Aspects of the in vitro bioactivity of hydraulic calcium (alumino)silicate cement

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy

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.

Acid neutralizing and remineralizing orthodontic adhesive containing hydrated calcium silicate

OBJECTIVES

The objective of this study was to evaluate an orthodontic adhesive containing hydrated calcium silicate (hCS) in terms of its bond strength with the enamel surface and its acid-neutralization and apatite-forming abilities.

METHODS

The experimental orthodontic adhesives were composed of 30 wt.% resin matrix and 70 wt.% filler, which itself was a mixture of silanized glass filler and hCS in weight ratios of 100% glass filler (hCS 0), 17.5% hCS (hCS 17.5), 35% hCS (hCS 35.0), and 52.5% hCS (hCS 52.5). The degree of conversion (DC) and shear bond strength (SBS) of bovine enamel surfaces were tested. pH measurements were performed immediately upon submersion of the specimens in a lactic acid solution. The surface precipitates that formed on specimens immersed in phosphate-buffered saline (PBS) were analyzed by scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) and Raman spectroscopy after 15, 30, and 90 days.

RESULTS

The experimental groups exhibited no significant differences in DC and had clinically acceptable SBS values. The hCS-containing groups showed increasing pH values as more hCS was added. hCS 52.5 produced Ca- and P-containing surface precipitates after PBS immersion, and hydroxyapatite deposition was detected after 15, 30, and 90 days.

CONCLUSIONS

These results suggest that orthodontic adhesives containing hCS are effective for acid neutralization. Furthermore, hCS has an apatite-forming ability for enamel remineralization.

CLINICAL SIGNIFICANCE

The novel orthodontic adhesive containing hCS exhibits a potential clinical benefit against demineralization and enhanced remineralization of the enamel surface around or beneath the orthodontic brackets.

Evaluation of pH, Calcium Ion Release, and Dimensional Stability of an Experimental Silver Nanoparticle-Incorporated Calcium Silicate-Based Cement

An experimental calcium silicate-based root-end filling material incorporated with silver nanoparticles intended for use in periapical surgeries was developed with the purpose to overcome the drawbacks of existing materials and to satisfy the ideal requirements of root-end filling materials. This study was designed to evaluate the physicochemical properties, pH, calcium ion release, and dimensional stability of the experimental cement, and compare the results with commercially available ProRoot MTA (Dentsply). An independent sample test was used to analyze the data. Mean initial pH (immediately after mixing) of the experimental cement was 10.42 ± 0.04 which was higher than that of MTA. However, there was a significant increase in pH of MTA at 1 day, 2 days, and 7 days. Presence of calcium chloride favored the release of calcium ions which was significantly increased in the experimental group at 24 hours. At the end of 30 days, MTA showed a significant expansion when compared to the experimental cement (p < 0.001). In conclusion, the experimental nanoparticle-incorporated calcium silicate-based cement showed clinically acceptable physicochemical properties.

The in vivo dissolution of tricalcium silicate bone cement

This study aimed to investigate the in vivo dissolution of tricalcium silicate (Ca₃ SiO₅ , C₃ S) bone cement in the rabbit femoral defect. Results indicated that C₃ S paste directly integrated with the bone tissue without the protection of the bone-like apatite. Calcium silicate hydrate gel (C-S-H gel) and Ca(OH)₂ were the main components of C₃ S paste. The dissolution model of C₃ S paste was a mass loss rather than a decrease in volume. The initial dissolution of C₃ S paste (0 ~ 6 weeks) was greatly attributed to the release of Ca(OH)₂ , and the later dissolution (>6 weeks) was attributed to the decalcification of C-S-H gel. Although the mass of C₃ S paste could decrease by more than 19 wt % after 6 weeks of implantation, the created pores (<1 μm) were not large enough for the bone tissue to migrate into C₃ S paste. The loss of Ca ions also resulted in the transformation of SiO₄ tetrahedrons from Q¹ and Q² to Q⁰ , Q³ , and Q⁴ in C-S-H gel. Because only isolated SiO₄ tetrahedrons (Q⁰ ) and Ca ions could be absorbed by the bone tissue, C₃ S paste gradually transformed into a silica-rich gel. The fundamental reason for no decrease in volume of C₃ S paste was that the SiO₄ tetrahedron network still maintained the frame structure of C₃ S paste during the implantation.

