Hydration characteristics of zirconium oxide replaced Portland cement for use as a root-end filling material

Assessment of Decision-Making and Material Selection for Vital Pulp Therapy in Deep Carious Lesions: A Study at the Faculty of Dentistry, King Abdulaziz University

PURPOSE

The purposes of this study were to assess decision-making, material selection, and management of deep carious lesions in permanent teeth requiring vital pulp therapy (VPT); investigate the intradepartmental and interdepartmental consensus in the management of those cases; and correlate this study's results to the current scientific literature, clinical experience, and postgraduate training among staff and postgraduate students at the Faculty of Dentistry, King Abdulaziz University.

MATERIALS AND METHODS

The survey included faculty from pedodontics, endodontics, and restorative/operative dentistry; postgraduate students; and interns, excluding specific categories such as retired faculty, external trainers, non-faculty hospital specialists, general practitioners, students, interns outside the institution, and other departments. An anonymous electronic questionnaire was developed and validated. Ethical approval was obtained, and the questionnaire was distributed to all 148 English-proficient members of the targeted population via email and WhatsApp, accompanied by a cover letter. The questionnaire encompassed demographic, education, experience, assessment, decision-making, and management sections. Data were collected and analyzed using Microsoft Excel, with results presented using categorical variables, Pareto charts, and statistical tests.

RESULTS

There were 86 responses, representing 58% of the target population, with the key findings including the prominence of "Pre-operative vitality test result" as the most important factor in assessing deep carious lesions, with no significant differences among specialties. The (one-step and one-visit) management approach was preferred by 50% of participants, with no significant specialty differences. For deep carious lesions without pulpal exposure, glass ionomer (GI)/resin-modified glass ionomer (RMGI) base was the top choice, with no variation among all specialties. In cases with pulpal exposure, the one-visit approach (direct pulp capping (DPC), base, and restoration) was the most favored, with no specialty differences. Material availability significantly influenced decision-making, with no specialty variations.

CONCLUSION

The study highlights the crucial role of pre-operative vitality tests in assessing deep carious lesions for VPT or root canal treatment (RCT). Participants generally favored VPT for cases with normal pulp vitality, with some departmental variation. Controlling bleeding post-pulpal exposure was a central concern. Mineral trioxide aggregate (MTA) was the most commonly used VPT material, followed by Ca(OH)2 and Biodentine. Factors such as treatment access, patient compliance, remaining dentin thickness, and oral hygiene had minimal impact on treatment choice. Limited availability of VPT materials was the primary reason for non-use. The survey's acceptable response rate raises concerns about potential non-response bias, though limitations include a lack of data on non-responders. Nevertheless, the survey's strength lies in its comprehensive coverage of key clinical aspects, engaging professionals from diverse specialties and educational levels who are collectively interested in addressing deep caries cases.

Influence of the addition of different metal oxides on physicochemical and biological properties of calcium fluorosilicate/PCL bone cement

Calcium silicate cements have been greatly developed in the last decades through different approaches. Among these approaches, the inclusion of antibacterial agents or addition of metal oxides. Herein, calcium silicate cement containing fluorine (CFS) was developed from sodium fluorosilicate precursor for the first time using chemical perception method. Afterwards, metal oxide Bi2O3 or MgO or ZrO2 was individually mixed with CFS powder and blended together using Polycaprolactone polymer (PCL). The cement mixtures were characterized using DSC, XRD, FTIR and SEM/EDX to determine the effect of metal oxide on the pure CFS. Furthermore, mechanical, antibacterial and cell viability properties were evaluated for the developed CFS mixture cements. Moreover, these CFS mixture cements were implanted in male Wistar rats to determine the effect of metal oxides on the rate of bone reformation. The findings of physicochemical and morphological characterization showed no remarkable effects on the pure CFS after mixing with each metal oxide. However, enhanced compressive strengths (up to 104.07N/cm2), antibacterial activity and cell viability (up to 96%) were achieved for the CFS cement mixtures. Finally, the in vivo studies confirmed the biocompatibility of the CFS cement mixtures and especially those mixed with Bi2O3 or ZrO2. Therefore, this study supports that CFS blends with Bi2O3 or ZrO2 can be novel promising cementing materials for bone restoration.

Physicochemical, Biological, and Antibacterial Properties of Four Bioactive Calcium Silicate-Based Cements

Calcium silicate-based cement (CSC) is a pharmaceutical agent that is widely used in dentistry. This bioactive material is used for vital pulp treatment due to its excellent biocompatibility, sealing ability, and antibacterial activity. Its drawbacks include a long setting time and poor maneuverability. Hence, the clinical properties of CSC have recently been improved to decrease its setting time. Despite the widespread clinical usage of CSC, there is no research comparing recently developed CSCs. Therefore, the purpose of this study is to compare the physicochemical, biological, and antibacterial properties of four commercial CSCs: two powder-liquid mix types (RetroMTA^® [RETM]; Endocem^® MTA Zr [ECZR]) and two premixed types (Well-Root™ PT [WRPT]; Endocem^® MTA premixed [ECPR]). Each sample was prepared using circular Teflon molds, and tests were conducted after 24 h of setting. The premixed CSCs exhibited a more uniform and less rough surface, higher flowability, and lower film thickness than the powder-liquid mix CSCs. In the pH test, all CSCs showed values between 11.5 and 12.5. In the biological test, cells exposed to ECZR at a concentration of 25% showed greater cell viability, but none of the samples showed a significant difference at low concentration (p > 0.05). Alkaline phosphatase staining revealed that cells exposed to ECZR underwent more odontoblast differentiation than the cells exposed to the other materials; however, no significant difference was observed at a concentration of 12.5% (p > 0.05). In the antibacterial test, the premixed CSCs showed better results than the powder-liquid mix CSCs, and ECPR yielded the best results, followed by WRPT. In conclusion, the premixed CSCs showed improved physical properties, and of the premixed types, ECPR exhibited the highest antibacterial properties. For biological properties, none of these materials showed significant differences at 12.5% dilution. Therefore, ECPR may be a promising material with high antibacterial activity among the four CSCs, but further investigation is needed for clinical situations.

Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments—30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank’s balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days.

