The effects of various additives on setting properties of MTA

Characteristics of novel root-end filling material using epoxy resin and Portland cement

OBJECTIVES

The aim of this study was to evaluate the physical properties and cytotoxicity of a novel root-end filling material (EPC) which is made from epoxy resin and Portland cement as a mineral trioxide aggregate (MTA) substitute.

MATERIALS AND METHODS

EPC, developed as a root-end filling material, was compared with MTA and a mixture of AH Plus sealer and MTA (AMTA) with regard to the setting time, radio-opacity, and microleakage. Setting times were evaluated using Vicat apparatus. Digital radiographs were taken to evaluate the aluminium equivalent radio-opacity using an aluminium step wedge. Extracted single-rooted teeth were used for leakage test using methylene blue dye. After canal shaping and obturation, the apical 3-mm root was resected, and a root-end cavity with a depth of 3 mm was prepared. The root-end cavities were filled with MTA, AMTA, and EPC for 15 specimens in each of three groups. After setting in humid conditions for 24 h, the specimens were tested for apical leakage. For evaluation of the biocompatibility of EPC, cell (human gingival fibroblast) viability was compared for MTA and Portland cement by MTT assay, and cell morphological changes were compared for MTA and AH Plus by fluorescence microscopy using DAPI and F-actin staining. The setting time, radio-opacity, and microleakage were compared using one-way ANOVA and Scheffe's post hoc comparison, and the cytotoxicity was compared using the nonparametric Kruskal-Wallis rank sum test. Statistical significance was set at 95%.

RESULTS

EPC had a shorter setting time and less microleakage compared with MTA (p < 0.05). EPC showed 5-mm aluminium thickness radio-opacity and similar biocompatibility to MTA.

CONCLUSIONS

Under the conditions of this study, EPC, a novel composite made from a mixture of epoxy resin and Portland cement, was found to be a useful material for root-end filling, with favourable radio-opacity, short setting time, low microleakage, and clinically acceptable low cytotoxicity.

CLINICAL RELEVANCE

The novel root-end filling material would be a potentially useful material for a surgical endodontic procedure with favourable properties.

Characterization of the mineral trioxide aggregate-resin modified glass ionomer cement interface in different setting conditions

INTRODUCTION

Mineral trioxide aggregate (MTA) has been used successfully for perforation repair, vital pulpotomies, and direct pulp capping. However, little is known about the interactions between MTA and glass ionomer cement (GIC) in final restorations. In this study, 2 null hypotheses were tested: (1) GIC placement time does not affect the MTA-GIC structural interface and hardness and (2) moisture does not affect the MTA-GIC structural interface and hardness.

METHODS

Fifty cylinders were half filled with MTA and divided into 5 groups. The other half was filled with resin-modified GIC either immediately after MTA placement or after 1 or 7 days of temporization in the presence or absence of a wet cotton pellet. The specimens were then sectioned, carbon coated, and examined using a scanning electron microscope and an electron probe microanalyzer (SEM-EPMA) for interfacial adaptation, gap formation, and elemental analysis. The Vickers hardness numbers of the interfacial MTA were recorded 24 hours after GIC placement and 8 days after MTA placement and analyzed using the analysis of variance test.

RESULTS

Hardness testing 24 hours after GIC placement revealed a significant increase in hardness with an increase of temporization time but not with a change of moisture conditions (P < .05). Hardness testing 8 days after MTA placement indicated no significant differences among groups. SEM-EPMA showed interfacial adaptation to improve with temporization time and moisture. Observed changes were limited to the outermost layer of MTA. The 2 null hypotheses were not rejected.

CONCLUSIONS

GIC can be applied over freshly mixed MTA with minimal effects on the MTA, which seemed to decrease with time.

In vitro evaluation of dentinal tubule penetration and biomineralization ability of a new root-end filling material

INTRODUCTION

Capasio is being developed as a new generation of endodontic material with potential use as a root-end filling material. The aim of this study was to compare the ability of Capasio and mineral trioxide aggregate (MTA) to penetrate human dentinal tubules and examine the interaction of Capasio and MTA with a synthetic tissue fluid (STF) and root canal walls in extracted human teeth.

