Comparative investigation of marginal adaptation of mineral trioxide aggregate and other commonly used root-end filling materials

In vitro bacterial penetration and dissemination through dentinal tubules in roots filled with calcium silicate-based cements

The aim of this study was to assess whether calcium silicate root fillings prevent bacterial penetration and to determine how bacteria penetrate roots. Extracted single-rooted, single-canal human teeth were decoronated, prepared and filled with ProRootMTA or Biodentine (n = 12 each). Positive and negative (n = 2 each) controls were not filled. A two-chamber model was used with Streptococcus gordonii. The lower compartment was evaluated for turbidity over 150 days. Roots were split and examined for bacteria via SEM. The chi-squared test was used for comparisons (α = 0.05). Experimental groups had bacteria in their coronal thirds. Tubules contained bacteria in 90.9% and 91.7% of areas examined in the Biodentine and ProRootMTA groups, respectively, with no significant difference (p = 0.914). Experimental and negative roots had no turbidity with no significant difference between Biodentine and ProRootMTA (p = 1.000). Positive controls had turbidity. Bacteria penetrate roots via dentine tubules of root-filled teeth. Biodentine was comparable to ProRoot MTA.

Effects of vehicles on the physical properties and biocompatibility of premixed calcium silicate cements

Premixed calcium silicate cements (pCSCs) contain vehicles which endow fluidity and viscosity to CSCs. This study aimed to investigate the effects of three vehicles, namely, polyethylene glycol (PEG), propylene glycol (PG), and dimethyl sulfoxide (DMSO), on the physicochemical properties and biocompatibility of pCSCs. The setting time, solubility, expansion rate, and mechanical strength of the pCSCs were evaluated, and the formation of calcium phosphate precipitates was assessed in phosphate-buffered saline (PBS). The effects of pCSC extracts on the osteogenic differentiation of mesenchymal stem cells (MSCs) were investigated. Finally, the tissue compatibility of pCSCs in rat femurs was observed. CSC containing PEG (CSC-PEG) exhibited higher solubility and setting time, and CSC-DMSO showed the highest expansion rate and mechanical strength. All pCSCs generated calcium phosphate precipitates. The extract of CSC-PG induced the highest expressions of osteogenic markers along with the greatest calcium deposites. When implanted in rat femurs, CSC-PEG was absorbed considerably, whereas CSC-PG remained relatively unaltered inside the femur.

Comparative Evaluation of Sealing Ability of Different Type of MTA as Root-End Filling Materials Using Dye Penetration Technique - An In Vitro Study

Introduction

The main goal of the root-end filling material is to create a hermetic seal to protect against microbes and their by-products. Excellent biocompatibility and sealing ability are characteristics of MTA developed by Torabinejad et al. This study aimed to compare the sealing ability of different type MTA as root-end filling material using dye penetration technique.

Material and Method

One-twenty (N = 120) extracted human maxillary anterior teeth were decontaminated, cleaned, and decoronated. Endodontic treatment and root-end resection were done. Then root-end cavity was prepared and filled with tested materials (N = 30). A calibrated stereomicroscope was used to evaluate linear measurement. All data were tabulated and statistically analyzed with a level of significance set at P < .05.

Result

This order of increasing microleaks was observed: MTA Angelus < MTA Plus < PRO-Root MTA < Control group. There was a statistically significant difference in mean microleakage in MTA Angelus and MTA Plus groups (P = 0.040). MTA Angelus shows the least microleakage among all the bioceramic material groups.

Conclusion

Although the sealing ability of MTA Angelus is superior to MTA Plus, PRO-Root MTA. MTA Plus, PRO-Root MTA could be considered an acceptable alternative to MTA Angelus in peri-radicular surgeries.

In vitro and in vivo evaluation of iRoot BP Plus as a coronal sealing material for regenerative endodontic procedures

OBJECTIVES

To investigate in vitro effects of a nanoparticle bioceramic material, iRoot BP Plus, on stem cells from apical papilla (SCAP) and in vivo capacity to induce pulp-dentin complex formation.

