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Abusrewil S, Scott JA, Alqahtani SS, Butcher MC, Tiba M, Kumar C, Mulvihill DM, Ramage G, McLean W. The Effect of Chitosan Incorporation on Physico-Mechanical and Biological Characteristics of a Calcium Silicate Filling Material. Dent J (Basel) 2024; 12:100. [PMID: 38668012 PMCID: PMC11048767 DOI: 10.3390/dj12040100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES A tricalcium silicate-based cement, Biodentine™, has displayed antibiofilm activity when mixed with chitosan powder. This study aimed to assess the effect of chitosan incorporation on the physico-mechanical and biological properties of Biodentine™. METHODS In this study, medium molecular weight chitosan powder was incorporated into Biodentine™ in varying proportions (2.5 wt%, 5 wt%, 10 wt%, and 20 wt%). The setting time was determined using a Vicat apparatus, solubility was assessed by calculating weight variation after water immersion, radiopacity was evaluated and expressed in millimeters of aluminum, the compressive strength was evaluated using an Instron testing machine, and the microhardness was measured with a Vickers microhardness tester. In addition, surface topography of specimens was analyzed using scanning electron microscopy, and the effect of chitosan on the viability of human embryonic kidney (HEK 293) cells was measured by a colorimetric MTT assay. RESULTS Incorporation of 2.5 wt% and 5 wt% chitosan powder delivered an advantage by speeding up the setting time of Biodentine material. However, the incorporation of chitosan compromised all other material properties and the crystalline structure in a dose-dependent manner. The chitosan-modified material also showed significant decreases in the proliferation of the HEK 293 cells, signifying decreased biocompatibility. SIGNIFICANCE Chitosan incorporation into calcium silicate materials adversely affects the physical and biological properties of the material. Despite the increased antimicrobial activity of the modified material, the diminution in these properties is likely to reduce its clinical value.
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Affiliation(s)
- Sumaya Abusrewil
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
| | - J. Alun Scott
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
| | - Saeed S. Alqahtani
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
| | - Mark C. Butcher
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK;
| | - Mohammed Tiba
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
| | - Charchit Kumar
- Materials and Manufacturing Research Group, James Watt, School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (C.K.); (D.M.M.)
| | - Daniel M. Mulvihill
- Materials and Manufacturing Research Group, James Watt, School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (C.K.); (D.M.M.)
| | - Gordon Ramage
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK;
| | - William McLean
- Glasgow Endodontology Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G12 8QF, UK; (S.A.); (S.S.A.); (M.T.); (W.M.)
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Carrazco Ávila PY, Arias Moliz T, Rosales Leal JI, Baca P, Rodríguez Valverde MÁ, Morales Hernandez ME. Novel Ti surface coated with PVA hydrogel and chitosan nanoparticles with antibacterial drug release: An experimental in vitro study. Clin Implant Dent Relat Res 2024; 26:427-441. [PMID: 38419213 DOI: 10.1111/cid.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/04/2023] [Accepted: 01/13/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The aims of this study were to design a novel titanium surface coated with a PVA hydrogel matrix and chitosan-based nanoparticles and to investigate the antibiotic release and its ability to inhibit microbial activity. METHODS Two drug delivery systems were developed and mixed. Chitosan-based nanoparticles (NP) and a polyvinyl alcohol film (PVA). The size, ζ-potential, stability, adhesive properties, and encapsulation profile of NP, as well as the release kinetics of drug delivery systems and their antimicrobial ability of PVA and PVANP films, were studied on Ti surfaces. The systems were loaded with doxycycline, vancomycin, and doxepin hydrochloride. RESULTS Nanoparticles presented a ζ-potential greater than 30 mV for 45 days and the efficiency drug encapsulation was 26.88% ± 1.51% for doxycycline, 16.09% ± 10.24% for vancomycin and 17.57% ± 11.08% for doxepin. In addition, PVA films were loaded with 125 μg/mL of doxycycline, 125 μg/mL of vancomycin, and 100 μg/mL of doxepin. PVANP-doxycycline achieved the antibacterial effect at 4 h while PVA-doxycycline maintained its effect at 24 h.