METHODS

Root-end preparations were filled with Capasio or MTA, allowed to set for 4 weeks in STF, and then sectioned at 1, 2, and 3 mm from resected surface. Depth of penetration was evaluated by using scanning electron microscopy (SEM). Next, Capasio and MTA samples were prepared both in 1-g pellets and in root-end preparations. Samples were placed in STF, allowed to set, and then characterized by using SEM, energy dispersive x-ray analysis (EDXA), and x-ray diffraction (XRD) techniques.

RESULTS

Penetration of Capasio into dentinal tubules was observed at all levels. No penetration of MTA into dentinal tubules was observed at any level. Both Capasio and MTA formed apatite crystals in the supernatant, on their exposed surfaces, and in the interfacial layers that were similar in structure and elemental composition when evaluated by using SEM and EDXA. XRD analysis of these crystals corresponds with those reported for hydroxyapatite.

CONCLUSIONS

When used as a root-end filling material, Capasio is more likely to penetrate dentinal tubules. Both Capasio and MTA promote apatite deposition when exposed to STF.

Discolouration potential of endodontic procedures and materials: a review

Advances in endodontic materials and techniques are at the forefront of endodontic research. Despite continuous improvements, tooth discolouration, especially in anterior teeth, is considered an undesirable consequence following endodontic treatment as it creates a range of aesthetic problems. This article aims to discuss the intrinsic and internalized tooth discolouration caused by endodontic procedures, and to address the discolouration potential of materials used during root canal treatment, including root canal irrigants, intra-canal medicaments, endodontic and post-endodontic filling materials. In addition, the discolouration patterns caused by combined endodontic and nonendodontic aetiological factors are discussed. The recommended guidelines that should be followed by dental practitioners to prevent and manage tooth discolouration are also outlined.

The effect of various concentrations of iodine potassium iodide on the antimicrobial properties of mineral trioxide aggregate--a pilot study

BACKGROUND

Mineral trioxide aggregate (MTA) is a multi-purpose dental material with various uses in dentistry. Iodine potassium iodide (IKI) is the most commonly used iodine compound in endodontics. We aimed to assess the antimicrobial activity of tooth-colored ProRoot MTA combined with IKI.

MATERIALS AND METHODS

The antimicrobial activity of IKI was assessed at three concentrations (1%, 2%, and 4%) as the mixing agents combined with MTA against Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. For each microorganism, three plates were inoculated with 100 μl of a microbial suspension (McFarland 0.5). Four wells were prepared in each plate. MTA (70 mg) was mixed with any of the three concentrations of IKI (25 μl) or sterile distilled water (25 μl) and placed in each well. The plates were incubated for 24 h at 37°C. Zones of inhibition (ZOI) were measured in millimeters by a blinded observer. Data were analyzed using analysis of variance and the Dunnett t-test.

RESULTS

All MTA mixtures with water or IKI solutions showed inhibitory zones. The mean ZOI of each MTA/IKI mixture was not significantly different from MTA/water mixture (P > 0.05). MTA/1% IKI had smaller ZOI than MTA/water against E. coli, E. faecalis, and C. albicans. MTA/2% IKI showed larger ZOI only against P. aeruginosa. MTA/4% IKI showed larger ZOI against P. aeruginosa and E. coli (P < 0.05).

CONCLUSIONS

Substitution of IKI solutions (1%, 2%, and 4%) for water did not significantly increase the antimicrobial activity of MTA.

Biocompatibility and osteogenic potential of new generation endodontic materials established by using primary osteoblasts

INTRODUCTION

Generex A and Generex B (calcium silicate based), Capasio (calcium-phospho-alumino silicate based) along with Ceramicrete-D (magnesium phosphate based) are being introduced as a new generation of endodontic materials with the potential to facilitate bone healing. The aim of this study was to evaluate the biocompatibility and osteogenic potential of these new materials by using primary osteoblasts.

