The self-setting properties and in vitro bioactivity of tricalcium silicate

Hydrated Calcium Silicate in Resin Composites for Prevention of Secondary Caries

INTRODUCTION AND AIMS

The gaps at the margins of restorative composite resin can increase as the carious process occurs underneath the materials, causing further demineralization along the tooth cavity wall. The aim of this study was to evaluate the effects of restorative resin composite containing hydrated calcium silicate (hCS) filler on enamel protection against demineralization by simulating microleakage between the test material and teeth in a cariogenic environment.

METHODS

The experimental resin composites were composed of 70 wt.% filler, which was mixed with a glass filler and hCS in a weight ratio of 70.0% glass (hCS 0), 17.5% hCS + 52.5% glass (hCS 17.5), 35.0% hCS + 35.0% glass (hCS 35.0), and 52.5% hCS + 17.5% glass (hCS 52.5). A light-cured experimental resin composite disk was positioned over a polished bovine enamel disk, separated by a 30-µm gap, and immersed in artificial saliva with pH 4.0 for 15, 30, and 60 days. After the immersion period, the enamel disk was separated from the resin composite disk and evaluated using a microhardness tester, atomic force microscopy, and polarized light microscopy. The opposing sides of the enamel and resin composite disks were observed using scanning electron microscopy/energy dispersive X-ray spectrometry.

RESULTS

The enamel surface showed a significant increase in microhardness, decreased roughness, and remineralization layer as the proportion of hCS increased (P < .05). In the scanning electron microscopy image, the enamel surface with hCS 35.0 and 52.5 after all experimental immersion periods, showed a pattern similar to that of a sound tooth.

CONCLUSIONS

The results demonstrated that increasing the hCS filler level of restorative resin composites significantly decreased enamel demineralization.

CLINICAL RELEVANCE

Hydrated calcium silicate laced restorative resin composites may be a promising dental biomaterial for protecting teeth against demineralization and preventing secondary caries around restorations.

Novel self-setting cements based on tricalcium silicate/(β-tricalcium phosphate/monocalcium phosphate anhydrous)/hydroxypropyl methylcellulose: From hydration mechanism to biological evaluations

Despite the clinical success of tricalcium silicate (TCS)-based materials in endodontics, the inferior handling characteristic, poor anti-washout property and slow setting kinetics hindered their wider applications. To solve these problems, an injectable fast-setting TCS/β-tricalcium phosphate/monocalcium phosphate anhydrous (β-TCP/MCPA) cement was developed for the first time by incorporation of hydroxypropyl methylcellulose (HPMC) and β-TCP/MCPA. The physical-chemical characterization (setting time, anti-washout property, injectability, compressive strength, apatite mineralization and sealing property) of TCS/(β-TCP/MCPA) were conducted. Its hydration mechanism was also investigated. Furthermore, the cytocompatibility and osteogenic/odontogenic differentiation of stem cells isolated from human exfoliated deciduous teeth (SHED) treated with TCS/β-TCP/MCPA were studied. The results showed that HPMC could provide TCS with good anti-washout ability and injectability but slow hydration process. However, β-TCP/MCPA effectively enhanced anti-washout characteristics and reduced setting time due to faster hydration kinetics. TCS/(β-TCP/MCPA) obtained around 90 % of injection rate and high compressive strength whereas excessive additions of β-TCP/MCPA compromised its injectability and compressive strength. TCS/(β-TCP/MCPA) can induce apatite deposition and form a tight marginal sealing at the dentin-cement interface. Additionally, TCS/(β-TCP/MCPA) showed good biocompatibility and promoted osteo/odontogenic differentiation of SHED. In general, our results indicated that TCS/(β-TCP/MCPA) may be particularly promising as an injectable bioactive cements for endodontic treatment.

Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study

PURPOSE

The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36 months in school children from the remote village of Kerung, Nepal.

METHODS

From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33 months, respectively.

RESULTS

After 12 months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33 months was 67.6% and 50%, respectively. Radiographically, no pathology was observed.

CONCLUSION

This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1 year and in a substantial number of cases for up to 21 and 33 months.

Bioactivity of Calcium Silicate-Based Endodontic Materials: A Comparative in vitro Evaluation

Background

Bioactivity refers to the ability of a material to interact with living organisms or biological systems in a way that elicits a specific response. In the context of materials science and medicine, bioactivity is particularly important because it can determine the suitability of material for various applications.

Objective

To evaluate and compare different commercially available calcium silicate-based materials regarding: 1. Morphological and elemental analysis at the dentin/material interface. 2. Calcium and silicon release and uptake by adjacent root canal dentine by evaluating the calcium and silicon incorporation depth in adjacent root canal dentin.

Materials and Methods

This study examined four calcium silicate-based cements: Biodentine, MTA Angelus, BioAggregate, and MTA Plus. One hundred extracted human teeth with intact apices and no cavities were selected. Root sections measuring 3 mm in length were created at the mid-root level using low-speed diamond discs. Bioactivity was evaluated at 1, 7, 30, and 90 days, respectively.

Results

The principal composition of the interfacial dentine layer and incorporation of calcium and silicon into dentine was measured at 1, 7, 30, and 90 days. Statistical analysis was performed by multiple comparisons using post hoc Tukey HSD.

Conclusion

All the materials have shown bioactivity, i.e. release of calcium, silicon, and their uptake in the adjacent dentin in the presence of phosphate-buffered saline.

Limitations and modifications in the clinical application of calcium sulfate

Calcium sulfate and calcium sulfate-based biomaterials have been widely used in non-load-bearing bone defects for hundreds of years due to their superior biocompatibility, biodegradability, and non-toxicity. However, lower compressive strength and rapid degradation rate are the main limitations in clinical applications. Excessive absorption causes a sharp increase in sulfate ion and calcium ion concentrations around the bone defect site, resulting in delayed wound healing and hypercalcemia. In addition, the space between calcium sulfate and the host bone, resulting from excessively rapid absorption, has adverse effects on bone healing or fusion techniques. This issue has been recognized and addressed. The lack of sufficient mechanical strength makes it challenging to use calcium sulfate and calcium sulfate-based biomaterials in load-bearing areas. To overcome these defects, the introduction of various inorganic additives, such as calcium carbonate, calcium phosphate, and calcium silicate, into calcium sulfate is an effective measure. Inorganic materials with different physical and chemical properties can greatly improve the properties of calcium sulfate composites. For example, the hydrolysis products of calcium carbonate are alkaline substances that can buffer the acidic environment caused by the degradation of calcium sulfate; calcium phosphate has poor degradation, which can effectively avoid the excessive absorption of calcium sulfate; and calcium silicate can promote the compressive strength and stimulate new bone formation. The purpose of this review is to review the poor properties of calcium sulfate and its complications in clinical application and to explore the effect of various inorganic additives on the physicochemical properties and biological properties of calcium sulfate.

