Mineral Trioxide Aggregate as Repair Material for Furcal Perforation: Case Series

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report

BACKGROUND

This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.

METHODS

Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.

RESULTS

At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period.

CONCLUSIONS

The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.

KEY POINTS

Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

From Crisis to Victory: Rescuing Root Canal Treatment With Bioactive Material in a Nail-Biting Case of Furcal Perforation

This case report illustrates the successful treatment of an iatrogenic furcal perforation using mineral trioxide aggregate (MTA) and its reinforcement with fiber-reinforced composites (FRCs). Endodontic perforations, particularly in the furcal area, present unique challenges that demand effective management strategies. MTA, known for its multifaceted properties including osteoinductive activity and sealing capabilities, has emerged as the gold standard material for perforation repair. This case report demonstrates the application of MTA in repairing the perforation site following thorough cleaning and shaping of the root canals. Furthermore, the use of FRCs, specifically glass fiber-reinforced composite (GFRC), is introduced to reinforce the repaired site, enhancing its mechanical properties and long-term stability. The discussion emphasizes the importance of selecting appropriate materials for endodontic perforation repair and highlights the advantages of FRCs in preventing structural failures. Future directions suggest further research to refine FRC formulations and standardize clinical protocols to maximize treatment outcomes. This case report contributes valuable insights to the advancement of endodontic therapy, showcasing the combined benefits of MTA and FRCs in achieving favorable treatment outcomes for iatrogenic furcal perforations.

7.5- to 11.5-Year Follow-up of the Fracture Removal Treatment for Propagated Crown Fractures

A definitive method to predictably treat propagated longitudinal fractures remains elusive. A proof-of-concept case report series documenting nonsurgical removal of propagated longitudinal fractures has shown up to 5 years of clinical and radiographic success. This installment of the case report series further documents these teeth with 7.5-year to 11.5-year recall evaluations. Three previously reported cases of fracture removal were followed at 11.5 years (1 case), 9.75 years (1 case), and 7.5 years (1 case) after treatment to determine the long-term clinical and radiographic success of nonsurgical fracture removal. This case report series has demonstrated 10-year success (clinically and radiographically) for the treatment of progressive longitudinal fractures. Propagated fractures can be nonsurgically removed and the iatrogenic defect repaired with long-term success providing a foundation for treatment and further investigation.

Efficacy of Mineral Trioxide Aggregate (MTA) as a Reparative Material in Iatrogenic Furcal Perforations in Mandibular Molars

BACKGROUND/OBJECTIVES

 Mineral trioxide aggregate (MTA) is widely recognized as one of the most biocompatible materials for perforation repairs during root canal treatment (RCT). Experimental evidence has consistently demonstrated MTA's superior sealing ability and biocompatibility compared to various dental materials, including amalgam, intermediate restorative material, zinc oxide eugenol cement, and resin-modified glass ionomer cement. This study aimed to assess the efficacy of MTA as a reparative material in iatrogenic furcal perforations during RCT.

MATERIALS & METHODS

A descriptive cross-sectional study was conducted from May 18, 2021, to November 17, 2021, at the Department of Operative Dentistry, Nishtar Institute of Dentistry, Multan, Pakistan. Seventy-six patients aged 18-60 years, of both genders, who developed iatrogenic furcal perforations during procedures were included. Patients with fractures or endo-perio lesions identified during clinical and radiographic examinations were excluded. Isolation was achieved using a rubber dam. The perforation site was cleaned and irrigated with 1% sodium hypochlorite to control hemorrhage and enhance visualization. Following the manufacturer's recommendations, the perforation site was sealed with MTA mixed with sterile saline.

RESULTS

The age range in this study was 18 to 60 years, with a mean age of 42.09 ± 9.69 years. Most patients (56.78%) were between 41-60 years old. Out of the 76 patients, 46 (60.53%) were male, and 30 (39.47%) were female, resulting in a male-to-female ratio of 1.5:1. The study found that MTA's efficacy as a reparative material in iatrogenic furcal perforations was observed in 61 (80.26%) patients. A 6-month follow-up revealed no periodontal ligament breakdown, demonstrating the efficacy of MTA as a reparative material in iatrogenic furcal perforations.