Portland Cement: An Overview as a Root Repair Material

Portland cement (PC) is used in challenging endodontic situations in which preserving the health and functionality of pulp tissue is of considerable importance. PC forms the main component of mineral trioxide aggregate (MTA) and demonstrates similar desirable properties as an orthograde or retrograde filling material. PC is able to protect pulp against bacterial infiltration, induce reparative dentinogenesis, and form dentin bridge during the pulp healing process. The biocompatibility, bioactivity, and physical properties of PC have been investigated in vitro and in animal models, as well as in some limited clinical trials. This paper reviews Portland cement's structure and its characteristics and reaction in various environments and eventually accentuates the present concerns with this material. This bioactive endodontic cement has shown promising success rates compared to MTA; however, considerable modifications are required in order to improve its characteristics and expand its application scope as a root repair material. Hence, the extensive chemical modifications incorporated into PC composition to facilitate preparation and handling procedures are discussed. It is still important to further address the applicability, reliability, and cost-effectiveness of PC before transferring into day-to-day clinical practice.

Physicochemical and biological properties of new tricalcium silicate-based repair material doped with fluoride ions and zirconium oxide as radiopacifier

This study evaluated the physicochemical and biological properties of novel reparative materials composed of pure tricalcium silicate (Ca₃ SiO₅ ), Ca₃ SiO₅ doped with fluoride ions (Ca₃ SiO₅ -F) and their association with ZrO₂ (Ca₃ SiO₅  + ZrO₂ , Ca₃ SiO₅ -F + ZrO₂ ), in comparison with Biodentine (BIO). Setting time radiopacity, pH, solubility, and dimensional change were evaluated based on ISO 6876 Standard. Volumetric change and flow/filling were assessed by microcomputed tomography (micro-CT). Biological properties were evaluated by the MTT assay 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), Neutral Red (NR), cell migration, alkaline phosphatase activity (ALP), and Alizarin Red Staining (ARS) assays. Statistical analysis was performed by ANOVA, Tukey, or Bonferroni tests (α = .05). Ca₃ SiO₅ -F + ZrO₂ had higher radiopacity, shorter setting time, and lower solubility and volumetric loss than BIO (p < .05). Ca₃ SiO₅ -F + ZrO₂ had flow and filling capacity similar to BIO (p > .05). All the cements evaluated had an alkaline pH. Ca₃ SiO₅ -F + ZrO₂ demonstrated cell viability similar to negative control (p > .05), increase in ALP activity in 7 days, mineralized nodule production in 21 days and repair capacity according to cell migration. In conclusion, Ca₃ SiO₅ -F + ZrO₂ had adequate setting time, radiopacity, solubility, and dimensional change. This material presented low volumetric change besides flow and filling capacity in micro-CT assessment. In addition, Ca₃ SiO₅ -F + ZrO₂ was biocompatible and bioactive, suggesting its use as reparative material.

Zr(OH)4 Catalyzed Controllable Selective Oxidation of Anilines to Azoxybenzenes, Azobenzenes and Nitrosobenzenes

The selective oxidation of aniline to metastable and valuable azoxybenzene, azobenzene or nitrosobenzene has important practical significance in organic synthesis. However, uncontrollable selectivity and laborious synthesis of the expensive required catalysts severely hinder the uptake of these reactions in industrial settings. Herein, we have pioneered the discovery of Zr(OH) 4 as an efficient heterogeneous catalyst capable of the selective oxidation of aniline, using either peroxide or O 2 as oxidant, to selectively obtain various azoxybenzenes, symmetric/unsymmetric azobenzenes, as well as nitrosobenzenes, by simply regulating the reaction solvent, without the need for additives. Mechanistic experiments and DFT calculations demonstrate that the activation of H 2 O 2 and O 2 is primarily achieved by the bridging hydroxyl and terminal hydroxyl groups of Zr(OH) 4 respectively. The present work provides an economical and environmentally friendly strategy for the selective oxidation of aniline in industrial applications.

Calcium silicate-based cements cause environmental stiffness and show diverse potential to induce osteogenesis in human osteoblastic cells

Calcium silicate-based cements differ markedly in their radiopacifiers and the presence of calcium sulfate, aluminates, carbonates and other components that can affect their biological properties. This study aimed to compare the biological properties of six calcium silicate cements in human osteoblastic cell culture (Saos-2 cells): Bio-C Repair (Bio-C), PBS HP (PBS-HP), Biodentine (Biodentine), MTA Repair HP (MTA-HP), NeoMTA Plus (NeoMTA-P), and ProRoot MTA (ProRoot). After exposure to these materials, the cells were analyzed by MTT, wound healing, cell migration, and alkaline phosphatase activity (ALP) assays, real-time PCR (qPCR) analysis of the osteogenesis markers (osteocalcin or bone gamma-carboxyglutamate protein, BGLAP; alkaline phosphatase, ALPL; bone sialoprotein or secreted phosphoprotein 1, BNSP), and alizarin red staining (ARS). Curiously, the migration rates were low 24-48 h after exposure to the materials, despite the cells showing ideal rates of viability. The advanced and intermediate cell differentiation markers BGLAP and BNSP were overexpressed in the Bio-C, MTA-HP, and ProRoot groups. Only the Biodentine group showed ALPL overexpression, a marker of initial differentiation. However, the enzymatic activity was high in all groups except Biodentine. The mineralization area was significantly large in the NeoMTA-P, ProRoot, PBS-HP, MTA-HP, and Bio-C groups. The results showed that cellular environmental stiffness, which impairs cell mobility and diverse patterns of osteogenesis marker expression, is a consequence of cement exposure. Environmental stiffness indicates chemical and physical stimuli in the microenvironment; for instance, the release of cement compounds contributes to calcium phosphate matrix formation with diverse stiffnesses, which could be essential or detrimental for the migration and differentiation of osteoblastic cells. Cells exposed to Bio-C, PBS-HP, ProRoot, NeoMTA-P, and MTA-HP seemed to enter the advanced or intermediate differentiation phases early, which is indicative of the diverse potential of cements to induce osteogenesis. Cements that quickly stimulate osteoblast differentiation may be ideal for reparative and regenerative purposes since they promptly lead to dentin or bone deposition.

A Systematic Review Comparing Mineral Trioxide Aggregate to Other Commercially Available Direct Pulp Capping Agents in Dogs

Vital pulp therapy (VPT) and direct pulp capping (DPC) are procedures regularly performed in dogs for the management of acute tooth fractures and as part of management for traumatic malocclusions. The purpose of this review is to apply an evidence-based medicine approach to systematically review and evaluate the scientific literature evaluating the efficacy of mineral trioxide aggregate (MTA) to other commercially available materials used for VPT in the permanent teeth of dogs. The 9 studies meeting inclusion criteria were reviewed and each studies evidence was classified using a grading system modified from the Oxford Centre for Evidence-Based Medicine. For the studies meeting inclusion criteria, MTA consistently performed as well or better than other commercially available products in terms of calcific barrier formation and biocompatibility. This review found a lack of consistency between the studies making a direct comparison of the results unreliable. Future studies would benefit from the implementation of a standard scoring system for histology, equivalent and longer study duration times and the correlation of histological and radiographic data.