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Affiliation(s)
- Pablo Yael Carrazco Ávila
- Department of Stomatology, School of Dentistry, Campus de Cartuja s/n, University of Granada, Granada, Spain
| | - Teresa Arias Moliz
- Department of Microbiology, School of Dentistry, University of Granada, Granada, Spain
| | - Juan Ignacio Rosales Leal
- Department of Stomatology, School of Dentistry, Campus de Cartuja s/n, University of Granada, Granada, Spain
| | - Pilar Baca
- Department of Stomatology, School of Dentistry, Campus de Cartuja s/n, University of Granada, Granada, Spain
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Jiang C, Sun Y, Li G, Zhou T, Wang Q, Zhang J, Song Y, Xu W, A L. Magnetic Hydroxyapatite-Coated Iron-Chromium Microspheres for Dental Surface Polishing and Plaque Removal. ACS APPLIED MATERIALS & INTERFACES 2024; 16:5554-5567. [PMID: 38278767 DOI: 10.1021/acsami.3c16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
This research aimed to engineer magnetic hydroxyapatite-coated iron-chromium (HAp-FeCr) microspheres to enhance dental surface polishing and plaque elimination. Utilizing a tailored sol-gel approach, the HAp-FeCr microspheres were synthesized and exhaustively characterized via scanning electron microscopy, energy-dispersive X-ray spectroscopy, ζ-potential, X-ray diffractometry, and X-ray photoelectron spectroscopy methodologies. Key findings showcased that these microspheres retained their magnetic properties post-HAp coating, as evidenced by the magnetization curves. An innovative magnetic polishing system was developed, incorporating these microspheres and a 2000 rpm magnet. Comparative evaluations between traditional air-powder polishing and the proposed magnetic technique demonstrated the latter's superiority. Notably, the magnetic polishing led to a substantial reduction in dental plaque on the tooth surface, decreasing bacterial adhesion and early biofilm formation by Streptococcus gordonii and Lactobacillus acidophilus, where the most pronounced effects were observed in samples with elevated HAp content. A significant 60% reduction in dental plaque was achieved with the magnetic method relative to air-powder polishing. Furthermore, the HAp-FeCr microspheres' biocompatibility was verified through cytotoxicity tests and animal studies. In essence, the magnetic HAp-FeCr microspheres present a novel and efficient strategy for dental treatments, holding immense potential for improving oral health.
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Affiliation(s)
- Cong Jiang
- Department of Oral Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Yue Sun
- Department of Oral Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
- Jilin Provincial Key Laboratory of Sciences and Technology for Stomatology Nanoengineering, Changchun 130021, China
| | - Gaojie Li
- Key Laboratory of Automobile Materials, Ministry of Education, College of Materials Science and Engineering, Jilin University, Changchun 130021, China
| | - Tianyu Zhou
- Department of Oral Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Qiqi Wang
- Department of Periodontology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Jingdan Zhang
- Department of Periodontology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Yulai Song
- Key Laboratory of Automobile Materials, Ministry of Education, College of Materials Science and Engineering, Jilin University, Changchun 130021, China
| | - Wenzhou Xu
- Department of Periodontology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
- Jilin Provincial Key Laboratory of Sciences and Technology for Stomatology Nanoengineering, Changchun 130021, China
| | - Lan A
- Department of Oral Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
- Jilin Provincial Key Laboratory of Sciences and Technology for Stomatology Nanoengineering, Changchun 130021, China
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Moradi Z, Abbasi M, Bahador A, Yekaninejad MS, Khanghah XM, Hoseini AP, Ranjbar Omrani L. Evaluation of cytotoxicity and antibacterial activity of different pulp capping liners. Biomater Investig Dent 2023; 10:2287019. [PMID: 38204476 PMCID: PMC10763819 DOI: 10.1080/26415275.2023.2287019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
This study compares the cytotoxicity and antibacterial activity of five pulp capping liners. This in vitro study was conducted on Fuji II LC glass ionomer, Dycal, Calcimol LC, TheraCal LC, and ACTIVA BioACTIVE. For cytotoxicity, the (MTT) methyl thiazolyl tetrazolium assay was performed on 3 samples from each group of human dental pulp cells (HDPSCs) after 24 h of incubation. The direct contact test (DCT) for antibacterial activity, 6 samples (3 for each material, and 3 for negative control), from each liner were made to evaluate Streptococcus mutans (S. mutans), Lactobacillus casei (L. casei), and Lactobacillus acidophilus (L. acidophilus). Data were analyzed by one-way ANOVA and Tukey's post-hoc test (alpha = 0.05). Data analysis showed that the cytotoxicity of the materials was significantly different (p < 0.001). Fuji II LC and ACTIVA BioACTIVE showed strong cytotoxicity, TheraCal LC moderate cytotoxicity, and Dycal and Calcimol LC slight cytotoxicity. The analysis also revealed a significant difference among the materials regarding antibacterial activity (p < 0.001). Tukey's test showed that the mean percentage of reduction in colony count was significant for all liners compared with the positive control (p < 0.001). The mean percentage of reduction in colony count for Dycal was significantly greater than that of Fuji II LC (p = 0.014), Calcimol LC (p = 0.003), and TheraCal LC (p = 0.001). ACTIVA BioACTIVE did not significantly differ from the other materials as regards antibacterial activity. Dycal showed significantly higher antibacterial activity than the other materials.