METHODS

Primary osteoblasts were prepared from rat calvaria and exposed to mineral trioxide aggregate (MTA), Generex A, Generex B, Capasio, and Ceramicrete-D prepared to standardized size and shape (n = 5). Trypan blue staining was used to evaluate cell viability from 1-6 days. Mineralization potential was evaluated by scanning electron microscopy for the presence of mineralized nodules. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

Only Generex A and MTA allowed cell growth and proliferation throughout the experiment. There were statistically significant differences between groups throughout the experiment beginning on day 1. The greatest amount of cell growth was consistently observed with Generex A and MTA. There was no difference in mineralized nodule formation between any test materials.

CONCLUSIONS

Generex A was the only new generation endodontic material that supported primary osteoblast growth; no material besides MTA facilitated nodule formation.

Influence of white mineral trioxide aggregate on inflammatory cells before and after expiry date

INTRODUCTION

The aim of this study was to compare the effect of subcutaneously implanted white mineral trioxide aggregate (WMTA) on inflammatory reactions before and after expiry date.

METHODS

Fifty Wistar rats were used in this study. Polyethylene tubes were filled with WMTA with expiry dates of 2008, 2009, and 2011, and empty ones serving as the controls were implanted into the subcutaneous tissue. The rats were sacrificed at 7-, 14-, 28-, and 60-day intervals. 5-μm sections were stained with hematoxylin and eosin and observed under a light microscope. Inflammatory reactions were categorized as 0, none (without inflammatory cells); 1, mild (inflammatory cells < 25); 2, moderate (25-125 inflammatory cells); and 3, severe (more than 125 inflammatory cells). Statistical analysis was performed with Kruskal-Wallis test.

RESULTS

All the experimental materials provoked moderate to severe inflammatory reactions after 7 days, which significantly differed from the control group (P < 0.05). At 14-day interval, WMTA with expiry date of 2008 and the control group elicited mild to moderate infiltration of inflammatory cells. However, WMTA with expiry dates of 2009 and 2011 provoked moderate to severe inflammatory reactions, which were significantly different from WMTA with expiry date of 2008 and the control group (P < 0.05). At 28- and 60-day intervals, the overall inflammation subsided in all the groups to mild to moderate infiltration of inflammatory cells without any significant differences (P < 0.05).

CONCLUSION

It seems that the expiry date has less negative effects on the response of inflammatory cells. WMTA keeps its biocompatibility even after expiry date.

Treatment of open apex teeth using two types of white mineral trioxide aggregate after initial dressing with calcium hydroxide in children

BACKGROUND

The clinical and radiographic success of two types of white mineral trioxide aggregate (MTA) as apical barriers in non-vital immature permanent incisors in children was investigated.

MATERIALS AND METHODS

Following an initial dressing with calcium hydroxide, MTA apical barriers were placed in 22 non-vital traumatized, permanent incisors with open apices in 21 children (mean age 10years). Teeth were alternately assigned to either white MTA ProRoot(®) or white MTA Angelus groups and treated by two operators. Clinical and radiographic reviews took place at baseline, 3 months and every 6months thereafter. Two other calibrated, blinded examiners evaluated all radiographs. Examiner agreement was assessed using Kappa-Cohen tests. Results were analysed using Fisher's exact tests and repeated measures anova.

RESULTS

The mean follow-up time was 23.4months. There were no statistically significant differences in clinical or radiographic outcomes between the two groups. The overall clinical success and relative radiographic success rate was 95.5%. Statistically significant reduction in periapical pathosis was shown over time in both groups (P<0.05). A significant relationship was identified between non-divergent apical anatomy and ideal positioning of the MTA plug in all teeth (P=0.04). Interestingly, coronal discolouration was observed in 22.7% of teeth following white MTA placement.

CONCLUSIONS

Apical barrier placement using both white MTA ProRoot(®) and white MTA Angelus after an initial calcium hydroxide dressing showed similar favourable clinical and radiographic outcomes.