Bonding to dentin using an experimental zirconium oxynitrate etchant

OBJECTIVE

To investigate, by means of microtensile bond strength test (μTBS), nanoleakage expression analysis (NL), gelatin zymography and in situ zymography, the effects of an experimental metal salt-based zirconium oxynitrate etchant [ZrO(NO₃)₂,] - ZON with two simplified adhesives on long-term bond strength and endogenous enzymatic activities.

METHODS

Middle/deep coronal dentin surfaces (N = 32) were conditioned either with a traditional 37 % H₃PO₄ etchant (TE) or with ZON. Further, a single-component etch-and-rinse adhesive (EF) or a universal adhesive (AU) were applied and μTBS and NL tests were performed. Additional freshly extracted teeth were processed for gelatin zymography and in situ zymography evaluation. The tests were performed at baseline and (T0) and after 1-year-aging (T12). Bond strength and in situ zymography results were analyzed using analysis of variance (ANOVA) (three-way and one-way, respectively), while Chi-squared test was used for the NL results. Statistical significance was preset at α = 0.05.

RESULTS

All the investigated factors (adhesive system, dentin conditioner and aging) significantly influenced μTBS, with the AU and ZON performing better compared to EF and TE, respectively, and with lower bond strength values after aging (p < 0.05). Incremented silver nitrate deposits were observed at the adhesive interfaces after aging, especially for the TE groups (p < 0.05). Further, the experimental groups treated with ZON had significantly lower levels of enzymatic activity compared to TE, as shown by gelatin and in situ zymography (p < 0.05).

CONCLUSIONS

The experimental etchant demonstrated promising results in hybrid-layer preservation over time when used with simplified bonding systems, and could therefore be recommended in the clinical practice.

Radiopacity of Premixed calcium silicate-based endodontic sealers

Background: Premixedcalcium silicate-based sealers are ready-to-use, injectable materials with advantageous biological properties that create environment favorable for periapical tissues repair and health. The aim of our study was to examine the radiopacities of premixed calcium silicate-based sealers:TotalFill BCSealer, EndoSequence BC Sealer, Ceraseal, Bio-C Sealer and to compare them with epoxy-basedsealer, AH Plus. Material and methods: Three specimens (2 mm thick and 5 mm in diameter) of each sealer were radiographed using charge-coupled device-baseddigital sensor (Trophy Radiology, Cedex, France) along with an aluminum stepwedge reference.For radiopacity determination, a graph of the logarithm of aluminum thickness versus radiographic density was plotted and a calibration curve was generated. Radiopacities were assessed from the graph and presented as millimeters of aluminum per millimeter of material (mmAl).ANOVA with a post hoc Tukey test was used for statistical analysis and significance was set at 0.05. Results: Radiopacity values of EndoSequence BC Sealer and Bio-C Sealerwere significantly lower than radiopacities of Ceraseal and AH Plus. Differences in values between EndoSequence BC Sealer and Bio-C Sealer as well as between Ceraseal and AH Plus were nonsignificant. TotalFill BC Sealer was nonsignificantly different from all other sealers. Conclusion: Premixed calcium silicate-based endodontic sealers evaluated in our study had radiopacity values higher than 9 mmAl, in ascending order,from Bio-C Sealer, EndoSequence BC Sealer, TotalFill BC Sealer to Ceraseal.

Material Pulp Cells and Tissue Interactions

Two increasingly common endodontic procedures, vital pulp therapy (VPT) and regenerative endodontic procedures, rely on dental tissue regeneration/repair mechanisms with the aid of biomaterials. These materials are applied in close contact to the pulpal tissue and are required to be biocompatible, form an antimicrobial seal, not induce staining, and be easy to manipulate. Historically, calcium hydroxide played an important role in VPT. However, over the last 3 decades, significant efforts in research and industry have been made to develop various biomaterials, including hydraulic tricalcium silicate cements. The present review summarized various hydraulic tricalcium silicate cements and their biological properties in clinical procedures, namely VPT and regenerative endodontic procedures.

In vitro induction of odontogenic activity of human dental pulp stem cells by white Portland cement enriched with zirconium oxide and zinc oxide components

Background. The aim of this in vitro study was to investigate the effect of zinc oxide (ZnO) and zirconium oxide (ZrO₂) microparticles (MPs) and nanoparticles (NPs) in combination with white Portland cement (WPC) on odontogenic capacity of human dental pulp stem cells over a period of 21 days.

Methods. Synthesized ZnO and ZrO₂ particles were characterized using scanning electron microscopy and transmission electron microscopy. The viability of human dental pulp stem cells was measured by a 3-(4,5-dimethylthiazolyl-2-yl)-2,5- diphenyltetrazolium bromide assay at 7-, 14- and 21-day intervals after seeding on WPC disks enriched with ZnO and ZrO₂ MPs and NPs. Odontogenic potential of ZnO and ZrO₂ particles in combination with WPC was investigated by alkaline phosphatase (ALP) activity and ionized calcium level of supernatant culture media at different time intervals. Data were analyzed using one-way ANOVA and post hoc Tukey tests.

Results. All the materials exhibited cell viability over a 21-day period, except for WPC with ZnO NPs on day 7, although it was not statistically significant (P>0.05). The ALP activity and ionized calcium level increased in all the groups compared to the control group (P<0.05). ZnO NPs had superior effect on odontogenic activity and calcium ion release compared to ZnO MPs (P=0.046). There was no significant difference between ZrO₂ MPs and NPs in odontogenic activity (P>0.05).

Conclusion. WPC enriched with ZnO and ZrO₂ increased ALP activity and calcium ion release of human dental pulp stem cells over a period of 21 days in vitro.

Biocompatibility evaluation of Jordanian Portland cement for potential future dental application

Background

The demand for novel Portland cement (PC)-based formulations to be used in dental applications is ever increasing in viewing the foregoing knowledge on the favorable effects of these formulations on cellular proliferation and healing, leading to treatment success.

