defined interface VOI (20 μ of interface dentine and 20 μ of gutta-percha/sealer). A method of analysis based on the root canal segmentation was used, and coronal, middle and apical thirds considered separately. The percentage of 3D void volume was compared statistically using one-way anova (significance for P < 0.05). Environmental Scanning Electron Microscope with Energy Dispersive X-ray (ESEM-EDX) analysis was performed on the surface of both sealers after soaking in HBSS. Results: Micro-CT detected gaps at the dentine-sealer interface in both groups. Void volumes wider than 10.21 μm(3) with 1.35 μm diameter were detected. Cul-de-sac-type voids (blind pores) and through-and-through voids (continuous pores) were discriminated. The apical thirds had a significantly lower 3D void volume (P < 0.05) than the middle and coronal thirds. The 3D void volume reduced significantly (P < 0.05) over time. ESEM-EDX analysis revealed that MTA Flow sealer created a dense apatite layer after 7 days of immersion in HBSS, whilst only sparse calcium phosphate deposits were detected on AH Plus even after 28 days. Conclusions: Micro-CT proved to be a powerful nondestructive 3D analysis tool for visualizing the porous internal microstructure of dental/endodontic materials at the interface with dentine. The proportion of voids was least in the apical third of root canals. Voids reduced over time in the presence of simulated body fluid.
Article
Calcium silicate-based materials (CSMs) are used in various endodontic procedures. The present study examined whether prolonged contact of mineralized dentin with recently commercialized versions of these materials adversely affects dentin collagen matrix integrity. Dentin slabs prepared from extracted human third molars (7 × 3 × 0.3 mm) were divided into 3 groups on the basis of the material to which dentin was exposed (MTA Plus, Biodentine, untreated control dentin slabs) and the time period of exposure (24 hours, 1, 2, and 3 months; n = 6). Hydroxyproline assay was performed on each group's supernatant to quantify the collagen extraction amounts of each group per time period. Data were analyzed with two-factor repeated-measures analysis of variance and Holm-Sidak pair-wise comparisons (α = 0.05) to determine the effects of material and aging time on collagen extraction. Dentin slabs from the 3 months of aging group were demineralized for transmission electron microscopy examination of collagen matrix ultrastructural changes. Material (P = .002), aging time (P < .001), and their interactions (P = .007) significantly affected the amount of hydroxyproline (pg/mg of mineralized dentin) extracted from mineralized dentin and were significantly correlated by power regression models. Collagen degradation was identified from the surface of dentin slabs that were in direct contact with CSMs. Prolonged contact of mineralized dentin with CSMs has an adverse effect on the integrity of the dentin collagen matrix. However, the amount of collagen extracted was limited to the contact surface. Clinicians can continue to apply CSMs in endodontic procedures; however, caution is advised when these materials are applied to thin dentinal walls.
Article
Prolonged exposure of root dentin to calcium hydroxide alters the fracture resistance of dentin. Calcium silicate-based materials (CSMs) used in endodontics release calcium hydroxide on setting. This study examined whether prolonged contact of dentin with CSMs adversely affects its mechanical properties. Dentin beams prepared from extracted human molars (7 × 3 × 0.3 mm) were divided into 3 groups on the basis of the material to which dentin was exposed (Biodentine, MTA Plus, and untreated control beams). Three-point flexure to failure was performed for each beam at designated exposure times (24 hours, 1, 2, and 3 months; n = 10). Data were analyzed with 2-factor repeated-measures analyses of variance to determine the effects of material and aging time on flexural modulus, flexural strength, and modulus of toughness (α = 0.05). For flexural modulus, there was no significant difference for material (P = .947) or aging time (P = .064) when compared with baseline control. For flexural strength, significant differences were associated with aging time (P < .001) but not with material (P = .349). Flexural strength of dentin exposed to Biodentine decreased significantly after 2 and 3 months, whereas that exposed to MTA Plus decreased significantly after 3 months of aging (P < .05). For modulus of toughness, significant declines were observed for both material (P < .004) and aging time (P < .001). Both CSMs alter material toughness more than the strength and stiffness of dentin after aging in 100% relative humidity. Because dentin toughness is attributed to its collagen matrix, the amount of collagen extracted from mineralized dentin and changes in collagen ultrastructure should be further examined after exposure of dentin to CSMs.