Evaluation of physical and biologic properties of the mixture of mineral trioxide aggregate and 4-META/MMA-TBB resin

OBJECTIVE

This study examined whether 4-methacryloxyethyl trimellitate anhydride/methylmethacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin can be used with mineral trioxide aggregate (MTA) to overcome MTA's shortcomings. The biologic reactions of the mixture of MTA powder and 4-META/MMA-TBB resin (MTA/4-META) and its potential in clinical applications were also investigated.

STUDY DESIGN

MTA powder was mixed with 4-META/MMA-TBB resin instead of water at the appropriate proportions determined by a series of studies prior to this experiment. MTA powder mixed with sterile water was used as control. The setting time, compressive strength, pH, and dye leakage of MTA/4-META and MTA were assessed by Gilmore apparatus, universal mechanical testing machine, pH meter, and methylene blue penetration method, respectively. Cytotoxicity also was evaluated by MTT assay with MC3T3-E1 cells.

RESULTS

The setting time of MTA/4-META was significantly lower than that of MTA: 11.2 ± 0.8 minutes versus 318 ± 56.0 minutes, respectively (P < .05). The mean compressive strength of MTA/4-META after 24 hours was significantly higher than that of MTA: 57.4 ± 11.6 MPa versus 18.7 ± 3.0 MPa, respectively (P < .05). MTA/4-META showed significantly less leakage than MTA (P < .05). The initial pHs for MTA and MTA/4-META at 2 hours were 10.73 ± 0.95 and 10.08 ± 0.13, respectively, and reached plateaus of 10.92 ± 0.31 and 10.54 ± 0.39 at 24 hours, respectively. The pH of MTA was higher than that of MTA/4-META in the entire period, but the differences were only significant up to 48 hours (P < .05). MTA and MTA/4-META both showed no cytotoxicity.

CONCLUSIONS

4-META/MMA-TBB resin as a mixing vehicle of MTA powder can improve the setting and handling properties of MTA and may maintain or improve its other biophysical properties.

Management of recently traumatized maxillary central incisors by partial pulpotomy using MTA: Case reports with two-year follow-up

In traumatized, young, permanent teeth, pulpotomy is classically undertaken to promote apexogenesis. The objective is to promote root development and apical closure. Once root end development and apical closure is achieved, the root canal treatment is completed. However, it has been suggested that mere pulp exposure does not cause pulpitis in the absence of bacteria. Recent studies have proposed that as long as a good seal is ensured, root canal treatment may not be necessary following pulpotomy. In this article we report two cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated with mineral trioxide aggregate following partial pulpotomy, with a two-year follow-up.

Effect of selected accelerants on setting time and biocompatibility of mineral trioxide aggregate (MTA)

OBJECTIVE

Various additives have been suggested to be used with mineral trioxide aggregate (MTA) to improve its handling characteristics. The purpose of this study was to evaluate the effects of various additives on setting time and cell attachment on gray MTA (GMTA).

STUDY DESIGN

Single-rooted caries-free teeth were split, and dentin disks with class I cavity were made and filled with test and control materials. Setting time was measured using Gilmore apparatus. Mouse MC3T3-E1 osteoblasts and L929 mouse fibroblasts were grown on dentin and GMTA disks. Cell attachment was examined under fluorescent microscope.

RESULTS

Adding KY liquid, CaCl(2), and NaOCl to GMTA improved the handling properties and decreased setting time. Osteoblasts and fibroblasts attached and spread on GMTA mixed with additives in a manner similar to GMTA mixed with water.

CONCLUSIONS

The various additives could be possible substitutes to water to decrease MTA setting time. MTA is biocompatible when mixed with the various additives.

"MTA"-an Hydraulic Silicate Cement: review update and setting reaction

OBJECTIVES

To review the current status and understanding of Portland cement-like endodontic materials commonly referred to by the trade designation "MTA" (alias "Mineral Trioxide Aggregate"), and to present an outline setting reaction scheme, hitherto unattempted.