Aim

This study investigated the effect of white and gray mineral trioxide aggregate (W-MTA and G-MTA) and white and gray Jordanian PC (W-PC and G-PC) in their raw state on the viability of Balb/C 3T3 fibroblasts using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

Materials and Methods

Materials were prepared in the form of disks, with a diameter of 5 mm and a thickness of 2 mm. In the first experiment, Balb/C 3T3 fibroblasts were cultured with the material disks using culture plate inserts. In the second experiment, material elutes were added to cultured cells. The elutes were prepared by adding 2 ml serum-free media to 10 disks of each material and then incubated at 37°C for different time intervals. Material elutes were analyzed using ion chromatography for traces of calcium. The data were analyzed using analysis of variance followed by Dunnett test (α = 0.05) or Tukey test (α = 0.05).

Results

In response to material disks, G-PC had a proliferative effect on cells at day 1 and day 2 with a significant difference from the control at day 1. G-MTA reduced cell viability with a significant difference from the control level at day 2. Elutes of PC showed biocompatible and even proliferative effects on Balb/C 3T3 fibroblasts. Calcium ions were found to leach continuously over the measurement period for all the materials tested in this work.

Conclusion

Jordanian PC in its raw state was found to be biocompatible, and the results of this work give promise of its wider use as a base for further development to improve the physiochemical and mechanical properties of the material.

FTIR characterization of the setting reaction of biodentine™

OBJECTIVE

To provide insight of the setting reactions of Biodentine™, a hydraulic calcium silicate cement, based upon observations using Fourier Transform Infra-Red (FTIR) spectroscopy.

METHODS

FTIR spectra of components before and during the setting reaction were taken using the attenuated total reflectance (ATR) technique. Measurements over wavelengths 600-4000cm^-1 were taken at regular intervals for two days.

RESULTS

FTIR spectrum of Biodentine™ powder revealed a number of peaks from 650 to 1100cm^-1 and a plateau from 1400 to 1500cm^-1, indicative of SiO and CO₃-bonding, while the mixing fluid exhibited water peaks. Results following mixing displayed three distinct regimes; (i) incubation phase, during the first 35min, when minimal change occurred, (ii) rapid transitory stage, between 35 and 90min, when major changes occurred, and (iii) slow sustained reaction stage for remaining 45h. Incubation appears to be associated with the presence of CO₃-peaks. The transition region indicates formation of CaOH and Jennite OH-peaks, anticipated intermediate reaction phases. At 90min, the end of second stage, CaOH and Jennite are replaced by a dominant Portlandite (Ca(OH)₂)-peak and minor presence of Tobermorite, another anticipated intermediate phase, and water reduction. During the following 45h Portlandite and Tobermorite decline while the water peak increases.

SIGNIFICANCE

FTIR can be used to follow the chemical reactions in dental cements and provides insight into the relatively slow setting reactions of hydraulic calcium silicate cements.

Novel Fast-Setting Mineral Trioxide Aggregate: Its Formulation, Chemical-Physical Properties, and Cytocompatibility

One of the main drawbacks that limits the application of mineral trioxide aggregate (MTA) in dental field is its long setting time. Mineral trioxide aggregate with accelerated setting properties and excellent chemical-physical and biological properties is still required. In this study, an innovative mineral trioxide aggregate, which consists of calcium silicates, calcium aluminates, and zirconium oxide, was designed to obtain fast-setting property. The optimized formulation can achieve initial setting in 10 min and final setting in 15 min, which are much faster than commercial mineral trioxide aggregate. In addition, the optimized fast-setting MTA showed adequate radiopacity and good biocompatibility. The ion concentrations after storage in water for 1 day were 52.3 mg/L Ca, 67.7 mg/L Al, 48.8 mg/L Si, and 11.7 mg/L Mg. The hydration products of hardened cements were investigated by X-ray diffraction, scanning electron microscopy, and Fourier transform infrared, showing the accelerated setting time was due to the formation of honeycomb-like calcium silicate hydrate gel. The novel MTA could be a promising material for dental applications.

Intratubular Biomineralization in a Root Canal Filled with Calcium-Enriched Material over 8 Years

This case report describes intratubular biomineralization in root canal, filled with calcium-enriched material after 8 years of clinical maintenance. The schematic findings of dentinal tubules were investigated with scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). The root canal obturation material was closely adapted to root dentin surface, suggesting the possibility of chemical bonding between the two interfaces. SEM and EDS observation of dentinal tubules showed intratubular biomineralized crystal structures with Ca/P ratio in a range of 1.30-2.12, suggesting bioactive capacity of calcium-enriched material.

Diametral tensile strength of novel fast-setting calcium silicate cement

Novel fast-setting calcium silicate cement with fluoride (CSC) has been developed for potential applications in tooth crown. The aim of this study was to test the diametral tensile strength (DTS) of different CSC compositions in humid condition on day1, 28, and 180. We tested 'bond CSC' with 3.5% fluoride and no radiocontrast, 'CSC' with 3.5% fluoride and 10% radiocontrast, 'ultrafast CSC' with 3.5% fluoride and 20% radiocontrast, 'high fluoride CSC' with 15% fluoride and 25% radiocontrast, Biodentine, and MTA. We filled the cements after mixing to cylindrical molds. Specimens were stored in >95% humidity. DTS was measured at each time point. CSC compositions had statistically higher DTS compared to MTA and Biodentine on day1. Bond CSC showed higher DTS versus all cements, except CSC, at all time points. DTS of all cements, except Biodentine, significantly increased in humid condition on day28 and day180 compared to day1.

Storage Medium Affects the Surface Porosity of Dental Cements

INTRODUCTION

Calcium silicate-based cements physical properties is influenced by environmental changes.

AIM

Here, we intended to evaluate the effect of storage medium on surface porosity of root Mineral Trioxide Aggregate (MTA) and Biodentine cement.

MATERIALS AND METHODS

A total of 40 polyethylene tubes were selected and divided into two groups: Group A (MTA) and Group B (Biodentine). Each group was subdivided into two subgroups (n=10). In subgroups A1 and B1, tubes were transferred to Distilled Water (DW), while samples of subgroup A2 and B2 were transferred to Synthetic Tissue Fluid (STF) as storage medium and samples were stored for three days. All specimens were then placed in a desiccator for 24 hours and then subject to surface porosity evaluation by Scanning Electron Microscopy (SEM) at ×500, ×1000, ×2000 and ×5000 magnifications. The number and the surface porosities were determined by Image J analysis. Data were analyzed by ANOVA at level of significance of p<0.05.

RESULTS

The lowest surface porosity was observed in MTA samples stored in STF and the highest was in Biodentine samples stored in DW. Significant differences were noted between groups and subgroups of each group (p< 0.05). MTA samples stored in DW and STF showed significantly lower surface porosities compared to Biodentine samples (p < 0.05).