Article
To evaluate the chemical-physical properties of TheraCal, a new light-curable pulp-capping material composed of resin and calcium silicate (Portland cement), compared with reference pulp-capping materials (ProRoot MTA and Dycal). Calcium (Ca) and hydroxyl (OH) ion release over 28 days, solubility and water uptake (weight percentage variation, Δ%) at 24 h, cure depth and radiopacity of TheraCal, ProRoot MTA and Dycal were evaluated. Statistical analysis (P < 0.05) of release of ion was carried out by two-way repeated measures anova with Tukey, whilst one-way anova with Tukey test was used for the other tests. TheraCal released significantly more calcium than ProRoot MTA and Dycal throughout the test period. TheraCal was able to alkalinize the surrounding fluid initially to pH 10-11 (3 h-3 days) and subsequently to pH 8-8.5 (7-14 days). TheraCal had a cure depth of 1.7 mm. The solubility of TheraCal (Δ-1.58%) was low and significantly less than that of Dycal (Δ-4.58%) and ProRoot MTA (Δ-18.34%). The amount of water absorbed by TheraCal (Δ +10.42%) was significantly higher than Dycal (Δ +4.87%) and significantly lower than ProRoot MTA (Δ +13.96%). TheraCal displayed higher calcium-releasing ability and lower solubility than either ProRoot MTA or Dycal. The capability of TheraCal to be cured to a depth of 1.7 mm may avoid the risk of untimely dissolution. These properties offer major advantages in direct pulp-capping treatments.
Article
Human orofacial bone mesenchymal stem cells (OFMSCs) from maxilla and mandible have robust osteogenic regenerative properties on the basis of our previous reports that demonstrate phenotypic and functional differences between jaw and axial bone mesenchymal stem cells in same individuals. Furthermore, a combination of OFMSCs with bioactive calcium-releasing cements can potentially improve OFMSC multilineage differentiation capacity, but biocompatibility of calcium-silicate cements with OFMSCs is still unclear. We tested the hypothesis that material extracts of calcium-releasing calcium-silicate cements support biomimetic microenvironment for survival and differentiation of human OFMSCs. Two experimental calcium-silicate cements, (1) calcium-silicate mineral powder (wTC) containing dicalcium and tricalcium-silicate, calcium sulfate, and calcium chloride and (2) wTC doped with alpha-tricalcium phosphate (wTC-αTCP), were designed and prepared. Cement setting times were assessed by Gilmore needles, ability to release calcium and hydroxyl ions was assessed by potentiometric methods, and OFMSC attachment to calcium-silicate discs was assessed. Calcium-silicate material extracts were tested for ability to support OFMSC survival and in vitro/in vivo differentiation. Fewer OFMSCs attached to calcium-silicate discs relative to tissue culture plastic (P = .001). Extracts of calcium-silicate cements sustained OFMSC survival, maintained steady state levels of vascular cell adhesion molecule-1, alkaline phosphatase, and bone sialoprotein while up-regulating their respective gene transcripts. Adipogenic and in vivo bone regenerative capacities of OFMSCs were also unaffected by calcium-silicate extracts. Ion-releasing calcium-silicate cements support a biomimetic microenvironment conducive to survival and differentiation of OFMSCs. Combination of OFMSCs and calcium-silicate cement can potentially promote tissue regeneration in periapical bone defects.