METHOD

The literature was searched using on-line tools, overlapping an earlier substantial review to pick up any omissions, including that in respect of ordinary Portland cement (OPC), with which MTA shares much. The search was conducted for the period January 2005 to December 2009 using 'MTA', 'GMTA', 'WMTA', and 'mineral AND trioxide AND aggregate' as keywords, with various on-line search engines including ScienceDirect (http://www.sciencedirect.com), SAGE Journals Online (http://online.sagepub.com), Wiley Online Library (http://onlinelibrary.wiley.com), SciELO Scientific electronic library online (http://www.scielo.br/scielo.php), JSTOR (http://www.jstor.org), and Scopus (http://www.scopus.com). References of articles found were cross-checked where appropriate for missed publications. Manufacturers' and related websites were searched with Google Search (http://www.google.com.hk).

RESULTS

A generic name for this class of materials, Hydraulic Silicate Cement (HSC), is proposed, and an outline reaction scheme has been deduced. HSC has distinct advantages apparent, including sealing, sterilizing, mineralizing, dentinogenic and osteogenic capacities, which research continues to demonstrate. However, ad hoc modifications have little supporting justification.

SIGNIFICANCE

While HSC has a definite place in dentistry, with few of the drawbacks associated with other materials, some improvements in handling and other properties are highly desirable, as are studies of the mechanisms of the several beneficial physiological effects. Reference to the extensive, but complex, literature on OPC may provide the necessary insight.

A differential scanning calorimetry study of the setting reaction of MTA

AIM

To evaluate the setting of mineral trioxide aggregate (MTA) at various time intervals using differential scanning calorimetry (DSC).

METHODOLOGY

Hydrated MTA and Portland cement were examined with DSC at the following intervals: immediate (0 h), 2 h, 4 h, 12 h, 24 h, 1 week, 1 month, 3 months and 1 year. DSC analysis consisted of a temperature scan from 37 to 640 degrees C, resulting in thermograms with reaction product decomposition endotherms. The thermogram peak attributed to calcium hydroxide product formation was identified and quantified to serve as an indicator of reaction product formation over time. Unmixed powders of both cements and individual components of MTA were also studied using DSC. The results were analysed with repeated measures anova between time intervals and a t-test between cements.

RESULTS

A low temperature endotherm attributed to various calcium silicate hydrates showed continual maturation of MTA up to 1 year. The rate of calcium hydroxide formation was greatest between 4 and 24 h after mixing with maximum amounts present at 7 days. Specimens aged greater than 1 month showed a decrease in calcium hydroxide content, presumably because of carbonation reactions. Portland cement had similar thermogram peaks, although the amount of calcium hydroxide formed was generally smaller compared to MTA. The endothermic peaks from the various powders and components were helpful in corroborating the peaks formed in the hydrated cements.

CONCLUSIONS

Hydration reactions and structure maturation in MTA continue well beyond clinically observed setting times.

Effects of root canal irrigants on the push-out strength and hydration behavior of accelerated mineral trioxide aggregate in its early setting phase

INTRODUCTION

The purpose of this study was to evaluate the effects of endodontic irrigants on the push-out strength and hydration behavior of accelerated mineral trioxide aggregate (MTA) in its early setting phase.

METHODS

In an in vitro perforation model, MTA with or without 10% CaCl(2) was condensed and allowed to initial set for 10 minutes. The samples were divided into four groups (n = 10) to be immersed into either 3.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine gluconate (CHX) for 30 minutes and then allowed to set for 48 hours. In the control group, a wet cotton pellet was placed over MTA. The maximum force applied to the set MTA mixture before dislodgement was recorded. Irrigant-treated surfaces were examined using a scanning electron microscope (SEM). Chemical elements of these surfaces were also analyzed by energy dispersive x-ray spectroscope (EDS).