Iodoform-Blended Portland Cement for Dentistry

Portland cement-based formulations blended with radiopacifying agents are popular endodontic materials for various root filling and pulp capping applications. Iodoform (CHI3) is an alternative candidate radiopacifier whose impact on the setting, bioactivity, antimicrobial properties and cytotoxicity of white Portland cement were evaluated in this study. Isothermal conduction calorimetry and 29Si magic angle spinning nuclear magnetic resonance spectroscopy (MAS NMR) showed that 20 wt% iodoform had no significant impact on the kinetics of cement hydration with respect to the formation of the major calcium silicate hydrate (C-S-H) gel product (throughout the 28-day observation). Conversely, transmission electron microscopy demonstrated that iodine was incorporated into the ettringite (Ca₆Al₂(SO₄)₃(OH)₁₂·26H₂O) product phase. Both iodoform-blended and pure Portland cements exhibited comparable biocompatibility with MG63 human osteosarcoma cells and similar bioactivity with respect to the formation of a hydroxyapatite layer upon immersion in simulated body fluid. By virtue of their high alkalinity, both cements inhibited the growth of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. However, in all cases, iodoform enhanced the antimicrobial effect and significantly reduced the minimum bactericidal concentration of the cement. In conclusion, iodoform offers antimicrobial advantages in Portland cement-based formulations where oral biofilm formation threatens the success of root filling materials and dentine substitutes. The reactivity with the calcium aluminosulfate components of the hydrating cement matrix warrants further research to understand the long-term stability of the cement matrix in the presence of iodoform.

Wollastonite as filler of an experimental dental adhesive

OBJECTIVE

The aim of this study was to formulate experimental dental adhesives with wollastonite and evaluate the physical, chemical, and bioactivity properties of the resins.

METHODS

Wollastonite was characterized by Fourier transform infrared spectroscopy, X-ray and laser diffraction analyses, and scanning electronic microscopy. An experimental adhesive resin was formulated, and wollastonite was used as filler at 0 (control group), 0.5, 1, or 2 wt.%. Radiopacity, degree of conversion (DC%), microhardness, softening in solvent, ultimate tensile strength (UTS), 24 h- and 1 year- microtensile bond strength (μTBS), mineral deposition, and color of the adhesives were evaluated.

RESULTS

Wollastonite particles showed a needle-like shape, a mean diameter of 70 (± 30) μm, characteristic chemical peaks, and pure crystalline β-CaSiO₃ phase. There were no significant differences (p > 0.05) for radiopacity, softening in solvent, and color change. The group with 2 wt.% of wollastonite showed higher microhardness and UTS in comparison to the control group (p < 0.05). After one year, the control group showed reduced μTBS compared to the immediate value (p < 0.05). The groups with wollastonite presented stable μTBS after one year in comparison to the immediate μTBS (p > 0.05). Wollastonite induced mineral deposition on the adhesive surface over the time of storage in simulated body fluid.

CONCLUSION

The addition of wollastonite improved the mechanical behavior of the adhesive without changing the analyzed chemical properties. The adhesives with this filler presented mineral deposition and acceptable clinical color. Moreover, dentin treated with wollastonite-doped adhesives showed higher bonding stability after one year of aging.

CLINICAL SIGNIFICANCE

Wollastonite, a silicate-based material, provided bioactivity for the adhesives, which assists in producing therapeutic tooth-restoration interfaces. Moreover, the incorporation of this mineral improOfiller to improve the biological properties of adhesives and assist in dentin-restoration stability.

Light Transmittance and Polymerization of Bulk-Fill Composite Materials Doped with Bioactive Micro-Fillers

This study investigated the effect of bioactive micro-fillers on the light transmittance and polymerization of three commercially available bulk-fill resin composites. These were mixed with 20 wt% bioactive glass 45S5, Portland cement, inert dental barium glass, or nothing (controls). Composites were photo-activated and light transmittance through 4 mm thick specimens was measured in real time. Moreover, degree of conversion (DC) and Knoop hardness (KHN) were assessed. Light transmittance of all bulk-fill composites significantly decreased (p < 0.05) with addition of 20 wt% bioactive glass 45S5 but not when inert barium glass was added. For bulk-fill composites modified with Portland cement, light irradiance dropped below the detection limit at 4 mm depth. The DC at the top surface of the specimens was not affected by addition of bioactive or inert micro-fillers. The bottom-to-top ratio of both DC and KHN surpassed 80% for bulk-fill composites modified with 20 wt% bioactive or inert glass fillers but fell below 20% when the composites were modified with Portland cement. In contrast to Portland cement, the addition of 20 wt% bioactive glass maintains adequate polymerization of bulk-fill composites placed at 4 mm thickness, despite a decrease in light transmittance compared to the unmodified materials.