CONCLUSION

Storage medium can drastically affect the surface porosity of tested calcium silicate-based cements. However, MTA showed lower surface porosity compared to Biodentine cement, which can result in lower microleakage in applied area.

Bioactivity and biomineralization ability of calcium silicate-based pulp-capping materials after subcutaneous implantation

AIM

To evaluate the abilities of three calcium silicate-based pulp-capping materials (ProRoot MTA, TheraCal LC and a prototype tricalcium silicate cement) to produce apatite-like precipitates after being subcutaneously implanted into rats.

METHODOLOGY

Polytetrafluoroethylene tubes containing each material were subcutaneously implanted into the backs of Wistar rats. At 7, 14 and 28 days post-implantation, the implants were removed together with the surrounding connective tissue, and fixed in 2.5% glutaraldehyde in cacodylate buffer. The chemical compositions of the surface precipitates formed on the implants were analysed with scanning electron microscopy-electron probe microanalysis (SEM-EPMA). The distributions of calcium (Ca) and phosphorus (P) at the material-tissue interface were also analysed with SEM-EPMA. Comparisons of the thicknesses of the Ca- and P-rich areas were performed using the Friedman test followed by Scheffe's test at a significant level of 5%.

RESULTS

All three materials produced apatite-like surface precipitates containing Ca and P. For each material, elemental mapping detected a region of connective tissue in which the concentrations of Ca and P were higher than those in the surrounding connective tissue. The thickness of this Ca- and P-rich region exhibited the following pattern: ProRoot MTA > prototype tricalcium silicate cement ≥ TheraCal LC. ProRoot MTA had a significantly thicker layer of Ca and P than the other materials at all time-points (P < 0.05), and a significant difference was detected between the prototype cement and TheraCal LC at 28 days (P < 0.05).

CONCLUSION

After being subcutaneously implanted, all of the materials produced Ca- and P-containing surface precipitates and a Ca- and P-rich layer within the surrounding tissue. The thickness of the Ca- and P-rich layer of ProRoot MTA was significantly thicker than that of the other materials.

Radiopacity of Mineral Trioxide Aggregate with and without Inclusion of Silver Nanoparticles

AIM

The aim of this study was to investigate the inclusion of silver nanoparticles (Ag NPs) in the mineral trioxide aggregate (MTA) composition to know which changes will result in the radiopacity of the material.

MATERIALS AND METHODS

The experiment was performed according to the American National Standard Institute/American Dental Association specification no. 57/2000 and ISO 6876/2001. Five plates with five holes measuring 1 mm in depth and 5 mm in internal diameter were filled according to the different experimental groups as follows: white mineral trioxide aggregate (WMTA) + NP50 - W MTA with liquid Ag NP 50 ppm, WMTA + NP30 - W MTA with liquid Ag NP 30 ppm, WMTA + NP22 - W MTA with liquid Ag NP 22 ppm, WMTA + NPP - white MTA with liquid Ag NP and powder 1%, WMTA (control). After filling the plates, they were kept in an incubator at 37°C in relative humidity for setting. Each sample was positioned along an aluminum step-wedge placed above the Opteo digital sensor system. The image was divided into four quadrants, and three readings were made for each quadrant to render the average of each quadrant. The resulting data were submitted to Kruskal-Wallis and Dunn's tests.

RESULTS

The results showed statistically significant differences between WMTA + NP30, WMTA + NP22, and WMTA + NPP interactions compared with WMTA (control) (p < 0.05). The radiopacity was in descending order: WMTA + NPP, WMTA + NP22, WMTA + NP30, MTA + NP50, and WMTA.

CONCLUSION

Silver NPs changed the radiopacity of WMTA, being more evident in WMTA + NP powder at 1% weight.

CLINICAL SIGNIFICANCE

The low radiopacity of MTA makes it difficult for any radiographic observation. The Ag NPs appear as an alternative, being an excellent radiopacifier as they have excellent antimicrobial property and relatively low toxicity.

Effect of Silver Nanoparticles on Physicochemical and Antibacterial Properties of Calcium Silicate Cements

Mineral trioxide aggregate (MTA) and Portland cement (PC) are calcium silicate cements. They have similar physicochemical, mechanical and biological properties. The addition of zirconium oxide (ZrO2) to PC provides radiopacity. Silver nanoparticles (AgNPs) may improve some properties of cements. The aim of this study was to evaluate the effect of AgNPs on physicochemical/mechanical properties and antibacterial activity of white MTA (WMTA) and PC associated with ZrO2. The following materials were evaluated: WMTA; PC 70% + ZrO2 30%; WMTA+ AgNPs; and PC 70% + ZrO2 30% + AgNPs. The study evaluated radiopacity, setting time, pH, compressive strength and solubility. For radiopacity analysis, radiographs were made alongside an aluminum (Al) step wedge. To evaluate the antibacterial activity, direct contact test was performed on planktonic cells and Enterococcus faecalis biofilm induced on bovine root dentin for 14 days. The experimental periods were 5 and 15 h. Data were obtained as CFU mL-1. The obtained data were submitted to ANOVA and Tukey tests (p<0.05). The addition of AgNPs to WMTA increased the pH, lowered the solubility and the initial and final setting times. The addition of AgNPs to PC/ZrO2 maintained the pH, lowered the solubility, and increased the setting time and compressive strength. The radiopacity of all materials was higher than 4 mmAl. The addition of AgNPs promoted an increase in antibacterial activity for calcium silicate cements and favored the physicochemical and mechanical properties of the materials.

Calcium silicate-based cements and functional impacts of various constituents

Calcium silicate-based cements have superior sealing ability, bioactivity, and marginal adaptation, which make them suitable for different dental treatment applications. However, they exhibit some drawbacks such as long setting time and poor handling characteristics. To overcome these limitations calcium silicates are engineered with various constituents to improve specific characteristics of the base material, and are the focus of this review. An electronic search of the PubMed, MEDLINE, and EMBASE via OVID databases using appropriate terms and keywords related to the use, application, and properties of calcium silicate-based cements was conducted. Two independent reviewers obtained and analyzed the full texts of the selected articles. Although the effects of various constituents and additives to the base Portland cement-like materials have been investigated, there is no one particular ingredient that stands out as being most important. Applying nanotechnology and new synthesis methods for powders most positively affected the cement properties.

Evaluation of the Ca ion release, pH and surface apatite formation of a prototype tricalcium silicate cement

AIM

To evaluate the Ca²⁺ -releasing, alkalizing and apatite-like surface precipitate-forming abilities of a prototype tricalcium silicate cement, which was mainly composed of synthetically prepared tricalcium silicate and zirconium oxide radiopacifier.

