Cytotoxicity of four categories of dental cements

Cell viability assessment and ion release profiles of GICs modified with TiO2- and Mg-doped hydroxyapatite nanoparticles

OBJECTIVES

To assess and compare the cell viability and ion release profiles of two conventional glass ionomer cements (GICs), Fuji IX and Ketac Molar EasyMix, modified with TiO2 and Mg-doped-HAp nanoparticles (NPs).

METHODS

TiO2 NPs, synthesized via a sol-gel method, and Mg-doped hydroxyapatite, synthesized via a hydrothermal process, were incorporated into GICs at a concentration of 5 wt.%. The biocompatibility of prepared materials was assessed by evaluating their effects on the viability of dental pulp stem cells (DPSCs), together with monitoring ion release profiles. Statistical analysis was performed using One-way analysis of variance, with significance level p < 0.05.

RESULTS

The addition of NPs did not significantly affect the biocompatibility of GICs, as evidenced by comparable decreased levels in cell viability to their original formulations. Distinct variations in cell viability were observed among Fuji IX and Ketac Molar, including their respective modifications. FUJI IX and its modification with TiO2 exhibited moderate decrease in cell viability, while other groups exhibited severe negative effects. While slight differences in ion release profiles were observed among the groups, significant variations compared to original cements were not achieved. Fluoride release exhibited an initial "burst release" within the initial 24 h in all samples, stabilizing over subsequent days.

CONCLUSIONS

The addition of NPs did not compromise biocompatibility, nor anticariogenic potential of tested GICs. However, observed differences among FUJI IX and Ketac Molar, including their respective modifications, as well as induced low viability of DPSC by all tested groups, suggest the need for careful consideration of cement composition in their biological assessments.

CLINICAL SIGNIFICANCE

The findings contribute to understanding the complex interaction between NPs and GIC matrices. However, the results should be interpreted recognizing the inherent limitations associated with in vitro studies. Further research avenues could explore long-term effects, in vivo performance, and potential clinical applications.

Cytotoxic effect of dental luting cement on human gingival mesenchymal stem cell and evaluation of cytokines and growth factor release - An in vitro study

AIM

In routine dental care, various dental luting cements are utilized to cement the dental prosthesis. Thus, the aim of the current study was to assess the Cytotoxic effect of three different dental luting cements on human gingival mesenchymal stem cell and evaluation of cytokines and growth factors release.

SETTINGS AND DESIGN

Cytotoxicity of glass ionomer cement (GIC), resin modified glass ionomer cement (RMGIC) and resin cement (RC) on the human gingival mesenchymal stem cells (HGMSCs) was evaluated. Amongst the cements tested, least cytotoxic cement was further tested for the release of cytokines and growth factors.

MATERIALS AND METHODS

MTT test was used to evaluate the cytotoxicity of the dental luting cements at 1 h, 24 h, and 48 h on HGMSCs. Cytokines such as interleukin (IL) 1α & IL 8 and growth factors such as platelet derived growth factor & transforming growth factor beta release from the least cytotoxic RC was evaluated using flow cytometry analysis.

STATISTICAL ANALYSIS USED

The mean absorbance values by MTT assay and cell viability at various time intervals between four groups were compared using a one way analysis of variance test and Tukey's post hoc test. The least cytotoxic RC group and the control group's mean levels of cytokines and growth factors were compared using the Mann-Whitney test.

RESULT

As exposure time increased, the dental luting cement examined in this study were cytotoxic. RC was the least cytotoxic, RMGIC was moderate and glass ionomer cement showed the highest cytotoxic effect. Concomitantly, a significant positive biological response of gingival mesenchymal stem cells with the release of ILs when exposed to the RC was observed.

CONCLUSION

For a fixed dental prosthesis to be clinically successful over the long term, it is imperative that the biocompatibility of the luting cement be taken into account in order to maintain a healthy periodontium surrounding the restoration.

Cytotoxicity of dental cement on soft tissue associated with dental implants at different time intervals

Background

To investigate and compare the effect of four commercially used dental cement at 24 hours, 48 hours,72 hours (h) and 6 days on the cellular response of human gingival fibroblast (HGF).

Methods

3 cement pellet samples were made for each 4-test cement (n=12). The cement used for this study were zinc phosphate (ZP), zinc oxide non-eugenol (ZOE), RelyX U200 (RU200), and glass ionomer cement (GIC). The cytotoxicity of peri-implant tissues was investigated using one commercial cell line. All processing was done following International Organization for Standardization (ISO) methods 10993-5 and 10993-12 (MTT assay Test). Cell cultures without dental cement were considered as control. Standard laboratory procedures were followed to permit cell growth and confluence over 48 hrs after sub-cultivation. Before being subjected to analysis, the cells were kept in direct contact with the cement samples for the suggested time period. To validate the results the specimens were tested three times each. Cell death and inhibition of cell growth were measured quantitatively. Results were analyzed using 1-way ANOVA (a=0.05) followed by Tukey B post hoc test.

Results

The study showed the dental cement test material was cytotoxic. ZOE, ZP, GIC, and RU200 were cytotoxic in decreasing order, respectively, significantly reducing cell viability after exposure to HGF (p <0.001).

Conclusions

Within the limitations of this in-vitro cellular study, results indicated that HGF were vulnerable to the test the dental cement. The highest cytotoxicity was observed in ZOE, followed by ZP, GIC, and RU200.

Cytotoxicity of dental cement on soft tissue associated with dental implants at different time intervals

Background: To investigate and compare the effect of four commercially used dental cement at 24 hours, 48 hours,72 hours (h) and 6 days on the cellular response of human gingival fibroblast (HGF). Methods: 3 cement pellet samples were made for each 4-test cement (n=12). The cement used for this study were zinc phosphate (ZP), zinc oxide non-eugenol (ZOE), RelyX U200 (RU200), and glass ionomer cement (GIC). The cytotoxicity of peri-implant tissues was investigated using one commercial cell line. All processing was done following International Organization for Standardization (ISO) methods 10993-5 and 10993-12 (MTT assay Test). Cell cultures without dental cement were considered as control. Standard laboratory procedures were followed to permit cell growth and confluence over 48 hrs after sub-cultivation. Before being subjected to analysis, the cells were kept in direct contact with the cement samples for the suggested time period. To validate the results the specimens were tested three times each. Cell death and inhibition of cell growth were measured quantitatively. Results were analyzed using 1-way ANOVA (a=0.05) followed by Tukey B post hoc test. Results: The study showed the dental cement test material was cytotoxic. ZOE, ZP, GIC, and RU200 were cytotoxic in decreasing order, respectively, significantly reducing cell viability after exposure to HGF (p <0.001). Conclusions: Within the limitations of this in-vitro cellular study, results indicated that HGF were vulnerable to the test the dental cement. The highest cytotoxicity was observed in ZOE, followed by ZP, GIC, and RU200.