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Affiliation(s)
- Zohre Moradi
- Dental Research Center, Dentistry Institue, Restorative Dentistry Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abbasi
- Dental Research Center, Dentistry Institue, Restorative Dentistry Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Bahador
- Oral Microbiology Laboratory, Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Xaniar Mohammadi Khanghah
- Department of Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirahmad Pahlavan Hoseini
- Department of Prosthodontics, Islamic Azad University Dental Branch of Medical sciences, Dental School, Tehran, Iran
| | - Ladan Ranjbar Omrani
- Dental Research Center, Dentistry Institue, Restorative Dentistry Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Smoczer C, Yuth KR, Askar MA, Young LA, Paurazas SB. Growth Factors Released from Advanced Platelet-Rich Fibrin in the Presence of Calcium-Based Silicate Materials and Their Impact on the Viability and Migration of Stem Cells of Apical Papilla. Dent J (Basel) 2023; 11:220. [PMID: 37754340 PMCID: PMC10530054 DOI: 10.3390/dj11090220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Advanced platelet-rich fibrin (A-PRF) provides the scaffold and growth factors necessary for stem cells to proliferate and differentiate in successful regenerative endodontic procedures. This study investigates the release of transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), and vascular endothelial growth factor (VEGF) from A-PRF in cell culture media in the presence and absence of mineral trioxide aggregate (MTA) or Biodentine. Additionally, this research assesses the viability and migration of stem cells of the apical papilla (SCAP) in previously conditioned media. A-PRF obtained from 14 participants were incubated for 7 days in cell culture media alone or via layering with MTA or Biodentine discs and the release of selected growth factors in the media was evaluated using ELISA. The viability of SCAP grown in conditioned media was measured using the CCK8 assay, while SCAP migration was assessed via a transwell assay by counting migrated cells. The release of TGF-β1, PDGF, and VEGF was significantly higher in media with A-PRF alone than in the presence of either calcium-based silicate material (p < 0.05), which showed no difference from the no-A-PRF control (p < 0.05). None of the tested growth factors released in the A-PRF-conditioned media correlated with clot weight. A-PRF-conditioned media, both with and without calcium-based silicate materials, did not impact SCAP viability and migration (p > 0.05). This study shows that SCAP behavior is not impacted by the decrease in growth factor released in the presence of calcium-based silicate materials and that their role in REPs warrants further investigation.
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Affiliation(s)
- Cristine Smoczer
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.)
| | - Kenneth R. Yuth
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Mazin A. Askar
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Laura A. Young
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.)
| | - Susan B. Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
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Desta NT. Morphological Interface Between Restorative and Pulp-Capping Materials: A Systematic Review. Clin Cosmet Investig Dent 2023; 15:99-108. [PMID: 37304374 PMCID: PMC10252935 DOI: 10.2147/ccide.s414418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background Bioceramic materials (BCMs) are widely used in vital pulp therapy (VPT) for their biocompatibility and bioactivity; however, their mechanical properties are equally important in the clinical outcome of the pulp-capped teeth. Objective To carry out an analysis of the research produced on the morphology of the interface between BM and restorative materials (RM) through a systematic review. Methodology An electronic search was performed in Scopus, PubMed, and Web of Science until December 9, 2022. The keywords used in combination with truncation and Boolean operators were: (morphology OR filtration OR porosity) AND (silicate OR composite) AND (cement) AND ("pulp capping" OR "vital pulp therapy" OR "vital pulp treatment"). Results Of the 387 articles initially retrieved from the electronic search databases, 5 articles met the criteria for qualitative data collection. MTA and Biodentine were the most studied BCMs. All the articles used a scanning electron microscope as a method of evaluating the samples. Sample sizes and setting times of RM and BCMs differed between studies. Three out of 5 studies used similar conditions of recorded temperature and humidity of 37°C and 100%, respectively. Conclusion The different biomaterials used, the application of adhesive systems, humidity and restoration time affect the bonding performance and the ultrastructural interface between BCMs and RMs. The scarcity of research on this point makes it necessary to delve into it and study new materials to obtain more scientific evidence.