Augmented physical, mechanical, and cellular responsiveness of gelatin-aldehyde modified xanthan hydrogel through incorporation of silicon nanoparticles for bone tissue engineering

Bioactive scaffolds fabricated from a combination of organic and inorganic biomaterials are a promising approach for addressing defects in bone tissue engineering. In the present study, a self-crosslinked nanocomposite hydrogel, composed of gelatin/aldehyde-modified xanthan (Gel-AXG) is successfully developed by varying concentrations of porous silicon nanoparticles (PSiNPs). The effect of PSiNPs incorporation on physical, mechanical, and biological performance of the nanocomposite hydrogel is evaluated. Morphological analysis reveals formation of highly porous 3D microstructures with interconnected pores in all nanocomposite hydrogels. Increased content of PSiNPs results in a lower swelling ratio, reduced porosity and pore size, which in turn impeded media penetration and slowed down the degradation process. In addition, remarkable enhancements in dynamic mechanical properties are observed in Gel-AXG-8%Si (compressive strength: 0.6223 MPa at 90 % strain and compressive modulus: 0.054 MPa), along with improved biomineralization ability via hydroxyapatite formation after immersion in simulated body fluid (SBF). This optimized nanocomposite hydrogel provides a sustained release of Si ions at safe dose levels. Furthermore, in-vitro cytocompatibility studies using MG-63 cells exhibited remarkable performance in terms of cell attachment, proliferation, and ALP activity for Gel-AXG-8%Si. These findings suggest that the prepared nanocomposite hydrogel holds promising potential as a scaffold for bone tissue engineering.

Sol-Gel Technologies to Obtain Advanced Bioceramics for Dental Therapeutics

The aim of this work is to review the application of bioceramic materials in the context of current regenerative dentistry therapies, focusing on the latest advances in the synthesis of advanced materials using the sol-gel methodology. Chemical synthesis, processing and therapeutic possibilities are discussed in a structured way, according to the three main types of ceramic materials used in regenerative dentistry: bioactive glasses and glass ceramics, calcium phosphates and calcium silicates. The morphology and chemical composition of these bioceramics play a crucial role in their biological properties and effectiveness in dental therapeutics. The goal is to understand their chemical, surface, mechanical and biological properties better and develop strategies to control their pore structure, shape, size and compositions. Over the past decades, bioceramic materials have provided excellent results in a wide variety of clinical applications related to hard tissue repair and regeneration. Characteristics, such as their similarity to the chemical composition of the mineral phase of bones and teeth, as well as the possibilities offered by the advances in nanotechnology, are driving the development of new biomimetic materials that are required in regenerative dentistry. The sol-gel technique is a method for producing synthetic bioceramics with high purity and homogeneity at the molecular scale and to control the surfaces, interfaces and porosity at the nanometric scale. The intrinsic nanoporosity of materials produced by the sol-gel technique correlates with the high specific surface area, reactivity and bioactivity of advanced bioceramics.

Intratubular crystal formation in the exposed dentin from nano-sized calcium silicate for dentin hypersensitivity treatment

The aim of this study is to evaluate intratubular crystal formation from the experimental material consisting of dicalcium silicate (C2S) and tricalcium silicate (C3S) with nano-scaled particle size. A total of twenty-four specimens were made by isolating 8 mm of the cervical part centered at the cementoenamel junction of extracted premolars. Twelve specimens were not treated and considered as control. The experimental material was applied to the other twelve specimens by brushing for 10,000 strokes. Each group was randomly divided into four subgroups according to the period of immersion in phosphate buffer saline (PBS) for 1, 30, 60, and 90 days each. The specimens were sectioned longitudinally and examined with scanning electron microscopy and energy dispersion X-ray spectroscopy. The intratubular crystal were formed in PBS and densely filled the dentinal tubules over time. The crystal formation occurred at a depth of more than 50 μm from the dentin surface. The Ca/P ratio of formed intratubular crystals was 1.68 after 3 months. The experimental material consisting of C2S and C3S with a nanoscale particle size can form hydroxyapatite-like crystals in dentinal tubules in PBS, and there is a possibility of reducing dentin hypersensitivity by blocking the dentinal fluid flow.

The Dual Effect of 3D-Printed Biological Scaffolds Composed of Diverse Biomaterials in the Treatment of Bone Tumors

Bone tumors, including primary bone tumors, invasive bone tumors, metastatic bone tumors, and others, are one of the most clinical difficulties in orthopedics. Once these tumors have grown and developed in the bone system, they will interact with osteocytes and other environmental cells in the bone system's microenvironment, leading to the eventual damage of the bone's physical structure. Surgical procedures for bone tumors may result in permanent defects. The dual-efficacy of tissue regeneration and tumor treatment has made biomaterial scaffolds frequently used in treating bone tumors. 3D printing technology, also known as additive manufacturing or rapid printing prototype, is the transformation of 3D computer models into physical models through deposition, curing, and material fusion of successive layers. Adjustable shape, porosity/pore size, and other mechanical properties are an advantage of 3D-printed objects, unlike natural and synthetic material with fixed qualities. Researchers have demonstrated the significant role of diverse 3D-printed biological scaffolds in the treatment for bone tumors and the regeneration of bone tissue, and that they enhanced various performance of the products. Based on the characteristics of bone tumors, this review synthesized the findings of current researchers on the application of various 3D-printed biological scaffolds including bioceramic scaffold, metal alloy scaffold and nano-scaffold, in bone tumors and discussed the advantages, disadvantages, and future application prospects of various types of 3D-printed biological scaffolds. Finally, the future development trend of 3D-printed biological scaffolds in bone tumor is summarized, providing a theoretical foundation and a larger outlook for the use of biological scaffolds in the treatment of patients with bone tumors.