Antibacterial and Physicochemical Properties of Orthodontic Resin Cement Containing ZnO-Loaded Halloysite Nanotubes

Demineralized white lesions are a common problem when using orthodontic resin cement, which can be prevented with the addition of antibacterial substances. However, the addition of antibacterial substances such as zinc oxide alone may result in the deterioration of the resin cement's functions. Halloysite nanotubes (HNTs) are known to be biocompatible without adversely affecting the mechanical properties of the material while having the ability to load different substances. The purpose of this study was to prepare orthodontic resin cement containing HNT fillers loaded with ZnO (ZnO/HNTs) and to investigate its mechanical, physical, chemical, and antibacterial properties. A group without filler was used as a control. Three groups containing 5 wt.% of HNTs, ZnO, and ZnO/HNTs were prepared. TEM and EDS measurements were carried out to confirm the morphological structure of the HNTs and the successful loading of ZnO onto the HNTs. The mechanical, physical, chemical, and antibacterial properties of the prepared orthodontic resin cement were considered. The ZnO group had high flexural strength and water absorption but a low depth of cure (p < 0.05). The ZnO/HNTs group showed the highest shear bond strength and film thickness (p < 0.05). In the antibacterial test, the ZnO/HNTs group resulted in a significant decrease in the biofilm's metabolic activity compared to the other groups (p < 0.05). ZnO/HNTs did not affect cell viability. In addition, ZnO was cytotoxic at a concentration of 100% in the extract. The nanocomposite developed in this study exhibited antimicrobial activity against S. mutans while maintaining the mechanical, physical, and chemical properties of orthodontic resin cement. Therefore, it has the potential to be used as an orthodontic resin cement that can prevent DWLs.

Cytotoxicity of Dental Cements on Soft Tissue Associated with Dental Implants

Purpose

To investigate and compare the cellular host response of human gingival fibroblasts (HGF) on four currently used cements. Methods and Material. 5 cement pellet samples were made for each of the 4 test cements (n = 20). The cements used for this study were zinc phosphate, zinc oxide noneugenol (ZOE), RelyX U200, and glass ionomer cement (GIC). One commercially available cell line was used to investigate the cytotoxicity of peri-implant tissues. Direct contact cell culture testing was conducted following International Organization for Standardization (ISO) methods 10993-5 and 10993-12 (MTT assay test). Cell cultures without dental cement were considered as control. Cells were allowed to grow and confluence over 48 hours after subcultivation according to standard laboratory procedures. The cells were kept in direct contact with the cement samples for 24 hours before being subjected to analysis. All specimens were tested in triplicate to validate the results. Quantitative evaluation of cytotoxicity was done to measure cell death and inhibition of cell growth. Results were analyzed using 1-way ANOVA (a = 0.05) followed by Tukey B post hoc test.

Results

The results of the study showed that HGF was vulnerable to the dental cement test material. GIC, zinc phosphate, ZOE, and resin cement were cytotoxic in decreasing order, respectively, and significantly reduced the cell viability after exposure to HGF (p < 0.001).

Conclusions

Within the limitations of this in vitro cellular study, results indicated that the test dental cements were cytotoxic to HGF. The highest cytotoxicity was observed in GIC followed by zinc phosphate, ZOE, and resin cement.

Cytotoxicity of two self-adhesive resin cements and their interference in the phagocytic activity of murine macrophages

Objectives

This study aimed to evaluate in vitro the effects of the self-adhesive resin cements RelyX U200 (3M ESPE) and seT PP (SDI Limited) on murine macrophages and the interference of the photoactivation.

Materials and Methods

Cell viability assays, cell adherence, yeast phagocytosis of Saccharomyces boulardii and production of reactive oxygen species (ROS) were performed in the presence of capillaries containing the respective self-adhesive cement when photoactivated or not.

Results

After long periods of contact, both types of cements, when not photoactivated, are more cytotoxic for macrophages. The seT PP cement when only chemically activated seems to interfere more negatively in the process of phagocytosis of yeasts S. boulardii. Both types of cements interfere in the cell adhesion process, independent of photoactivation. None of the types of cements tested was able to induce the production of ROS.

Conclusions

Our results highlight the great importance of the photoactivation of self-adhesive resin cements in the dental clinic, since RelyX U200, when photoactivated, presented the best results within the evaluated parameters.

Influence of curing modes on conversion and shrinkage of dual-cure resin-cements

OBJECTIVE

To explore the effect of curing modes of dual-cure resin cements on their degree of conversion (DC) and polymerization shrinkage (PS) over specific post-activation periods.

METHODS

Five self-adhesive (PANAVIA SA, RelyX Universal Resin, RelyX Unicem 2, Bifix SE, and SpeedCEM Plus) and three conventional (PANAVIA V5, Nexus Third Generation, and RelyX Ultimate Universal) dual-cure resin cements were studied. Four specimens (n = 4) were made per curing mode (light/self-cure) to measure either DC or PS. FTIR was utilized to measure real-time DC (%) over 24 h. The Bonded Disk method was used to measure shrinkage at 23 °C over 1 h. The data were analyzed using one-way ANOVA, Tukey post-hoc tests and independent/ paired sample t-tests (a = 0.05).

RESULTS

After 1 h post-activation, the DC of light-cured (LC) specimens ranged between 66.6% and 77.4%, whereas for self-cured (SC) specimens DC ranged between 44.4% and 73.2%. After 24 h, the DC of LC specimens ranged between 74.8% and 82.4% and between 62.7% and 81.7% for SC specimens. After 24 h, the DC of three cements (BSE, PV5, and RXU) were comparable between their curing modes (p > 0.05), whereas five cements (CEM, NX3, PSA, RXU2, RXL) had significantly lower DC for SC compared to LC specimens (p < 0.05). After 1 h post-activation, shrinkage ranged between 5.9% and 8.5% for LC and between 4.9% and 8.3% for SC specimens. Most cements were not significantly different between curing modes. However, light-cured PAS, RXL and RXU2 had significantly higher shrinkage (p < 0.05). After 1 h post-activation, a strong positive correlation existed between conversion and shrinkage (LC: r² = 0.95 and SC: r² = 0.93).

SIGNIFICANCE

Whenever light access is possible, light-curing of resin-cements remains beneficial to the overall efficacy of their conversion and thus all factors that depend on that. Conversion and shrinkage behavior are intrinsically important factors in clinical selection of resin-cement products.

A novel insertion design of fiber materials for the adhesive reattachment in vertically fractured teeth

Objective

This ex vivo study aimed to evaluate the strengthening effect of different ferrule and reattachment designs with fiber and adhesive materials on vertically fractured teeth.

Methods

Ninety extracted single-root premolars were instrumented and divided into nine groups (two control groups and seven experimental groups; n = 10). The negative control (NC) group comprised of intact teeth, while the positive control (PC) group comprised of root canal-treated teeth. The roots of the teeth in the experimental groups were vertically fractured into two equal fragments. The fragments were reattached with one of the followings: 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin, 4-META/MMA-TBB + quartz fiber post, 4-META/MMA-TBB + glass fiber bundles, 4-META/MMA-TBB + quartz fiber post + 1 mm ferrule, 4-META/MMA-TBB + glass fiber bundles + 1 mm ferrule, 4-META/MMA-TBB + quartz fiber post + 2 mm ferrule, and 4-META/MMA-TBB + glass fiber bundles + 2 mm ferrule. The core build-ups were made with composite resin. The specimens were subjected to compressive loading until failure occurred. Mean load necessary to fracture each sample and the fracture types of these samples were recorded.

Results

The highest mean fracture load was recorded in the NC group (1,036.7 N), which was not significantly higher than the PC group (989.66 N) (p > 0.05). The roots reattached with quartz fiber post demonstrated significantly less fracture strength (871.9 N) as compared to the other test and control groups (p < 0.05). There was no significant difference between the PC group and reattached fragments with different ferrule designs in terms of fracture resistance (p > 0.05).