MATERIALS AND METHODS

The sealing ability of iRoot BP Plus was measured via scanning electron microscopy (SEM). SCAP were isolated and treated in vitro by iRoot BP Plus conditioned medium, with mineral trioxide aggregate (MTA) conditioned medium and regular medium used as controls, respectively. Cell proliferation was assessed by BrdU labeling and MTT assay and cell migration was evaluated with wound healing and transwell assays. Osteo/odontogenic potential was evaluated by Alizarin red S staining and qPCR. Pulp-dentin complex formation in vivo was assessed by a tooth slice subcutaneous implantation model.

RESULTS

iRoot BP Plus was more tightly bonded with the dentin. There was no difference in SCAP proliferation between iRoot BP Plus and control groups (P > 0.05). iRoot BP Plus had a greater capacity to elevated cell migration (P < 0.05) and osteo/odontogenic marker expression and mineralization nodule formation of SCAP compared with MTA groups (P < 0.05). Furthermore, the new continuous dentine layer and pulp-like tissue was observed in the iRoot BP Plus group in vivo.

CONCLUSIONS

iRoot BP Plus showed excellent sealing ability, promoted the migration and osteo/odontogenesis of SCAP and induced pulp-dentin complex formation without affecting the cell proliferation, which indicated iRoot BP Plus was a promising coronal sealing material in REPs.

CLINICAL RELEVANCE

The coronal sealing materials play crucial roles for the outcomes of REPs. This study showed that iRoot BP Plus has good coronal sealing and promote pulp-dentin complex formation compared with MTA, providing experimental evidences for the clinical application of iRoot BP Plus as a promising coronal seal material in REPs.

Effect of blood contamination on marginal adaptation of cold ceramic and MTA angelus: a scanning electron microscopic study

BACKGROUND

This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM).

METHODS

This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05).

RESULTS

The mean marginal gap was 8.98 μm in the CC, and 16.26 μm in the MTA Angelus group; this difference was statistically significant (P < 0.001).

CONCLUSIONS

The present in vitro study revealed that following complete blood contamination of powder, CC showed significantly superior marginal adaptation than MTA Angelus as shown by SEM assessment.

Sealing ability of two root-end filling materials at different retro-preparation lengths

PURPOSE

The aim of the present study was to evaluate the sealing performance, expressed as microleakage (ML), of two root-end filling materials when used at different retro-preparation lengths.

METHODS

Fifty single-rooted human teeth were collected for the study. The teeth were cut at the cement-enamel junction and endodontic treatment was performed. Each root was cut at 3 mm from the apex and then stored in wet condition. The teeth were divided into three groups according to the retro-preparation length: control group (no retro-preparation); group 1 (retro-preparation of 3 mm); group 2 (retro-preparation of 9 mm). The teeth were equally allocated to either Biodentine or Super EBA treatment group. The teeth were immersed in 3% methylene blue dye solution for 24 h. The samples were split longitudinally and the depth of dye penetration was examined through light microscopy.

RESULTS

No significant statistical differences were found at different retro-preparation lengths (P > 0.05). Differences were found between materials (P > 0.05).

CONCLUSION

Biodentine showed significantly lower ML when compared to Super-EBA and no statistical significative differences were observed when samples were retro-prepared at 3 mm or 9 mm.

Comparison of Obturation Quality after MTA Orthograde Filling with Various Obturation Techniques

This study aimed to quantify and compare the obturation quality after mineral trioxide aggregate (MTA) orthograde fillings with three different obturation techniques. Thirty-three extracted human maxillary molars were collected. Distobuccal and palatal canals were prepared to an apical size of #40/06 with a Profile Ni-Ti system. All 66 canals were divided into two groups according to the material (EZ-seal or OrthoMTA) and then obturated using three different techniques: manual compaction using S-kondenser (group H), compactor activation (group C), or reverse rotary motion of Ni-Ti file (group R). The obturated roots were scanned using micro-computed tomography (micro-CT). The percentage of voids located in the apical 5 mm was measured separately, that is, closed, open, and total porosity. There was no relation between the filling material and obturation technique (p > 0.05). The percentage volume of open and total porosity was higher in EZ-seal than in OrthoMTA (open: p = 0.002, total: p = 0.001). Group H showed higher open and total porosity than groups C and R. Micro-CT analysis showed that the void volume after orthograde MTA fillings significantly decreased when the additional activation was accompanied by hand condensation. Obturation with a Ni-Ti file using reverse motion could be recommended as an MTA orthograde filling technique.