Chemical-Physical Properties and Bioactivity of New Premixed Calcium Silicate-Bioceramic Root Canal Sealers

The aim of the study was to analyze the chemical−physical properties and bioactivity (apatite-forming ability) of three recently introduced premixed bioceramic root canal sealers containing varied amounts of different calcium silicates (CaSi): a dicalcium and tricalcium silicate (1−10% and 20−30%)-containing sealer with zirconium dioxide and tricalcium aluminate (CERASEAL); a tricalcium silicate (5−15%)-containing sealer with zirconium dioxide, dimethyl sulfoxide and lithium carbonate (AH PLUS BIOCERAMIC) and a dicalcium and tricalcium silicate (10% and 25%)-containing sealer with calcium aluminate, tricalcium aluminate and tantalite (NEOSEALER FLO). An epoxy resin-based sealer (AH PLUS) was used as control. The initial and final setting times, radiopacity, flowability, film thickness, open pore volume, water absorption, solubility, calcium release and alkalizing activity were tested. The nucleation of calcium phosphates and/or apatite after 28 days aging in Hanks balanced salt solution (HBSS) was evaluated by ESEM-EDX, vibrational IR and micro-Raman spectroscopy. The analyses showed for NeoSealer Flo and AH Plus the longest final setting times (1344 ± 60 and 1300 ± 60 min, respectively), while shorter times for AH Plus Bioceramic and Ceraseal (660 ± 60 and 720 ± 60 min, respectively). Radiopacity, flowability and film thickness complied with ISO 6876/12 for all tested materials. A significantly higher open pore volume was observed for NeoSealer Flo, AH Plus Bioceramic and Ceraseal when compared to AH Plus (p < 0.05), significantly higher values were observed for NeoSealer Flo and AH Plus Bioceramic (p < 0.05). Ceraseal and AH Plus revealed the lowest solubility. All CaSi-containing sealers released calcium and alkalized the soaking water. After 28 days immersion in HBSS, ESEM-EDX analyses revealed the formation of a mineral layer that covered the surface of all bioceramic sealers, with a lower detection of radiopacifiers (Zirconium for Ceraseal and AH Plus Bioceramic, Tantalum for NeoSealer Flo) and an increase in calcium, phosphorous and carbon. The calcium phosphate (CaP) layer was more evident on NeoSealer Flo and AH Plus Bioceramic. IR and micro-Raman revealed the formation of calcium carbonate on the surface of all set materials. A thin layer of a CaP phase was detected only on AH Plus Bioceramic and NeoSealer Flo. Ceraseal did not show CaP deposit despite its highest calcium release among all the tested CaSi-containing sealers. In conclusion, CaSi-containing sealers met the required chemical and physical standards and released biologically relevant ions. Slight/limited apatite nucleation was observed in relation to the high carbonation processes.

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.

Influence of Acidic Environmental Conditions on Push-Out Bonding Strength of Four Calcium Silicate-Based Materials to Root Dentin

Introduction. Calcium silicate-based cements (CSCs) are frequently used in various endodontic procedures such as perforation repair, vital pulp therapy, regenerative treatments, or apexification. One of their areas of use, treatment of perforations, can be challenging in clinical practice. Selection of stable, durable, and compatible material with structural and biological alterations is a must in such situations. Aim. This study aimed to compare the dislocation resistance of various calcium-silicate-containing materials used in endodontic treatment exposed to various environmental conditions in a push-out study model. Methods. Selected ninety-six human mandibular premolars with single root canals were cut from the middle portion to obtain dentin slices of 2 mm thickness (n = 192). Then, the canal lumen was enlarged by using #4Gates-Glidden drills. Specimens for each repair material (MTA, Angelus, Endosequence RRM (ERRM), Biodentine, BioMTA) were placed in shaped lumens, wrapped in pieces of gauze, and randomly divided into four groups (n = 48) according to the storage time and media: group A: 4 days in phosphate-buffered saline (PBS), group B: 4 days in acetic acid (pH = 4.4), group C: 34 days in PBS, and group D: 4 days in acetic acid (pH = 4.4) followed by exposure to PBS for 30 days. A universal testing machine measured the dislodgement resistance followed by scanning electron microscopy imaging to evaluate the material-dentin interface. Results. ERRM showed the highest dislocation resistance in all test groups ( $p<0.05$ ). The greatest bonding strength was observed (13,54 ± 5,56 MPa) after exposure to 34 days in PBS (pH = 7.2). The values for ERRM decreased in contact with acetic acid (pH = 4.4) and increased when placed in PBS ( $p>0.05$ ). Conclusion. All repair materials showed a higher dislocation resistance when stored in PBS regardless of storage time. However, the improved pH of the surrounding media was not successful in reversing the deteriorating effect caused by lower pH in relation to dislocation resistance in all tested materials except for ERRM.

Inflammatory response and immunohistochemical characterization of experimental calcium silicate-based perforation repair material

This study compares the immunohistochemical reaction of a new experimental tricalcium silicate perforation repair material to mineral trioxide aggregate (MTA) and Biodentine. A total of 162 mature premolar teeth from 12 dogs were divided into three experimental groups (n = 54 teeth each) according to the evaluation period: 1, 2 and 3 months. Each group was further divided into two equal subgroups (n = 27 teeth each) according to the time of repair: immediate repair and delayed repair. Each subgroup was subdivided according to the material used into three experimental subdivisions (n = 8 teeth each): MTA, Biodentine (Septodont) and experimental material, and two control subdivisions: positive control (n = 2 teeth) and negative control (one tooth). Under general anaesthesia, access cavity was done. Cleaning and shaping were performed using ProTaper universal rotary instruments. The canals were obturated using cold lateral compaction technique with Gutta percha and Adseal sealer. Furcation perforations were created then randomly sealed using the three materials either immediately or after one month (delayed repair). Inflammatory cell count and immunohistochemical analysis of osteopontin-positive area fraction were digitally analysed using the ImageJ software. Delayed furcal perforation repair showed significantly higher inflammatory cell count than immediate repair. No significant difference in inflammatory cell count and immunohistochemical analysis was detected between the three tested materials. The immunohistochemical analysis revealed the highest immunopositive area fraction in the 3-month evaluation period. The experimental tricalcium silicate cement performed similarly to Biodentine and MTA regarding the osteopontin expression during perforation repair, suggesting it is a suitable alternative with favourable handling characters.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set

Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

The Development Tendency of 3D-Printed Bioceramic Scaffolds for Applications Ranging From Bone Tissue Regeneration to Bone Tumor Therapy

Three-dimensional (3D) printing concept has been successfully employed in regenerative medicine to achieve individualized therapy due to its benefit of a rapid, accurate, and predictable production process. Traditional biocomposites scaffolds (SCF) are primarily utilised for bone tissue engineering; nevertheless, over the last few years, there has already been a dramatic shift in the applications of bioceramic (BCR) SCF. As a direct consequence, this study focused on the structural, degeneration, permeation, and physiological activity of 3D-printed BCR (3DP-B) SCF with various conformations and work systems (macros, micros, and nanos ranges), as well as their impacts on the mechanical, degeneration, porosity, and physiological activities. In addition, 3DP-B SCF are highlighted in this study for potential uses applied from bone tissue engineering (BTE) to bone tumor treatment. The study focused on significant advances in practical 3DP-B SCF that can be utilized for tumor treatment as well as bone tissue regeneration (BTR). Given the difficulties in treating bone tumors, these operational BCR SCF offer a lot of promise in mending bone defects caused by surgery and killing any remaining tumor cells to accomplish bone tumor treatment. Furthermore, a quick assessment of future developments in this subject was presented. The study not only summarizes recent advances in BCR engineering, but it also proposes a new therapeutic strategy focused on the extension of conventional ceramics' multifunction to a particular diagnosis.

Bioactive Ceramic Scaffolds for Bone Tissue Engineering by Powder Bed Selective Laser Processing: A Review

The implementation of a powder bed selective laser processing (PBSLP) technique for bioactive ceramics, including selective laser sintering and melting (SLM/SLS), a laser powder bed fusion (L-PBF) approach is far more challenging when compared to its metallic and polymeric counterparts for the fabrication of biomedical materials. Direct PBSLP can offer binder-free fabrication of bioactive scaffolds without involving postprocessing techniques. This review explicitly focuses on the PBSLP technique for bioactive ceramics and encompasses a detailed overview of the PBSLP process and the general requirements and properties of the bioactive scaffolds for bone tissue growth. The bioactive ceramics enclosing calcium phosphate (CaP) and calcium silicates (CS) and their respective composite scaffolds processed through PBSLP are also extensively discussed. This review paper also categorizes the bone regeneration strategies of the bioactive scaffolds processed through PBSLP with the various modes of functionalization through the incorporation of drugs, stem cells, and growth factors to ameliorate critical-sized bone defects based on the fracture site length for personalized medicine.

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.

PDMS-enhanced slowly degradable Ca-P-Si scaffold: Material characterization, fabrication and in vitro biocompatibility study

A slowly degradable bone scaffold can well maintain the balance between new bone regeneration and scaffold resorption, esp. for seniors or patients suffering from pathological diseases, because too fast degradation can lead to the loss of long-term biological stability and result in scaffold failure. In this present study, calcium phosphate silicate (CPS) and polydimethylsiloxane (PDMS) were blended in different ratios to formulate slurries for scaffold fabrication. The effects of crosslinked PDMS on the CPS material properties were first characterized and the most viable formulation of CPS-PDMS slurry was determined based on the aforementioned results to 3D fabricate scaffolds. The biocompatibility of CPS-PDMS was further evaluated based on the scaffold extract's cytotoxicity to osteoblast cells. Furthermore, real-time PCR was used to investigate the effects of scaffold extract to increase osteoblast proliferation. It is showed that the crosslinked PDMS interfered with CPS hydration and reduced both setting rate and compressive strength of CPS. In addition, CPS porosity was also found to increase with PDMS due to uneven water distribution as a result of increased hydrophobicity. Degradation and mineralization studies show that CPS-PDMS scaffold was slowly degradable and induced apatite formation. In addition, the in vitro analyses show that the CPS-PDMS scaffold did not exert any cytotoxic effect on osteoblast cells but could improve the cell proliferation via the TGFβ/BMP signaling pathway. In conclusion, CPS-PDMS scaffold is proved to be slowly degradable and biocompatible. Further analyses are therefore needed to demonstrate CPS-PDMS scaffold applications in bone regeneration.

In vitro biocompatibility and bioactivity of calcium silicate‑based bioceramics in endodontics (Review)

Calcium silicate-based bioceramics have been applied in endodontics as advantageous materials for years. In addition to excellent physical and chemical properties, the biocompatibility and bioactivity of calcium silicate-based bioceramics also serve an important role in endodontics according to previous research reports. Firstly, bioceramics affect cellular behavior of cells such as stem cells, osteoblasts, osteoclasts, fibroblasts and immune cells. On the other hand, cell reaction to bioceramics determines the effect of wound healing and tissue repair following bioceramics implantation. The aim of the present review was to provide an overview of calcium silicate-based bioceramics currently applied in endodontics, including mineral trioxide aggregate, Bioaggregate, Biodentine and iRoot, focusing on their in vitro biocompatibility and bioactivity. Understanding their underlying mechanism may help to ensure these materials are applied appropriately in endodontics.

Effect of different manipulations on the physical, chemical and microstructural characteristics of Biodentine

OBJECTIVE

The water to powder ratio and method of mixing is important for the properties of hydraulic cements. For this purpose a number of clinicians prefer premixed materials. Dental manufacturing companies provide predosed materials, however the manufacturer instructions are not always adhered to. The aim of this research is to investigate physical and chemical alterations of the tricalcium silicate-based cement Biodentine when manipulated according to the manufacturer's instructions (control) or changing the doses and mixing of the material components.

METHODS

6 groups were constituted according to different mixing and dosing of powder and liquid. The hydrated cements were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR). Calcium ion concentration of the leachate was also investigated. Assessment of the physical characteristics included setting time and microhardness.