Conclusions

The customized fiber bundles may be more suitable for reattachment of vertically fractured teeth than the rigid fiber posts. For reattachment procedures, the ferrule design may be preferred to increase the fracture strength of vertically fractured teeth.

Application of Texture and Fractal Dimension Analysis to Evaluate Subgingival Cement Surfaces in Terms of Biocompatibility

Biocompatibility is defined as “the ability of a biomaterial, prosthesis, or medical device to perform with an appropriate host response in a specific application”. Biocompatibility is especially important for restorative dentists as they use materials that remain in close contact with living tissues for a long time. The research material involves six types of cement used frequently in the subgingival region: Ketac Fil Plus (3M ESPE, Germany), Riva Self Cure (SDI, Australia) (Glass Ionomer Cements), Breeze (Pentron Clinical, USA) (Resin-based Cement), Adhesor Carbofine (Pentron, Czech Republic), Harvard Polycarboxylat Cement (Harvard Dental, Great Britain) (Zinc polycarboxylate types of cement) and Agatos S (Chema-Elektromet, Poland) (Zinc Phosphate Cement). Texture and fractal dimension analysis was applied. An evaluation of cytotoxicity and cell adhesion was carried out. The fractal dimension of Breeze (Pentron Clinical, USA) differed in each of the tested types of cement. Adhesor Carbofine (Pentron, Czech Republic) cytotoxicity was rated 4 on a 0–4 scale. The Ketac Fil Plus (3M ESPE, Germany) and Riva Self Cure (SDI, Australia) cements showed the most favorable conditions for the adhesion of fibroblasts, despite statistically significant differences in the fractal dimension of their surfaces.

Evaluation of the anti-inflammatory effects of surface-reaction-type pre-reacted glass-ionomer filler containing root canal sealer in lipopolysaccharide-stimulated RAW264.7 macrophages

A prototype surface-reaction-type pre-reacted glass-ionomer (S-PRG) filler containing root canal sealer (S-PRG sealer) exhibits bioactive potential by releasing multiple ions. This study explored the suppressive effects and modes of action of S-PRG sealer extracts on proinflammatory cytokine expression in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Expression of proinflammatory cytokines was evaluated by RT-qPCR and ELISA. Expression of phosphorylated nuclear factor-kappa B (p-NF-kB) p65 was evaluated by western blotting. S-PRG sealer extracts significantly downregulated mRNA expression levels of interleukin (IL)-1α, IL-6, and TNF-α in LPS-stimulated RAW264.7 cells; the extracts also reduced the levels of IL-6 protein and p-NF-kB. In order to verify that Zn²⁺ was responsible for downregulation of proinflammatory cytokine expression, N,N,N',N'-tetrakis(2-pyridylmethyl) ethylenediamine (TPEN) was used as a heavy metal chelator with strong affinity for Zn²⁺. These effects were mitigated by TPEN. The application of ZnCl₂ reproduced the actions of S-PRG sealer extracts. These data suggest that S-PRG sealer has anti-inflammatory potential involving heavy metal ions such as Zn²⁺.

Biocompatibility assessment of resin-based cements on vascularized dentin/pulp tissue-engineered analogues

OBJECTIVES

A three-dimensional (3D) dentin/pulp tissue analogue, resembling the human natural tissue has been engineered in an in vitro setup, aiming to assess the cytocompatibility of resin-based dental restorative cements.

METHODS

Stem Cells from Apical Papilla (SCAP) and Human Umbilical Vein Endothelial Cells (HUVEC) were embedded in Collagen-I/Fibrin hydrogels at 1:3 ratio within 24-well plates. Hanging culture inserts were placed over the hydrogels, housing an odontoblast-like cell layer and a human treated-dentin barrier. Shear modulus of the hydrogels at 3.5 and 5 mg/ml was evaluated by dynamic mechanical analysis. Eluates of two resin-based cements, a dual-cure- (Breeze™, Pentron: Cement-1/C1), and a self-adhesive cement (SpeedCEMplus™, Ivoclar-Vivadent: Cement-2/C2) were applied into the dentin/pulp tissue analogue after pre-stimulation with LPS. Cytocompatibility was assessed by MTT assay, live/dead staining and real-time PCR analysis.

RESULTS

Both hydrogel concentrations showed similar shear moduli to the natural pulp until day (D) 7, while the 5 mg/ml-hydrogel substantially increased stiffness by D14. Both cements caused no significant toxicity to the dentin/pulp tissue analogue. C1 induced stimulation (p < 0.01) of cell viability (158 ± 3%, 72 h), while pre-stimulation with LPS attenuated this effect. C2 (±LPS) caused minor reduction of viability (15-20%, 24 h) that recovered at 72 h for the LPS+ group. Both cements caused upregulation of VEGF, ANGP-1, and downregulation of the respective receptors VEGFR-2 and Tie-1.

SIGNIFICANCE

Both resin-based cements showed good cytocompatibility and triggered angiogenic response within the dentin/pulp tissue analogue, indicating initiation of pulp repair responses to the released xenobiotics.

Biocompatibility of self-adhesive resin cement with fibroblast cells

STATEMENT OF PROBLEM

Dental cements that release monomers that negatively impact adjacent oral soft tissues may adversely affect clinical outcomes. However, in vitro studies evaluating the cytotoxic and genotoxic potential of substances released from dental cements are lacking.

PURPOSE

The purpose of this in vitro study was to define and compare the cytotoxicity and genotoxicity of the eluates of a self-adhesive resin cement (RelyX Unicem 2 Automix) autopolymerized and light polymerized with 2 other types of luting cements: a glass ionomer cement (Ketac Cem Easymix) and a resin-modified glass ionomer cement (Ketac Cem Plus).

MATERIAL AND METHODS

The eluates were prepared, and 3T3 mouse fibroblast cells were exposed for 24 hours to serial eluate dilutions of the 3 types of cement. Cytotoxicity was determined by using a cell viability assessment through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and crystal violet assays. Genotoxic effects were determined by using the cytokinesis-block micronucleus assay.

RESULTS

Cell viability was higher in the presence of the glass ionomer cement eluate than of the resin-modified glass ionomer cement and resin cement eluates. A pronounced decrease in viability was found when the cells were exposed to undiluted samples of resin-modified glass ionomer cement (around 50%) or resin cement (around 80% to 90%). No significant difference in cell viability was found between autopolymerized and light-polymerized resin cements. All cements induced a dose-dependent response of mononucleated cell formation. However, only the resin cements showed double strand breaks significant differences in the deoxyribonucleic acid (DNA) molecules against the basal DNA lesions that occurred spontaneously.

CONCLUSIONS

The glass ionomer cement was not found to be cytotoxic or genotoxic, whereas the eluates derived from the resin-modified glass ionomer cement and resin cement, independently of the polymerization method, were cytotoxic in fibroblast cells. Maximum cytotoxicity was observed in the presence of resin cement, which also showed genotoxicity, independently of being light polymerized.

