A comparative study of selected properties of ProRoot mineral trioxide aggregate and two Portland cements

Radiopacity evaluation of Portland and MTA-based cements by digital radiographic system

OBJECTIVE

The aim of the present study was to evaluate the radiopacity of Portland and MTA-based cements using the Digora TM digital radiographic system.

MATERIAL AND METHODS

The performed tests followed specification number 57 from the American National Standard Institute/American Dental Association (2000) for endodontic sealing materials. The materials were placed in 5 acrylic plates, especially designed for this experiment, along with a graduated aluminum stepwedge varying from 1 to 10 mm in thickness. The set was radiographed at a 30 cm focus-object distance and with 0.2 s exposure time. After the radiographs were taken, the optical laser readings of radiographs were performed by Digora TM system. Five radiographic density readings were performed for each studied material and for each step of the aluminum scale.

RESULTS

White ProRoot MTA (155.99±8.04), gray ProRoot MTA (155.96±16.30) and MTA BIO (143.13±16.94) presented higher radiopacity values (p<0.05), while white non-structural Portland (119.76±22.34), gray Portland (109.71±4.90) and white structural Portland (99.59±12.88) presented lower radiopacity values (p<0.05).

CONCLUSIONS

It was concluded that MTA-based cements were the only materials presenting radiopacity within the ANSI/ADA specifications.

Evaluation of the physical properties of an endodontic Portland cement incorporating alternative radiopacifiers used as root-end filling material

AIM

To investigate the physical and chemical properties of Portland cement (PC) loaded with alternative radiopacifying materials for use as root-end filling materials in a mineral trioxide aggregate (MTA)-like system.

METHODOLOGY

Portland cement loaded with barium sulphate, gold and silver/tin alloy was mixed with water, and the physical and chemical properties of the hydrated cements were evaluated. MTA and intermediate restorative material (IRM) were used as controls. The radiopacity was compared to the equivalent thickness of aluminium, and the setting time of the cements was assessed using an indentation technique. The compressive strength and the stress-strain relationship were determined at 28 days. The stress-strain relationship was determined by monitoring the strain generated when the cement was subjected to compressive load. In addition, the pH was determined in water and simulated body fluid for a period of 28 days.

RESULTS

The radiopacity of the cements using alternative radiopacifiers was comparable to MTA (P > 0.05). IRM demonstrated a higher radiopacity than all the materials tested (P < 0.05). All the cements with the exception of IRM exhibited an alkaline pH and had an extended setting time when compared to IRM. MTA had a longer setting time than the PC (P < 0.001), and its setting time was similar to the gold-loaded cement (P = 0.159). The addition of a radiopacifier retarded the setting time (P < 0.001) but did not have any effect on the compressive strength as all loaded cements had comparable strength to PC (P > 0.05). IRM was the weakest cement tested (P < 0.001). The cement loaded with gold radiopacifier had comparable strength to MTA (P = 1). The stress-strain relationship was linear for all the cements with IRM generating more strain on loading.

CONCLUSIONS

Within the parameters set in this study, bismuth oxide in MTA can be replaced by gold or silver/tin alloy. The physical, mechanical and chemical properties of the cement replaced with alternative radiopacifiers were similar and comparable to ProRoot MTA.

Reparative dentinogenesis induced by mineral trioxide aggregate: a review from the biological and physicochemical points of view

This paper aims to review the biological and physicochemical properties of mineral trioxide aggregate (MTA) with respect to its ability to induce reparative dentinogenesis, which involves complex cellular and molecular events leading to hard-tissue repair by newly differentiated odontoblast-like cells. Compared with that of calcium hydroxide-based materials, MTA is more efficient at inducing reparative dentinogenesis in vivo. The available literature suggests that the action of MTA is attributable to the natural wound healing process of exposed pulps, although MTA can stimulate hard-tissue-forming cells to induce matrix formation and mineralization in vitro. Physicochemical analyses have revealed that MTA not only acts as a "calcium hydroxide-releasing" material, but also interacts with phosphate-containing fluids to form apatite precipitates. MTA also shows better sealing ability and structural stability, but less potent antimicrobial activity compared with that of calcium hydroxide. The clinical outcome of direct pulp capping and pulpotomy with MTA appears quite favorable, although the number of controled prospective studies is still limited. Attempts are being conducted to improve the properties of MTA by the addition of setting accelerators and the development of new calcium silicate-based materials.