RESULTS

Microstructural differences were visible only in the Biodentine mixed manually with water, in which early hydration rate was also affected, with lower calcium ion release. Increase of Biodentine liquid increased the calcium ion release, but also increased the setting time. Manual manipulation required more liquid (both water and Biodentine liquid) added to the mixture to guarantee a similar consistency to the control. A decrease in setting time was also noted. All groups showed higher values of microhardness at 24 h compared to the freshly set materials. In the freshly set materials, there was an overall decrease in microhardness in all groups when compared to group control, particularly significant when increasing the dosage of Biodentine liquid.

SIGNIFICANCE

When mixing Biodentine, altering the mixing procedure in terms of type and amount of liquid added to the powder and mixing device chosen has an effect on the physical, chemical and mechanical characteristics and surface topography of the material, when compared to Biodentine mixed according to the manufacturer's recommendations. Hence, the manufacturer's instructions should be strictly followed.

Physicochemical and Biological Properties of Mg-Doped Calcium Silicate Endodontic Cement

Calcium silicate-based cement has been widely used for endodontic repair. However, it has a long setting time and needs to shorten setting time. This study investigated the effects of magnesium (Mg) ion on the setting reaction, mechanical properties, and biological properties of calcium silicate cement (CSC). Sol-gel route was used to synthesize Mg ion-doped calcium silicate cement. Synthesized cement was formulated with the addition of different contents of Mg ion, according to 0, 1, 3, 5 mol% of Mg ion-doped calcium silicate. The synthesized cements were characterized with X-ray diffraction (XRD), Fourier transformed infrared spectroscopy (FT-IR), and scanning electron microscopy (SEM). We also evaluated the physicochemical and biological properties of cement, such as the setting time, compressive strength, micro-hardness, simulated body fluid (SBF) immersion, cytotoxicity, and cell differentiation tests. As a result, the Mg ion improves the hydration properties of calcium silicate cement, and the setting time is reduced by increasing the amounts of Mg ion. However, the mechanical properties deteriorated with increasing Mg ion, and 1 and 3 mol% Mg-doped calcium silicate had appropriate mechanical properties. Also, the results of biological properties such as cytotoxicity, ALP activity, and ARS staining improved with Mg ion. Consequently, the optimal condition is 3 mol% of Mg ion-doped calcium silicate (3%Mg-CSC).

Developing a biodegradable tricalcium silicate/glucono-delta-lactone/calcium sulfate dihydrate composite cement with high preliminary mechanical property for bone filling

Bone cements with the feature of easily shaping could ideally match the defect site and prevent the ingrowth of fibrous tissue. In this manuscript, a biodegradable tricalcium silicate (C₃S)/glucono-delta-lactone (GDL)/calcium sulfate dihydrate (CSD) organic-inorganic composite cement was fabricated with shorter setting time (less than 15 min) and high preliminary mechanical property (5.27 MPa in the first hour). Many methods were applied to study the physicochemical and biological properties of the cement in vitro. The weight loss in PBS can reach 58% after 12 weeks soaking indicating the better biodegradability. The excellent bioactivity in vitro was emerging after the cement was soaked in the simulated body fluid. The cell experiments showed that suitable concentration of the extract liquid of cement was conducive to the proliferation, differentiation and extracellular matrix calcification of the mouse bone marrow stromal cells. Briefly, the C₃S/GDL/CSD composite cement would have the bright capacity for bone filling.

Preparation and properties of tristrontium aluminate as an alternative component of mineral trioxide aggregate (MTA) cement

This study evaluated tristrontium aluminate (S₃A) and its viability as a component for tricalcium silicate (C₃S) cements. The properties of S₃A, C₃S, and S₃A/C₃S mixtures were evaluated in terms of setting time, compressive strength, flowability, and radiopacity. X-ray diffraction (XRD) pattern verified the powder synthesized in the laboratory as S₃A, consequently, confirming the preparation method. S₃A exhibited the lowest setting time, followed by C₃S and S₃A/C₃S mixtures. Compressive strength of C₃S was significantly higher than S₃A. The S₃A/C₃S mixture showed comparable compressive strength to C₃S for 1-day post initial mixing. There was no significant difference in flowability between S₃A/C₃S and mineral trioxide aggregate (MTA). S₃A showed comparable radiopacity to MTA, whereas that of the S₃A/C₃S mixture was significantly lower comparatively; however, it achieved sufficient radiopacity (3 mm aluminum thickness equivalent). Further studies are needed to improve the manufacturing process of S₃A and evaluate the bioactive effect of strontium.

Effect of Tricalcium Silicate on Direct Pulp Capping: Experimental Study in Rats

Objectives Conduct a histological comparison of the pulp response to different materials, with a focus on the continuity and morphology of the mineralized barrier after direct pulp capping.

Materials and Methods  One hundred and eight maxillary first molars of 54 Wistar rats were subject to direct pulp capping and divided into three groups according to the materials used: calcium hydroxide (CH), mineral trioxide aggregate (MTA), and Biodentine. All cavities were sealed, and the animals were euthanized at 7, 14, and 21 days. Descriptive histological evaluation of the inflammation and formation of the mineralized barrier was performed.

Statistical Analysis  Statistical analyses were performed using the Kruskal–Wallis test, which was complemented by the Dunn test; differences with p < 0.05 were considered statistically significant.

Results  The results showed that MTA and Biodentine elicited less intense inflammatory reactions than CH. With respect to the formation and quality of the dentin barrier formed, differences were observed at 21 days between the analyzed groups; the best results being obtained following treatment with MTA and Biodentine.

Conclusion  MTA and Biodentine induced formation of a more continuous and uniform mineralized barrier with less intense pulp response than CH.

Preclinical effectiveness of an experimental tricalcium silicate cement on pulpal repair

OBJECTIVES

To investigate the pulpal repair potential of an experimental zirconium-oxide containing tricalcium-silicate cement, referred to as 'TCS 50'.

MATERIALS AND METHODS

The effect of TCS 50 on viability, proliferation, migration, and odontoblastic differentiation of human dental pulp cells (HDPCs) was assessed using XTT assay, in-vitro wound healing assay and RT-PCR, respectively. Additionally, the pulp-capping potential was evaluated using a vital human tooth model. Statistical analysis was performed using non-parametric Kruskal-Wallis test and post-hoc test (Mann-Whitney U test). The tests were performed at a significance level of α = 0.05.