CONCLUSION

This study concludes that the efficacy of MTA as a reparative material in iatrogenic furcal perforations is remarkable and significant.

Clinical application of calcium silicate-based bioceramics in endodontics

Pulp treatment is extremely common in endodontics, with the main purpose of eliminating clinical symptoms and preserving tooth physiological function. However, the effect of dental pulp treatment is closely related to the methods and materials used in the process of treatment. Plenty of studies about calcium silicate-based bioceramics which are widely applied in various endodontic operations have been reported because of their significant biocompatibility and bioactivity. Although most of these materials have superior physical and chemical properties, the differences between them can also have an impact on the success rate of different clinical practices. Therefore, this review is focused on the applications of several common calcium silicate-based bioceramics, including Mineral trioxide aggregate (MTA), Biodentine, Bioaggregate, iRoot BP Plus in usual endodontic treatment, such as dental pulp capping, root perforation repair, regenerative endodontic procedures (REPs), apexification, root-end filling and root canal treatment (RCT). Besides, the efficacy of these bioceramics mentioned above in human trials is also compared, which aims to provide clinical guidance for their clinical application in endodontics.

Management of a Previously Failed Root Perforation Repair with Geristore and Deepithelialized Gingival Graft: A 5-Year Follow-Up Case Report

Iatrogenic root perforation presents a significant management challenge for clinicians as it may seriously harm the periodontium. More specifically, perforations occurring relative to the crestal bone have a poor prognosis even after repair due to their proximity to the gingival tissues. The current literature reports the use of various materials for root perforation repair including calcium hydroxide, glass ionomer cement, amalgam, and mineral trioxide aggregate (MTA), to name a few. This case report describes the clinical management of a cervical perforation that occurred on the maxillary central incisor. The perforated area was initially repaired with MTA but failed after one year, which resulted in an active lesion at the midlabial aspect of the tooth. The case was subsequently treated using a resin-modified glass ionomer cement (Geristore®) and deepithelialized free gingival graft (DGG). There were favorable clinical and radiographic outcomes at 1-, 3-, and 5-year follow-up. The use of DGG, however, led to some late complications such as gingival cul-de-sac and color discrepancy, which were later resolved with gingivoplasty and frenectomy. We thus conclude that Geristore® has the potential to be a better repair material than the existing ones for crestal and subcrestal root perforations.

Clinical applications of calcium silicate-based materials: a narrative review

Calcium silicate-based materials are hydrophilic materials with biocompatibility and bioactivity properties. Despite many advantages, they might present some problems related to discolouration, setting time, manipulation and solubility depending on the composition of the product and the type of clinical application. Calcium silicate-based materials can be evaluated under two types according to their intended use: calcium silicate-based cements (CSCs) and calcium silicate-based sealers (CSSs). CSCs can be used in many endodontic procedures including perforation repair, resorption repair, apical barriers, guided endodontic repair, vital pulp treatment, endodontic surgery, root fractures and root canal filling as a core obturation material. CSSs are available for use with gutta-percha to obturate root canals using cold and warm techniques, including the sealer-based obturation technique. The purpose of this review is to evaluate the available literature on CSCs and CSSs and to provide up-to-date information and recommendations for their clinical applications.

Outcomes of furcal perforation management using Mineral Trioxide Aggregate and Biodentine: a systematic review

Furcal perforation is an iatrogenic or pathologic communication between the pulp chamber floor and the alveolar bone. The outcome of perforation sealing depends greatly on the tissue compatibility and bioactivity and sealing properties of the repair materials. Mineral trioxide aggregate (MTA) and Biodentine are currently the most used materials to treat this condition. The present systematic review aimed to report the treatment outcome of repaired furcal perforation using MTA and Biodentine and identify which material would yield a better outcome.