A poly(2-hydroxyethyl methacrylate)-based resin improves the dentin remineralizing ability of calcium silicates

Bioactive polymeric composites have received great attention for their capability to remineralize the dentin tissue. This study was aimed at evaluating if a poly(HEMA-co-TEGDMA) resin (HEMA: 2-hydroxyethyl methacrylate; TEGDMA: triethyleneglycol dimethacrylate) may increase the in vitro apatite forming ability of a calcium silicate cement (CaSi), in view of developing a hydrophilic light-curable composite bio-remineralizing restorative material (R-CaSi). To this purpose, the following experiments were carried out: (1) In vitro apatite forming ability of R-CaSi and CaSi was comparatively assessed by micro-Raman spectroscopy after immersion of the cement disks in Dulbecco's Phosphate Buffered Saline (DPBS) at 37°C for 1-28days; (2) Previously demineralized human dentin slices were soaked for 7days in close contact with the CaSi and R-CaSi cements as well as poly(HEMA), poly(TEGDMA) and poly(HEMA-co-TEGDMA), and then were comparatively analyzed by IR spectroscopy. Micro-Raman spectroscopy showed that in calcium phosphate nucleation tests, the B-type carbonated apatite deposit formed on R-CaSi was thicker than that on CaSi; therefore, the poly(HEMA-co-TEGDMA) resin proved able to increase the in vitro apatite forming ability of the calcium silicate-based cement. Both cements were found to induce dentin remineralization, R-CaSi to a higher extent, in agreement with the calcium phosphate nucleation tests. This result may be ascribed to the positive role played by the polymeric component, which was found to interact with collagen and to chelate calcium ions. Upon remineralization, collagen underwent conformational rearrangements and the formed apatite phase, rather than a simple deposit, was intimately bound to the collagen matrix, thanks to the calcium ions chelated by it.

Hydration kinetics, ion-release and antimicrobial properties of white Portland cement blended with zirconium oxide nanoparticles

This study examines the impact of 20 wt% zirconium oxide nanoparticles on the early hydration kinetics of white Portland cement by isothermal conduction calorimetry and transmission electron microscopy. The findings confirm that the nano-ZrO2 particles do not directly participate in the chemical reactions during cement hydration; although, they do divert the normal hydration processes and accelerate the initial setting reactions. The rate of heat evolution and the extent of the exotherm associated with these reactions are reduced in the presence of nano-ZrO2. The incorporation of nano-ZrO2 into the cement also decreases the solubility of the silicate phases but does not compromise its capacity to release hydroxide ions. There was no observed difference in the antimicrobial activity of the nano-ZrO2-blended and unblended cement pastes against S. aureus and E. coli; however, a modest reduction in this property was noted against P. aeruginosa for the blended cement.

β-Dicalcium silicate-based cement: synthesis, characterization and in vitro bioactivity and biocompatibility studies

β-dicalcium silicate (β-Ca₂ SiO₄, β-C₂ S) is one of the main constituents in Portland cement clinker and many refractory materials, itself is a hydraulic cement that reacts with water or aqueous solution at room/body temperature to form a hydrated phase (C-S-H), which provides mechanical strength to the end product. In the present investigation, β-C₂ S was synthesized by sol-gel process and it was used as powder to cement preparation, named CSiC. In vitro bioactivity and biocompatibility studies were assessed by soaking the cement samples in simulated body fluid solutions and human osteoblast cell cultures for various time periods, respectively. The results showed that the sol-gel process is an available synthesis method in order to obtain a pure powder of β-C₂ S at relatively low temperatures without chemical stabilizers. A bone-like apatite layer covered the material surface after soaking in SBF and its compressive strength (CSiC cement) was comparable with that of the human trabecular bone. The extracts of this cement were not cytotoxic and the cell growth and relative cell viability were comparable to negative control.

Microstructure and chemistry affects apatite nucleation on calcium phosphate bone graft substitutes

The bioactivity of calcium phosphate bone grafts of varying chemistry and strut-porosity was compared by determining the rate of formation of hydroxycarbonate apatite crystals on the material surface after being soaked in simulated body fluid for up to 30 days. Three groups of silicate-substituted hydroxyapatite material were tested, with each group comprising a different quantity of strut-porosity (23, 32, and 46 % volume). A commercially available porous β-tricalcium phosphate bone graft substitute was tested for comparison. Results indicate that strut-porosity of a material affects the potential for formation of a precursor to bone-like apatite and further confirms previous findings that β-tricalcium phosphate is less bioactive than hydroxyapatite.