The comparison of MTA, Geristore® and Amalgam with or without Bioglass as a matrix in sealing the furcal perforations (in vitro study)

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.

Comparative evaluation of marginal adaptation of mineral trioxide aggregate, Biodentine, and geristore as a root end filling material: An in vitro scanning electron microscope study

Aim

The aim of this in vitro study was to measure the quality of marginal adaptation of three root end filling materials by scanning electron microscope (SEM).

Methodology

Thirty extracted human permanent single-rooted single canal maxillary anterior teeth with mature apices were prepared up to 60 K-file and obturated. Teeth were resected 3 mm from the apex using a cross-cut fissure bur at 90° angle to the long axis of the tooth. Root end cavities of 3 mm were prepared in each of the teeth with an ultrasonic tip to receive the root end filling material. Group 1 - mineral trioxide aggregate (MTA), Group 2 - Biodentine, and Group 3 - Geristore. The samples were mounted in resin blocks for sectioning with a hard-tissue microtome and sectioned apically at 1 mm and 2 mm levels from the apex. They were gold sputtered and viewed under SEM for evaluating the adaptation of the material to the canal walls.

Results

The mean value for Group II (Biodentine) was lower than the mean value for Group I (MTA) and Group III (Geristore) at 1 mm and 2 mm.

Conclusion

Biodentine showed significantly better marginal adaptation as compared to MTA and Geristore.

Biomimetic Approaches in Clinical Endodontics

In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.

Application of bioactive glasses in various dental fields

Bioactive glasses are a group of bioceramic materials that have extensive clinical applications. Their properties such as high biocompatibility, antimicrobial features, and bioactivity in the internal environment of the body have made them useful biomaterials in various fields of medicine and dentistry. There is a great variation in the main composition of these glasses and some of them whose medical usage has been approved by the US Food and Drug Administration (FDA) are called Bioglass. Bioactive glasses have appropriate biocompatibility with the body and they are similar to bone hydroxyapatite in terms of calcium and phosphate contents. Bioactive glasses are applied in different branches of dentistry like periodontics, orthodontics, endodontics, oral and maxillofacial surgery, esthetic and restorative dentistry. Also, some dental and oral care products have bioactive glasses in their compositions. Bioactive glasses have been used as dental implants in the human body in order to repair and replace damaged bones. Other applications of bioactive glasses in dentistry include their usage in periodontal disease, root canal treatments, maxillofacial surgeries, dental restorations, air abrasions, dental adhesives, enamel remineralization, and dentin hypersensitivity. Since the use of bioactive glasses in dentistry is widespread, there is a need to find methods and extensive resources to supply the required bioactive glasses. Various techniques have been identified for the production of bioactive glasses, and marine sponges have recently been considered as a rich source of it. Marine sponges are widely available and many species have been identified around the world, including the Persian Gulf. Marine sponges, as the simplest group of animals, produce different bioactive compounds that are used in a wide range of medical sciences. Numerous studies have shown the anti-tumor, anti-viral, anti-inflammatory, and antibiotic effects of these compounds. Furthermore, some species of marine sponges due to the mineral contents of their structural skeletons, which are made of biosilica, have been used for extracting bioactive glasses.

Bioactive Glass Applications in Dentistry

At present, researchers in the field of biomaterials are focusing on the oral hard and soft tissue engineering with bioactive ingredients by activating body immune cells or different proteins of the body. By doing this natural ground substance, tissue component and long-lasting tissues grow. One of the current biomaterials is known as bioactive glass (BAG). The bioactive properties make BAG applicable to several clinical applications involving the regeneration of hard tissues in medicine and dentistry. In dentistry, its uses include dental restorative materials, mineralizing agents, as a coating material for dental implants, pulp capping, root canal treatment, and air-abrasion, and in medicine it has its applications from orthopedics to soft-tissue restoration. This review aims to provide an overview of promising and current uses of bioactive glasses in dentistry.

Comparative Analysis of Clinical Effects of Mineral Trioxide Aggregate in the Treatment of Endodontic Diseases

BACKGROUND

We aimed to evaluate the efficacy of mineral trioxide aggregate (MTA) in the treatment of endodontic disease.

METHODS

Oversell, 384 patients with endodontic disease treated in Xuzhou Stomatological Hospital, Xuzhou, China, from June 2015 to June 2017 were selected, and randomly divided into four groups with 96 cases per group. The repair effects of MTA, zinc phosphate cement (ZPC), silver amalgam and light-curing calcium hydroxide (LCH) on the teeth and dental pulp of patients in the four groups were compared. Meanwhile, the ill symptoms of the patients were observed to confirm whether they could be alleviated. Besides, whether the repair effects were related to ages of patients, perforation diameters of diseased teeth and repair materials was discussed.

RESULTS

The success rates of MTA group, ZPC group, LCH group and silver amalgam group were 90.6%, 68.7%, 70.8% and 52.1%, respectively. The success rate of MTA group was significantly higher than that of ZPC group, silver amalgam group and LCH group. When the success rates of four groups were compared, the differences were statistically significant (P=0.0072). The patient's age, repair material and perforation diameter were positively correlated with MTA repair effect (P=0.003, P=0.002, P=0.01). The patients' teeth in each group were repaired with different materials, and the reexamination was conducted 4 weeks later. Three patients in the silver amalgam group were found to have gingival swelling.

