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Birant S, Gümüştaş B. The effect of thermal aging on microhardness and SEM/EDS for characterisation bioactive filling materials. BMC Oral Health 2024; 24:1142. [PMID: 39334004 PMCID: PMC11438397 DOI: 10.1186/s12903-024-04643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The aim of this study is to evaluate the surface microhardness, surface chemical composition of bioactive restorative materials pre- and post- thermal aging. METHOD A total of 200 disc-shaped samples were prepared by using the materials: Cention N, ACTIVA BioActive Restorative, Equia Forte HT Fil, Glass Fill glass carbomer cement (GCP), and Fuji II LC. Vickers microhardness test were used to measure surface hardness. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM/EDS) was used to determine the characterization of the microstructures and elemental analysis of the materials. These measurements were repeated after thermal aging. One-Way ANOVA test, Bonferroni test and the Games-Howell test was used for data analysis. The significance level was accepted as 0.05. RESULTS Cention N had the highest vickers microhardness value before thermal cycle. The highest fluoride ion ratio among the materials before thermal aging was detected in the Equia Forte HT Fil and Fuji II LC groups. While a decrease in fluorideF ion was detected in all groups except the Cention N group after thermal aging. It is observed that ACTIVA BioActive Restorative has a more microporous and rougher surface in the scanning electron microscopy image after the thermal cycle than in the image before the thermal cycle. CONCLUSIONS The chemical properties of the materials and the properties of the filler particles may be related to the differences in the mechanical properties, surface characterizations and ion releases of the materials Thermal aging affected the microhardness, surface characteristics and elemental mass ratios of the studied materials. Alkasite bioactive materials are more similar to composite restorative materials and show better mechanical properties than other materials, but do not have the same effect on fluoride release. CLINICAL RELEVANCE Most of the bioactive materials showed a decrease in the fluoride ion ratio after thermal aging, while no difference was found in the ion exchange of alkasite materials. Material selection should be made more carefully in caries-active individuals whose fluoride release is clinically important.
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Affiliation(s)
- Sinem Birant
- Faculty of Dentistry, Department of Pediatric Dentistry, Istanbul University-Cerrahpaşa, Cerrahpaşa Yerleşkesi Kocamustafapaşa Caddesi No:53, Istanbul, 34098, Turkey.
| | - Burak Gümüştaş
- Faculty of Dentistry, Department of Restorative Dentistry, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Ibrahim MS, AlKhalefah AS, Alsaghirat AA, Alburayh RA, Alabdullah NA. Comparison between Different Bulk-Fill and Incremental Composite Materials Used for Class II Restorations in Primary and Permanent Teeth: In Vitro Assessments. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6674. [PMID: 37895656 PMCID: PMC10608519 DOI: 10.3390/ma16206674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Several advantages, including improved aesthetics and conservative cavity preparation, made resin-based composite (RBC) a popular restorative material. However, several limitations come with RBC restorations such as the necessity for proper isolation of the tooth and an incremental layering for the material due to the limitations of the depth of cure. Despite these advantages and limitations, the usage of these restorative materials is increasingly being expanded due to the advancement made since their introduction. To overcome some of the limitations, several types of RBC restorations were developed. MATERIALS AND METHODS Four different RBC materials used for class II restorations in primary and permanent teeth were compared: Z350 XT Filtek™ Universal Restorative (ZXT), Filtek™ Bulk Fill Flowable Restorative (FBF), Beautifil-Bulk Flowable (BBF) and Tetric™ N-Flow (TNF). Flexure strength, elastic modulus, surface roughness, microhardness and microleakage were assessed using standard methods or previously published protocols. The data and differences between the groups were analyzed using One-way analysis of variance (ANOVA), Tukey's multiple comparisons, Kruskal-Wallis and Wilcoxon rank-sum (Mann-Whitney) tests. RESULTS The study found that BBF (86.24 ± 7.41 MPa) and ZXT (64.45 ± 11.52 MPa) had higher flexural strength than FBF (50.89 ± 8.44 MPa) and TNF (50.67 ± 9.40 MPa), while both exhibited the highest values of surface roughness. Elastic modulus was the highest with BBF, which was not statistically significant from FBF or ZXT (p > 0.05). ZXT (109.7 ± 7.83 VH) exhibited the highest value of microhardness, which was statistically significant from the other three materials (p < 0.0001). Microleakage was assessed after thermocycling for 20,000 cycles to simulate two years in the mouth. FBF (70%) exhibited the most resistance to microleakage. CONCLUSIONS Different types of RBC restorations exhibit different characteristics. The clinician needs to choose the most appropriate restorative material based on different clinical scenarios.
