Mineral Trioxide Aggregate as Repair Material for Furcal Perforation: Case Series

The comparison of MTA, Geristore® and Amalgam with or without Bioglass as a matrix in sealing the furcal perforations (in vitro study)

AIM

The objective of this in vitro was to assess the sealing ability of MTA, Geristore®, and amalgam with and without Bioglass as a matrix used to repair furcation perforations in mandibular molars by using dye penetration.

MATERIALS AND METHODS

One hundred mandibular molars were randomly divided into six experimental groups. Five teeth with perforation were used as positive control while five teeth without perforation were used as negative control group. Furcal perforations were made in the teeth. Perforations were repaired with amalgam in group 1, amalgam and Bioglass in group 2, MTA in group 3, MTA and Bioglass in group 4, Geristore® in group 5, and Geristore® and Bioglass in group 6. All repairing materials were allowed to set for 72 h. Leakage at the repaired sites was then evaluated using dye penetration and clearing technique under stereomicroscope.

RESULTS

The perforations repaired with MTA and Geristore® leaked significantly less than amalgam (p = 0.000). Bioglass reduced sealing ability of MTA and Geristore® significantly (p = 0.000, p = 0.019), while reduced the sealing ability of amalgam insignificantly (p = 0.78).

CONCLUSION

MTA and Geristore® have shown acceptable sealing ability in furcal perforation in comparison to amalgam while Bioglass as a matrix beneath them has reduced their sealing ability.

Environmental scanning electron microscopy connected with energy dispersive x-ray analysis and Raman techniques to study ProRoot mineral trioxide aggregate and calcium silicate cements in wet conditions and in real time

INTRODUCTION

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.