Understanding mineral trioxide aggregate/Portland-cement: a review of literature and background factors

AIM

This was to carry out a review of the literature concerning mineral trioxide aggregate (MTA) and Portland cement with regards to clinical, biological and mechanical findings and a possible substitution of MTA through Portland cement for endodontic use.

STUDY DESIGN

Electronic literature search of scientific papers from January 1993 to January 2009 was carried out on the MEDLINE and Scopus databases using specific key words. In total, 57 papers were identified that dealt with MTA and Portland cement in a relevant way.

RESULTS

The review of 50 papers conforming to the applied criteria showed that MTA and Portland cements have the same clinical, biological and mechanical properties. In animal experiments and technical characterisations both materials seemed to have very similar properties. The only difference is bismuth oxide in MTA added for better radio opacity. It seems likely that MTA materials are based on industrial Portland cements mixed with bismuth oxide. More studies, especially some long-term studies comparing MTA and Portland cement, are necessary.

CONCLUSION

The existing literature gives a solid base for clinical studies with Portland cement in order to replace MTA as an endodontic material. Portland cement could be a substitute for most endodontic materials used in primary teeth.

Effect of acid-etching procedure on selected physical properties of mineral trioxide aggregate

AIM

To evaluate the effect of acid-etch procedures on the compressive strength and surface microhardness of tooth-coloured mineral trioxide aggregate (MTA).

METHODOLOGY

White ProRoot MTA (Dentsply Tulsa Dental) was mixed and packed into cylindrical tubes of 4 mm in diameter and 6 mm in height. Three groups, each of 15 specimens were subjected to an acid-etch procedure either 4, 24 or 96 h after mixing. The compressive strength was measured and compared with unetched control groups. Differences between groups were analysed using the Kruskall-Wallis test. A further batch of cylindrical specimens of 6 mm in diameter and 12 mm in height were prepared for testing surface microhardness. Three groups of 15 specimens were subjected to the acid-etch procedure at either 4, 24 or 96 h following mixing. Data were subjected to one-way anova. Changes in the surface microstructure before and after the acid-etch procedures were analysed using a scanning electron microscope (SEM).

RESULTS

There was a general trend for the compressive strength and surface microhardness of specimens to increase with time. In terms of compressive strength, the increase was significant between 4 h and the other time periods for both experimental and control groups (P < 0.0001); however, there was no significant difference between 24 and 96 h. The increase in surface microhardness was significant between 4, 24 and 96 h (P < 0.0001). In addition, there was a significant difference between experimental and control groups at all time periods (P < 0.0001). SEM examination revealed morphological differences between the intact and the etched MTA surfaces.

CONCLUSIONS

Acid-etch procedures affected the compressive strength and surface microhardness of ProRoot MTA. This indicates that it may be better to postpone restorative procedures for at least 96 h after mixing MTA. Etching created surface changes that might have the potential to enhance bonding of resinous materials.

Pulpotomy of human primary molars with MTA and Portland cement: a randomised controlled trial

OBJECTIVE

This study compared the clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) and Portland cement (PC) as pulp dressing agents in carious primary teeth.

METHODOLOGY

Thirty carious primary mandibular molars of children aged 5-9 years old were randomly assigned to MTA or PC groups, and treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement. Clinical and radiographic successes and failures were recorded at 6, 12, 18 and 24-month follow-up.

RESULTS

All pulpotomised teeth were clinically and radiographically successful at all follow-up appointments. Six out of 15 teeth in the PC group and five out of 14 teeth in the MTA group exfoliated throughout the follow-up period. No statistically significant difference regarding dentine bridge formation was found between both groups throughout the follow-up period. As far as pulp canal obliteration is concerned, a statistically significant difference was detected at 6-month follow-up (p <0.05), since the beginning of mineralised material deposition could be radiographically detected in 100% and 57.14% of the teeth treated with PC and MTA, respectively.