In vitro cytotoxicity of different dental resin-cements on human cell lines

Adhesive resin-cements are increasingly used in modern dentistry. Nevertheless, released substances from resin materials have been shown to cause cellular toxic effects. Disc-shaped specimens from 12 different resin cements and one conventional zinc phosphate cement were prepared and used for direct stimulation of five different human cell lines via transwell cell culture system or in an indirect way using conditioned cell culture media. Cytotoxicity was determined using LDH and BCA assays. All tested cements led to a decrease of cell viability but to a distinct extent depending on cell type, luting material, and cytotoxicity assay. In general, cements exhibited a more pronounced cytotoxicity in direct stimulation experiments compared to stimulations using conditioned media. Interestingly, the conventional zinc phosphate cement showed the lowest impact on cell viability. On cellular level, highest cytotoxic effects were detected in osteoblastic cell lines. All resin cements reduced cell viability of human cells with significant differences depending on cell type and cement material. Especially, osteoblastic cells demonstrated a tremendous increase of cytotoxicity after cement exposure. Although the results of this in vitro study cannot be transferred directly to a clinical setting, it shows that eluted substances from resin cements may disturb osteoblastic homeostasis that in turn could lead to conditions favoring peri-implant bone destruction. Thus, the wide use of resin cements in every clinical situation should be scrutinized. A correct use with complete removal of all cement residues and a sufficient polymerization should be given the utmost attention in clinical usage.

Degree of conversion of two self-adhesive resin luting cements through different lengths of fiber post

PURPOSE

To evaluate the degree of conversion (DoC) of self-adhesive resin luting cements when irradiated through different fiber post lengths.

METHODS

A total of 60 teeth were sectioned to achieve lengths of 4 mm, 7 mm, and 10 mm, while 60 fiber posts were trimmed to give 3 mm, 6 mm, and 9 mm lengths. Post space was created to accommodate the fiber post and 1 mm of luting cement apically. Two self-adhesive resin luting cements (Multilink Speed and RelyX U200) were used. A total of four cycles of 20 s irradiation was done with an attenuated total reflectance Fourier transform infrared spectroscopy reading between each cycle.

RESULTS

The mean ± standard deviation DoC achieved with a light-emitting diode and quartz tungsten halogen for Multilink Speed was 67.4 ± 2.7% and 72.4 ± 4.0%, respectively, while for RelyX U200, the corresponding values were 56.5 ± 2.7% and 62.0 ± 3.8%, respectively. For Multilink Speed, there was no significant difference between the control and the 3 mm group, while for RelyX U200, no significant difference was found between the 6 mm and 9 mm groups. All the other groups showed significant differences.

CONCLUSION

The DoC reduced as the post length increased.

A Novel Bioactive Endodontic Sealer Containing Surface-Reaction-Type Prereacted Glass-Ionomer Filler Induces Osteoblast Differentiation

Surface‑reaction‑type prereacted glass-ionomer (S‑PRG) fillers exhibit bioactive properties by the release of multiple ions. This study examined whether a novel endodontic sealer containing S‑PRG fillers (PRG+) has the capacity to induce osteoblast differentiation. Kusa‑A1 osteoblastic cells were cultured with extracts of PRG+, PRG- (an experimental sealer containing S‑PRG‑free silica fillers), AH Plus (an epoxy-resin‑based sealer), and Canals N (a zinc-oxide noneugenol sealer). Cell viability and mineralized nodule formation were determined using WST‑8 assay and Alizarin red staining, respectively. Osteoblastic-marker expression was analyzed with RT‑qPCR and immunofluorescence. Phosphorylation of extracellular signal‑regulated kinase (ERK) and p38 mitogen‑activated protein kinase (MAPK) was determined with Western blotting. Extracts of freshly mixed PRG+, PRG-, and AH Plus significantly decreased cell growth, but extracts of the set samples were not significantly cytotoxic. Set PRG+ significantly upregulated mRNAs for alkaline phosphatase and bone sialoprotein (IBSP) compared to set PRG-, and upregulation was blocked by NPS2143, a calcium‑sensing receptor antagonist. Set PRG+ significantly accelerated IBSP expression, mineralized nodule formation, and enhanced the phosphorylation of ERK and p38 compared with set PRG-. In conclusion, PRG+ induced the differentiation and mineralization of Kusa‑A1 cells via the calcium-sensing receptor-induced activation of ERK and p38 MAPK.

The antimicrobial and cytotoxic effects of a copper-loaded zinc oxide phosphate cement

Objectives

Evidence about modifications of dental luting materials to minimize biological failure at the “marginal gap” between teeth and fixed prosthodontics is scarce. We compared a copper-modified (Co-ZOP) and a conventional zinc oxide phosphate cement (ZOP) in terms of antimicrobial and cytotoxic potentials in vitro and in vivo.

Materials and methods

Specimens of ZOP and Co-ZOP were characterized by the mean arithmetic roughness (Ra) and surface free energy (SFE). Powder components were examined using scanning electron microscopy (SEM). Energy-dispersive X-ray spectroscopy (EDX) showed elemental material compositions. In vitro microbial adhesion was shown using SEM, luminescence, and fluorescence assays. CCK-8 assays of mouse fibroblasts (L929) and human gingival fibroblasts (GF-1) were performed after 6, 24, and 48 h of specimen incubation. In vivo, ZOP and Co-ZOP specimens were applied intraorally for 12 h; biofilm accumulation was shown using SEM.

Results

Ra of ZOP and Co-ZOP showed no significant differences; SFE was significantly higher for Co-ZOP. EDX exhibited minor copper radiation for Co-ZOP, none for ZOP. In vitro fungal adhesion to Co-ZOP was significantly higher than to ZOP; in vitro streptococcal adhesion, cytotoxicity, and in vivo biofilm formation were not significantly different.

Conclusions

Co-ZOP showed low surface allocations of copper with no improved antimicrobial properties compared with conventional ZOP in vitro or in vivo.

Clinical relevance

Antimicrobial effects and low cytotoxicity of biomaterials are important for the clinical outcome. Based on our in vitro and in vivo results, no clinical recommendation can be given for the tested Co-ZOP.

In Vitro Evaluation of the Biological Effects of ACTIVA Kids BioACTIVE Restorative, Ionolux, and Riva Light Cure on Human Dental Pulp Stem Cells

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.

Effect of various polymerization protocols on the cytotoxicity of conventional and self-adhesive resin-based luting cements

OBJECTIVES

This study evaluated the cytotoxicity of resin-based luting cements on fibroblast cells using different polymerization protocols.

MATERIALS AND METHODS

Two conventional dual-polymerized (RelyX ARC, VariolinkN) and two self-adhesive resin cements (RelyX Unicem, Multilink Speed) specimens were polymerized using four different polymerization protocols: (a) photo-polymerization with direct light application, (b) photo-polymerization over ceramic and (c) resin nano-ceramic discs and (d) auto-polymerization. The specimens were then assigned to four groups to test cytotoxicity at 0, 1, 2 and 7 preincubation days (n = 5). MTT test was performed using NIH/3T3 fibroblast cells. Data were analysed using three- and one-way ANOVA. Multiple comparisons were made using Bonferroni post hoc test (p < 0.05).

RESULTS

The highest cytotoxic values were recorded at day 2 for conventional resin cements and at day 0 for self-adhesive resin cements. Self-adhesive resin cements showed the most cytotoxic effect at the second day, while conventional resin cements presented immediate cytotoxicity. Auto-polymerized resin specimens and especially Multilink Speed demonstrated the most cytotoxic effect regardless of the preincubation time. Cytotoxicity of cements tested reached the lowest level at day 7. Interposition of ceramic or nano-ceramic restorative material did not significantly affect the cytotoxicity of tested luting cements (p > 0.05).