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Affiliation(s)
- Maria Salem Ibrahim
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ahmed Saleh AlKhalefah
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.A.); (A.A.A.); (R.A.A.); (N.A.A.)
| | - Abdullah Ali Alsaghirat
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.A.); (A.A.A.); (R.A.A.); (N.A.A.)
| | - Read Ahmed Alburayh
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.A.); (A.A.A.); (R.A.A.); (N.A.A.)
| | - Nezar Ahmed Alabdullah
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.A.); (A.A.A.); (R.A.A.); (N.A.A.)
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Bishayi D, Srinivasan A, Mahabala KY, Natarajan S, Rao A, Nayak AP. A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration. Eur Arch Paediatr Dent 2022; 24:195-201. [PMID: 36575275 DOI: 10.1007/s40368-022-00773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant. METHODS This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test. RESULTS The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively). CONCLUSION Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.
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Affiliation(s)
- D Bishayi
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Srinivasan
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - S Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Kadhi H, Winnier J, Ratnaparkhi I. Assessment of microleakage and interfacial adaptation following simultaneous activation technique in primary molars. PEDIATRIC DENTAL JOURNAL 2022. [DOI: 10.1016/j.pdj.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Comparative Evaluation of Microleakage of Bioactive, Ormocer, and Conventional GIC Restorative Materials in Primary Molars: An In Vitro Study Microleakage of Three Restorative Materials. Int J Dent 2022; 2022:7932930. [PMID: 35310459 PMCID: PMC8933070 DOI: 10.1155/2022/7932930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
This in vitro study aimed to evaluate and compare the microleakage of bioactive, ormocer, and conventional glass ionomer cement (GIC) restorative materials in primary molars. In this study, class V cavities were prepared on the buccal surface of 75 noncarious extracted primary molars. The teeth were then restored as per the groups assigned. Group A, group B, and group C used bioactive restorative materials, ormocer restorative materials, and conventional GIC restorative materials for restorations, respectively. The teeth were then thermocycled and subjected to microleakage analysis via dye penetration. The microleakage scores were compared for differences using the Kruskal–Wallis test. This was followed by multiple pairwise comparisons using the Dunn test. All testing was carried out using a ‘p’ value of <0.05. The percentage of samples showing microleakage score 0 depicting no dye penetration was highest for group A (56%) followed by group C (44%) and group B (12%). Statistical analysis revealed highest microleakage with group B, which was statistically significant (
< 0.05). Microleakage was evident in all the materials tested. The lowest microleakage was seen with bioactive restorative material.
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Mechanical and Tribological Characterization of a Bioactive Composite Resin. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11178256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite developments and advances in dental materials which allow for greater restorative performance, there are still challenges and questions regarding the formulation of new compositions and chemical reactions of materials used in restorative dentistry. The aim of this study was to assess and compare the mechanical and tribological characteristics of a bioactive resin, a composite resin, and a glass ionomer. Twenty specimens of each material were divided into two groups: one control group (n = 10), not subjected to thermocycling, and one test group (n = 10) submitted to thermocycling. The Vickers microhardness test was carried out and surface roughness was evaluated. The tribological sliding indentation test was chosen. The bioactive resin had the lowest hardness, followed by the composite resin, and the glass ionomer. The bioactive resin also showed greater resistance to fracture. For the tribological test, the wear rate was lower for the bioactive resin, followed by the composite resin, and the glass ionomer. The bioactive resin presented a smooth surface without visible cracks, while the other materials presented a brittle peeling of great portions of material. Thus, the bioactive resin performs better in relation to fracture toughness, wear rate and impact absorption than the composite resin and much better than the glass ionomer.