In-vitro evaluation of microleakage of bioceramic root-end filling materials: A spectrophotometric study

Aim

To evaluate the microleakage of newer bioceramic root-end filling materials.

Material and method

Sixty freshly extracted human single-rooted mandibular premolar teeth were selected for the study. Teeth with fractured root, cracks, anddilacerations were rejected. All teeth were cleaned with ultrasonic scalers. Standard access opening was done and root canal treatment was performed with rotary files followed by obturation. After storing in saline for a week apical 3 ​mm of the root was resected at 900 angles to the long axis of the root. Retro cavity preparation was done with ultrasonic tips. The teeth were divided into four groups of 15 specimens each. Group I - Biodentin, GroupII-Bioaggregate, Group III - MTA Plus, and Group IV - MTA. After the restoration of retro cavities of all the teeth as per manufacture instructions, two coats of nail varnish were applied to leave apical 3 ​mm. All teeth were stored in 2% methylene blue for 72 ​h followed by emersion in 65% nitric acid for the next 72 ​h for Dye extraction. The obtained supernatant solution was then centrifuged and optical density or absorbance was measured with a UV spectrophotometer.

Result

Microleakage was found to be increasing in this order: Biodentin ​< ​Bioaggregate ​< ​MTA Plus ​< ​MTA. No significant difference was found in the microleakage of Biodentin compared to that of Bioaggregate(p ​> ​0.01).

Conclusion

All materials exhibit some amount of microleakage. Biodentin shows the least microleakage among all the bioceramic material groups. Hence, Biodentin and bioaggregate are better material of choice for the retrograde filling to prevent microleakage.

Scanning electron microscopy analysis of marginal adaptation of mineral trioxide aggregate, tricalcium silicate cement, and dental amalgam as a root end filling materials

The aim of this research was to examine marginal adaptation of three root end filling materials mineral trioxide aggregate (MTA), Biodentine and amalgam. Ninety single-rooted extracted human teeth of the maxillary intercanine sector were used in the study. After the endodontic treatment and retrograde preparation, teeth were divided into three groups, depending on the root-end filling material. Teeth were cut in longitudinal manner. Measurements of the total width of the marginal gap in micrometers were performed using scanning electron microscopy. The results showed that MTA and Biodentine have better marginal adaptation compared to amalgam expressed through the mean value of the measured edge crack, however without significant difference (p > .05). Mean value of the measured edge crack in Group 1 (MTA) was 8.17 μm, in Group 2 (Biodentine) 8.53 μm, and in Group 3 (amalgam) 9.13 μm. All tested materials show a satisfactory degree of marginal adaptation, but MTA and Biodentine proved to be superior to amalgam.

Apicoectomy of Perforated Root Canal Using Bioceramic Cement and Photodynamic Therapy

Root perforation is a common endodontic accident. Its management depends mainly on root canal disinfection and sealing the perforation area by preventing any communication with the periodontium to prevent recontamination. A patient was referred to treat root perforation due to a previous treatment of tooth #22. The diagnosis was symptomatic periapical periodontitis, and the treatment plan was to retreat the root canal of #22 and make a surgical intervention (apicoectomy) associated with antimicrobial photodynamic therapy as a complementary technique. Five mineral oxides (5MO) cement was used as a root-end filling material. The procedures were performed in two sessions and controlled in two visits (after 30 days and 12 months). A bone neoformation was observed at the periapical area of tooth #22. 5MO bioceramic cement was effective in inducing the repair of the periapical lesion and had the ability to seal the exposed periapical area of the tooth. Its success depended mainly on root canal and surgical site disinfection.