METHODOLOGY

A comprehensive search was conducted using the PubMed database to identify experimental studies and case reports that describe treatment of furcal perforation. Studies and case reports that evaluated the outcome of repaired furcal perforations using MTA and Biodentine, published in English from 2018 to April 2022, were identified. Unavailable full texts were excluded.

RESULTS

Initial screening of 724 articles (670 studies and 54 case reports). After discarding the duplicated studies, we reviewed 50 studies, selecting 13 for abstract analysis. We retrieved and evaluated full texts of eight studies and five case reports. Both materials had an equivalent success rate in the first three months but by 12 months Biodentine performed better than MTA clinically and radiographically.

CONCLUSIONS

Repair of furcal perforation with Biodentine yields a better outcome compared to MTA.

Antimicrobial Activity of Calcium Silicate-Based Dental Materials: A Literature Review

Endodontic biomaterials have significantly improved dental treatment techniques in several aspects now that they can be used for vital pulp treatments, as temporary intracanal medication, in definitive fillings, in apical surgeries, and for regenerative procedures. Calcium silicate-based cement is a class of dental material that is used in endodontics in direct contact with the dental structures, connective tissue, and bone. Because the material interacts with biological tissues and stimulates biomineralization processes, its properties are of major importance. The main challenge in endodontic treatments is the elimination of biofilms that are present in the root canal system anatomical complexities, as it remains even after chemical-mechanical preparation and disinfection procedures. Thus, an additional challenge for these biomaterials is to exert antimicrobial activity while maintaining their biological properties in parallel. This article reviews the literature for studies considering the antimicrobial properties of calcium silicate-based dental biomaterials used in endodontic practice. Considering the reviewed studies, it can be affirmed that the reduced antimicrobial effect exhibited by calcium silicate-based endodontic materials clearly emphasizes that all clinical procedures prior to their use must be carefully performed. Future studies for the evaluation of these materials, and especially newly proposed materials, under poly-microbial biofilms associated with endodontic diseases will be necessary.

Effect of pulpal floor perforation repair on biomechanical response of mandibular molar: A finite element analysis

Background:

Evaluation of the biomechanical response of tooth with perforation repair is important to attain predictable prognosis. It may remain altered even after perforation repair due to the loss of tooth structure.

Aim:

The aim of this study is to assess and compare the effect of pulpal floor perforation repair of different sites with biodentine, on the biomechanical response of mandibular molar through 3-dimensional (3D) finite element analysis (FEA).

Materials and Methods:

Five different 3D models were constructed based on the site of perforation on the pulpal floor using cone-beam computed tomographic images of an extracted mandibular molar. Perforation size was standardized and simulated to be repaired with calcium silicate-based cement. A force of 200 N was applied simulating normal occlusal loads. Static linear FEA was performed using the Ansys FEA software. Tensile stresses were evaluated (P_max).

Statistical Analysis Used:

The data were evaluated using the independent t-test (P = 0.05).

Results:

All the simulated models with perforation repair exhibited higher stress values than their equivalent sites in the control group. The P_max values of the repaired models were highest in central furcal perforation, followed by buccal furcal perforation. However, there was no statistically significant difference in the stress accumulation among the different repaired perforation sites.

Conclusion:

The site of the pulpal floor perforation affected the stress distribution and accumulation. Central and buccal furcal perforation repairs on the pulpal floor with calcium silicate-based cement in mandibular molar are likely to have an increased risk of fracture.