METHODOLOGY

The prototype tricalcium silicate cement, white ProRoot MTA (WMTA) and TheraCal LC (a light-cured resin-modified calcium silicate-filled material) were examined. The chemical compositions were analysed with a wavelength-dispersive X-ray spectroscopy electron probe microanalyser with an image observation function (SEM-EPMA). The pH and Ca²⁺ concentrations of water in which the set materials had been immersed were measured, and the latter was assessed with the EDTA titration method. The surface precipitates formed on the materials immersed in phosphate-buffered saline (PBS) were analysed with SEM-EPMA and X-ray diffraction (XRD). Kruskal-Wallis tests followed by Mann-Whitney U-test with Bonferroni correction were used for statistical analysis (α = 0.05).

RESULTS

The prototype cement contained Ca, Si and Zr as major elemental constituents, whereas it did not contain some metal elements that were detected in the other materials. The Ca²⁺ concentrations and pH of the immersion water samples exhibited the following order: WMTA = prototype cement > TheraCal LC (P < 0.05). All three materials produced Ca- and P-containing surface precipitates after PBS immersion, and the precipitates produced by TheraCal LC displayed lower Ca/P ratios than those formed by the other materials. XRD peaks corresponding to hydroxyapatite were detected in the precipitates produced by the prototype cement and WMTA.

CONCLUSION

The prototype tricalcium silicate cement exhibited similar Ca²⁺ -releasing, alkalizing and apatite-like precipitate-forming abilities to WMTA. The Ca²⁺ -releasing, alkalizing and apatite-like precipitate-forming abilities of TheraCal LC were lower than those of the other materials.

Effect of addition of nano-hydroxyapatite on physico-chemical and antibiofilm properties of calcium silicate cements

Objective

Mineral Trioxide Aggregate (MTA) is a calcium silicate cement composed of Portland cement (PC) and bismuth oxide. Hydroxyapatite has been incorporated to enhance mechanical and biological properties of dental materials. This study evaluated physicochemical and mechanical properties and antibiofilm activity of MTA and PC associated with zirconium oxide (ZrO₂) and hydroxyapatite nanoparticles (HAn).

Material and Methods

White MTA (Angelus, Brazil); PC (70%)+ZrO₂ (30%); PC (60%)+ZrO₂ (30%)+HAn (10%); PC (50%)+ZrO₂ (30%)+HAn (20%) were evaluated. The pH was assessed by a digital pH-meter and solubility by mass loss. Setting time was evaluated by using Gilmore needles. Compressive strength was analyzed by mechanical test. Samples were radiographed alongside an aluminum step wedge to evaluate radiopacity. For the antibiofilm evaluation, materials were placed in direct contact with E. faecalis biofilm induced on dentine blocks. The number of colony-forming units (CFU mL-1) in the remaining biolfilm was evaluated. The results were submitted to ANOVA and the Tukey test, with 5% significance.

Results

There was no difference in pH levels of PC+ZrO₂, PC+ZrO₂+HAn (10%) and PC+ZrO₂+HAn (20%) (p>0.05) and these cements presented higher pH levels than MTA (p<0.05). The highest solubility was observed in PC+ZrO₂+HAn (10%) and PC+ZrO₂+HAn (20%) (p<0.05). MTA had the shortest initial setting time (p<0.05). All the materials showed radiopacity higher than 3 mmAl. PC+ZrO₂ and MTA had the highest compressive strength (p<0.05). Materials did not completely neutralize the bacterial biofilm, but the association with HAn provided greater bacterial reduction than MTA and PC+ZrO₂ (p<0.05) after the post-manipulation period of 2 days.

Conclusions

The addition of HAn to PC associated with ZrO₂ harmed the compressive strength and solubility. On the other hand, HAn did not change the pH and the initial setting time, but improved the radiopacity (HAn 10%), the final setting time and the E. faecalis antibiofilm activity of the cement.

Modified tricalcium silicate cement formulations with added zirconium oxide

OBJECTIVES

This study aims to investigate the effect of modifying tricalcium silicate (TCS) cements on three key properties by adding ZrO₂.

MATERIALS AND METHODS

TCS powders were prepared by adding ZrO₂ at six different concentrations. The powders were mixed with 1 M CaCl₂ solution at a 3:1 weight ratio. Biodentine (contains 5 wt.% ZrO₂) served as control. To evaluate the potential effect on mechanical properties, the mini-fracture toughness (mini-FT) was measured. Regarding bioactivity, Ca release was assessed using ICP-AES. The component distribution within the cement matrix was evaluated by Feg-SEM/EPMA. Cytotoxicity was assessed using an XTT assay.

RESULTS

Adding ZrO₂ to TCS did not alter the mini-FT (p = 0.52), which remained in range of that of Biodentine (p = 0.31). Ca release from TSC cements was slightly lower than that from Biodentine at 1 day (p > 0.05). After 1 week, Ca release from TCS 30 and TCS 50 increased to a level that was significantly higher than that from Biodentine (p < 0.05). After 1 month, Ca release all decreased (p < 0.05), yet TCS 0 and TCS 50 released comparable amounts of Ca as at 1 day (p > 0.05). EPMA revealed a more even distribution of ZrO₂ within the TCS cements. Particles with an un-reacted core were surrounded by a hydration zone. The 24-, 48-, and 72-h extracts of TCS 50 were the least cytotoxic.

CONCLUSIONS

ZrO₂ can be added to TCS without affecting the mini-FT; Ca release was reduced initially, to reach a prolonged release thereafter; adding ZrO₂ made TCS cements more biocompatible.

CLINICAL RELEVANCE

TCS 50 is a promising cement formulation to serve as a biocompatible hydraulic calcium silicate cement.

Bioactivity of MTA Plus, Biodentine and an experimental calcium silicate-based cement on human osteoblast-like cells

AIM

To compare the bioactivity of Biodentine (BIO, Septodont), MTA Plus (MTA P, Avalon) and calcium silicate experimental cement (CSC) with resin (CSCR) associated with zirconium (CSCR ZrO₂ ) or niobium (CSCR Nb₂ O₅ ) oxide as radiopacifiers.