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Usta SN, Solana C, Ruiz-Linares M, Baca P, Ferrer-Luque CM, Cabeo M, Arias-Moliz MT. Effectiveness of conservative instrumentation in root canal disinfection. Clin Oral Investig 2023; 27:3181-3188. [PMID: 36867258 PMCID: PMC10264279 DOI: 10.1007/s00784-023-04929-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES The impact of conservative instrumentation on the disinfection of root canals with different curvatures has not yet been determined. This ex vivo study aimed to evaluate and compare the effect of conservative instrumentation with TruNatomy (TN) and Rotate and a conventional rotary system, ProTaper Gold (PTG), on root canal disinfection during chemomechanical preparation of straight and curved canals. MATERIALS AND METHODS Ninety mandibular molars with straight (n = 45) and curved (n = 45) mesiobuccal root canals were contaminated with polymicrobial clinical samples. Teeth were divided into three subgroups (n = 14) according to the file systems and the curvature. Canals were instrumented with TN, Rotate, and PTG, respectively. Sodium hypochlorite and EDTA were used as irrigants. Intracanal samples were taken before (S1) and after (S2) instrumentation. Six uninfected teeth were used as negative controls. The bacterial reduction between S1 and S2 was measured by ATP assay, flow cytometry, and culture methods. Kruskal-Wallis and ANOVA tests were followed by the Duncan post hoc test (p < 0.05). RESULTS Bacterial reduction percentages were similar for the three file systems in straight canals (p > 0.05). However, PTG showed a lower reduction percentage of intact membrane cells in flow cytometry than TN and Rotate (p = 0.036). For the curved canals, no significant differences were obtained (p > 0.05). CONCLUSION Conservative instrumentation of straight and curved canals using TN and Rotate files resulted in similar bacterial reduction compared to PTG. CLINICAL RELEVANCE The disinfection efficacy of conservative instrumentation is similar to conventional instrumentation in straight and curved root canals.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Etlik, Keçiören, 06018 Ankara Turkey
| | - Carmen Solana
- Department of Stomatology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Matilde Ruiz-Linares
- Department of Stomatology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Pilar Baca
- Department of Stomatology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Carmen María Ferrer-Luque
- Department of Stomatology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Monica Cabeo
- Department of Microbiology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
| | - Maria Teresa Arias-Moliz
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Microbiology, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo S/N., 18071 Granada, Spain
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Kato G, Gomes PS, Neppelenbroek KH, Rodrigues C, Fernandes MH, Grenho L. Fast-Setting Calcium Silicate-Based Pulp Capping Cements-Integrated Antibacterial, Irritation and Cytocompatibility Assessment. MATERIALS (BASEL, SWITZERLAND) 2023; 16:450. [PMID: 36614788 PMCID: PMC9822223 DOI: 10.3390/ma16010450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Calcium silicate-based cements (CSCs) are endodontic materials widely used in vital pulp-capping approaches. Concerning the clinical application, the reduced set time and pre-mixed formulations are relevant characteristics during the operative management of pulpal exposure, aiming to optimise the work time and improve cross-infection/asepsis control. Additionally, clinical success seems to be greatly dependent on the biological performance of the materials that directly contact the living pulp. As such, this work approaches an integrative biological characterisation (i.e., antibacterial, irritation, and cytocompatibility assays) of three fast-setting CSCs-BiodentineTM, TotalFill® BC RRM™ Fast Putty, and Theracal LC®. These cements, after setting for 24 h, presented the expected topography and elemental composition (assessed by scanning electron microscopy, coupled with EDS analysis), in accordance with the information of the manufacturer. The set cements displayed a significant and similar antibiofilm activity against S. mutans, in a direct contact assay. Twenty-four-hour eluates were not irritant in the standardised CAM assay, but elicited distinct dose- and time-dependent cytotoxicity profiles on fibroblastic cells-i.e., Biodentine was devoid of toxicity, TotalFill presented a slight dose-dependent initial toxicity that was easily overcome, and Theracal LC was deleterious at high concentrations. When compared to long-setting ProRoot MTA cement, which highlighted the pursued integrative approach, Biodentine presented a similar profile, but TotalFill and Theracal LC displayed a poorer performance regarding antibiofilm activity/cytocompatibility features, and Theracal LC suggested eventual safety concerns.