Formative feedback generation in a VR-based dental surgical skill training simulator

Fine motor skill is indispensable for a dentist. As in many other medical fields of study, the traditional surgical master-apprentice model is widely adopted in dental education. Recently, virtual reality (VR) simulators have been employed as supplementary components to the traditional skill-training curriculum, and numerous dental VR systems have been developed academically and commercially. However, the full promise of such systems has yet to be realized due to the lack of sufficient support for formative feedback. Without such a mechanism, evaluation still demands dedicated time of experts in scarce supply. To fill the gap of formative assessment using VR simulators in skill training in dentistry, we present a framework to objectively assess the surgical skill and generate formative feedback automatically. VR simulators enable collecting detailed data on relevant metrics throughout a procedure. Our approach to formative feedback is to correlate procedure metrics with the procedure outcome to identify the portions of a procedure that need to be improved. Specifically, for the errors in the outcome, the responsible portions of the procedure are identified by using the location of the error. Tutoring formative feedback is provided using the video modality. The effectiveness of the feedback system is evaluated with dental students using randomized controlled trials. The findings show the feedback mechanisms to be effective and to have the potential to be used as valuable supplemental training resources.

The Response of the Pulp-Dentine Complex, PDL, and Bone to Three Calcium Silicate-Based Cements: A Histological Study in an Animal Rat Model

Objective

The aim of this study was to histologically examine the tissue reaction of three different calcium silicate cements in the closure of perforations in rat incisor teeth. Material and Methods. An experimental lateral root perforation with pulp exposure was performed in 32 lower incisors of 16 male Wistar albino rats. They were randomly assigned into three test groups (each including eight teeth) that were filled either by Biodentine (BD) or MicroMega mineral trioxide aggregate (MM-MTA) or EndoSequence root repair material putty (ESRRM putty), besides eight unperforated incisors from the other four rats (control group). The inflammatory response and healing process were evaluated histologically and scored after one and four weeks. Differences among groups were tested by Kruskal-Wallis tests at P ≤ 0.05.

Results

In the first week, BD produced more inflammatory response in the pulpal (score 3) than other materials (score 2). Only ESRRM putty showed odontoblast-like cells in 50%, 25% dentine-like deposit, 25% evidence of bone deposition in the drilling site (score 2), and minimum periodontal ligament (PDL) necrosis and disorganization (25%, score 2). After one month, all groups had healthy pulpal tissue, but 25% of ESRRM putty retained score 1 inflammatory response, and 50% of the BD case had an incomplete palisading odontoblast layer (score 3). A thick and regular dentine bridge deposition was seen in the ESRRM putty group in comparison with MM-MTA and BD cases. The cortical plate healing in all ESRRM putty samples was complete (score 3), while an incomplete closure was seen in MM-MTA and BD groups (score 2). Both the MM-MTA and ESRRM putty groups had fully organized PDL (score 2), while in 50% of BD cases, a necrotizing area and disorganized PDL with inflammatory cells infiltration were still present. Statistically significant differences in the scores of any histologic parameters among the three tested materials were observed neither in the 1st nor in the 4th weeks of the experimental period.

Conclusion

Better tissue compatibility and repair of pulpal and periodontal tissue have been detected after lateral perforation in the root of rat incisors when treated with ESRRM putty than MM-MTA and BD. However, the difference was not significant.

A review of the literature on the efficacy of mineral trioxide aggregate in conservative dentistry

The aim of this literature review was to assess the clinical performance of MTA to establish the evidence level for its effectiveness in vital pulp therapy, perforation repair, and retrograde root canal filling. A comprehensive literature survey was performed via electronic databases of PubMed/MEDLINE. A total of 58 papers were reviewed in this study, of which 2 were systematic reviews/meta-analysis, 9 were randomized controlled trials (RCTs), and the rest were fallen into other categories. Mineral trioxide aggregate (MTA) provided better pulp protection as a direct capping material when compared with calcium hydroxide. As perforation repair materials, MTA demonstrated an excellent sealing ability in vitro. For periodontal tissues around a perforation, MTA provided normal healing processes in clinical trials. It is therefore concluded that MTA has a high potential in repairing perforations. MTA is the most promising material when used for retrograde root canal filling demonstrating normal healing in short/long term clinical outcomes.