METHODOLOGY

According to the relevance of osteoblastic cell response for mineralized tissue repair, human osteoblastic cells (Saos-2) were exposed to test materials and assessed for viability (MTT), cell proliferation, gene expression of alkaline phosphatase (ALP) osteogenic marker by real-time PCR (RT-qPCR), ALP activity assay and alizarin red staining (ARS) to detect mineralization nodule deposition in osteogenic medium. Unexposed cells acted as the control group (C). Statistical analysis was carried out using ANOVA and the Bonferroni post-test (P < 0.05).

RESULTS

All tested cements showed dose-dependent responses in cell viability (MTT). Exposed cells revealed good viability (80-130% compared to the control group) in the highest dilutions of all types of cement. MTA P, BIO and CSCR ZrO₂ significantly increased the velocity of cell proliferation after three days of cell exposure in the wound-healing assay (P < 0.05), which corroborated MTT data. On day 3, the ALP transcript level increased, especially to CSCR Nb₂ O₅ (P < 0.05). All cements exhibited suitable ALP enzyme activity, highlighting the 7-day period of cell exposure. ARS, CSCR Nb₂ O₅ , revealed a significant potential to induce mineralization in vitro.

CONCLUSIONS

All materials had suitable biocompatibility and bioactivity. The MTA P, BIO and CSCR ZrO₂ groups had the highest viability rates and velocity of proliferation whilst the CSCR Nb₂ O₅ group produced more mineralized nodules.

Physical and Chemical Properties and Subcutaneous Implantation of Mineral Trioxide Aggregate Mixed with Propylene Glycol

INTRODUCTION

The aim of this study was to evaluate the physical, chemical, and biological properties of mineral trioxide aggregate (MTA) mixed with 80% distilled water and 20% propylene glycol (PG) compared with MTA mixed with distilled water only.

METHODS

Flowability, film thickness, and solubility were analyzed according to American National Standards Institute/American Dental Association specification 57/2000. Initial and final setting times were assessed according to American Society for Testing and Materials specification C266/08. Porosity was assessed by using mercury intrusion porosimetry after 1 and 28 days of hydration, and the pH and calcium ion release were assessed after 3, 24, 72, and 168 hours. For the tissue reaction, the cements were implanted in 24 albino rats (2 groups, n = 12). An analysis of the inflammatory infiltrate was performed after 15, 30, and 60 days.

RESULTS

MTA + PG exhibited lower film thickness and higher final setting time. No differences were verified for flowability (P > .05). MTA + PG showed high porosity at 1 day of hydration (P < .05). All the test cements demonstrated an alkaline pH. Microscopic analysis of the specimens revealed neoformation of connective tissue in contact with the cements.

CONCLUSIONS

The introduction of PG as a mixing vehicle alters the physical and chemical properties of MTA and is biologically acceptable.

Experimental Calcium Silicate-Based Cement with and without Zirconium Oxide Modulates Fibroblasts Viability

The aim of this study was to verify whether the use of zirconium oxide as a radiopacifier of an experimental calcium silicate-based cement (WPCZO) leads to cytotoxicity. Fibroblasts were treated with different concentrations (10 mg/mL, 1 mg/mL, and 0.1 mg/mL) of the cements diluted in Dulbecco's modified Eagle's medium (DMEM) for periods of 12, 24, and 48 h. Groups tested were white Portland cement (WPC), white Portland cement with zirconium oxide (WPCZO), and white mineral trioxide aggregate Angelus (MTA). Control group cells were not treated. The cytotoxicity was evaluated through mitochondrial-activity (MTT) and cell-density (crystal violet) assays. All cements showed low cytotoxicity. In general, at the concentration of 10 mg/mL there was an increase in viability of those groups treated with WPC and WPCZO when compared to the control group (p<0.05). A similar profile for the absorbance values was noted among the groups: 10 mg/mL presented an increase in viability compared to the control group. On the other hand, smaller concentrations presented a similar or lower viability compared to the control group, in general. A new dental material composed of calcium silicate-based cement with 20% zirconium oxide as the radiopacifier showed low cytotoxicity as a promising material to be exploited for root-end filling.

Effects of a discoloration-resistant calcium aluminosilicate cement on the viability and proliferation of undifferentiated human dental pulp stem cells

Discoloration-resistant calcium aluminosilicate cement has been formulated to overcome the timely problem of tooth discoloration reported in the clinical application of bismuth oxide-containing hydraulic cements. The present study examined the effects of this experimental cement (Quick-Set2) on the viability and proliferation of human dental pulp stem cells (hDPSCs) by comparing the cellular responses with commercially available calcium silicate cement (white mineral trioxide aggregate; WMTA) after different aging periods. Cell viability and proliferation were examined using assays that examined plasma membrane integrity, leakage of cytosolic enzyme, caspase-3 activity for early apoptosis, oxidative stress, mitochondrial metabolic activity and intracellular DNA content. Results of the six assays indicated that both Quick-Set2 and WMTA were initially cytotoxic to hDPSCs after setting for 24 h, with Quick-Set2 being comparatively less cytotoxic than WMTA at this stage. After two aging cycles, the cytotoxicity profiles of the two hydraulic cements were not significantly different and were much less cytotoxic than the positive control (zinc oxide-eugenol cement). Based on these results, it is envisaged that any potential beneficial effect of the discoloration-resistant calcium aluminosilicate cement on osteogenesis by differentiated hDPSCs is more likely to be revealed after outward diffusion and removal of its cytotoxic components.

Pulp tissue response to Portland cement associated with different radio pacifying agents on pulpotomy of human primary molars

The objective of this research was to evaluate the response of Portland cement associated with different radio pacifying agents on pulp treatment of human primary teeth by clinical and radiographic exams and microscopic analysis. Thirty mandibular primary molars were randomly divided into the following groups: Group I - Portland cement; Group II - Portland cement with iodoform (Portland cement + CHI3 ); Group III - Portland cement with zirconium oxide (Portland cement + ZrO2 ); and treated by pulpotomy technique (removal of a portion of the pulp aiming to maintain the vitally of the remaining radicular pulp tissue using a therapeutic dressing). Clinical and radiographic evaluations were recorded at 6, 12 and 24 months follow-up. The teeth at the regular exfoliation period were extracted and processed for histological analysis. Data were tested using statistical analysis with a significance level of 5%. The microscopic findings were descriptively analysed. All treated teeth were clinically and radiographically successful at follow-up appointments. The microscopic analysis revealed positive response to pulp repair with hard tissue barrier formation and pulp calcification in the remaining roots of all available teeth. The findings of this study suggest that primary teeth pulp tissue exhibited satisfactory biological response to Portland cement associated with radio pacifying agents. However, further studies with long-term follow-up are needed to determine the safe clinical indication of this alternative material for pulp therapy of primary teeth.