RESULTS

The push-out strength of group A1 (NaOCl-treated accelerated MTA) was the highest of all groups. When compared with nonaccelerated MTA, CaCl(2)-accelerated MTA showed significantly higher push-out strength (p < 0.05). NaOCl-treated groups showed significantly higher push-out strength than CHX-treated groups (p < 0.05). Scanning electron microscopic examination and EDS analysis showed that the formation of calcium hydroxide crystals on accelerated MTA exposed to NaOCl was increased compared with those of the control group.

CONCLUSION

These findings imply that the use of accelerated MTA under the NaOCl irrigation was effective in perforation repair without altering its hydration behavior even in the early setting phase.

The effect of blood contamination on the compressive strength and surface microstructure of mineral trioxide aggregate

AIM

To investigate the effects of whole, fresh human blood contamination on compressive strength and surface microstructure of grey and tooth-coloured mineral trioxide aggregate (MTA).

METHODOLOGY

The materials investigated were grey ProRoot MTA Original (Dentsply Tulsa Dental, Johnson City, TN, USA) and tooth-coloured ProRoot MTA (Dentsply Tulsa Dental). Three groups of 10 custom-made cylindrical moulds (internal dimensions 6 +/- 0.1 mm length and 4 +/- 0.1 mm diameter) were filled with tooth-coloured MTA. In the control group, MTA was mixed with water and exposed to water. In the second group, MTA was mixed with water and exposed to whole, fresh human blood. In the third group, MTA was mixed with and exposed to whole, fresh human blood. These three groups were then duplicated using grey MTA, creating a total of 60 samples. A predetermined amount of MTA and appropriate liquid were triturated in a plastic mixing capsule then subjected to ultrasonic energy after placement in the moulds. After 4 days of incubation, specimens were subjected to compressive strength testing. The surface microstructure of one extra specimen in each group was examined using scanning electron microscopy. Data were subjected to a two-way anova.

RESULTS

Regardless of MTA type, the mean compressive strength values of both experimental groups, which were in contact with blood, were significantly less than that of the control groups (P < 0.0001). In experimental groups in which MTA was mixed with water and exposed to blood, there was a significant difference (P < 0.0001) in compressive strength between tooth-coloured MTA (30.37 +/- 10.16 MPa) and grey MTA (13.92 +/- 3.80 MPa).

CONCLUSION

When blood becomes incorporated into MTA, its compressive strength is reduced. In clinical situations in which blood becomes mixed with MTA, its physical properties are likely to be compromised.

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.

Evaluation of pH and calcium ion release of root-end filling materials containing calcium hydroxide or mineral trioxide aggregate

INTRODUCTION

To evaluate calcium ion release and pH of Sealer 26 (S26) (Dentsply, Rio de Janeiro, RJ, Brazil), white mineral trioxide aggregate (MTA), Endo CPM Sealer (CPM1) (EGEO SRL Bajo licencia MTM Argentina SA, Buenos Aires, Argentina), Endo CPM Sealer in a thicker consistency (CPM 2), and zinc oxide and eugenol cement (ZOE).

METHODS

Material samples (n = 10) were placed in polyethylene tubes and immersed in 10 mL of distilled water. After 3, 6, 12, 24, and 48 hours and 7, 14, and 28 days, the water pH was determined with a pH meter, and calcium release was assessed by atomic absorption spectrophotometry. An empty tube was used as the control group.

RESULTS

The control group presented a pH value of 6.9 at all studied periods and did not show the presence of calcium ion. S26 presented greater hydroxyl ion release up to 12 hours (p < 0.05). From 24 hours until 28 days, S26, MTA, CPM1, and CPM2 had similar results. In all periods, ZOE presented the lowest hydroxyl ion release. CPM1, followed by CPM2, released the most calcium ions until 24 hours (p < 0.05). Between 48 hours and 7 days, CPM1 and CPM2 had the highest release. A greater calcium ion release was observed for CPM2, followed by CPM1 at 14 days and for S26, CPM1, and CPM2 at 28 days. ZOE released the least calcium ions in all periods.

CONCLUSION

Sealer 26, MTA, and Endo CPM sealer at normal or thicker consistency release hydroxyl and calcium ions. Endo CPM sealer may be an alternative as root-end filling material.