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Affiliation(s)
- Gabriel Kato
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/Requimte, University of Porto, 4100-007 Porto, Portugal
| | - Pedro Sousa Gomes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/Requimte, University of Porto, 4100-007 Porto, Portugal
| | - Karin Hermana Neppelenbroek
- Department of Periodontics and Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru 17012-901, SP, Brazil
| | - Cláudia Rodrigues
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Maria Helena Fernandes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/Requimte, University of Porto, 4100-007 Porto, Portugal
| | - Liliana Grenho
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/Requimte, University of Porto, 4100-007 Porto, Portugal
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Koutroulis A, Valen H, Ørstavik D, Kapralos V, Camilleri J, Sunde PT. Surface characteristics and bacterial adhesion of endodontic cements. Clin Oral Investig 2022; 26:6995-7009. [PMID: 35931891 DOI: 10.1007/s00784-022-04655-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effect of inclusion of silver nano-particles (SNP) or bioactive glass (BG) on the surface characteristics and bacterial adhesion of prototype tricalcium silicate (TCS)-based cements alongside two commercial cements, under different aging periods and exposure conditions. MATERIALS AND METHODS A basic formulation of radio-opacified TCS without (TZ-base) and with additions of SNP (0.5, 1, or 2 mg/ml) or BG (10 or 20%) was used. Biodentine and intermediate restorative material (IRM) served as reference materials. Material disks were immersed in ultrapure water or fetal bovine serum (FBS) for 1, 7, or 28 days. Surface roughness (n = 3), microhardness (n = 9), and wettability (n = 6) were analyzed by standard procedures. Adhesion of Enterococcus faecalis was assessed by fluorescence microscopy (n = 5). Data from these assays were evaluated for normality and comparisons among groups were conducted with statistical procedures (p < 0.05 for significance). RESULTS The surface morphology of SNP- and BG-containing cements had higher roughness values than TZ-base after 28 days (p < 0.05). No differences in microhardness were observed among prototype cements (p > 0.05). Biodentine presented smooth surface characteristics and the highest hardness values (p < 0.05). The FBS-immersion resulted in surface reactions in prototype materials and Biodentine, depicted with scanning electron microscopy. All 1- and 7-day prototype cements showed negligible bacterial adhesion, while in Biodentine and IRM, noticeable E. faecalis adherence was observed from day 1 (p < 0.05). CONCLUSIONS Incorporation of SNP or BG did not improve the antibacterial effect of the experimental cement; all 28-day aged materials failed to inhibit bacterial adherence. The measured physical parameters did not appear to be related to the degree of bacterial adhesion. Exposure of TCS-based cements in FBS resulted in surface reactions, which did not affect bacterial adhesion. CLINICAL RELEVANCE Changes in the surface characteristics of prototype TCS-based cements by inclusion of SNP and BG or exposure to different environments did not affect bacterial adhesion. All experimental materials showed inferior physical properties and higher antibacterial effect than Biodentine.
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Affiliation(s)
- Andreas Koutroulis
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Blindern, P.O. Box 1109, 0317, Oslo, Norway.
| | - Håkon Valen
- Nordic Institute of Dental Materials (NIOM), Oslo, Norway
| | - Dag Ørstavik
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Blindern, P.O. Box 1109, 0317, Oslo, Norway
| | - Vasileios Kapralos
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Blindern, P.O. Box 1109, 0317, Oslo, Norway
| | - Josette Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pia Titterud Sunde
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Blindern, P.O. Box 1109, 0317, Oslo, Norway
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Camilleri J, Atmeh A, Li X, Meschi N. Present status and future directions: Hydraulic materials for endodontic use. Int Endod J 2022; 55 Suppl 3:710-777. [PMID: 35167119 PMCID: PMC9314068 DOI: 10.1111/iej.13709] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic. OBJECTIVES Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified. METHODS The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated. RESULTS A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated. CONCLUSIONS The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.
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Affiliation(s)
- Josette Camilleri
- School of DentistryCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Amre Atmeh
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM)Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)DubaiUnited Arab Emirates
| | - Xin Li
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
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Ruiz-Linares M, de Oliveira Fagundes J, Solana C, Baca P, Ferrer-Luque CM. Current status on antimicrobial activity of a tricalcium silicate cement. J Oral Sci 2022; 64:113-117. [PMID: 35197418 DOI: 10.2334/josnusd.21-0439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Biodentine (BD) is a bioactive material with many indications in endodontic therapy. The purpose of this study was to compile and review the outcomes of in vitro and in vivo studies of BD in terms of antimicrobial effectiveness. An electronic search was carried out in PubMed, from January 2009-April 2021 using the keywords: (Biodentine or dentine substitute or "Ca3SiO5" or tricalcium silicate cement or bioceramic cement) and (antimicrobial activity or antimicrobial effect or antimicrobial effectiveness or antibacterial activity or antibacterial effect or antibacterial effectiveness or antibiofilm activity or antibiofilm effectiveness). Two independent reviewers evaluated the studies for eligibility. All studies that did not include BD or its antimicrobial properties, as well as abstracts not written in English, were excluded. This review identified the need to develop standardized methods to evaluate antimicrobial activity in vitro. Most of the studies were against planktonic bacteria and gave conflicting results. Studies ex vivo and in vivo against biofilm are required to elucidate the antimicrobial activity of BD.