Tooth discoloration induced by calcium-silicate-based pulp-capping materials

Objectives:

The aim of this study was to evaluate tooth discoloration induced by contact with various calcium silicate-based pulp capping materials in the presence or absence of blood in vitro.

Materials and Methods:

Eighty bovine samples were divided into six experimental groups and two control groups according to the type of material used (ProRoot [PR], Endocem [EC], or EndocemZr [ECZ]) and the presence or absence of contamination with blood. A spectrophotometer was used to calculate the color difference (ΔE) between the baseline measurement (after placement of materials) and measurements taken 1, 2, 4, and 8 weeks. The results were analyzed with repeated measures analysis of variance, Tukey's post-hoc tests and independent t-tests (P = 0.05).

Results:

The PR group and EC group showed significantly higher mean values of ΔE than the negative control group after 2 weeks (P < 0.05), whereas ECZ did not. There were larger ΔE values when there was contact with blood, especially in PR and EC group (P < 0.05).

Conclusions:

ECZ which contains zirconium oxide as a radiopacifier showed less discoloration irrespective of blood contamination compared to PR and EC.

Odontogenic effects of a fast-setting calcium-silicate cement containing zirconium oxide

A fast-setting calcium-silicate cement (Endocem) was introduced in the field of dentistry for use in vital pulp therapy. Similar to mineral trioxide aggregate (MTA), it contains bismuth oxide to provide radiopacity. Recently, another product, EndocemZr, which contains zirconium oxide (ZrO2) as a radiopacifier, was developed by the same company. In this study, the biological/odontogenic effects of EndocemZr were investigated in human primary dental pulp cells (hpDPCs) in vitro and on capped rat teeth in vivo. The biocompatibility of EndocemZr was similar to that of ProRoot and Endocem on the basis of cell viability tests and cell morphological analysis. The mineralization nodule formation, expression of odontogenic-related markers, and reparative dentin formation of EndocemZr group was similar to those of other material groups. Our results suggest that EndocemZr has the potential to be used as an effective material for vital pulp therapy, similar to ProRoot and Endocem.

Clinical and radiographic evaluation of Portland cement added to radiopacifying agents in primary molar pulpotomies

AIM

This was to evaluate the clinical and radiographic outcomes of Portland cement (PC) added to radiopacifying agents in primary molar pulpotomies.

METHODS

Thirty primary mandibular molars of children aged between 5 and 9 years were randomly assigned to the following groups: PC; PC with iodoform (PC + CHI(3)); PC with zirconium oxide (PC + ZrO(2)) and treated by pulpotomy technique. Clinical and radiographic follow-up assessments were performed at 6, 12 and 24 months. Statistical analysis was performed by Fisher's exact test (P < 0.05).

RESULTS

The clinical and radiographic evaluations showed 100 % success rates, and the results showed no statistically significant difference between groups.

CONCLUSIONS

According to this study, PC added to radiopacifying agents exhibited satisfactory clinical and radiographic results in primary molar pulpotomies.

Calcium Silicate-Based Cements Associated with Micro- and Nanoparticle Radiopacifiers: Physicochemical Properties and Bioactivity

Objective. The aim of this study was to evaluate the physicochemical properties and bioactivity of two formulations of calcium silicate-based cements containing additives (CSCM) or resin (CSCR), associated with radiopacifying agents zirconium oxide (ZrO2) and niobium oxide (Nb2O5) as micro- and nanoparticles; calcium tungstate (CaWO4); and bismuth oxide (Bi2O3). MTA Angelus was used as control. Methods. Surface features and bioactivity were evaluated by scanning electron microscopy and the chemical composition by energy dispersive X-ray spectrometry (EDS-X). Results. CSCM and CSCR presented larger particle sizes than MTA. Hydroxyapatite deposits were found on the surface of some materials, especially when associated with the radiopacifier with ZrO2 nanoparticles. All the cements presented calcium, silicon, and aluminum in their composition. Conclusion. Both calcium silicate-based cements presented composition and bioactivity similar to MTA when associated with the radiopacifiers evaluated.

Analysis of metal contents in Portland Type V and MTA-based cements

The aim of this study was to determine, by Atomic Absorption Spectrometry (AAS), the concentration levels of 11 metals in Type V gray and structural white PC, ProRoot MTA, and MTA Bio. Samples, containing one gram of each tested cement, were prepared and transferred to a 100 mL Teflon tube with a mixture of 7.0 mL of nitric acid and 21 mL of hydrochloric acid. After the reaction, the mixture was filtered and then volumed to 50 mL of distilled water. For each metal, specific patterns were determined from universal standards. Arsenic quantification was performed by hydride generator. The analysis was performed five times and the data were statistically analyzed at 5% level of significance. Only the cadmium presented concentration levels of values lower than the quantification limit of the device. The AAS analysis showed increased levels of calcium, nickel, and zinc in structural white PC. Type V PC presented the greatest concentration levels of arsenic, chromium, copper, iron, lead, and manganese (P < 0.05). Bismuth was found in all cements, and the lowest concentration levels were observed in Portland cements, while the highest were observed in ProRoot MTA. Both PC and MTA-based cements showed evidence of metals inclusion.

Effect of zirconium oxide and zinc oxide nanoparticles on physicochemical properties and antibiofilm activity of a calcium silicate-based material

The aim of the present study was to evaluate the antibiofilm activity against Enterococcus faecalis, compressive strength. and radiopacity of Portland cement (PC) added to zirconium oxide (ZrO₂), as radiopacifier, with or without nanoparticulated zinc oxide (ZnO). The following experimental materials were evaluated: PC, PC + ZrO₂, PC + ZrO₂ + ZnO (5%), and PC + ZrO₂ + ZnO (10%). Antibiofilm activity was analyzed by using direct contact test (DCT) on Enterococcus faecalis biofilm, for 5 h or 15 h. The analysis was conducted by using the number of colony-forming units (CFU/mL). The compressive strength was performed in a mechanical testing machine. For the radiopacity tests, the specimens were radiographed together with an aluminium stepwedge. The results were submitted to ANOVA and Tukey tests, with level of significance at 5%. The results showed that all materials presented similar antibiofilm activity (P > 0.05). The addition of nanoparticulated ZnO decreased the compressive strength of PC. All materials presented higher radiopacity than pure PC. It can be concluded that the addition of ZrO₂ and ZnO does not interfere with the antibiofilm activity and provides radiopacity to Portland cement. However, the presence of ZnO (5% or 10%) significantly decreased the compressive strength of the materials.