Article
An innovative light-curable calcium-silicate cement containing a HEMA-TEGDMA-based resin (lc-MTA) was designed to obtain a bioactive fast setting root-end filling and root repair material. lc-MTA was tested for setting time, solubility, water absorption, calcium release, alkalinizing activity (pH of soaking water), bioactivity (apatite-forming ability) and cell growth-proliferation. The apatite-forming ability was investigated by micro-Raman, ATR-FTIR and ESEM/EDX after immersion at 37°C for 1-28 days in DPBS or DMEM+FBS. The marginal adaptation of cement in root-end cavities of extracted teeth was assessed by ESEM/EDX, and the viability of Saos-2 cell on cements was evaluated. lc-MTA demonstrated a rapid setting time (2min), low solubility, high calcium release (150-200ppm) and alkalinizing power (pH 10-12). lc-MTA proved the formation of bone-like apatite spherulites just after 1 day. Apatite precipitates completely filled the interface porosities and created a perfect marginal adaptation. lc-MTA allowed Saos-2 cell viability and growth and no compromising toxicity was exerted. HEMA-TEGDMA creates a polymeric network able to stabilize the outer surface of the cement and a hydrophilic matrix permeable enough to allow water absorption. SiO(-)/Si-OH groups from the mineral particles induce heterogeneous nucleation of apatite by sorption of calcium and phosphate ions. Oxygen-containing groups from poly-HEMA-TEGDMA provide additional apatite nucleating sites through the formation of calcium chelates. The strong novelty was that the combination of a hydraulic calcium-silicate powder and a poly-HEMA-TEGDMA hydrophilic resin creates the conditions (calcium release and functional groups able to chelate Ca ions) for a bioactive fast setting light-curable material for clinical applications in dental and maxillofacial surgery. The first and unique/exclusive light-curable calcium-silicate MTA cement for endodontics and root-end application was created, with a potential strong impact on surgical procedures.
Article
Apatite-forming ability, considered as an index of bioactivity (bond-to-bone ability), was tested on ProRoot MTA cement after immersion in phosphate-containing solution (DPBS). Disk samples were prepared and immersed in DPBS for 10 min, 5 h, 1 and 7 days. The cement surface was studied by attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy, by micro-Raman spectroscopy and by environmental scanning electron microscope with energy dispersive X-ray (ESEM-EDX) analyses. The pH of the storage solution was also investigated. Spectroscopic analyses revealed calcium phosphate bands after 5-h immersion in DPBS. After 1 day, an even coating composed of apatite spherulites (0.1-0.8 micron diameter) was observed by ESEM/EDX. After 7 days, its thickness had increased. Apatite nucleation had already occurred after 5-h immersion. At this time, the presence of portlandite (i.e. Ca(OH)(2) , calcium hydroxide) on the cement surface was also observed; at longer times, this component was released into the medium, which underwent a remarkable pH increase. The study confirms the ability of ProRoot MTA to form a superficial layer of apatite within hours. The excellent bioactivity of ProRoot MTA might provide a significant clinical advantage over the traditional cements used for root-end or root-perforation repair.
Article
ProRoot mineral trioxide aggregate (MTA) and calcium silicate cements are able to set in a moist environment. The aim of the study was to examine the surface structure and composition of a cement paste under wet conditions and in real time during setting by environmental scanning electron microscopy connected with energy dispersive x-ray analysis (ESEM-EDX) and micro-Raman techniques. White ProRoot MTA and experimental white tetrasilicate cement (wTC) and wTC containing bismuth oxide (wTC-Bi) were studied. Cement disks were analyzed 10 minutes after powder-liquid mixing (freshly prepared samples) and after immersion in Dulbecco phosphate-buffered saline at 37 degrees C for 24 hours (24-hour-aged samples). Freshly prepared wet cements at ESEM-EDX exposed an irregular surface (displaying calcium, silicon, aluminum, chlorine reflexes, and bismuth traces in MTA and wTC-Bi) with needle-like and cubic-hexagonal shaped crystals. Aggregates of spheroidal Ca-P-rich crystals (spherulites) appeared on the surface of 24-hour-aged samples. The starting unhydrated powders displayed the typical Raman bands of Portland cement components: alite, belite, and calcium sulfate (only as anhydrite in MTA and as both anhydrite and gypsum in wTC and wTC-Bi). MTA powder showed higher amount of calcium carbonate and lower quantities of anhydrite and higher crystallinity of the silicate component, leading to a slower hydration reaction. Products/markers of hydration reactions were present on fresh samples; ettringite formed on the surface of all the cements; calcium hydroxide (portlandite) was detected only on the surface of wTC, but no conclusion can be drawn on wTC-Bi and MTA because of the interference of bismuth oxide. Calcium phosphate and calcite/aragonite bands were detected on all 24-hour-aged cements; portlandite was no longer detected on wTC. ESEM and micro-Raman are powerful and suitable techniques to investigate endodontic calcium silicate hydrated cements in real time and in their humid state without inducing artifacts by sample preparation. The formation of apatite spherulites on calcium silicate cements might have clinical relevance.