RESULTS

The effect of TCS 50 towards HDPCs was dose dependent. Undiluted TCS 50 extract showed no immediate adverse impact on cell viability (p > .05); however, it significantly inhibited proliferation and migration of HDPCs (p < .05). A 25% diluted TCS 50 extract showed no significant effect on cell viability, proliferation or migration (p > .05), and it significantly enhanced odontoblastic differentiation of HDPCs (p < .05). In pulps capped with TCS 50 for both 2 and 4 weeks, H&E staining revealed a normal morphology of pulp tissue; mineralized foci with cellular components entrapped in the matrix were formed underneath the exposure site. Collagen I expression was weak within the matrix of mineralized foci, while the expression of nestin was positive for entrapped cellular components within the mineralized foci, indicating that the formed mineralized foci corresponded to an initial form of reparative dentin formation.

CONCLUSION

TCS 50 is capable of generating an early pulp-healing reaction and therefore could serve as a promising pulp-capping agent.

Tissue Engineering and Regenerative Medicine: Achievements, Future, and Sustainability in Asia

Exploring innovative solutions to improve the healthcare of the aging and diseased population continues to be a global challenge. Among a number of strategies toward this goal, tissue engineering and regenerative medicine (TERM) has gradually evolved into a promising approach to meet future needs of patients. TERM has recently received increasing attention in Asia, as evidenced by the markedly increased number of researchers, publications, clinical trials, and translational products. This review aims to give a brief overview of TERM development in Asia over the last decade by highlighting some of the important advances in this field and featuring major achievements of representative research groups. The development of novel biomaterials and enabling technologies, identification of new cell sources, and applications of TERM in various tissues are briefly introduced. Finally, the achievement of TERM in Asia, including important publications, representative discoveries, clinical trials, and examples of commercial products will be introduced. Discussion on current limitations and future directions in this hot topic will also be provided.

Review on calcium- and magnesium-based silicates for bone tissue engineering applications

Bone is a self-engineered structural component of the human body with multifaceted mechanical strength, which provides indomitable support to the effective functioning of the human body. It is indispensable to find a suitable biomaterial for substituting the bone as the bone substitute material requirement is very high due to the rate of bone fracture and infection lead to osteoporosis in human beings increases rapidly. It is not an easy task to design a material with good apatite deposition ability, a faster rate of dissolution, superior resorbability, high mechanical strength, and significant bactericidal activity. Since the synthetic hydroxyapatite was not able to achieve the dahlite phase of hydroxyapatite (natural bone mineral phase), silicates emerged as an alternate biomaterial to meet the need for bone graft substitutes. All silicates do not exhibit the properties required for bone graft substitutes, as their composition and methodology adopted for the synthesis are different. Calcium, magnesium, and silicon play a major role in the formation of bone mineral and their metabolism during bone formation. In this review, the relationship between composition and activity of calcium, magnesium-based silicates have been discussed along with the future scope of these materials for hard tissue engineering applications.

Study on strontium doped tricalcium silicate synthesized through sol-gel process

We successfully synthesized a strontium-doped tricalcium silicate (Sr_xCa_3-xSiO₅, Sr = 0 to 2 mol%) bone cement using the sol-gel process. The material properties including crystallinity, setting time, mechanical strength, and hydration products were characterized. Release of ions and pH values of simulated body fluid soaked with the bone cement were measured. In vitro biocompatibility of different concentrations of the material was evaluated by the viability of L929 cells. The setting times of as-prepared slurries were all <70 min. Doping with 0.5 mol% Sr reduced the final setting time by 20 min. After 14 days curing, 0.25 mol% Sr-doped Sr_xCa_3-xSiO₅ possessed the highest compressive strength of 45 MPa among all the Sr-doped groups with no statistical difference to Ca₃SiO₅. The bioactivity of the materials was confirmed with the formation of an apatite layer on the surface of the materials after immersion in simulated body fluid. In addition, the proliferation of L929 cells exposed to 1 mol% Sr was significantly promoted as compared to no Sr doping. Sr_xCa_3-xSiO₅ is a novel and advanced material that has the potential to serve as a bone cement in bone restoration with appropriate mechanical strength and favorable biocompatibility.

The comparative evaluation of shear bond strength of a bioactive material to different universal bonding agents - An in vitro study

Background:

An ideal dental repair material should possess certain important properties such as adequate adhesive ability, insolubility, dimensional stability, biocompatibility, and bioactivity. Newer materials claiming better performance are continuously being introduced in the market to optimize the care of dental patients.

Aim:

The aim of this study was to evaluate the shear bond strength of three different universal adhesives to OrthoMTA.

Materials and Methods:

Sixty-four specimens of OrthoMTA measuring 4 mm internal diameter and 2 mm height were prepared and divided into two main groups. After 12 min, 32 samples were randomly selected and divided into four subgroups of eight samples each. Subgroup-I: Single Bond Universal, Subgroup-II: Prime-and-Bond NT, Subgroup-III: Palfique Universal bond, Subgroup-IV: Control. After the application of adhesives, the composite resin was applied using a cylindrical plastic matrix of 2 mm internal diameter and 2 mm height over OrthoMTA. This procedure was repeated 24 h after mixing an additional 32 samples, respectively. Shear bond strengths were measured using Universal testing machine and fractured specimen were examined under stereomicroscope. Data were statistically analyzed using a two-way ANOVA test and Tukey's multiple post hoc test.

Results:

Statistical analysis revealed that subgroup-III exhibited higher bond strength at both 12 min and 24 h time intervals. It was also observed that most of the failures occurred cohesively within OrthoMTA.

Conclusion:

Shear bond strength was higher at 24 h than compared to 12 min. Subgroup-III exhibited higher bond strength than other subgroups.