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Ciurea A, Delean AG, Didilescu A, Monea M, Roman A, Boariu M, Stratul ȘI, Mîrza CM, Micu IC, Șurlin P, Soancă A. In Vitro Study on the Adhesive Performance of Some Resin-Based Materials Used to Restore Class II Cavities. MATERIALS 2021; 14:ma14154299. [PMID: 34361493 PMCID: PMC8348953 DOI: 10.3390/ma14154299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
The study aimed to evaluate the adhesive performances of two ormocer materials and two micro-hybrid composites placed to restore class II cavities. We tested the null hypothesis, which considered that the adhesive behaviors of tested materials did not differ. On each extracted tooth, two class II cavities were prepared having an enamel located cervical margin and a cementum located cervical margin, respectively, and were restored using two different restoration techniques. The teeth followed a tooth impregnating protocol and were sectioned and evaluated by optical microscopy to highlight the marginal microleakage around restorations. Cervical and occlusal microleakage as well as microleakage ratios were calculated. The microleakage test showed that all tested materials exhibited some degree of dentinal microleakage both on cervical and occlusal areas irrespective of the restoration technique. Some significant differences were recorded in adhesion performance of the materials. The cervical microleakage ratio was significantly increased for one of the micro-hybrid resin composites in comparison with one of the ormocer materials (p = 0.0159). Significantly differences were observed in occlusal microleakage ratios when the two micro-hybrid composites were compared (p = 0.047). The results failed to reject the null hypothesis. The present study could not demonstrate the superiority of ormocer-materials relative to conventional composites.
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Affiliation(s)
- Andreea Ciurea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, 15 Victor Babeş St., 400012 Cluj-Napoca, Romania; (A.C.); (I.C.M.); (A.S.)
| | - Ada Gabriela Delean
- Department of Odontology and Endodontics, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 33 Moților St., 400012 Cluj-Napoca, Romania;
| | - Andreea Didilescu
- Department of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania;
| | - Monica Monea
- Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 38 Gheorghe Marinescu St., 540139 Târgu Mureș, Romania;
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, 15 Victor Babeş St., 400012 Cluj-Napoca, Romania; (A.C.); (I.C.M.); (A.S.)
- Correspondence: ; Tel.: +40-264-597256
| | - Marius Boariu
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy, 9 Bd. Revoluției 1989 St., 300070 Timisoara, Romania;
| | - Ștefan Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy, 9 Bd. Revoluției 1989 St., 300070 Timisoara, Romania;
| | - Camelia-Manuela Mîrza
- Department of Pathophysiology, Iuliu Hațieganu University of Medicine and Pharmacy, 2-4 V.Babeș St., 400012 Cluj-Napoca, Romania;
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, 15 Victor Babeş St., 400012 Cluj-Napoca, Romania; (A.C.); (I.C.M.); (A.S.)
| | - Petra Șurlin
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, 2 Petru Rares St., 200349 Craiova, Romania;
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, 15 Victor Babeş St., 400012 Cluj-Napoca, Romania; (A.C.); (I.C.M.); (A.S.)
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Adhesion of Flowable Resin Composites in Simulated Wedge-Shaped Cervical Lesions: An In Vitro Pilot Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11073173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The resin composite restoration of non-carious cervical lesions (NCCLs) still faces some drawbacks mostly related to the quality of the marginal seal. This study attempts to evaluate the adhesive capacities of two flowable and two conventional hybrid resin composite restorations of NCCLs having two types of cervical margins. Our null hypothesis assumes the same adhesive behavior of different materials. The relative composition of dental–restoration structures was also measured. Thus, restored wedge-shaped cervical cavities were realized on both the buccal and oral surfaces of extracted teeth. After immersion in dye solution, sectioning of the teeth was performed. We proposed an optical microscopy method to quantify the dye penetration along the restoration–tooth interface and scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX) to evaluate the quality of the peripheral seal. The data obtained revealed an amount of dentinal microleakage for all tested materials, despite the favorable results of the restoration peripheral seal. Therefore, data from this study failed to reject the null hypothesis. The adhesion is not influenced by the position of cervical margins. The SEM revealed occasional disruptions of the adhesive interface. EDX sustains the qualitative compositions as provided by the manufacturers. Conclusions: The four experimental composites are recommended to restore NCCLs in clinic.