CONCLUSIONS

Cytotoxicity of dual-polymerized resin cements was material-dependent and decreased gradually up to 7 days. Photo-polymerization plays an important role in reducing the cytotoxic effects.

CLINICAL RELEVANCE

When luting ceramic or resin nano-ceramic restorations of which thickness does not exceed 2 mm, the level of cytotoxicity with the tested materials is not significant. Luting of restorative materials that do not allow for light transmission such as metal-fused porcelain, clinicians should be cautious in the use of dual-polymerized conventional resin cements as only auto-polymerization of resin cements takes place under such materials.

Evaluation of the biocompatibility of resin composite-based dental materials with gingival mesenchymal stromal cells

Resin composite-based dental materials can leach certain components into the oral environment, causing potentially harmful gingival biological effect. Gingival tissue is a rich source of mesenchymal stem cells (MSCs) that is easily accessible, and can be used as a complementary approach for the investigation of dental material biocompatibility. Using gingival MSCs (gMSCs), the present study aimed to investigate the cytotoxicity of two classes of restorative dental materials (ormocers and resin composites) used to restore class II cavities close to the gingival margin, in addition to analyzing the leached compounds from these resin composite-based materials. Functionality assays (Colony-forming unit, migratory potential, and proliferation assays) and a viability assay (MTT) were employed. Cells' aspect was observed by scanning electron microscopy (SEM). Leached monomers were also quantitated using high-performance liquid chromatography (HPLC). The cytotoxicity of the biomaterials was highlighted by impaired functionality and diminished viability of gMSCs. Despite being variants of the same commercial material, the two ormocers behaved differently one material having a more negative impact on cell functionality than the other. Cells appeared to attach well to all materials. Main monomer molecules were mostly released by the tested materials. For all samples, an increased elution of monomers was recorded in artificial saliva as compared with culture medium. One composite material has released nearly eight times more urethane dimetacrylate in artificial saliva than in culture medium. Significantly lower gMSC viability scores were recorded for all the investigated samples in comparison with the control.

Comparison of the Effects of Cytotoxicity and Antimicrobial Activities of Self-adhesive, Eugenol and Noneugenol Temporary and Traditional Cements on Gingiva and Pulp Living Cells

Aims and objectives:

The aim of this in vitro study was to investigate the antibacterial and cytotoxic effect of cements: zinc polycarboxylate, glass ionomer, self-adhesive resin cement, eugenol-containing and eugenol-free temporary cements.

Materials and methods:

The agar-diffusion test was carried out on 4 types of bacteria: Streptococcus mutans ( S. mutans; ATCC 35668), Streptococcus salivarius ( S. salivarius; ATCC 13419), Streptococcus sangius ( S. sangius; ATCC 10556), and Lactobacillus casei ( L. casei; ATCC 27139). Freshly prepared cement samples were placed on a brain heart infusion medium and left at 37°C for 24 hours in a CO2 incubator. Ampicillin disks of 10 mg were used as positive controls. Antimicrobial effects were determined using the zone of inhibition measurement in millimeters at 24 and 48 hours. Cytotoxicity was assessed through a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay (SERVA Electrophoresis GmbH, Heidelberg, Germany). To evaluate cell viability, an optical density microplate reader (Tecan™ Sunrise, Männedorf, Switzerland) was used at 24 and 48 hours at 570 and 630 nm, respectively.

Results:

Except the positive control group, the Adhesor luting cement showed a higher inhibitory effect on S. sangius and L. casei. RelyX Temp E temporary cement showed an inhibitory effect on S. sangius and L. casei, whereas the Cavex temporary cement showed an inhibitory effect on only S. sangius at 24 and 48 hours. At 100% concentration, Cavex temporary cement showed the least toxicity (23.6% pulp cell and 9.9% gingival cell) and highest cell viability (76.4% pulp cell and 90.1% gingival cell) at 24 hours. However, Meron, Adhesor, Panavia SA luting, and RelyX Temp E temporary cements showed the highest toxicity (above 94% gingival cell and 95% pulp cell) at 100% concentration.

Conclusions:

Meron, Adhesor, Panavia SA luting, and RelyX Temp E temporary cements may have a cytotoxic potential. None of the cements showed an inhibitory effect on S. mutan and S. salivarius, whereas Adhesor luting cement has a higher inhibitory effect than that of S. sangius and L. casei.

Oxidative stress induced by self-adhesive resin cements affects gene expression, cellular proliferation and mineralization potential of the MDPC-23 odontoblast-like cells

OBJECTIVE

Clinical issues have been raised about problems related to cytotoxic effects caused when applying self-adhesive cement. It was hypothesized that byproducts eluted from self-adhesive cements modulate oxidative stress response, the gene expression of signaling pathways of inflammatory process/transcriptional activators, and the expression and activity of interstitial collagenases, and modify the phenotypic characteristics of cellular proliferation and mineral deposition in odontoblastic-like cells.

METHODS

Cements (MaxCem Elite [MAX] and RelyX U200 [U200)]) were mixed, dispensed into moulds, and photoactivated according to the manufacturers' instructions. Immortalized rat odontoblast-like cells (MDPC-23) were cultured and exposed to polymerized specimens of cements for 4 h. Reactive oxidative specimen production and quantification of gene expression were evaluated. Cell proliferation assay and alizarin red staining were also performed to evaluate the disturbance induced by the cements on cellular proliferation and mineralization.

RESULTS

Despite their cytotoxic effects, both self-adhesive cements influenced the metabolism in the odontoblast cells on different scales. MAX induced significantly higher oxidative stress in odontoblast cells than U200. Gene expression varied as a function of exposure to self-adhesive cements; MAX induced the expression of pro-inflammatory cytokines such as TNF-α, whereas U200 downregulated, virtually depleted TNF-α expression, also inducing overexpression of the transcriptional factor Runx2. Overexpression of heme oxygenase-1 (HO-1) and thioredoxin reductase 1 (TRXR1) occurred after exposure to both cements, antioxidant genes that are downstream of Keap1-Nrf2-ARE system. MAX significantly induced the overexpression of collagenase MMP-1, and U200 induced the expression of gelatinase MMP-2. MAX significantly inhibited cell proliferation whereas U200 significantly activated cell proliferation. Alizarin red staining revealed significantly decreased mineral deposition especially when exposed to MAX.

SIGNIFICANCE

These results support the hypothesis that byproducts of different self-adhesive cements play important roles in the highly orchestrated process which ultimately affect the cellular proliferation and the mineral deposition in odontoblastic-like cells, possibly delaying the reparative dentin formation after cementation of indirect restorations, especially on recently exposed dentin preparations.

A review on potential toxicity of dental material and screening their biocompatibility

OBJECTIVES

A wide range of compounds are utilized in dentistry such as dental composites, resins, and implants. The successful clinical use of dental materials relies on theirm physiochemical properties as well as biological and toxicological reliability. Different local and systemic toxicities of dental materials have been reported. Placement of these materials in oral cavity for a long time period might yield unwanted reactions. An extensive variety of materials is used in dentistry including filling materials, restorative materials, intracanal medicines, prosthetic materials, different types of implants, liners, and irrigants. The increasing rate in development of the novel materials with applications in the dental field has led to an increased consciousness of the biological risks and tempting restrictions of these materials. The biocompatibility of a biomaterial used for the replacement or filling of biological tissue such as teeth always had a high concern within the health care disciplines for patients.

