Genotoxicity and cytotoxicity of mineral trioxide aggregate and regular and white Portland cements on Chinese hamster ovary (CHO) cells in vitro

Effects of Calcination Temperature on the Synthesis of One-Pot Sol-Gelled Barium Titanate Powder and Its Performance as an Endodontic Radiopacifier

Barium titanate (BaTiO3, BTO), conventionally used for dielectric and ferroelectric applications, has been assessed for biomedical applications, such as its utilization as a radiopacifier in mineral trioxide aggregates (MTA) for endodontic treatment. In the present study, BTO powders were prepared using the sol-gel process, followed by calcination at 400-1100 °C. The X-ray diffraction technique was then used to examine the as-prepared powders to elucidate the effect of calcination on the phase composition and crystalline size of BTO. Calcined BTO powders were then used as radiopacifiers for MTA. MTA-like cements were investigated to determine the optimal calcination temperature based on the radiopacity and diametral tensile strength (DTS). The experimental results showed that the formation of BTO phase was observed after calcination at temperatures of 600 °C and above. The calcined powders were a mixture of BaTiO3 phase with residual BaCO3 and/or Ba2TiO4 phases. The performance of MTA-like cements with BTO addition increased with increasing calcination temperature up to 1000 °C. The radiopacity, however, decreased after 7 days of simulated oral environmental storage, whereas an increase in DTS was observed. Optimal MTA-like cement was obtained by adding 40 wt.% 1000 °C-calcined BTO powder, with its resulting radiopacity and DTS at 4.83 ± 0.61 mmAl and 2.86 ± 0.33 MPa, respectively. After 7 days, the radiopacity decreased slightly to 4.69 ± 0.51 mmAl, accompanied by an increase in DTS to 3.13 ± 0.70 MPa. The optimal cement was biocompatible and verified using MG 63 and L929 cell lines, which exhibited cell viability higher than 95%.

An in vitro assessment of cytotoxicity and genotoxicity of root repair materials

Background

The success of the root-end procedure depends on the regeneration of the functional periodontal attachment system, including the cementum on the resected root-end surface, periodontal ligament (PDL), and alveolar bone. As root end filling materials remain in close contact with live periapical tissues, they may influence the endodontic treatment outcome.

Aim

To assess and compare the cytotoxicity and genotoxicity of three root repair materials, mineral trioxide aggregate (MTA), endosequence, and geristore in human-cultured periodontal ligament fibroblasts.

Materials and Methods

Cultured human periodontal ligament fibroblasts of the third passage were used in the study. They were placed in contact with the root repair materials. The cytotoxic effect on PDL fibroblasts was determined by (3-(4,5-dimethylthiazol-2-yl)-2,5-tetrazolium bromide) assay after 24 hours and 48 hours intervals. Cell viability was determined using an inverted phase contrast microscope. The genotoxic effect on the periodontal fibroblast cells was determined by comet assay using imaging software.

Statistical Analysis Used

Data were analyzed using Tukey's multiple comparison test and Dunnett's multiple test.

Results

All the test materials showed higher cytotoxicity and genotoxicity at the 48th hour interval with a statistically significant difference from the control group (P < 0.05). MTA was shown to be least cytotoxic and genotoxic to PDL fibroblasts, followed by endosequence root repair material and geristore at 24 hour and 48 hour intervals.

Conclusion

The cytotoxicity and genotoxicity of MTA were the least compared to endosequence and geristore on human-cultured PDL fibroblasts.

Cytotoxicity and genotoxicity of Bio-C Repair, Endosequence BC Root Repair, MTA Angelus and MTA Repair HP

The aim was to evaluate in vitro cytotoxicity and genotoxicity of Bio-C Repair (BCR), compared to Endosequence BC Root Repair (ERRM), MTA Angelus (MTA-Ang), and MTA Repair HP (MTA-HP). MC3T3 osteoblastic cells were exposed to extracts of the repairing bioceramic cements. After 1, 3, and 7 days, cytotoxicity and genotoxicity were evaluated by MTT and Micronucleus tests, respectively. Cells not exposed to biomaterials were used as a negative control. Data were compared using ANOVA two-way, followed by the Tukey Test (α=5%). MTA-Ang and MTA-HP showed no difference in relation to control regarding cytotoxicity in any experimental times. BCR and ERRM reduced cell viability after 3 and 7 days (p<0.05); however, the reduction caused by BCR was less than that caused by ERRM. Considering the micronucleus formation, all biomaterials caused an increase after 3 and 7 days (p<0.05), being greater for the BCR and ERRM groups. It can be concluded that BCR is non-cytotoxic in osteoblastic cells, as well as MTA-Ang e MTA Repair HP. BCR and ERRM showed greater genotoxicity than others tested biomaterials.