Article
Mineral trioxide aggregate (MTA) is a therapeutic, endodontic repair material that is reported to exhibit calcified tissue-conductive activity although the mechanisms remain unclear. We hypothesize that the dissolution of calcium from MTA into the surrounding environment may play an important role in the osteoblastic/cementoblastic differentiation of human periodontal ligament cells (HPLCs). Two populations of HPLCs were obtained from two patients, respectively, and were cultured in the presence or absence of MTA discs and/or CaCl(2) in order to investigate calcium release, calcification activity, calcium-sensing receptor (CaSR) gene expression and bone morphogenetic protein-2 (BMP-2), and BMP-2 receptor protein and gene expression. MTA released a substantial accumulation of calcium (4 mmol/L) within 14 days into culture media. After 4 weeks, the two populations of HPLCs independently exhibited calcification as well as BMP-2 distribution in the vicinity of MTA. HPLCs inherently expressed genes encoding for the CaSR and BMP-2 receptors. Exogenous CaCl(2) media supplementation induced CaSR gene expression in HPLCs and calcification and BMP-2 synthesis throughout the entire HPLC cultures, whereas MgCl(2) had no effect. Both MTA and CaCl(2) stimulated BMP-2 gene expression above that of baseline levels. Here we show the first report showing that HPLCs cocultured directly with MTA up-regulated BMP2 expression and calcification. These results may be through CaSR interactions that were potentially activated by the release of calcium from MTA into the culture environment.
Article
Mineral trioxide aggregate (MTA) has been recommended for various uses in endodontics. Two previous publications provided a comprehensive list of articles from November 1993-September 2009 regarding the chemical and physical properties, sealing ability, antibacterial activity, leakage, and biocompatibility of MTA. The purpose of Part III of this literature review is to present a comprehensive list of articles regarding animal studies, clinical applications, drawbacks, and mechanism of action of MTA. A review of the literature was performed by using electronic and hand-searching methods for the clinical applications of MTA in experimental animals and humans as well as its drawbacks and mechanism of action from November 1993-September 2009. MTA is a promising material for root-end filling, perforation repair, vital pulp therapy, and apical barrier formation for teeth with necrotic pulps and open apexes. Despite the presence of numerous case reports and case series regarding these applications, there are few designed research studies regarding clinical applications of this material. MTA has some known drawbacks such as a long setting time, high cost, and potential of discoloration. Hydroxyapatite crystals form over MTA when it comes in contact with tissue synthetic fluid. This can act as a nidus for the formation of calcified structures after the use of this material in endodontic treatments. On the basis of available information, it appears that MTA is the material of choice for some clinical applications. More clinical studies are needed to confirm its efficacy compared with other materials.
Article
An ideal orthograde or retrograde filling material should seal the pathways of communication between the root canal system and its surrounding tissues. It should also be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, insoluble in tissue fluids, and dimensionally stable. Mineral trioxide aggregate (MTA) was developed and recommended initially because existing root-end filling materials did not have these "ideal" characteristics. MTA has also been recommended for pulp capping, pulpotomy, apical barrier formation in teeth with open apexes, repair of root perforations, and root canal filling. Since MTA's introduction in 1993, numerous studies have been published regarding various aspects of this material. The aim of Part I of this literature review is to present investigations regarding the chemical, physical, and antibacterial properties of MTA. A review of the literature was performed by using electronic and hand-searching methods for the chemical and physical properties and antibacterial activity of MTA from November 1993-September 2009. There are many published reports regarding the chemical, physical, and antibacterial properties of MTA. Our search showed that MTA is composed of calcium, silica, and bismuth. It has a long setting time, high pH, and low compressive strength. It possesses some antibacterial and antifungal properties, depending on its powder-to-liquid ratio. MTA is a bioactive material that influences its surrounding environment.