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Biophysical and Fluoride Release Properties of a Resin Modified Glass Ionomer Cement Enriched with Bioactive Glasses. Symmetry (Basel) 2021. [DOI: 10.3390/sym13030494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to evaluate the bond strength, microleakage, cytotoxicity, cell migration and fluoride ion release over time from a resin-modified glass-ionomer cement (RMGIC) enriched with bioactive glasses (BAGs) and a nanohybrid restorative polymer resin agent used as adhesion material in the cemented brackets. One hundred and twenty bovine lower incisors were divided into three groups: (Transbond Plus Self Etching Primer (TSEP)/Transbond XT (TXT), TSEP/ACTIVA, orthophosphoric acid gel/ACTIVA) and brackets were bonded. A bond strength test and microleakage test were applied. A fluoride release test was applied after 60 days for the TXT and ACTIVA group. To evaluate cytotoxicity and cell migration, a cell viability and scratch migration assay were done for each group. p values < 0.05 were considered significant. Regarding bond strength and microleakage test, no significant differences were found between TSEP/TXT and TSEP/ACTIVA. At 6.4 pH, ACTIVA showed a higher degree of fluoride ion release, which increased with acid pH (3.5), with a maximum fluoride secretion at 30 days. MTT assay revealed that TXT reduces the viability of gingival cells with significant differences (p < 0.001) compared to the untreated cells (control group). ACTIVA provides optimal adhesive and microfiltration properties, releases substantial amounts of fluoride ions in both acid and neutral media, and its biocompatibility is greater than that of traditional composite resin adhesive systems.
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López-García S, Pecci-Lloret MP, Pecci-Lloret MR, Oñate-Sánchez RE, García-Bernal D, Castelo-Baz P, Rodríguez-Lozano FJ, Guerrero-Gironés J. In Vitro Evaluation of the Biological Effects of ACTIVA Kids BioACTIVE Restorative, Ionolux, and Riva Light Cure on Human Dental Pulp Stem Cells. MATERIALS 2019; 12:ma12223694. [PMID: 31717445 PMCID: PMC6888068 DOI: 10.3390/ma12223694] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
This study aimed to analyze the biological effects of three new bioactive materials on cell survival, migration, morphology, and attachment in vitro. ACTIVA Kids BioACTIVE Restorative (Pulpdent, Watertown, MA, USA) (Activa), Ionolux (Voco, Cuxhaven, Germany), and Riva Light Cure UV (SDI, Bayswater, Australia) (Riva) were handled and conditioned with a serum-free culture medium. Stem cells from human dental pulp (hDPSCs) were exposed to material extracts, and metabolic activity, cell migration, and cell morphology were evaluated. Cell adhesion to the different materials was analyzed by scanning electron microscopy (SEM). The chemical composition of the materials was evaluated by energy-dispersive X-ray (EDX). One-way analysis of variance followed by a Tukey test was performed (p < 0.05). Ionolux promoted a drastic reduction in metabolic activity and wound closure compared to the control (p < 0.05), whereas Activa induced adequate metabolic activity and cell migration. Moreover, SEM and immunofluorescence analysis showed abundant cells exposed to Activa. The materials showed different surface morphologies, and EDX spectra exhibited different peaks of C, O, Si, S, Ca, and F ions in glass ionomer cements. The results showed that Activa induced cell migration, cell attachment, and cell viability to a greater extent than Riva and Ionolux.
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Affiliation(s)
- Sergio López-García
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
- Department of Genetics and Microbiology, Faculty of Biology, University of Murcia, 30100 Murcia, Spain
| | - María P. Pecci-Lloret
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - Miguel R. Pecci-Lloret
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - Ricardo E. Oñate-Sánchez
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - David García-Bernal
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
| | - Pablo Castelo-Baz
- Endodontics Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Francisco Javier Rodríguez-Lozano
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
- Correspondence: ; Tel.: +0034-868889518
| | - Julia Guerrero-Gironés
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
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