MATERIALS AND METHODS

Any material used in humans should be tested before clinical application. There are many tests evaluating biocompatibility of these materials at the point of in vitro, in vivo, and clinical investigations.

RESULTS

The current review discusses the potential toxicity of dental material and screening of their biocompatibility.

CLINICAL RELEVANCE

It is essential to use healthy and safe materials medical approaches. In dentistry, application of different materials in long-term oral usage demands low or nontoxic agents gains importance for both patients and the staff. Furthermore, screening tests should evaluate any potential toxicity before clinical application.

Hydroxyapatite decreases cytotoxicity of a glass ionomer cement by calcium fluoride uptake in vitro

BACKGROUND

Glass ionomer cements (GICs) are widely used in dentistry because of their remineralizing and cariostatic potential induced by fluoride. In vitro studies have reported cell toxicity triggered by GICs; however, the influence of hydroxyapatite (HAp) must be considered. The aim of this study was to evaluate the effect of HAp in decreasing the cytotoxicity of the GIC 3M Vitrebond in vitro.

METHODS

Samples of 3M Vitrebond (powder, liquid and light-cured) were incubated in Dulbecco's modified Eagle's medium-Ham's F12 (DMEM-F12) for 24 hours at 37°C. Subsequently, the light-cured medium was treated with 100 mg/mL of HAp overnight. Toxicity of conditioned media diluted 1:2, 1:4, 1:8 and 1:20 was analyzed on human gingival fibroblasts (HGFs) using light microscopy and the fluorometric microculture cytotoxicity assay. The amounts of calcium fluoride (CaF₂) were determined by the alizarin red S method.

RESULTS

The exposure of HGFs to light-cured induced cell death and morphological changes such as chromatin condensation, pyknotic nuclei and cytoplasmic modifications. Exposure to light-cured treated with HAp, significantly increased cell viability leading to mostly spindle-shaped cells (p<0.001). The concentration of CaF₂ released by the light-cured was 200 ppm, although, in the light-cured/HAp conditioned medium, this quantity decreased to 88 ppm (p<0.01).

CONCLUSIONS

These data suggest that HAp plays a protective role, decreasing the cytotoxic effect of 3M Vitrebond induced by CaF₂.

Applications of inflammation-derived gingival stem cells for testing the biocompatibility of dental restorative biomaterials

BACKGROUND

Normal or inflamed gingival tissues are regarded as a source of mesenchymal stem cells (MSCs) abundant and easily accessible through minimally invasive dental procedures. Due to the proximity of dental resin composites to gingival tissues and to the possible local cytotoxic effect of the eluted components, gingiva-derived MSCs could be used to investigate the biocompatibility of dental biomaterials.

PURPOSE

The present research aimed to isolate (MSCs) from inflamed and normal gingiva, to fully characterize them and to observe their behavior in relation with some commercial resin composite materials and one experimental material.

MATERIAL AND METHODS

Following their isolation, putative MSCs from both gingival sources were grown under the same culture conditions and characterized by immunophenotyping of cell surface antigens by flow-cytometry and transcription factors by immunocytochemical staining. Moreover, stemness gene expression was evaluated by RT-PCR analysis. Multipotent mesenchymal differentiation potential was investigated. Osteogenic and neurogenic differentiated cells were highlighted by immunocytochemical staining, chondrogenic cells by cytochemical staining, and adipocytes by cytochemical staining and spectrophotometry, respectively. Resin composite cytotoxicity was evaluated by cell membrane fluorescent labeling with PKH 26 and MTT assay. The results of PKH labeling were statistically analysed using two-way RM ANOVA with Bonferroni post-tests. For MTT assay, two-way RM ANOVA with Bonferroni post-tests and unpaired t test with Welch's correction were used.

RESULTS

A similar expression pattern of surface markers was observed. The cells were positive for CD105, CD73, CD90, CD49e, CD29, CD44 and CD166 and negative for CD45, CD34, CD14, CD79, HLA-DR and CD117 indicating a mesenchymal stem cell phenotype. The qRT-PCR analysis revealed a low gene expression for NOG, BMP4 and Oct3/4 and an increased expression for Nanog in both cells lines. Immunocytochemical analysis highlighted a more intense protein expression for Nanog, Oct3/4 and Sox-2 in MSCs derived from normal gingiva than from inflamed gingiva. Multipotent differentiation capacity of MSCs isolated from both sources was highlighted. The tested materials had no hazardous effect on MSCs as the two cell lines developed well onto resin composite substrates. Cell counting revealed some significant differences in the number of PKH-labeled MSCs at some experimental moments. Also, some differences in cell viability were recorded indicating better developmental conditions offered by some of the tested biomaterials.

CONCLUSIONS

The experimental resin composite behaved like the most biocompatible commercial material. Inflamed gingiva-derived MSCs retain their stem cell properties and could be used as a valuable cell line for testing dental biomaterials.

Evaluation of residual monomer release and toxicity of self-adhesive resin cements

The aim of this study was to evaluate the amount of leached residual monomers from self-adhesive resin cements and evaluate their toxicity in-vitro. A total of 60 disk-shaped specimens (5 mm in diameter and 0.5 mm in thickness) were prepared from each cement (RelyX U200, SpeedCEM, G-Cem) (n=20). Specimens were immersed in artificial saliva and the amount of released monomers [urethane dimethacrylate (UDMA) and triethyleneglycol dimethacrylate (TEGDMA)] was identified. Then, the cytotoxicity and genotoxicity effect on cells were evaluated using the defined amounts of released monomers from cements. The highest monomer release was detected in G-Cem (p<0.05). The highest cytotoxicity value was identified from SpeedCEM (p<0.01) and the highest genotoxicity values were calculated from RelyX U200 (p<0.05). Released UDMA and TEGDMA from self-adhesive resin cements induced cytotoxicity and genotoxicity effect on cells.

Cytotoxicity of three light-cured resin cements on 3T3 fibroblasts

Abstract Introduction Light-cured resin cements are the first choice for the cementation of laminate veneers. Ideally, they should be biocompatible and offer minimum risks to patients. Objective The aim of this study was to evaluate, in vitro, the cytotoxicity of three resin cements: Variolink II, Ivoclar Vivadent (C1), Allcem Veneer, FGM (C2), and Rely X Veneer, 3M ESPE (C3). Material and method Twenty four samples of each of the cements were fabricated in a standardized metal mold, light activated, and transferred to a 96-well cell plate with culture of fibroblasts. After 24, 48, and 72h of incubation, cytotoxicity was assessed and cell viability was calculated by the methyl-thiazol-tetrazolium (MTT) colorimetric assay. Absorbance was measured at 570 nm using a microplate spectrophotometer. Result The following results were found: Variolink II presented viability of 72.24% (SD 6.80) after 24h, 83.92% (SD 5.26) after 48h, and 92.77% (SD 5.59) after 72h; Allcem Veneer exhibited viability of 70.46% (SD 12.91) after 24h, 85.03% (SD 21.4) after 48h, and 70.46% (SD 12.91) after 72h; Rely X Veneer showed viability of 5.06% (SD 0.88) after 24h, 5.84% (SD 1.18) after 48h, and 6.99% (SD 1.34) after 72h. Conclusion Under these testing conditions, Rely X Veneer presented significantly higher cytotoxicity compared with those of the other light-cured resin cements assessed.