Article
To compare residual root-end filling material in apical root-end cavities following their removal with ultrasonic retrotips. Thirty single-rooted teeth were filled with Thermafil and AH Plus sealer. Root-ends were resected at 90 degrees, 3 mm from the apex. Root-end cavities were prepared with diamond burs and ultrasonic retrotips and filled with one of three filling materials: group I: Retro-TC (calcium silicate-based cement), group II: IRM (Dentsply, Germany), group III: Vitrebond (3M ESPE, USA). After 30 days of storage, ultrasonic retrotips were used to remove materials from the root-end cavities. The ultrasonic application time was fixed at 60 s. Polyether impressions and replicas of the root-ends were made. Root apices and replicas were examined by one operator under a scanning electron microscope. Remnants of residual materials were evaluated using a four-level scoring system; fractures, smear layer and exposed dentinal tubules were also examined. Forty per cent of the specimens filled with Retro-TC revealed complete removal of the material with exposure of dentinal tubules, whilst 60% contained residual cement. Twenty per cent of specimens filled with IRM were completely devoid of material, whereas 80% had retained material. Ten per cent of specimens filled with Vitrebond retained a moderate amount of material whilst 90% had substantial retention of the material. Statistically significant differences were found (P < 0.05) amongst the three groups of materials. Retro-TC was successfully removed in 40% of cases using ultrasonics retrotips for 60 s, whereas IRM and Vitrebond specimens had evidence of retained material in 80% and 90% of all specimens respectively.
Article
The purpose of this study was to investigate the effects of mineral trioxide aggregate (MTA) on survival, mineralization, and expression of mineralization-related genes of cementoblasts. Immortalized cementoblasts (OCCM) were maintained with Dulbecco modified Eagle medium containing 10% fetal bovine serum. Methyl-thiazol-diphenyl-tetrazolium experiments were performed at 24 and 72 hours to evaluate bioactive components released by MTA (0.002-20 mg/mL) on the cell survival of OCCM. Von Kossa staining was used to evaluate biomineralization of OCCM cells. Images of cementoblasts were taken on day 3 by using inverted microscopy. Gene transcripts for bone sialoprotein (BSP), OCN, collagen type I (COL I), and osteopontin (OPN) were evaluated on days 3 and 5 by using semiquantitative reverse transcriptase polymerase chain reaction. The 20 mg/mL concentration of MTA was toxic for OCCM cells, whereas other concentrations of MTA tested exhibited similar cell numbers when compared with control group, and the 0.02 mg/mL concentration of MTA increased OCCM cell survival at 72 hours. Although an apparent decrease in mineralization was observed in the highest 3 concentrations of MTA used, 0.02 and 0.002 mg/mL concentrations of MTA induced greater biomineralization of OCCM cells than seen in the control. Moreover, increased BSP and COL I mRNA expression was observed at 0.02 and 0.002 mg/mL concentrations of MTA. MTA did not have a negative effect on the viability and morphology of cementoblasts and induced biomineralization of cementoblasts at the concentrations of 0.02 and 0.002 mg/mL. Based on these results MTA can be considered as a favorable material regarding cell-material interaction.