Physico-mechanical characteristics of tri-calcium silicate pastes as dentin substitute and interface analysis in class II cavities: effect of CaCl2 and SBF solutions

The influence of using simulated body fluid (SBF) as a curing medium on some characteristics of pure single tri-calcium silicate (C₃S) bio-cement was investigated. CaCl₂ salt solution was used as an accelerating liquid for setting and hardening of C₃S pastes in comparison with distilled water (DW). Solid state reaction was applied to synthesis C₃S phase at elevated temperature followed by rapid cooling. The results showed that 10 wt.% CaCl₂ solution was the optimum concentration that showed the lowest setting time (106 min). C₃S pastes prepared with CaCl₂ solution have better physical and mechanical properties than those mixed with DW even after curing under SBF solution for the different curing ages. However, SBF solution has an adverse effect on the hydrated compound C-S-H that results in a little decrease in strength and hardness values. The elemental analysis emphasized the presence of apatite layer on the surface of the hardened C₃S paste. Scanning electron microscopy (SEM) photomicrographs and elemental analysis revealed reliable adaptation of the experimentally prepared C₃S paste to the tooth structure, in addition to its bioactivity makes it a consistent material to be used as dentin substitute.

Advancements and frontiers in nano-based 3D and 4D scaffolds for bone and cartilage tissue engineering

Given the enormous increase in the risks of bone and cartilage defects with the rise in the aging population, the current treatments available are insufficient for handling this burden, and the supply of donor organs for transplantation is limited. Therefore, tissue engineering is a promising approach for treating such defects. Advances in materials research and high-tech optimized fabrication of scaffolds have increased the efficiency of tissue engineering. Electrospun nanofibrous scaffolds and hydrogel scaffolds mimic the native extracellular matrix of bone, providing a support for bone and cartilage tissue engineering by increasing cell viability, adhesion, propagation, and homing, and osteogenic isolation and differentiation, vascularization, host integration, and load bearing. The use of these scaffolds with advanced three- and four-dimensional printing technologies has enabled customized bone grafting. In this review, we discuss the different approaches used for cartilage and bone tissue engineering.

A novel, doped calcium silicate bioceramic synthesized by sol-gel method: Investigation of setting time and biological properties

The aim of the current study was to synthesize a fast-setting ion-doped calcium silicate bioceramic by the sol-gel method and to characterize its in vitro apatite-forming ability and cell viability. Calcium silicate (CS), doped calcium silicate with zinc and magnesium, with Ca/Zn molar ratios of 6.7:1 (DCS1), and 4.5:1 (DCS2), were synthesized by the sol-gel method. Matreva white MTA (WMTA, Matreva, CA, Egypt) was used as a control. The synthesized powders were characterized by x-ray diffraction. Setting time was measured using the Gilmore needle indentation technique. The in vitro apatite-forming ability of the materials was evaluated by scanning electron microscope and energy dispersive X-ray. NIH3T3-E1 cells viability was tested using MTT assay. The ion release of Ca, Si, Zn, and Mg was measured using inductive coupled plasma-optical emission spectroscopy (ICP-OES). One-way ANOVA was used to analyze setting time results. The Tukey's HSD post hoc test was used to establish significance (p < 0.001). For nonparametric data, the Kruskal-Wallis H test with Dunn's correction for post hoc comparison was used (p < 0.05). CS, DCS1, and DCS2 showed a significant decrease in setting time 33 ± 1.63 min, 28 ± 1.63 min, and 41.75 ± 2.87 min, respectively, compared to WMTA 91 ± 3.16 min (p < 0.001). DCS1 showed the highest apatite-forming ability and cell viability compared to the other groups. Ca and Si ions release decreased in both DCS1 and DCS2. The physical and biological properties of CS can be successfully improved by the sol-gel synthesis and ions doping. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:56-66, 2020.

Effects of dodecacalcium hepta-aluminate content on the setting time, compressive strength, alkalinity, and cytocompatibility of tricalcium silicate cement

Objective

This study aimed to investigate the effects of dodecacalcium hepta-aluminate (C12A7) content on some physicochemical properties and cytocompatibility of tricalcium silicate (C3S) cement using human dental pulp cells (hDPCs).

Material and Methods

High purity C3S cement was manufactured by a solid phase method. C12A7 was mixed with the cement in proportions of 0, 5, 8, and 10 wt% (C12A7-0, −5, −8, and −10, respectively). Physicochemical properties including initial setting time, compressive strength, and alkalinity were evaluated. Cytocompatibility was assessed with cell viability tests and cell number counts. Statistical analysis was performed by using one-way analysis of variance (ANOVA) and Tukey's test (p<0.05).

Results

The initial setting time of C3S-based cement was shorter in the presence of C12A7 (p<0.05). After 1 day, C12A7-5 showed significantly higher compressive strength than the other groups (p<0.05). After 7 days, the compressive strength of C12A7-5 was similar to that of C12A7-0, whereas other groups showed strength lower than C12A7-0. The pH values of all tested groups showed no significant differences after 1 day (p>0.05). The C12A7-5 group showed similar cell viability to the C12A7-0 group (p>0.05), while the other experimental groups showed lower values compared to C12A7-0 group (p<0.05). The number of cells grown on the C12A7-5 specimen was higher than that on C12A7-8 and −10 (p<0.05).

Conclusions

The addition of C12A7 to C3S cement at a proportion of 5% resulted in rapid initial setting time and higher compressive strength with no adverse effects on cytocompatibility.

Tricalcium silicate/graphene oxide bone cement with photothermal properties for tumor ablation

Illustration of the Tricalcium silicate/graphene oxide bone cement for bone tumor ablation.

Synthesis of ternary bioactive glass derived aerogel and xerogel: study of their structure and bioactivity

In this work ternary bioactive glasses with the molar composition 63 % SiO2, 28 % CaO, and 9 % P2O5 have been prepared via sol-gel processing route leading to xerogel or aerogel glasses, depending on the drying conditions. Two types of drying methods were used: atmospheric pressure drying (evaporative), to produce xerogels, and supercritical fluids drying, to obtain aerogels. Both dried gels were subjected to heat-treatment at three different temperatures: 400, 600 and 800 ºC in order to the removal of synthesis byproducts and structural modifications. The resulting materials were characterized by X-ray diffraction (XRD), Fourier transforms infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermal gravimetric analysis (TGA) and differential thermal analysis (DTA), and by in vitro bioactivity tests in simulated body fluid. The influence of the drying and the sintering temperature of their structure, morphology, and bioactivity of the final products were evaluated. The results show a good bioactivity of xerogel and aerogel bioactive glass powders with the formation of an apatite layer after one day of immersion in SBF solution for aerogel bioactive glass powders and a particle size less than 10 nm. An apatite layer formed after 3 days in the case of xerogel bioactive glass powders and a particle size around 100 nm.