Periradicular inflammatory response, bone resorption, and cementum repair after sealing of furcation perforation with mineral trioxide aggregate (MTA Angelus™) or Biodentine™

OBJECTIVE

This study assessed tissue responses after furcation perforation and immediate sealing with either Biodentine™ or MTA Angelus™.

MATERIAL AND METHODS

Sixty male Wistar rats were used (n = 6 per group/period). The mandibular first molars had the furcation mechanically exposed and sealed with either MTA or Biodentine™ and restored with silver amalgam. In an additional test group, teeth were sealed only with Biodentine™. Furcation sealing with gutta-percha and silver amalgam restoration served as positive control, and healthy untreated teeth were the negative control. Histological evaluation was performed after 14 or 21 days. Kruskal-Wallis and Dunn's post hoc tests were performed to analyze the extent and intensity of tissue inflammation, bone resorption, and cementum repair (p < 0.05).

RESULTS

Biodentine™ and MTA presented satisfactory results, showing a milder inflammatory response when compared to the control, regardless of the material used for coronal sealing and of the experimental period evaluated (p < 0.0001). All test groups showed less bone resorption than the positive control after 21 days (p < 0.05), and such differences were more pronounced in teeth restored with silver amalgam. Cementum repair was performed in 30% of MTA and Biodentine™ samples but not carried out in any positive control specimen.

CONCLUSIONS

Biodentine™ and MTA promoted similar responses when used to seal furcation perforations and should therefore be regarded as a promising alternative.

CLINICAL RELEVANCE

Knowledge about tissue responses to restorative materials is essential for improving root perforation sealing protocols. The present results showed that both Biodentine™ and MTA promoted appropriate periradicular tissue reactions in a preclinical test for evaluating furcation perforation treatments.

Periodontal healing following non-surgical repair of an old perforation with pocket formation and oral communication

Iatrogenic perforations negatively impact the outcome of endodontic treatments. Studies on prognostic factors showed that perforations in the coronal third of the root with periodontal pocket formation have an unfavorable prognosis. A 36-year-old female was referred for endodontic evaluation of tooth #13 with a history of an iatrogenic perforation, happened 3 years ago. There was a sinus tract associated with perforation, 10 mm probing on the mesial and mesio-palatal, bleeding on probing, radiolucent lesion adjacent to the perforation and complete resorption of the interdental bone between teeth #13 and #12. After the treatment options were discussed, she chose to save the tooth. The tooth was accessed under rubber dam isolation, the perforation site was cleaned and disinfected using 0.5% sodium hypochlorite and sealed with calcium-enriched mixture cement. Eighteen months after treatment the tooth was functional and asymptomatic. The probing depths were normal without bleeding on probing. Radiographically, the interdental crestal bone formed between teeth #13 and #12. Despite all negative prognostic factors in this case (i.e., perforations in the coronal third, pocket formation, and radiolucent lesion), healing was unexpectedly achieved via non-surgical repair of the perforation. Further research on biological aspects of healing in the periodontium following iatrogenic perforations are recommended.

A New Biphasic Dicalcium Silicate Bone Cement Implant

This study aimed to investigate the processing parameters and biocompatibility of a novel biphasic dicalcium silicate (C₂S) cement. Biphasic α´_L + β-C₂S_ss was synthesized by solid-state processing, and was used as a raw material to prepare the cement. In vitro bioactivity and biocompatibility studies were assessed by soaking the cement samples in simulated body fluid (SBF) and human adipose stem cell cultures. Two critical-sized defects of 6 mm Ø were created in 15 NZ tibias. A porous cement made of the high temperature forms of C₂S, with a low phosphorous substitution level, was produced. An apatite-like layer covered the cement’s surface after soaking in SBF. The cell attachment test showed that α´_L + β-C₂S_ss supported cells sticking and spreading after 24 h of culture. The cement paste (55.86 ± 0.23) obtained higher bone-to-implant contact (BIC) percentage values (better quality, closer contact) in the histomorphometric analysis, and defect closure was significant compared to the control group (plastic). The residual material volume of the porous cement was 35.42 ± 2.08% of the initial value. The highest BIC and bone formation percentages were obtained on day 60. These results suggest that the cement paste is advantageous for initial bone regeneration.