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Affiliation(s)
| | | | - Carmen Solana
- Department of Stomatology, School of Dentistry, University of Granada
| | - Pilar Baca
- Department of Stomatology, School of Dentistry, University of Granada
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12
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Wang Z, Shen Y, Haapasalo M. Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7594. [PMID: 34947188 PMCID: PMC8706218 DOI: 10.3390/ma14247594] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022]
Abstract
Microbes are prevalent in the root canals of necrotic teeth, and they are the cause of primary and post-treatment apical periodontitis. Bacteria can dwell within the infected root canal system as surface-adherent biofilm structures, which exhibit high resistance to antimicrobial agents. Bioceramic materials, with their biocompatible nature and excellent physico-chemical properties, have been widely used in dental applications, including endodontics. This review focuses on the application of bioceramic technology in endodontic disinfection and the antibiofilm effects of endodontic bioceramic materials. Different bioceramic materials have shown different levels of antibiofilm effects. New supplements have emerged to potentially enhance the antibiofilm properties of bioceramics aiming to achieve the goal of microbial elimination in the root canal system.
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Affiliation(s)
| | | | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Z.W.); (Y.S.)
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Ruiz-Linares M, Solana C, Baca P, Arias-Moliz MT, Ferrer-Luque CM. Antibiofilm potential over time of a tricalcium silicate material and its association with sodium diclofenac. Clin Oral Investig 2021; 26:2661-2669. [PMID: 34713359 DOI: 10.1007/s00784-021-04237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this study are to investigate, over time, the antimicrobial activity against polymicrobial biofilms and ability to inhibit biofilm formation, of Biodentine (BD) alone and with 5% and 10% sodium diclofenac (DC). MATERIAL AND METHODS The antimicrobial activity of BD alone and modified with 5% and 10% DC against polymicrobial biofilm growth in dentin was determined by a modified direct contact test. The study groups were (1) BD; (2) BD + 5% DC; and (3) BD + 10% DC. The viability of microorganisms after 1 and 4 weeks was quantified by means of an ATP assay and flow cytometry. The antibiofilm efficacy of the materials, preventing polymicrobial biofilm formation over time, was assessed by confocal laser scanning microscopy (CLSM). RESULTS The results obtained with both the ATP test and flow cytometry showed that BD alone and with 5% and 10% DC exerted antibiofilm activity with respect to the control, in the two evaluated times (p < 0.001). Comparison between groups showed a tendency of increased antimicrobial effect, both over time and depending on the DC concentration. These results coincide with those obtained in CLSM analysis, where efficacy increased with time and DC concentration. CONCLUSIONS AND CLINICAL RELEVANCE Biodentine, over time, showed antimicrobial and antibiofilm efficacy on polymicrobial biofilms. The addition of 5% and 10% DC to BD enhanced this effect, in a concentration- and time-dependent manner.
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Affiliation(s)
- M Ruiz-Linares
- Department of Stomatology, School of Dentistry, Campus de Cartuja, Colegio Máximo s/n, 18071, Granada, Spain
| | - C Solana
- Department of Stomatology, School of Dentistry, Campus de Cartuja, Colegio Máximo s/n, 18071, Granada, Spain.