Cyto-Genotoxicity of Tritiated Stainless Steel and Cement Particles in Human Lung Cell Models

During the decommissioning of nuclear facilities, the tritiated materials must be removed. These operations generate tritiated steel and cement particles that could be accidentally inhaled by workers. Thus, the consequences of human exposure by inhalation to these particles in terms of radiotoxicology were investigated. Their cyto-genotoxicity was studied using two human lung models: the BEAS-2B cell line and the 3D MucilAirTM model. Exposures of the BEAS-2B cell line to particles (2 and 24 h) did not induce significant cytotoxicity. Nevertheless, DNA damage occurred upon exposure to tritiated and non-tritiated particles, as observed by alkaline comet assay. Tritiated particles only induced cytostasis; however, both induced a significant increase in centromere negative micronuclei. Particles were also assessed for their effects on epithelial integrity and metabolic activity using the MucilAirTM model in a 14-day kinetic mode. No effect was noted. Tritium transfer through the epithelium was observed without intracellular accumulation. Overall, tritiated and non-tritiated stainless steel and cement particles were associated with moderate toxicity. However, these particles induce DNA lesions and chromosome breakage to which tritium seems to contribute. These data should help in a better management of the risk related to the inhalation of these types of particles.

Cytotoxic Effect of Nano Fast Cement and ProRoot Mineral Trioxide Aggregate on L-929 Fibroblast Cells: an in vitro Study

Statement of the Problem:

Endodontic materials that are placed in direct contact with living tissues should be biocompatible. The cytotoxicity of Nano Fast Cement (NFC) compared to ProRoot Mineral Trioxide Aggregate (ProRoot MTA) must be evaluated.

Purpose:

This In vitro study aimed to assess the cytotoxic effects of NFC in comparison to ProRoot MTA on L-929 mouse fibroblast cells.

Materials and Method:

In this animal study, L-929 mouse fibroblast cells were grown in Dulbecco's Modified Eagle's medium (DMEM) supplemented with 10% fetal bovine serum (FBS) in an atmosphere of 5% co₂/95% air at 37 C̊. A total of 10⁴ cells from the fourth collection were plated in each well of a 96-well micro-titer plate. Materials were mixed according to the manufacturer’s instruction and placed into the related plastic molds with 5 mm diameter and 3 mm height. After 24 hours and a complete setting, the extracts of the tested materials were produced at six different concentrations and placed in the related wells. Cells in DMEM served as the negative control group. DMEM alone was used as the positive control group. Methyl-thiazoltetrazolium (MTT) colorimetric assay was conducted after 24, 48, and 72 hours. The absorbance values were measured by ELISA plate reader at 540 nm wavelength. Three-way analysis of variance, post-hoc Tukey, LSD, and independent t-test were used for the statistical analyses using SPSS software, version 16.0.

Results:

There was no statically significant difference between MTA and NFC in cell viability values at different concentrations and different time intervals (p= 0.649). Viability values were significantly decreased after 72 hours, but there was no significant difference between the first and second MTT assays (p= 0.987). Cytotoxicity significantly increased at concentrations higher than 6.25 µɡ/ml.

Conclusion:

Cytotoxicity depends on time, concentration, and cement composition. There was no statistically significant difference between NFC and MTA concerning their cytotoxic effects on L-929 mouse fibroblast cells.

Portland Cement: An Overview as a Root Repair Material

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

A review on current research status of the surface modification of Zn-based biodegradable metals

Recently, zinc and its alloys have been proposed as promising candidates for biodegradable metals (BMs), owning to their preferable corrosion behavior and acceptable biocompatibility in cardiovascular, bone and gastrointestinal environments, together with Mg-based and Fe-based BMs. However, there is the desire for surface treatment for Zn-based BMs to better control their biodegradation behavior. Firstly, the implantation of some Zn-based BMs in cardiovascular environment exhibited intimal activation with mild inflammation. Secondly, for orthopedic applications, the biodegradation rates of Zn-based BMs are relatively slow, resulting in a long-term retention after fulfilling their mission. Meanwhile, excessive Zn2+ release during degradation will cause in vitro cytotoxicity and in vivo delayed osseointegration. In this review, we firstly summarized the current surface modification methods of Zn-based alloys for the industrial applications. Then we comprehensively summarized the recent progress of biomedical bulk Zn-based BMs as well as the corresponding surface modification strategies. Last but not least, the future perspectives towards the design of surface bio-functionalized coatings on Zn-based BMs for orthopedic and cardiovascular applications were also briefly proposed.

Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review

Background

Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth.

Materials and methods

This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested.

Results

Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability.

Conclusion

There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials.

Clinical significance

The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength.

How to cite this article

Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30–39.

Genotoxicity of root canal sealers: a literature review

OBJECTIVES

Root canal sealers are widely used worldwide in endodontics to prevent reinfection and growth of surviving microorganisms. Considering the strong correlation between genetic damage and carcinogenesis, evaluation of genotoxicity induced by endodontic sealers is recommended for elucidating the true health risks to patients and professionals. The purpose of this article was to provide a comprehensive review of studies involving genotoxicity analysis of endodontic sealers and the used methodologies.

MATERIALS AND METHODS

A literature search was made in PubMed using the following combination of words "genotoxicity," "mutagenicity," "endodontic sealers," and "root canal sealers." A total of 39 articles with genotoxicity studies were selected for the present study.

RESULTS

Sealers have been ranked in decreasing order of their genotoxicity as: ZOE sealers > GIC sealers > S sealers > ER sealers > MR sealers > Novel sealers > CH sealers > CS sealers.

CONCLUSIONS

All published data showed some evidence of genotoxicity for most of the commercial root canal sealers; however, contradictory results were found, mainly for AH Plus, the most studied sealer.

CLINICAL RELEVANCE

The information provided would direct the endodontists to use the less genotoxic materials in endodontic treatment in a way to reduce DNA damage promoting oral healthcare.

Genotoxicity and Hemocompatibility of a Novel Calcium Aluminate-Based Cement

Objective:

The aim of this in vitro study was to evaluate the genotoxicity and hemocompatibility of a novel calcium aluminate-based cement, EndoBinder (EB) (Binderware, São Carlos, SP, Brazil) and compare it with Angelus White Mineral Trioxide Aggregate (MTA) (AWMTA) (Angelus, Soluções Odontológicas, Londrina, PR, Brazil).

Methods:

For evaluation of genotoxicity, a comet assay was performed with Chinese hamster ovary (CHO) cells that had been grown for 24 h in Dulbecco’s Modified Eagle Medium incubated with each of the cements for 24 h at 37°C. DNA percentage in head and Olive tail moment were analyzed. For assessment of hemocompatibility, erythrocyte lysis quantification, and concentration of plasma fibrinogen were determined in human blood samples placed in contact with each of the materials. One way analysis of variance (ANOVA) followed by post hoc Tukey test and Student t-test were used for data analysis of genotoxicity and hemocompatibility, respectively.

Results:

Results showed that the genotoxic effects of EB and AWMTA were comparable to that of the negative control, with no statistically significant differences between AWMTA and negative control (P>0.05). Compared to AWMTA, EB showed greater hemolytic potential when placed in direct contact with erythrocytes (P<0.05). Fibrinogen values were low for both materials, with protein concentration being greater in samples exposed to EB than to AWMTA.

Conclusion:

Both materials presented a higher hemolytic behaviour compared to what is established by international standards. Fibrinogen formation was low for both materials, and DNA damage induction was not observed in a comet assay.

Chemical analysis and biological properties of two different formulations of white portland cements

White Portland cement (WPC) has generated research interests in the field of endodontics. This study compared between the properties of two formulations of white Portland cement (WPC) of different origin (Malaysia [MA] and Egypt [EG]). WPCs with and without calcium chloride dihydrate were prepared. Scanning electron microscope (SEM), energy dispersive X-ray micro-analysis, and X-ray diffraction were used for surface morphology evaluation, elemental, and phase analysis, respectively. After the preparation of optimized serial dilutions, the cytotoxicity was evaluated on human periodontal ligament fibroblasts (HPLFs) and dental pulp stem cells (DPSCs) using methyl-thiazol-diphenyltetrazolium assay after 24 and 72 h. Cell attachment properties were examined under SEM after 24 and 72 h. Results showed that the surface morphology and chemical composition of both formulations demonstrated detectable variations. The cytotoxicity evaluation showed different cellular responses of HPLFs compared to DSPCs. Both formulations favored the viability of HPLFs. However, the fast set formulations demonstrated severe cytotoxicity on DPSCs. Significant differences between EGWPC and MAWPC were identified (p < 0.05). The cell attachment properties were favorable; however, HPLFs attached and spread over the samples better than DPSCs. In conclusion, WPC of different origin may show differences in chemical and biological properties. The addition of CaCl2 ·2H2 O to WPC can affect its properties. Human cell types may react differently towards different formulations of WPCs. SCANNING 38:303-316, 2016. © 2015 Wiley Periodicals, Inc.