CONCLUSION

The therapeutic effect of MTA was significant in the treatment of endodontic disease, and it is worthy of clinical application.

Setting Time and Surface Microhardness of Mineral Trioxide Aggregate and 1% and 5% Fluoride-Doped Mineral Trioxide Aggregate Mixed with Water and Gel-like Polymer

Introduction

Mineral trioxide aggregate (MTA) is extensively used in endodontics. However, it has limitations such as long setting time, low compressive strength and poor handling properties. Our study aimed to compare the setting time and surface microhardness of MTA and fluoride-doped MTA (FMTA) using gel-like polymer (GLP) or distilled water (DW) as liquid.

Methods and Materials

An MTA-like cement was prepared by mixing Portland cement, bismuth oxide and gypsum (75%, 20% and 5%, respectively). FMTA (1% and 5%) was made by substituting 1% and 5% of MTA powder with fluoride. GLP, composed of methyl cellulose (MC) and propylene glycol (PG), was used as the hydrating liquid and compared with distilled water. Six experimental groups (n=10) were examined for each test. The samples were subjected to Vickers surface microhardness test after 4 and 28 days. Setting time was measured using ANSI/ADA standards. Data was analyzed using two-way and repeated measured ANOVA and the Tukey HSD tests.

Results

The MTA-like cement hydrated with GLP showed a significantly reduced setting time (P<0.05); 1% FMTA, mixed with GLP, had the shortest initial and final setting times. The microhardness values of all samples increased at different rates during 28 days (P<0.00001). The microhardness significantly decreased by addition of fluoride to MTA (P<0.001).

Conclusions

The results of the present in vitro study suggested that using GLP as the hydrating liquid enhances the setting time with no adverse effect on the surface microhardness. However, adding fluoride can negatively affect the microhardness of MTA.

Cytokine expression in response to root repair agents

AIM

To evaluate the expression of TNF-α, IL-6, IFN-γ, TGF-β, IL-4, IL-10, RANKL, RANK and OPG on mouse calvarial bone treated with MTA, Geristore^® and Emdogain^® .

METHODOLOGY

Bone wounds were made on the heads of C57BL/6 mice, breaking the periosteum and the cortical surface of the calvaria. Each repair agent was inserted into sectioned Eppendorf microtubes and placed on the bone wound, and soft tissues were sutured. At 14 and 21 days, animals were sacrificed and the treated region was dissected. The calvaria bone was removed, and RNA was extracted. mRNA expression of the aforementioned cytokines was assessed using real-time PCR. Data were analysed by nonparametric methods, including the Mann-Whitney and Kruskal-Wallis tests (P < 0.05).

RESULTS

Following treatment with Emdogain^® and MTA, mRNA expression of RANKL, RANK and OPG increased significantly (P < 0.05) between days 14 to 21. Geristore^® did not alter the basal expression of these mediators during the same period of evaluation. Whilst treatment with Emdogain^® did cause a significant increase in TNF-α mRNA expression between days 14 and 21 (P < 0.05), treatment with MTA did not alter the basal expression of this cytokine at either experimental time point. However, TNF-α mRNA expression was down-regulated significantly at day 21 (P < 0.05) when Geristore^® was applied. A significant increase in the mRNA expression of IL-6, TGF-β, IL-10, IL-4 and IFN-γ was observed with Emdogain^® and MTA treatment between days 14 to 21, whereas Geristore^® reduced significantly the expression of IL-6, TGF-β and IL-4 (P < 0.05).

CONCLUSION

The clinical indication of these repair agents depends on the root resorption diagnosis. Whilst MTA and Emdogain^® induce a pro- and anti-inflammatory response early and late, respectively, Geristore^® was not associated with an inflammatory reaction when compared with both repair agents.

Subcutaneous connective tissue reactions to various endodontic biomaterials: an animal study

BACKGROUND AND AIMS

Biocompatibility of root-end filling materials is a matter of debate. The aim of this study was to compare the biocompatibility of a variety of commercial ProRoot WMTA cements and a resin-based cement (Geristore®) with different pH values of setting reaction and different aluminum contents, implanted into the subcutaneous connective tissue of rats at various time intervals.

MATERIALS AND METHODS

Fifty Sprague-Dawley rats were used in this study. Polyethylene tubes were filled with Angelus WMTA, ProRoot WMTA, Bioaggregate, and Geristore. Empty control tubes were implanted into subcutaneous tissues and harvested at 7-, 14-, 28- and 60-day intervals. Tissue sections of 5 μm were stained with hematoxylin and eosin and observed under a light microscope. Inflammatory reactions were categorized as 0, none (without inflammatory cells); 1, mild (inflammatory cells ≤25); 2, moderate (25-125 inflammatory cells); and 3, severe (>125 inflammatory cells). Statistical analysis was performed with Kruskal-Wallis and Mann Whitney U tests.

RESULTS

ProRoot WMTA and Angelus elicited significantly less inflammation than other materials (P<0.05). After 7 days, however, all the materials induced significantly more inflammation than the controls (P<0.05). Angelus-MTA group exhi-bited no significant differences from the Bioaggregate group (P=0.15); however, ProRoot WMTA elicited significantly less inflammation than Bioaggregate (P=0.02). Geristore induced significantly more inflammation than other groups (P<0.05).

CONCLUSION

Geristore induced an inflammatory response higher than ProRoot WMTA; therefore, it is not recommended for clinical use.