| | - P Baca
- Department of Stomatology, School of Dentistry, Campus de Cartuja, Colegio Máximo s/n, 18071, Granada, Spain
| | - M T Arias-Moliz
- Department of Microbiology, School of Dentistry, Campus de Cartuja, Colegio Máximo s/n, 18071, Granada, Spain
| | - C M Ferrer-Luque
- Department of Stomatology, School of Dentistry, Campus de Cartuja, Colegio Máximo s/n, 18071, Granada, Spain
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Oliveira LV, de Souza GL, da Silva GR, Magalhães TEA, Freitas GAN, Turrioni AP, de Rezende Barbosa GL, Moura CCG. Biological parameters, discolouration and radiopacity of calcium silicate-based materials in a simulated model of partial pulpotomy. Int Endod J 2021; 54:2133-2144. [PMID: 34418112 DOI: 10.1111/iej.13616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022]
Abstract
AIM To analyse the discolouration, radiopacity, pH and calcium ion release of Biodentine (BD), Bio-C repair (BCR) and Bio-C temp (BCT), as well as their biological effects on human dental pulp cells (hDPCs). METHODOLOGY Sixty-four extracted bovine incisors were prepared to simulate crown fractures with pulp exposure and open root apex. The roots were filled using a mixture of agar and blood (control), and BD, BCR or BCT were placed over this mixture. Colour assessment analyses of the samples were performed before and immediately after material insertion and repeated at 30 and 90 days, using a spectrophotometer. The colour change of each specimen was evaluated at the crown and calculated based on the CIELab colour space. Digital radiographs were acquired for radiopacity analysis. hDPCs were placed in contact with different dilutions of culture media previously exposed to such materials and tested for cell viability using the MTT assay. The pH and calcium ion release of all materials were measured after 24 h; the data were assessed using one-way analysis of variance (ANOVA). Cell viability was analysed by two-way ANOVA. Differences in colour parameters and wound-healing data were assessed by two-way repeated measures ANOVA (α = 0.05). Tukey's and Dunnett's tests were used to compare the experimental groups with the control group. RESULTS BCR had grater radiopacity and smaller colour alteration (ΔEab/ΔE00) than the other materials tested (p < .005; p < .001). No significant differences in pH were found amongst the tested materials (p > .05). BCT was associated with the largest release of calcium ions (p < .0001). BD had cell viability similar to that of the control at the lowest dilutions, and BCR was similar to that of the control, regardless of the dilution tested (p > .05). BCT had a lower percentage of viability than that of the control at all tested dilutions (p < .0001). Cell migration rates in BD and BCR were similar to those in the control group after 24 h and 48 h (p > .05), whilst BCT had larger voids than the control in both periods (p < .0001). CONCLUSIONS BCR, BCT and BD were associated with tooth discolouration. BCR had the lowest staining values, the highest radiopacity and viability greater than 80% hDPCs.
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Affiliation(s)
- Lilian Vieira Oliveira
- Department of Endodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Gabriela Leite de Souza
- Department of Endodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Gisele Rodrigues da Silva
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | - Ana Paula Turrioni
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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López-García S, Pecci-Lloret MP, Pecci-Lloret MR, Oñate-Sánchez RE, García-Bernal D, Castelo-Baz P, Rodríguez-Lozano FJ, Guerrero-Gironés J. In Vitro Evaluation of the Biological Effects of ACTIVA Kids BioACTIVE Restorative, Ionolux, and Riva Light Cure on Human Dental Pulp Stem Cells. MATERIALS 2019; 12:ma12223694. [PMID: 31717445 PMCID: PMC6888068 DOI: 10.3390/ma12223694] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
This study aimed to analyze the biological effects of three new bioactive materials on cell survival, migration, morphology, and attachment in vitro. ACTIVA Kids BioACTIVE Restorative (Pulpdent, Watertown, MA, USA) (Activa), Ionolux (Voco, Cuxhaven, Germany), and Riva Light Cure UV (SDI, Bayswater, Australia) (Riva) were handled and conditioned with a serum-free culture medium. Stem cells from human dental pulp (hDPSCs) were exposed to material extracts, and metabolic activity, cell migration, and cell morphology were evaluated. Cell adhesion to the different materials was analyzed by scanning electron microscopy (SEM). The chemical composition of the materials was evaluated by energy-dispersive X-ray (EDX). One-way analysis of variance followed by a Tukey test was performed (p < 0.05). Ionolux promoted a drastic reduction in metabolic activity and wound closure compared to the control (p < 0.05), whereas Activa induced adequate metabolic activity and cell migration. Moreover, SEM and immunofluorescence analysis showed abundant cells exposed to Activa. The materials showed different surface morphologies, and EDX spectra exhibited different peaks of C, O, Si, S, Ca, and F ions in glass ionomer cements. The results showed that Activa induced cell migration, cell attachment, and cell viability to a greater extent than Riva and Ionolux.
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Affiliation(s)
- Sergio López-García
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
- Department of Genetics and Microbiology, Faculty of Biology, University of Murcia, 30100 Murcia, Spain
| | - María P. Pecci-Lloret
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - Miguel R. Pecci-Lloret
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - Ricardo E. Oñate-Sánchez
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
| | - David García-Bernal
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
| | - Pablo Castelo-Baz
- Endodontics Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Francisco Javier Rodríguez-Lozano
- Laboratory of Cellular Therapy and Hematopoietic Transplant, Internal Medicine Department, IMIB-Virgen de la Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (S.L.-G.)