CONCLUSIONS

PC may serve as an effective and less expensive MTA substitute in primary molar pulpotomies. Further studies and longer follow-up assessments are needed.

Pulpotomies with Portland cement in human primary molars

Two clinical cases in which Portland cement (PC) was applied as a medicament after pulpotomy of mandibular primary molars in children are presented. Pulpotomy using PC was carried out in two mandibular first molars and one mandibular second molar, which were further followed-up. At the 3, 6 and 12-month follow-up appointments, clinical and radiographic examinations of the pulpotomized teeth and their periradicular area revealed that the treatments were successful in maintaining the teeth asymptomatic and preserving pulpal vitality. Additionally, the formation of a dentin bridge immediately below the PC could be observed in the three molars treated. PC may be considered as an effective alternative for primary molar pulpotomies, at least in a short-term period. Randomized clinical trials with human teeth are required in order to determine the suitability of PC before unlimited clinical use can be recommended.

Immediate and delayed solubility of mineral trioxide aggregate and Portland cement

This study investigated the solubility of mineral trioxide aggregate (MTA) and Portland cement since its mixture until 672 hours, by means of two complimentary methods. Metal ring molds filled with the cements were covered with distilled water and, at each experimental time (3, 24, 72, 168, 336 and 672 hours), were weighed as soon as the plates in which the samples have been placed. Empty rings served as the control group (n=8). Mean weight gain and loss was determined and analyzed statistically by two-way ANOVA and Tukey's test for all pairwise comparisons. Only Portland cement showed less than 3% weight loss through 24 hours. Detached MTA residues were heavier than those of Portland cement over the 3 to 168 hours. The weight of MTA rings increased more than that of Portland rings within 672 hours (p=0.05). The findings of the present study indicate that, in an aqueous environment MTA is more soluble than Portland cement and exceeds the maximum weight loss considered acceptable by ISO 6876 standard (2001).

Mineral trioxide aggregate in paediatric dentistry

OBJECTIVE

The aim of this study was to present a review of the reported literature on: (i) the physical and chemical properties; and (ii) clinical applications of mineral trioxide aggregate (MTA) in the practice of paediatric dentistry.

METHOD

Electronic literature search of scientific papers from January 1993 to June 2008 was carried out on the MEDLINE, Embase, Entrez Pubmed, and Scopus databases using specific key words. The search yielded 448 papers, out of which 100 were identified as conforming to the applied criteria. These papers formed the basis of the review and the clinical scenarios presented which demonstrate the application of MTA in the practice of paediatric dentistry.

CONCLUSION

Paediatric dentists have successfully employed MTA in a variety of endodontic/restorative applications since the late 1990s. Clinical impressions have generally been favourable and support the findings of laboratory and animal-based investigations. Very few clinical studies have been reported so far in humans, and although these have been positive, the body of research is currently insufficient to enable a meaningful systematic review and meta-analysis.

New Portland cement-based materials for endodontics mixed with articaine solution: a study of cellular response

The biocompatibility of innovative tetrasilicate cements proposed for root-end filling restorations was tested. White ProRoot-MTA and AH Plus were used as control. The new cements were mixed with a local anesthetic solution (4% articaine) to form a paste. Human osteoblast-like cells Saos-2 were challenged in short-term cultures (72 hours) with solid materials and with material extracts prepared in culture medium. Cell growth and viability, cellular attachment, and morphologic features were assessed to verify cell/material interactions. No acute toxicity was exerted by the experimental cements in the assay systems. On solid samples Saos-2 adhered and proliferated on all the experimental cements and on MTA. The ultrastructural findings revealed that Saos-2 were able to adhere and to spread. The maintenance of the osteoblastic phenotype on the innovative cements was confirmed by the alkaline phosphatase assay. All experimental cements prepared with articaine supported the growth of bone-like cells, showing suitable properties to be used as canal sealers and root-end filling materials.