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

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

Cytotoxicity, genotoxicity and antibacterial effectiveness of a bioceramic endodontic sealer

AIM

To compare the characteristics of bioceramic endodontic sealer Endosequence BC sealer with those of AH Plus sealer.

METHODOLOGY

Cytotoxicity and genotoxicity were analysed on human gingival fibroblasts submitted to cell culture medium conditioned by sealers using the MTT reduction assay and micronucleus formation test (MNT), respectively. Cells grown on fresh medium served as controls. Cell viabilities were measured at 1, 3, 5 and 7 days. The antibacterial activity was analysed on an Enterococcus faecalis strain (ATCC 29212) using both on agar diffusion test (ADT) and a direct contact test (DCT). The inhibition zones in ADT were measured after 48 h and the colony-forming units counting in the DCT after 1, 24, 72 and 168 h. Data were compared by anova and Tukey's test and MNT by Fisher's exact test (P < 0.05).

RESULTS

Cultures submitted to Endosequence BC sealer had a significantly higher number of viable cells (P < 0.01) and less micronucleus formation (P < 0.05) than AH Plus sealer. Endosequence BC sealer exhibited significantly smaller inhibition zones (6.00 ± 0.03 mm) than AH Plus sealer (10.31 ± 0.21 mm) (P < 0.05). Moreover, Endosequence BC sealer had significantly smaller antibacterial activity than AH Plus sealer up to 1 h of direct contact (P < 0.05). On other exposure times, both materials had similar antibacterial effectiveness (P > 0.05).

CONCLUSIONS

Bioceramic-based sealer had less cytotoxicity and genotoxicity and similar antibacterial effect against E. faecalis in comparison with AH Plus sealer.

Biological effects and washout resistance of a newly developed fast-setting pozzolan cement

INTRODUCTION

Mineral trioxide aggregate has been widely used as a retrograde filling material. The aim of this study was to evaluate the biological effects of a newly developed fast-setting, mineral trioxide aggregate-derived pozzolan cement (Endocem). Furthermore, we explored whether this cement is resistant to washout in comparison with ProRoot.

METHODS

Biocompatibility was evaluated on the basis of cell morphology and a viability test. The expression of osteogenic genes was evaluated by performing real-time polymerase chain reaction, and calcified nodule formation was assessed by alizarin red S staining. The setting time was measured, and washout testing was performed by placing the material into fetal bovine serum.

RESULTS

The biocompatibility and osteogenicity of Endocem were similar to those of ProRoot. Moreover, Endocem showed a higher resistance to washout than ProRoot did.

CONCLUSIONS

These results suggest that Endocem can be used as an available retrograde filling material because it sets faster and shows similar biological effects when compared with ProRoot.

Effect of acid etching on marginal adaptation of mineral trioxide aggregate to apical dentin: microcomputed tomography and scanning electron microscopy analysis

The present investigation assessed the effect of acid etching on marginal adaptation of white- and gray-colored mineral trioxide aggregate (MTA) to apical dentin using microcomputed tomography (micro-CT) and scanning electron microscopy (SEM). Sixty-four extracted single-rooted human maxillary teeth were used. Following root-end resection and apical preparation, the teeth were equally divided into four groups according to the following root end filling materials: (i) white-colored MTA (WMTA), (ii) etched WMTA (EWMTA), (iii) gray-colored MTA (GMTA) and (iv) etched GMTA (EGMTA). After 48 h, the interface between root-end filling materials and the dentinal walls was assessed using micro-CT and SEM. Data were statistically analyzed using the Kruskal-Wallis and Dunn tests. Micro-CT analysis revealed gap volumes between the apical cavity dentin walls and EGMTA, GMTA, EWMTA and WMTA of (0.007 1±0.004) mm(3), (0.053±0.002) mm(3), (0.003 6±0.001) mm(3) and (0.005 9±0.002) mm(3) respectively. SEM analysis revealed gap sizes for EGMTA, WMTA, EWMTA and GMTA to be (492.3±13.8) µm, (594.5±17.12) µm, (543.1±15.33) µm and (910.7±26.2) µm respectively. A significant difference in gap size between root end preparations filled with GMTA and EGMTA was found (P<0.05). No significance difference in gap size between WMTA and EWMTA were found in either SEM or micro-CT analysis. In conclusion, pre-etching of apical dentin can provide a better seal for GMTA but not for WMTA.