3D-printed bioceramic scaffolds: From bone tissue engineering to tumor therapy

Toward the aim of personalized treatment, three-dimensional (3D) printing technology has been widely used in bone tissue engineering owing to its advantage of a fast, precise, and controllable fabrication process. Conventional bioceramic scaffolds are mainly used for bone tissue engineering; however, there has been a significant change in the application of bioceramic scaffolds during the past several years. Therefore, this review focuses on 3D-printed bioceramic scaffolds with different compositions and hierarchical structures (macro, micro, and nano scales), and their effects on the mechanical, degradation, permeability, and biological properties. Further, this review highlights 3D-printed bioceramic scaffolds for applications extending from bone tissue regeneration to bone tumor therapy. This review emphasizes recent developments in functional 3D-printed bioceramic scaffolds with the ability to be used for both tumor therapy and bone tissue regeneration. Considering the challenges in bone tumor therapy, these functional bioceramic scaffolds have a great potential in repairing bone defects induced by surgery and kill the possibly residual tumor cells to achieve bone tumor therapy. Finally, a brief perspective regarding future directions in this field was also provided. The review not only gives a summary of the research developments in bioceramic science but also offers a new therapy strategy by extending multifunctions of traditional biomaterials toward a specific disease.

STATEMENT OF SIGNIFICANCE

This review outlines the development tendency of 3D-printed bioceramic scaffolds for applications ranging from bone tissue regeneration to bone tumor therapy. Conventional bioceramic scaffolds are mainly used for bone tissue engineering; however, there has been a significant change in the application of bioceramic scaffolds during the past several years. Therefore, this review focuses on 3D-printed bioceramic scaffolds with different compositions and hierarchical structures (macro, micro, and nano scales), and their effects on the mechanical, degradation, permeability, and biological properties. Further, this review highlights 3D-printed bioceramic scaffolds for applications extending from bone tissue regeneration to bone tumor therapy. This review emphasizes recent developments in the functional 3D-printed bioceramic scaffolds with the ability to be used for both bone tumor therapy and bone tissue regeneration.

The Effect of Commercially Available Endodontic Cements and Biomaterials on Osteogenic Differentiation of Dental Pulp Pluripotent-Like Stem Cells

The aim of this study is to compare the osteogenic differentiation capacity of the dental pulp pluripotent-like stem cells (DPPSCs) using conditional media pretreated with ProRoot-MTA, Biodentine (BD) or the newly manufactured pure Portland cement Med-PZ (MZ). DPPSCs, isolated from human third molars, are the most relevant cell model to draw conclusions about the role of biomaterials on dental tissue regeneration. Cytotoxicity, alkaline phosphatase (ALP) activity, and calcium deposition analysis were evaluated at different differentiation time points. Gene expression of key osteogenic markers (RUNX2, Collagen I and Osteocalcin) was determined by qRT-PCR analysis. The osteogenic capacity of cells cultured in conditioned media prepared from MZ or MTA cements was comparable. BD conditioned media supported cell proliferation but failed to induce osteogenesis. Relative to controls and other cements, high osteogenic gene expression was observed in cultures pre-treated with the novel endodontic cement MZ. In conclusion, the in vitro behavior of a MZ- endodontic cement was evaluated, showing similar enhanced cell proliferation compared to other commercially available cements but with an enhanced osteogenic capacity with prospective potential as a novel cement for endodontic treatments.

Cytotoxicity of Different Concentrations of Three Root Canal Sealers on Human Mesenchymal Stem Cells

This study assessed the dose-dependent effect on the cytotoxicity of BioRoot RCS (BR) and Endosequence BC (BC) sealers in human bone marrow mesenchymal stem cells (hMSCs) compared to those of the AH Plus sealer. Cells were exposed to different dilutions of extracts from freshly prepared sealers (1:2, 1:8, 1:32). Unexposed cells acted as the negative control. Cytotoxicity was evaluated by an alamar blue assay. Cell morphology was analyzed by using scanning electron microscopy after exposure to the different sealers’ extracts. Statistical analysis was performed using a one-way analysis of variance and the Bonferroni post hoc test (p < 0.05). The cytotoxicities of BC and BR were less than that of AH Plus. In the presence of 1:2 BR, the cell proliferation was significantly lower than the control. At 1:8 and 1:32 concentrations, both the tricalcium silicate sealers led to similar cellular proliferation. Cells in BC and BR sealers’ extracts spread better than those in AH Plus extract.

Assessment of calcium sulfate hemihydrate-Tricalcium silicate composite for bone healing in a rabbit femoral condyle model

Calcium sulfate or plaster of Paris (POP) is considered as a bone cement with a fast degradation rate, which frequently makes it resorb before the bone defect area is completely filled by new bone. The incorporation of tricalcium silicate (C3S) into POP cement has been proven as a feasible approach to reduce the in vitro degradation rate and improve the in vitro bioactivity of the material. However, the in vivo performance of the POP/C3S composite cement is still unclear. Therefore, the aim of the present study is to assess the biodegradability and osteogenesis of POP/C3S composite cement in comparison with those of POP bone cement. To carry out the in vivo evaluation, POP and POP/C3S cements were implanted into a femoral condyle defect model in rabbits (5 mm diameter × 10 mm length) for 4, 8, and 12 weeks duration. The area of the remaining cement and new bone regeneration in bone defect were investigated and quantitatively measured using radiography, micro-computed tomography, and histological staining. For both cements, no sign of inflammation was observed. POP cement was completely degraded at the 8th week of post-implantation. By contrast, only approximately 50% by volume of POP/C3S composite cement degraded at the 12th week, which allowed a long-term framework for new bone formation. The osteogenic ability of POP/C3S composite cement was significantly superior to that of POP as indicated by the higher mineralization rate and maturity of the newly formed bone around the composite cement. In summary, our findings demonstrated that the in vivo degradation behaviors and osteogenic ability of POP cement could be improved by incorporating C3S in vivo, suggesting that POP/C3S composite cement has potential as a biodegradable cement for bone repair.