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
- Correspondence: ; Tel.: +0034-868889518
| | - Julia Guerrero-Gironés
- Departament of Special Care and Gerodontology, Faculty of Medicine, University of Murcia, 30007 Murcia, Spain; (M.P.P.-L.); (M.R.P.-L.); (R.E.O.-S.); (J.G.-G.)
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16
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Biological Effects of New Hydraulic Materials on Human Periodontal Ligament Stem Cells. J Clin Med 2019; 8:jcm8081216. [PMID: 31416236 PMCID: PMC6722926 DOI: 10.3390/jcm8081216] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The aim of this study was: to evaluate the biological properties of new hydraulic materials: Bio-C Repair and Bio-C Sealer. Methods: Periodontal ligament stem cells were exposed to several dilutions of Bio-C Repair and Bio-C Sealer. The ion release profile and pH were determined. Metabolic activity, cell migration and cell survival were assessed using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT), wound-healing assays and Annexin assays, respectively. Cells were cultured in direct contact with the surface of each material. These were then analyzed via scanning electron microscopy (SEM) and energy dispersive X-ray (EDX). Statistical differences were assessed using a two-way ANOVA (α < 0.05). Results: Similar pH was observed in these cements. Bio-C Sealer released significantly more Ca and Si ions (p < 0.05) in comparison with Bio-C Repair. Undiluted Bio-C Sealer induced a significant reduction on cellular viability, cell survival and cell migration when compared to the control (p < 0.05). Moreover, SEM showed abundant cells adhered on Bio-C Repair and a moderate number of cells attached on Bio-C Sealer. Finally, EDX analysis identified higher percentages of Ca and O in the case of Bio-C repair than with Bio-C sealer, while other elements such as Zr and Si were more abundant in Bio-C sealer. Conclusions: Bio-C Repair displayed higher cell viability, cell adhesion and migration rates than Bio-C Sealer.
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Rodríguez‐Lozano FJ, Collado‐González M, López‐García S, García‐Bernal D, Moraleda JM, Lozano A, Forner L, Murcia L, Oñate‐Sánchez RE. Evaluation of changes in ion release and biological properties of NeoMTA‐Plus and Endocem‐MTA exposed to an acidic environment. Int Endod J 2019; 52:1196-1209. [DOI: 10.1111/iej.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/28/2019] [Indexed: 12/27/2022]
Affiliation(s)
- F. J. Rodríguez‐Lozano
- Cellular Therapy and Hematopoietic Transplant Unit Hematology Department Virgen de la Arrixaca Clinical University Hospital IMIB‐Arrixaca University of Murcia Murcia Spain
- Special Care in Dentistry and Gerodontology Faculty of Medicine School of Dentistry University of Murcia Murcia Spain
| | - M. Collado‐González
- Cellular Therapy and Hematopoietic Transplant Unit Hematology Department Virgen de la Arrixaca Clinical University Hospital IMIB‐Arrixaca University of Murcia Murcia Spain
- Special Care in Dentistry and Gerodontology Faculty of Medicine School of Dentistry University of Murcia Murcia Spain
| | - S. López‐García
- Cellular Therapy and Hematopoietic Transplant Unit Hematology Department Virgen de la Arrixaca Clinical University Hospital IMIB‐Arrixaca University of Murcia Murcia Spain
| | - D. García‐Bernal
- Cellular Therapy and Hematopoietic Transplant Unit Hematology Department Virgen de la Arrixaca Clinical University Hospital IMIB‐Arrixaca University of Murcia Murcia Spain
- Department of Internal Medicine University of Murcia Murcia Spain
| | - J. M. Moraleda
- Cellular Therapy and Hematopoietic Transplant Unit Hematology Department Virgen de la Arrixaca Clinical University Hospital IMIB‐Arrixaca University of Murcia Murcia Spain
- Department of Internal Medicine University of Murcia Murcia Spain
| | - A. Lozano
- Department of Stomatology. Clínica Odontológica Universitat de València Valencia Spain
| | - L. Forner
- Department of Stomatology. Clínica Odontológica Universitat de València Valencia Spain
| | - L. Murcia
- Department of Genetics and Microbiology University of Murcia Murcia Spain
| | - R. E. Oñate‐Sánchez
- Special Care in Dentistry and Gerodontology Faculty of Medicine School of Dentistry University of Murcia Murcia Spain
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