Correlation between clinical performance and degree of conversion of resin cements: a literature review

Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.

Biocompatibility Evaluation of Dental Luting Cements Using Cytokine Released from Human Oral Fibroblasts and Keratinocytes

Dental luting cements are commonly used in dentistry for cementation of prosthetic restoration. Many previous studies focused on the measurement of the cell viability as the method of cytotoxicity evaluation during biocompatibility study for the material. In this study, the biocompatibility of various dental luting cements were evaluated using the new method of cytokine release measurement in order to better simulate inflammatory reactions in animal or clinical model using two different oral cells; immortalized human gingival fibroblast and immortalized human oral keratinocytes. Cells were exposed to extractions of various commercially available dental luting cements for different durations. Cytokines of IL-1α and IL-8 were measured from the supernatants of the cells and the results were then compared to the conventional MTT viability test. The result from the conventional cell viability study showed a relatively simple and straight forward indication that only one of the dental luting cements tested in this study was cytotoxic with increasing duration of exposure for both cells. Meanwhile, the result from the cytokine measurement study was much more complex at the time point they were measured, type of cells used for the study and the type of cytokines measured, all of which influenced the interpretation of the results. Hence, the better understanding of the cytokine release would be required for the application in biocompatibility evaluation.

Resin luting materials: Tissue response in dog's teeth

The aim of this study was to evaluate radiographically and histologically the pulpal and periapical response to self-adhesive (Rely X™ Unicem) and self-etching and self-curing (Multilink(®)) resin-based luting materials in deep cavities in dogs' teeth. Deep class V cavities (0.5-mm-thick dentin) were prepared in 60 canine premolars and the following materials were applied on cavity floor: Groups I/V-RelyX™ Unicem; Groups II/VI-Multilink(®); Groups III/VII-zinc phosphate cement (control) and; Groups IV/VIII-gutta-percha (control). Cavities were restored with silver amalgam. Animals were euthanized after 10 days (groups I-IV) and 90 days (groups V-VIII). Tooth/bone blocks were radiographed and processed for histopathological evaluation of pulp and periapical tissue response to the materials. All materials presented similar histopathological features and radiographic findings at both periods. The pulp tissue was intact. The apical and periapical regions and periodontal ligament thickness were normal. No inflammatory cells, resorption of mineralized tissue (dentin, cementum, and alveolar bone) or bacteria were observed. The lamina dura was intact and no areas of periapical bone rarefaction or internal/external root resorption were observed radiographically. It can be concluded that Rely X™ Unicem and Multilink(®) caused no adverse tissue reactions and may be indicated for cementation of indirect restorations in deep dentin cavities without pulp exposure.

Iatrogenic Damage to the Periodontium by Chemicals and Dental Materials

The toxicity and tissue reactions to dental materials are receiving more attention as a wide variety of materials are used and as federal agencies demonstrate more concern in this area. A further indication of the importance of the interaction of materials and tissues is the development of recommended standard practices and tests for the biological interaction of materials.

Biocompatibility of 4-META/MMA-TBB resin used as a dental luting agent

STATEMENT OF PROBLEM

The bonding and biological properties of currently used luting/cementing materials need to be improved. 4-Acryloyloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butylborane (4-META/MMA-TBB) resin is primarily used for splinting mobile teeth or treating fractured teeth. It undergoes moisture-resistant polymerization and bonds strongly to dentin and metals.

PURPOSE

The purpose of this in vitro study was to compare the biological and biochemical properties META/MMA-TBB resin with those of conventional polymethyl methacrylate (PMMA)-MMA resin and other currently used luting materials in order to determine whether it may be a viable dental luting agent.

MATERIAL AND METHODS

The degree of polymerization of 4-META/MMA-TBB resin, PMMA-MMA autopolymerizing resin, 10-methacryloyloxydecyl dihydrogen phosphate-dimethacrylate (MDP-DMA) adhesive resin, and a glass ionomer cement was measured by Fourier-transformed infrared spectroscopy. Free radical production during setting was evaluated by electron spin resonance (ESR) spectroscopy. Rat dental pulp cells cultured on these materials were examined for cell viability, attachment, proliferation, and functional phenotype.

RESULTS

The degree of polymerization of 4-META/MMA-TBB resin was 82% thirty minutes after preparation, compared to 66% for PMMA-MMA autopolymerizing resin. ESR spectroscopy revealed free radical production from 4-META/MMA-TBB resin and glass ionomer cement was equivalent 24 hours after preparation, with no spike in radical generation observed. In contrast, free radical production from PMMA-MMA and MDP-DMA adhesive resins was rapid and sustained and 10 to 20 times greater than that from 4-META/MMA-TBB. The percentage of viable dental pulp cells 24 hours after seeding was considerably higher on MDP-DMA and 4-META/MMA-TBB resin than on glass ionomer cement. Cell number, proliferation, and alkaline phosphatase activity were highest on 4-META/MMA-TBB resin and lowest on the glass ionomer cement.

CONCLUSIONS

4-META/MMA-TBB resin is at least as biocompatible, and perhaps even more biocompatible, than other current luting materials, with fast, favorable, and nontoxic polymerization properties. Further in vivo and human studies of 4-META/MMA-TBB resin as a dental luting agent are warranted.

Intentional replantation of adhesively reattached vertically fractured maxillary single-rooted teeth

AIM

To evaluate the clinical outcomes of intentionally replanted maxillary single-rooted teeth with vertical root fractures (VRFs) after being repaired extraorally using 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement.

METHODOLOGY

Twenty-one root filled maxillary single-rooted teeth with VRFs were evaluated. After atraumatic extraction, fractured fragments were adhesively cemented. The teeth were then replanted and splinted to the neighbouring teeth for 2 weeks. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 months, and radiographic evaluations were made using PAI scores at baseline and 12 months. Mobility was evaluated using periotest values (PTV) at baseline, 1, 3, 6 and 12 months. Replanted teeth, contralateral teeth (control teeth) and adjacent teeth were analysed statistically using repeated measures one-way anova, unpaired t-tests and Wilcoxon matched-pairs signed-rank tests.

RESULTS

Two teeth were extracted in the first month after surgery. PI, GI, CAL and PD scores of the replanted teeth were significantly lower at 6 month (P < 0.0001 for all) and 12 month (P < 0.0001 for all) postoperatively when compared to baseline, but the values were not significantly different from those of the control and adjacent teeth. PTV of the test teeth increased significantly (P < 0.0001) after the intervention and decreased to baseline levels by month 12. PTVs were significantly higher (P < 0.05) at baseline, 1, 3 and 6 months in the test teeth when compared with the control teeth, but were not significantly different at month 12. PAI scores of teeth with VRF were significantly lower (P < 0.05) at 12 months compared with baseline.

CONCLUSIONS

Adhesive cementation and intentional replantation were an effective treatment modality for this group of vertically fractured maxillary single-rooted teeth. The clinical periodontal parameters decrease by month 6, and the mobility returned to the physiological limits of natural teeth 12 months after replantation.