Effect of Laser-Activated Irrigation on the Push-Out Bond Strength of ProRoot Mineral Trioxide Aggregate and Biodentine in Furcal Perforations

OBJECTIVE

The objective of the present study was to assess the effect of erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser-activated irrigation (LAI) of NaOCl on the push-out bond strength of furcal perforations repaired with ProRoot mineral trioxide aggregate (MTA) and Biodentine.

BACKGROUND DATA

Several studies investigated the adhesion of calcium silicate-based cements after exposure to endodontic irrigants, while effect of LAI on bond strength remains to be elucidated.

MATERIALS AND METHODS

Bur-cut furcal perforations with standard dimensions were created in 100 extracted human mandibular molars. Teeth were randomly distributed into two groups (n = 50/group) according to the repair material applied: (1) ProRoot MTA or (2) Biodentine. The specimens were further assigned into five subgroups according to the irrigation regimens used over the set materials: (a) distilled water with needle irrigation; (b) 5.25% NaOCl with needle irrigation; (c) distilled water with LAI; (d) 5.25% NaOCl with LAI; and (e) no irrigation (control). Bond strengths of the test materials were assessed by using push-out bond strength test.

RESULTS

Biodentine showed significantly higher dislocation resistance than ProRoot MTA (p < 0.05). Laser activation of 5.25% NaOCl and distilled water did not significantly affect the push-out bond strength results (p > 0.05).

CONCLUSIONS

Biodentine showed higher dislocation resistance than ProRoot MTA as a perforation repair material. Er,Cr:YSGG laser activation of irrigation aqueous solutions had no adverse effect on push-out bond strength of Biodentine and ProRoot MTA.

Radicular Perforation Repair with Mineral Trioxide Aggregate: A Case Report with 10-Year Follow-up

Background:

Iatrogenic complications such as accidental perforation of the root or the floor of the pulp chamber may occur.

Case Report:

Patient was referred for root canal retreatment of the mandibular left second molar with periapical lesion evidenced through radiographic examination. During post removal, iatrogenic perforation occurred at the mesial face of the distal root. After clinical localization of the perforation and bleeding control, MTA was applied. In a second appointment, the root canal filling was removed and the chemical-surgical retreatment of the canals was performed, followed by the obturation with gutta-percha and sealer. Patient returned after three days reporting no pain. After 6 months, 3, 7 and 10 years of follow-up.

Conclusion:

Absence of pain, normal periodontal probing and lack of radiolucent area at the region of perforation and the periapices were detected, which evidenced the successful repair of the tooth.

Histologic tissue response to furcation perforation repair using mineral trioxide aggregate or dental pulp stem cells loaded onto treated dentin matrix or tricalcium phosphate

Objectives

The aim of this study is to compare the effect of treated dentine matrix (TDM) and tricalcium phosphate (TCP) scaffolds on odontogenic differentiation and mineralization of dental pulp stem cells (DPSCs) in furcation perforations created in the pulp chamber floor of premolar teeth in dogs.

Material and methods

DPSCs were isolated and cultured from the dental pulp of the maxillary left second and third premolars of dogs. The DPSCs were loaded on TCP (SC+TCP) and TDM (SC+TDM) scaffolds and inserted into intentionally perforated pulp chamber floors of premolars in dogs; six teeth were used for each group. Three more groups of six specimens were created, and mineral trioxide aggregate (MTA), TDM, and TCP were inserted into the perforations to act as controls. An intact premolar and no treatment in the perforation site were used as positive and negative controls respectively. After 3 months, the animals were sacrificed and the type of inflammation, presence of dentine, continuation and type of cementum, type of connective tissue, and presence of foreign body reaction were evaluated, and significant differences were between groups determined using the Fisher’s exact test. The evaluation of the amount of inflammation and the percentage of new bone formation was evaluated using the Mann-Whitney U test.