Synthesis of partial-stabilized cement (PSC) via sol–gel process

The traditional method of preparing partial-stabilized cement (PSC), which is a kind of calcium silicate cement, is through power mixing method. Low reaction efficiency and initial strength limited the application of PSC as a dental root-end filling material. This study provides a one-step sol-gel process for the synthesis of PSC. A complexing ligand is used for tuning down the activity of aluminum sec-butoxide (ASB) in order to avoid possible self-polymerization. After the modification with complex ligand, there is no residue of reactant observed on the analysis of SDT, and bonding between metal atoms is observed in the FTIR spectrum. Each component of PSC is identified using XRD. The hydration product, which is called portlandite, of sol-gel-synthesized PSC is observed after 1 day of hydration, and crystallinity of portlandite increases much faster than that of traditional PSC. The initial strength of sol-gel-synthesized PSC achieves detectable level 24 h earlier than that of traditional PSC; microhardness value of sol-gel-synthesized PSC at 7th day is 2.98 HV, which is much higher than that of traditional PSC (2.05 HV). PSC is successfully synthesized and the initial strength of PSC is improved by this modified sol-gel process.

The effect of pH on surface hardness and microstructure of mineral trioxide aggregate

AIM

To evaluate the surface microhardness of mineral trioxide aggregate (MTA) specimens following exposure of their surface to a range of acidic environments during hydration. In addition, the morphological microstructure features of samples were studied by scanning electron microscopy (SEM).

METHODOLOGY

White ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN, USA) was mixed and packed into cylindrical polycarbonate tubes. Four groups, each of 10 specimens, were formed using a pressure of 3.22 MPa and exposed to pH 4.4, 5.4, 6.4 and 7.4, respectively, for 4 days. Vickers microhardness of the surface of each specimen was measured after exposure. Four groups of two specimens were prepared and treated in the same way prior to qualitative examination by SEM. Data were subjected to one-way anova and post hoc Tukey's test.

RESULT

The greatest mean surface hardness values (53.19 +/- 4.124) were observed following exposure to pH 7.4 with the values decreasing to 14.34 +/- 6.477 following exposure to pH 4.4. The difference between these values at the 95% CI (33.39-44.30) was statistically significant (P < 0.0001). There were no distinct morphological differences between groups in terms of the internal microstructure. However, a trend was observed that the more acidic the solution, the more extensive the porosity of the specimens.

CONCLUSION

Under the conditions of this study, surface hardness of MTA was impaired in an acidic environment.

The effect of condensation pressure on selected physical properties of mineral trioxide aggregate

AIM

To examine the effect of condensation pressure on surface hardness, microstructure and compressive strength of mineral trioxide aggregate (MTA).

METHODOLOGY

White ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN, USA) was mixed and packed into cylindrical polycarbonate tubes. Six groups each of 10 specimens were subjected to pressures of 0.06, 0.44, 1.68, 3.22, 4.46 and 8.88 MPa respectively. The surface hardness of each specimen was measured using Vickers microhardness. Cylindrical specimens of 4 mm in diameter and 6 mm in height were prepared in polycarbonate cylindrical moulds for testing the compressive strength. Five groups of 10 specimens were prepared using pressures of 0.06, 0.44, 1.68, 3.22 or 4.46 MPa. Data were subjected to one-way anova. The microstructure was analysed using a scanning electron microscope (SEM) after sectioning specimens with a scalpel.

RESULT

A trend was observed for higher condensation pressures to produce lower surface hardness values. A condensation pressure of 8.88 MPa produced specimens with significantly lower values in terms of surface hardness than other groups (P<0.001). A condensation pressure of 1.68 MPa conferred the maximum compressive strength; however, it was not statistically different. Higher condensation pressures resulted in fewer voids and microchannels when analysed with SEM. In specimens prepared with lower condensation pressures distinctive crystalline structures were observed. They tended to appear around microchannels.

CONCLUSION

Condensation pressure may affect the strength and hardness of MTA. Use of controlled condensation pressure in sample preparation for future studies is suggested.