Article
Calcium hydroxide is often used for induction of reparative dentin formation in endodontic treatment. However, little is known about the mechanism by which calcium hydroxide works. The calcium ion (Ca2+) is an important regulator of cell functions. In this study, we examined the effect of extracellular Ca2+ on gene expression of bone-related proteins in human cultured pulp cells in serum-free conditions. A Ca2+ level elevated by 0.7 mM induced an increase in mRNA expression of osteopontin and bone morphogenetic protein (BMP)-2. However, mRNA levels of BMP-4 and alkaline phosphatase decreased under the elevated Ca2+ culture condition. The same concentration of additional magnesium ions had little effect on expressions of the examined bone-related protein mRNAs. These findings suggest that Ca2+ in Ca(OH)2 specifically modulates osteopontin and BMP-2 levels during calcification in pulp.
Article
This study tested mineral trioxide aggregate (MTA) solubility and porosity with different water-to-powder proportions. The study also determined the chemical composition of the salts dissolved by MTA. Four sets of specimens using the following water-to-powder proportions were prepared: 0.26, 0.28, 0.30, and 0.33 grams of water per gram of cement. The latter is the ratio recommended by the manufacturer. It was determined that the degree of solubility and porosity increased as the water-to-powder ratio increased. Significant differences were found among the sets of specimens. The chemical analyses of the salts dissolved by MTA in the water identified the presence of calcium as the main chemical compound. The pH level of the solution was highly alkaline, ranging between 11.94 and 11.99. It can be stated that the calcium found in the solution should be in its hydroxide state at this high pH level. This ability to release calcium hydroxide could be of clinical significance because it could be related to the proven capacity of MTA to induce mineralization.
Article
Unlabelled: Root-end filling materials are commonly used following endodontic surgical procedures; however, their effect on adjacent soft tissues is poorly understood. We predict that, due to the differences in their chemical composition, these materials will have profoundly different effects on the survival and differentiation of fibroblasts. Many of the root-end filling materials examined were initially cytotoxic to both PDL and gingival fibroblasts in co-culture experiments; however, this was reduced after the materials were washed in either mineral trioxide aggregate (MTA) or hybrid ionomere composite resin (HICR) for 2 wks. Additionally, PDL fibroblasts displayed enhanced proliferation on MTA and survival on amalgam when compared with gingival fibroblasts. MTA preferentially induced alkaline phosphatase expression and activity in both PDL and gingival fibroblasts. In contrast, HICR inhibited alkaline phosphatase expression and activity. In addition, MTA and HICR repressed pleiotrophin in PDL fibroblasts, while HICR repressed periostin in both fibroblasts. Thus, root-end filling materials differentially affect periodontal fibroblast differentiation. Abbreviations: mineral trioxide aggregate (MTA), zinc-oxide eugenol cement (ZOEC), hybrid ionomer composite resin (HICR), reverse-transcriptase polymerase chain-reaction (RT-PCR).
Article
We studied the thermal properties of cavity liners that included calcium phosphate as inorganic filler, in contrast to the conventional pulp capping agents. Therefore, thermal diffusivity, specific heat capacity, and thermal conductivity were measured. In addition, thermal conductivity results were compared with those of restorative materials and human dentin to examine thermal insulation effects. The thermal conductivity of cavity liners ranged from 0.23 to 0.28 W m(-1) K(-1), and that of pulp capping agents ranged from 0.44 to 0.48 W m(-1) K(-1). Test results indicated that the thermal conductivity of cavity liner was lower than those of human dentin, pulp capping agent, cast alloy, and composite resin for restoration, hence suggesting that cavity liner has a good thermal insulation effect.
Article
ProRoot Mineral Trioxide Aggregate (MTA) has been indicated as a pulp capping material. The purpose of this study was to evaluate the effect of tooth-colored (white) MTA on pulp cell apoptosis and cell cycle. Mouse odontoblast-like cells (MDPC-23) and undifferentiated pulp cells (OD-21) were exposed to 0 to 100 mg MTA for 24 h. Propidium iodide staining followed by flow cytometry demonstrated that MTA did not induce apoptosis of MDPC-23 or OD-21 (p > 0.05). Cell cycle analysis showed that MTA induced a modest (but significant) increase in the percentage of MDPC-23 in the S and G2 phases, and OD-21 in the S phase of cell cycle, as compared to untreated controls (p </= 0.05). In conclusion, MTA induced proliferation, and not apoptosis, of pulp cells in vitro. These findings suggest a potential mechanism to explain the regenerative effect observed in the dentin-pulp complex when MTA was used for direct pulp capping.