Results

The negative control group was associated with severe inflammation and granulation tissue formation. In the positive control group, intact periodontal tissues and no inflammation were observed. Dentine bridge formation was not seen in specimens of any group. The specimens in the SC+TDM group were associated with significantly more bone formation than other groups (P < 0.001). The amount of inflammation was less than 10 % in specimens of all groups with the exception of three specimens in the TCP group that were categorized as 10–30 %. Chronic inflammation without foreign body reactions was the major pattern of inflammation in groups. Formation of cementum with a cellular and continuous appearance was seen in all specimens.

Conclusions

SC+TDM was associated with significantly more bone formation when used to repair uninfected furcation perforations in the premolar teeth of dogs.

Clinical relevance

Application of TDM as a biological scaffold in combination with DPSCs may offer an advantage during the repair of root perforation defects.

Efficacy of MTA and CEM Cement with Collagen Membranes for Treatment of Class II Furcation Defects

OBJECTIVES

This study aimed to compare the efficacy of MTA and CEM cement in Class II furcation defects in human mandibular molars.

MATERIALS AND METHODS

Forty furcation defects were treated in 16 patients with chronic periodontitis. The clinical parameters of probing depth (PD), vertical and horizontal clinical attachment levels (VCAL and HCAL), open vertical and horizontal furcation depths (OVFD and OHFD), and gingival margin level (GML) were measured at baseline and at 3- and 6-month (re-entry surgery) postoperatively. Data were analyzed at a significance level of P<0.05.

RESULTS

Use of MTA and CEM caused significant decreases in PD, VCAL, HCAL, OVFD and OHFD at re-entry, with no statistically significant differences between the two treatment options in soft and hard tissue parameters.

CONCLUSION

Both treatment modalities caused significant gains in attachment levels and bone fills, proving efficacy for treatment of Class II furcation involvements.

(α'(H))-Dicalcium silicate bone cement doped with tricalcium phosphate: characterization, bioactivity and biocompatibility

The influence of phosphorus doping on the properties of (α'(H))-dicalcium silicate (C(2)S) bone cement was analyzed, in addition to bioactivity and biocompatibility. All the cements were composed of a solid solution of TCP in C(2)S ([Formula: see text]-C(2)S(ss)) as the only phase present. The compressive strength ranged from 3.8-16.3 MPa. Final setting times ranged from 10 to 50 min and were lower for cements with lower L/P content. Calcium silicate hydrate was the principal phase formed during the hydration process of the cements. The cement exhibited a moderate degradation and could induce carbonated hydroxyapatite formation on its surface and into the pores. The cell attachment test showed that the (α'(H))-C(2)SiO(4) solid solution supported human adipose stem cells adhesion and spreading, and the cells established close contacts with the cement after 24 h of culture. The novel (α'(H))-C(2)S(ss) cements might be suitable for potential applications in the biomedical field, preferentially as materials for bone/dental repair.

Evaluation of coronal leakage and pathway of dye leakage after obturation with various materials for open apical foramina

The aim of this study was to investigate coronal leakage after obturation with mineral trioxide aggregate (MTA), resin-based sealer, and silicon-based sealer for open apical foramina and to evaluate pathway of leakage. Twenty-eight maxillary premolars were used, and instrumented to ISO size #80. Teeth were randomly divided into four groups as follows: Group A filled with MTA, Group B with gutta-percha and resin-based sealer, Group C with polymer-based material and resin-based sealer, and Group D with gutta-percha and silicon-based sealer. All samples were evaluated for coronal leakage with methylene blue solution and spectrophotometry. After leakage testing, samples were cut, and sections were observed. Dye leakage of Group A was significantly lowest among all groups at 15 days and 30 days. Defects which induced coronal leakage in resin-based sealer were observed at 7 mm from the apex. Coronal leakage after obturation with MTA for open apical foramina was significantly lower than resin-based sealer and silicon-based sealer.