Healing of apical rarefaction of three nonvital open apex anterior teeth using a white portland cement apical plug

The major challenge of performing root canal treatment in an open apex pulp-less tooth is to obtain a good apical seal. MTA has been successfully used to achieve a good apical seal, wherein the root canal obturation can be done immediately. MTA and White Portland Cement has been shown similarity in their physical, chemical and biological properties and has also shown similar outcome when used in animal studies and human trials. In our study, open apex of three non vital upper central incisors has been plugged using modified white Portland cement. 3 to 6 months follow up revealed absence of clinical symptoms and disappearance of peri-apical rarefactions. The positive clinical outcome may encourage the future use of white Portland cement as an apical plug material in case of non vital open apex tooth as much cheaper substitute of MTA.

Compressive Strength and Setting Time of MTA and Portland Cement Associated with Different Radiopacifying Agents

Objective. The aim of this study was to evaluate the compressive strength and setting time of MTA and Portland cement (PC) associated with bismuth oxide (BO), zirconium oxide (ZO), calcium tungstate (CT), and strontium carbonate (SC). Methods. For the compressive strength test, specimens were evaluated in an EMIC DL 2000 apparatus at 0.5 mm/min speed. For evaluation of setting time, each material was analyzed using Gilmore-type needles. The statistical analysis was performed with ANOVA and the Tukey tests, at 5% significance. Results. After 24 hours, the highest values were found for PC and PC + ZO. At 21 days, PC + BO showed the lowest compressive strength among all the groups. The initial setting time was greater for PC. The final setting time was greater for PC and PC + CT, and MTA had the lowest among the evaluated materials (P < 0.05). Conclusion. The results showed that all radiopacifying agents tested may potentially be used in association with PC to replace BO.

Cement-related particles interact with proinflammatory IL-8 chemokine from human primary oropharyngeal mucosa cells and human epithelial lung cancer cell line A549

Epidemiological studies have shown that respirable exposure to emitted cement particulate matter is associated with adverse health risk for human. The underlying mechanisms, however, are poorly understood. To examine the effect of cement, nine blinded cement-related particulates (<10 μm) were assessed with regard to their induction of the proinflammatory cytokines IL-6 and IL-8 in human primary epithelial cells (pEC) from oropharyngeal mucosa as well as from nonsmall-cell lung carcinoma (non-SCLC) cells A549. It was demonstrated that the cement specimens did not act cytotoxic as assessed by the lactate dehydrogenase (LDH) assay. The basal and IL-1β-induced IL-8 expression was suppressed, in contrast to an unchanged IL-6. At the transcript level the basal and induced IL-6 and IL-8 gene expression was not influenced by cement dust. To discover the mechanism by which cement influenced the IL-8 expression the following experiments were performed. Submerse exposure experiments have shown that the release of IL-8 was suppressed by cement dust. Furthermore, the incubation of IL-8 with cement-related specimens under cell-free condition led to a loss of immunoreactive IL-8. An immunological masking of IL-8 by free soluble components of respiratory epithelial cells was excluded. Thus, the decrease of IL-8 protein content after cement exposure seems to be a result of the adsorption of IL-8 protein to cement particles and the inhibition of IL-8 release. In conclusion, due to absent cytotoxic and inflammatory effects of cement-related specimens in both human pEC and A549 cell models it remains open how cement exposure may lead to the respiratory adverse effects in humans.

The use of Portland cement in the repair of mandibular fractures in rats

PURPOSE

To evaluate the bone healing of mandibular fractures following the use of Portland cement.

METHODS

Thirty-two male Wistar rats were divided into control and experimental groups. In the control group the rats were submitted to a mandibular fracture, which was reduced, and the soft tissues were sutured. In the experimental group the rats had the mandibular fracture reduced and maintained with the Portland cement. The animals were euthanized 7 and 21 days after surgery by injecting a lethal dose of anesthetic. The following variables were studied: weight of the animals, radiographic images, histopathological features and time of surgery.

RESULTS

A weight loss was observed in the specimens of both groups at the different times of evaluation, a greater difference in weight before and after surgery being found in the experimental group, which was statistically significant (p <0.05, p = 0.041). From the histological point of view, with a margin of error (5.0%) the only two significant differences (p <0.05) recorded in the variables were "Material deployed" and "Bone resorption" during the evaluations at 7 and 21 days, respectively.