Cytotoxicity evaluation of zinc oxide-eugenol and non-eugenol cements using different fibroblast cell lines

OBJECTIVES

Despite being commonly used as temporary cements in dentistry, there is a lack of studies regarding the cytotoxicity of zinc oxide-eugenol (ZOE) and zinc oxide non-eugenol (ZONE) cements. In addition, cytotoxicity evaluation of the materials often involves animal-based cells. Therefore, in this study, a cytotoxicity evaluation of commercially available ZOE and ZONE cements was carried out using both animal and human-based cells.

MATERIALS AND METHODS

The extraction or dilution of the extraction from four commercially available cements (two zinc oxide-eugenol and two zinc oxide non-eugenol) was tested for cytotoxicity, using three different cells and a water-soluble treatzolium salt assay. The results were confirmed using a confocal laser microscope following calcein AM and ethidium homodimer-1 staining.

RESULTS

The results showed that there was a significant difference in cell viability depending on which cell was used, even when the same material was tested. Generally, L929 showed relatively low cell viability with a low EC50 (effective concentration of extracts that caused 50% of cell viability compared to the control) value compared to both HGF-1 and hTERT-hNOF. Such results were also confirmed by a confocal laser microscope.

CONCLUSIONS

Careful consideration on interpreting the results for cytotoxicity evaluation of ZOE and ZONE cements is needed when different cells are used.

Human and bovine pulp-derived cell reactions to dental resin cements

OBJECTIVES

The objective of this study was to evaluate the cytotoxic reaction of transfected human pulp derived cells (tHPDC) and transfected bovine pulp derived cells (tBPDC) after exposure to resin cements [RelyX UnicemClicker (RX), MaxCem (MC), Panavia F 2.0 (PF), BisCem (BC), and Bistite II DC (BII)] and to compare it to the generation of reactive oxygen species (ROS).

MATERIALS AND METHODS

Set materials were extracted in culture medium, cell survival as a measure of cytotoxicity was determined photometrically using crystal violet after cells were exposed to the extracts for 24 h. The generation of ROS was detected by flow cytometry after cells were exposed to extract dilutions for 1 h.

RESULTS

The ranking of the least to the most cytotoxic material was: RX < BII < PF < BC < MC for both cell lines, but for tHPDC, only MC and PF eluates were different from untreated controls. Generally, tBPDC were more susceptible to materials than tHPDC, but only for RX and BC was this difference statistically significant. All undiluted extracts increased ROS production in both cell lines but to a higher amount in tHPDC than in tBPDC.

CONCLUSIONS

tHPDC reacted less sensitive than tBPDC in the cytotoxicity test but with the same rank order of materials. In contrast, the cellular oxidative stress reaction was more pronounced in tHPDC than in tBPDC.

CLINICAL RELEVANCE

Depending on the residual dentine layer in deep cavities, biologically active resin monomers or additives released from resin cements may influence the dentine–pulp complex, for instance, its regenerative and reparative capacities.

Cytotoxicity testing of temporary luting cements with two- and three-dimensional cultures of bovine dental pulp-derived cells

This study evaluated the cytotoxicity of eugenol-containing and eugenol-free temporary luting cements. For cytotoxicity testing, bovine pulp-derived cells transfected with Simian virus 40 Large T antigen were exposed to extracts of eugenol-containing (Rely X Temp E) and eugenol-free (Provicol, PreVISION CEM, and Rely X Temp NE) temporary luting cements for 24 h. The cytotoxicity of the same materials was also evaluated in a dentin barrier test device using three-dimensional cell cultures of bovine pulp-derived cells. The results of the cytotoxicity studies with two-dimensional cultures of bovine dental pulp-derived cells revealed that cell survival with the extracts of Rely X Temp E, Provicol, PreVISION CEM, and Rely X Temp NE was 89.1%, 84.9%, 92.3%, and 66.8%, respectively. Rely X Temp NE and Provicol showed cytotoxic effects on bovine dental pulp-derived cells (P < 0.05). The results of the dentin barrier test revealed that cell survival with the above-mentioned temporary cement was 101.5%, 91.9%, 93.5%, and 90.6%, respectively. None of the temporary luting cements significantly reduced cell survival compared with the negative control in the dentin barrier test (P > 0.05). Biologically active materials released from temporary luting cements may not influence the dentine-pulp complex if the residual dentine layer is at least 0.5 mm thick.

Toxicity evaluation of two dental composites: three-dimensional confocal laser scanning microscopy time-lapse imaging of cell behavior

The purpose of this study was to investigate the in vitro biocompatibility of two dental composites (namely A and B) with similar chemical composition used for direct restoration using three-dimensional confocal laser scanning microscopy (CLSM) time-lapse imaging. Time-lapse imaging was performed on cultured human HGF-1 fibroblast-like cells after staining using Live/Dead®. Image analysis showed a higher mortality rate in the presence of composite A than composite B. The viability rate decreased in a time-dependent manner during the 5 h of exposure. Morphological alterations were associated with toxic effects; cells were enlarged and more rounded in the presence of composite A as shown by F-actin and cell nuclei staining. Resazurin assay was used to confirm the active potential of composites in cell metabolism; results showed severe cytotoxic effects in the presence of both no light-curing composites after 24 h of direct contact. However, extracts of polymerized composites induced a moderate decrease in cell metabolism after the same incubation period. Composite B was significantly better tolerated than composite A at all investigated end points and all time points. The finding confirmed that the used CLSM method was sufficiently sensitive to differentiate the biocompatibility behavior of two composites based on similar methacrylate monomers.

Retentive strength of two-piece CAD/CAM zirconia implant abutments

PURPOSE

The purpose of this study is to evaluate the retention of two-piece computer-aided design (CAD)/computer aided manufacturing (CAM) zirconia abutments after artificial aging under simulated oral conditions using three different types of resin-based luting agents.

MATERIAL AND METHODS

Twenty-one CAD/CAM-generated zirconia copings (CERCON Compartis, Degudent, Hanau, Germany) were bonded to a prefabricated secondary titanium implant insert (XiVE Ti-Base, Dentsply Friadent, Mannheim, Germany), using three different types of resin-based luting agents: group A: Panavia 21 (Kuraray Co, Kurashiki, Japan); group B: Multilink Implant (Ivoclar Vivadent, Schaan, Liechtenstein); and group C: SmartCem2 (Dentsply DeTrey, Konstanz, Germany). The bonding surfaces of the titanium inserts and the zirconia ceramic copings were air-abraded and cleaned in alcohol. All specimens were stored in distilled water for 60 days and subsequently thermal-cycled 15,000 times (5-55 °C). The dislodging force of the copings along the long axis of the implant/abutment complex was recorded using a universal testing machine with 2 mm/min crosshead speed. Data were analyzed descriptively and by performing the Kruskal-Wallis test.

RESULTS

The mean retention values were 924.93 ± 363.31 N for Panavia 21, 878.05 ± 208.33 N for Multilink Implant, and 650.77 ± 174.92 N for SmartCem2. The Kruskal-Wallis test indicated no significant difference between the retention values of the tested luting agents (p = 0.1314). The failure modes of all tested two-piece abutments were completely adhesive, leaving the detached zirconia coping and titanium insert undamaged.

CONCLUSION

The use of resin-based luting agents in combination with air abrasion of titanium inserts and zirconia copings led to a stable retention of two-piece CAD/CAM abutments. The bonding stability of the investigated luting agents exceeded the general limits of fracture resistance of two-piece zirconia abutments. A notable difference between the mean retention values of the tested bond materials was shown. However, the statistical analysis revealed that this difference was not significant.