Setting time and expansion in different soaking media of experimental accelerated calcium-silicate cements and ProRoot MTA

OBJECTIVES

The setting time and the expansion in deionized water, phosphate-buffered saline (PBS), 20% fetal bovine serum (FBS)/80% PBS or hexadecane oil of experimental accelerated calcium-silicate cements and ProRoot MTA were evaluated.

STUDY DESIGN

Different compounds such as sodium fluoride, strontium chloride, hydroxyapatite, and tricalcium phosphate were separately added to a basic experimental calcium-silicate cement to test their effect on setting and expansion. The initial and final setting times were determined using appropriate Gilmore needles. A linear variable differential transformer (LVDT) device was used to test the restricted hygroscopic linear expansion over 180 minutes of cements immersed in different solutions. Results were statistically compared using a 2-way ANOVA test (cement type versus solution type).

RESULTS

All experimental cements showed initial setting times between 28 and 45 minutes and final setting times between 52 and 80 minutes. MTA showed a final setting time of 170 minutes. Final setting time of all experimental cements was faster than MTA. All cements showed slight (0.04%-0.77%) expansion in water, PBS, or FBS/PBS. Only fluoride-containing cement showed a significant expansion in water (6.68%) and in PBS (6.72%). The PBS/FBS contamination significantly reduced the expansion of fluoride-containing cement (2.98%) and MTA (0.07%). In contrast, cements showed a slight shrinkage when immersed in hexadecane, especially fluoride-containing cement.

CONCLUSIONS

The study demonstrated that: (1) the setting time of calcium-silicate cements may be effectively reduced; (2) the expansion is a water dependent mechanism owing to water uptake, because no expansion occurred in cements immersed in oil; (3) a correlation between setting time and expansion in water and PBS exists; (4) fluorine-containing cement showed a significant expansion in water and in PBS; (5) the immersion in FBS/PBS strongly reduced the expansion of MTA and fluoride-doped cement suggesting that fluid contamination (ie, blood) during surgical procedures may greatly affect the expansion of some calcium-silicate cements.

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.

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.

Comparative analysis of the particle size and shape of commercially available mineral trioxide aggregates and Portland cement: a study with a flow particle image analyzer

The aim of this study is to characterize the particle size distribution and circularity of various Mineral Trioxide Aggregates (MTA) (ProRoot MTA/ MTA Angelus/Gray and White) and Portland cements with effective size ranges of 1.5-160 microm using a flow particle analyzer (Sysmex FPIA-3000, Kobe, Japan). Cumulative percentage of particles between 6 and 10 microm were, 65, 73, 48, 53, and 70 %, for Gray ProRoot MTA, White ProRoot MTA, Gray MTA Angelus, White MTA Angelus, and Portland cement, respectively. ProRoot MTA contains fewer large particles than MTA Angelus. MTA Angelus contains a higher number of small particles than ProRoot MTA. White MTA contains smaller particles with a narrower range of size distribution than Gray MTA. MTA Angelus particles have relatively low circularity and wide size distribution and are less homogeneous than ProRoot MTA.

Chemical Modification of ProRoot MTA to Improve Handling Characteristics and Decrease Setting Time

Mineral trioxide aggregate (MTA) fulfills many of the ideal properties of a root-end filling material. However, the composition of this material often makes MTA difficult to use, a direct result of its granular consistency, slow setting time, and initial looseness. Additives used by the Portland cement (PC) industry to increase PC's plasticity and decrease its setting time were added first to PC and then to gray MTA in an attempt to improve MTA's handling characteristics, with the combination providing the best handling characteristics tested for its effect on compressive strength (for changes in the original material's properties) and decrease in setting time. An admix of 1% methylcellulose and 2% calcium chloride resulted in a mix of chemically modified MTA that, when compared with unmodified MTA, (1) handled similarly to a reinforced zinc oxide-eugenol cement, (2) gave an approximately equal compressive strength, and (3) set one third faster (57 +/- 3 minutes).