Article
To compare solubility, microhardness and radiopacity of ProRoot mineral trioxide aggregate (MTA) with two Portland cements (PC: CEM I and CEM II). Solubility: for standardized samples (n = 12/group) ring moulds were filled with the cements. These samples were immersed in double-distilled water for 1 min, 10 min, 1 h, 24 h, 72 h, and 28 days. Mean loss of weight was determined. Microhardness: five samples of each cement were produced. All samples were loaded with a diamond indenter point with a weight of 100 g for 30 s. Radiopacity: five samples per cement were produced. These samples were tested according to the ISO standards to compare their radiodensity to that of an aluminium step wedge (1-9 mm). Differences between the three materials with respect to their solubility, microhardness and radiopacity were analysed using ANOVA and Student-Newman-Keuls. After 28 days MTA was of low solubility (0.78%) compared with CEM I (31.38%) and CEM II (33.33%). At exposure times >1 min the two PCs were significantly more soluble than MTA (P < 0.05). The microhardness for MTA was significantly higher (39.99 HV; P < 0.001) compared with the two PC (CEM I: 16.32 HV; CEM II: 13.51 HV). MTA was significantly more radiopaque (5.34 mm Al) than CEM I (3.32 mm Al) and CEM II (2.52 mm Al) (P < 0.05), whereas CEM I was significantly more radiopaque than CEM II (P < 0.05). Mineral trioxide aggregate displayed superior material properties than both Portland cements.
Article
The cellular response to mineral trioxide aggregate (MTA) is important for the repair and regeneration of periradicular tissues. The purpose of this study was to analyze the response of human alveolar bone cells to MTA. A human alveolar bone chip was obtained from an oral surgical procedure and explant cultures harvested after 3 to 4 weeks of outgrowth in alpha-minimum essential medium supplemented with fetal calf serum. Cells in early passage were seeded onto preset ProRoot (gray) MTA, tooth-colored (white) MTA, and MTA prepared with local anesthetic solution. Scanning electron microscopy showed cells were attached and spread out onto MTA within 24 hours, and proliferated to form a matrix-like layer within 7 days. Cell attachment and cell-surface interactions with the gray and white MTA, and with the MTA prepared with local anesthetic were comparably propagated for 14 days. The surgically derived human alveolar bone cells provided a clinically relevant model that demonstrated the capacity of both ProRoot and tooth-colored MTA to support cell attachment, proliferation, and matrix formation.
Article
To evaluate the release of calcium and hydroxide ions from the pulp-capping materials Hydro C, NuCap, Life, and Ultrablend Plus. The materials were manipulated and inserted into tubes measuring 1 cm in length and 1 mm in diameter. The filled tubes were individually immersed in flasks containing 10 mL deionized water. The tubes were removed from the flasks after 3, 24, 72, and 168 hours, and the release of hydroxide and calcium ions was measured with a pH-meter and an atomic absorption spectrophotometer, respectively. The data were compared by analysis of variance and Tukey test. The results showed that Ultrablend Plus provided the greatest release of calcium ions, with a significant difference observed between Life and Ultrablend after 3 hours. Evaluation after 24, 72, and 168 hours showed a significant difference between Ultrablend and the other materials. No hydroxide release was observed from the Ultrablend cement at any time period. After 3 hours, significant differences were observed between Hydro C and the Life and Ultrablend materials and between NuCap and the Life and Ultrablend materials. After 24 hours, significant differences were observed between the NuCap agent and the other materials. After 72 hours, a significant difference was noted only between NuCap and Ultrablend, whereas after 168 hours a significant difference was observed between NuCap and the Hydro C and Ultrablend materials. All materials released calcium and hydroxide ions, except Ultrablend Plus which did not show any release of hydroxide ions.