Washout resistance of fast-setting pozzolan cement under various root canal irrigants

Objectives

Fast-setting pozzolan cement (Endocem, Maruchi) was recently developed. The aim of this study was to investigate the effects of various root canal irrigants on the washout of Endocem in comparison to the previously marketed mineral trioxide aggregate (ProRoot; Dentsply) in a furcal perforation model.

Materials and Methods

ProRoot and Endocem were placed into acrylic molds on moist Oasis. Each mold was then immediately exposed to either physiologic saline, 2.5% sodium hypochlorite (NaOCl), or 2% chlorhexidine (CHX) under gentle shaking for five minutes. Washout testing was performed by scoring scanning electron microscope (SEM) images.

Results

Endocem exhibited higher washout resistance compared to ProRoot, especially in the NaOCl group.

Conclusions

These results suggest that Endocem can be considered a useful repair material for furcal perforation, especially in a single-visit scenario.

Comparative evaluation of push-out bond strength of ProRoot MTA, Biodentine, and MTA Plus in furcation perforation repair

PURPOSE

Few studies have comparatively evaluated the push-out bond strength of different calcium silicate-based materials (CSMs) used in furcal perforation repair. The objective of this in vitro study was to comparatively evaluate the push-out bond strength of commercially available CSMs used as furcation repair materials, in the presence of blood contamination.

MATERIALS AND METHODS

Furcal perforations were made in 120 molars and were divided on the basis of the repair material used (ProRoot MTA, Biodentine, and MTA Plus), blood contamination, and duration of setting time (24 h vs. 7 days). Push-out bond strength was measured and analyzed by three-way analysis of variance (ANOVA) test.

RESULTS

Push-out bond strength increased with time. The 24-h push-out strength of MTA was less than that of Biodentine. Blood contamination affected the push-out bond strength of MTA Plus irrespective of the setting time.

CONCLUSION

Caution should be taken while condensing restorative materials over furcation repair materials.

"MTA"-an Hydraulic Silicate Cement: review update and setting reaction

OBJECTIVES

To review the current status and understanding of Portland cement-like endodontic materials commonly referred to by the trade designation "MTA" (alias "Mineral Trioxide Aggregate"), and to present an outline setting reaction scheme, hitherto unattempted.

METHOD

The literature was searched using on-line tools, overlapping an earlier substantial review to pick up any omissions, including that in respect of ordinary Portland cement (OPC), with which MTA shares much. The search was conducted for the period January 2005 to December 2009 using 'MTA', 'GMTA', 'WMTA', and 'mineral AND trioxide AND aggregate' as keywords, with various on-line search engines including ScienceDirect (http://www.sciencedirect.com), SAGE Journals Online (http://online.sagepub.com), Wiley Online Library (http://onlinelibrary.wiley.com), SciELO Scientific electronic library online (http://www.scielo.br/scielo.php), JSTOR (http://www.jstor.org), and Scopus (http://www.scopus.com). References of articles found were cross-checked where appropriate for missed publications. Manufacturers' and related websites were searched with Google Search (http://www.google.com.hk).

RESULTS

A generic name for this class of materials, Hydraulic Silicate Cement (HSC), is proposed, and an outline reaction scheme has been deduced. HSC has distinct advantages apparent, including sealing, sterilizing, mineralizing, dentinogenic and osteogenic capacities, which research continues to demonstrate. However, ad hoc modifications have little supporting justification.

SIGNIFICANCE

While HSC has a definite place in dentistry, with few of the drawbacks associated with other materials, some improvements in handling and other properties are highly desirable, as are studies of the mechanisms of the several beneficial physiological effects. Reference to the extensive, but complex, literature on OPC may provide the necessary insight.