CONCLUSION

The Portland cement served to promote bone healing.

"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.

Understanding mineral trioxide aggregate/Portland-cement: a review of literature and background factors

AIM

This was to carry out a review of the literature concerning mineral trioxide aggregate (MTA) and Portland cement with regards to clinical, biological and mechanical findings and a possible substitution of MTA through Portland cement for endodontic use.

STUDY DESIGN

Electronic literature search of scientific papers from January 1993 to January 2009 was carried out on the MEDLINE and Scopus databases using specific key words. In total, 57 papers were identified that dealt with MTA and Portland cement in a relevant way.

RESULTS

The review of 50 papers conforming to the applied criteria showed that MTA and Portland cements have the same clinical, biological and mechanical properties. In animal experiments and technical characterisations both materials seemed to have very similar properties. The only difference is bismuth oxide in MTA added for better radio opacity. It seems likely that MTA materials are based on industrial Portland cements mixed with bismuth oxide. More studies, especially some long-term studies comparing MTA and Portland cement, are necessary.

CONCLUSION

The existing literature gives a solid base for clinical studies with Portland cement in order to replace MTA as an endodontic material. Portland cement could be a substitute for most endodontic materials used in primary teeth.

The nociceptive and anti-nociceptive effects of white mineral trioxide aggregate

AIM

To assess the nociceptive and antinociceptive effects of white mineral trioxide aggregate (WMTA) using the orofacial formalin test in rats.

METHODOLOGY

Rats (n = 10 in each group) were separately injected into the ipsilateral upper lip with either 40 microL of a 2.5% formalin solution and eugenol (50 mg kg(-1)) or WMTA (5, 10 and 20 mg dissolved in 0.2 mL saline) alone. In a second experiment to evaluate antinociception effects, 15 min prior to formalin injection, rats were pre-treated with either white ProRoot MTA (20 mg dissolved in 0.2 mL saline) or eugenol. The time each rat spent rubbing the injected site with its paw, as an index of nociception, was recorded for a period of 45 min.

RESULTS

Administration of 40 microL white ProRoot MTA (5, 10 and 20 mg per 0.2 mL) alone did not produce any significant nociceptive response. Moreover, prior treatment with WMTA caused significant (P < 0.001) inhibition of formalin-induced nociception. Injection of eugenol (50 mg kg(-1)) provoked the first phase of a nociceptive response, although its intensity was reduced compared with that produced by formalin. Pre-treatment with eugenol significantly (P < 0.0001) inhibited the induction of nociception by formalin. Comparison of the behavioural responses observed in WMTA and eugenol-treated rats alone or in combination with formalin revealed that WMTA did not only induce pain behaviour but also prevented formalin-induced nociception.

CONCLUSION

White mineral trioxide aggregate, when compared with eugenol, was more effective in treating nociceptive pain in the orofacial formalin test.

Study of the bismuth oxide concentration required to provide Portland cement with adequate radiopacity for endodontic use

OBJECTIVE

The purpose of this study was to determine the ideal concentration of bismuth oxide in white Portland cement to provide it with sufficient radiopacity for use as an endodontic material (ADA specification #57).

STUDY DESIGN

2-mm thick standardized test specimens of white MTA and of white Portland cement, as controls, and of white Portland cement with the experimental addition of 5%, 10%, 15%, 20%, 25% or 30% of bismuth oxide were radiographed and compared with various thicknesses of pure aluminum, using optic density to determine the observed grayscale levels of radiopacity in a scale ranging from 0 to 255. The data was submitted to ANOVA (p<0.05) and the Ryan-Einot-Gabriel-Welch and Quiot test (REGWQ) for multiple comparison of the means.

RESULTS

White Portland cement with 0%, 5%, 10%, 15%, 20%, 25% and 30% of bismuth oxide presented mean readings of 63.3, 95.7, 110.7, 142.7, 151.3, 161.0 and 180.0 respectively. MTA presented a mean reading of 157.3. The readings of MTA and white Portland cement with 15% bismuth oxide did not differ significantly from the reading observed for a thickness of 4 mm of aluminum (145.3), which is considered ideal for a test specimen by ADA specification #57 (2 mm above the thickness of the test specimen).

CONCLUSION

White MTA and white Portland cement with 15% bismuth oxide presented the radiopacity required for an endodontic cement.