Marginal adaptation, solubility and biocompatibility of TheraCal LC compared with MTA-angelus and biodentine as a furcation perforation repair material

BACKGROUND

This study evaluated the marginal adaptation, solubility and biocompatibility of TheraCal LC compared with mineral trioxide aggregate (MTA-Angelus) and Biodentine when used as a furcation perforation repair material.

METHODS

The marginal adaptation was assessed by scanning electronic microscope and presence of any gap between the dentin surface and filling material in each quadrant of the sample was analyzed at 1000 X magnification. The solubility was measured after one week by the ISO standard method. Biocompatibility was evaluated by the inflammatory response and radiography after one month and three months of repair of experimental furcation perforations in dog's teeth.

RESULTS

There were significant differences in the marginal adaptation, solubility and biocompatibility of the tested materials (P < 0.05). TheraCal LC showed the highest frequency distribution of gap presence that was followed by the MTA-Angelus then Biodentine. The least soluble material after one week was TheraCal LC that was followed by the MTA-Angelus and Biodentine. After one month and three months, TheraCal LC showed the highest inflammatory response and highest frequency distribution of radiolucency that was followed by the Biodentine then MTA-Angelus.

CONCLUSION

Unlike Biodentine, TheraCal LC is incapable of alternating the MTA in furcation perforation repair due to its poor biocompatibility and poor marginal adaptation.

Antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans: An in vitro study

OBJECTIVE

To evaluate the antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans.

MATERIAL AND METHODS

A total of 171 sterile dentin blocks, measuring 4 mm × 4 mm × 1 mm, were incubated in media containing E. faecalis (3.1 × 10⁸ cells/mL) and/or C. albicans (1 × 10⁷ cells/mL) for 2 d. These blocks were randomly divided into three groups: the control (no treatment with biomaterials), MTA (treated with an MTA sample with width and thickness same as those of the dentin block after the material was set), and NeoMTA Plus (treated with NeoMTA Plus in a fashion similar to the treatment of the MTA group) groups. The biomaterials remained in contact with the biofilms for 24 h. Quantitative analyses of the number of colony-forming units (CFUs) and metabolic activity (XTT), were performed. Furthermore, qualitative analysis of biofilm structure was performed by scanning electron microscopy. Data were statistically analyzed considering a significance level of 5%.

RESULTS

XTT and the number of CFUs were similar among the groups (p > 0.05). The type of biofilm (mono- or dual-species) or the biomaterial used (MTA or NeoMTA Plus) did not affect the results. Biofilm structure exhibited a robust architecture composed of yeast and bacterial cell multilayers and was homogeneous among the groups.

CONCLUSION

NeoMTA Plus was not effective against mono- and dual-species biofilms of E. faecalis and C. albicans. Further research investigating biofilm removal methods including those involving the use of biomaterials with antiseptics and other supporting therapies is warranted.

Preparation and properties of tristrontium aluminate as an alternative component of mineral trioxide aggregate (MTA) cement

This study evaluated tristrontium aluminate (S₃A) and its viability as a component for tricalcium silicate (C₃S) cements. The properties of S₃A, C₃S, and S₃A/C₃S mixtures were evaluated in terms of setting time, compressive strength, flowability, and radiopacity. X-ray diffraction (XRD) pattern verified the powder synthesized in the laboratory as S₃A, consequently, confirming the preparation method. S₃A exhibited the lowest setting time, followed by C₃S and S₃A/C₃S mixtures. Compressive strength of C₃S was significantly higher than S₃A. The S₃A/C₃S mixture showed comparable compressive strength to C₃S for 1-day post initial mixing. There was no significant difference in flowability between S₃A/C₃S and mineral trioxide aggregate (MTA). S₃A showed comparable radiopacity to MTA, whereas that of the S₃A/C₃S mixture was significantly lower comparatively; however, it achieved sufficient radiopacity (3 mm aluminum thickness equivalent). Further studies are needed to improve the manufacturing process of S₃A and evaluate the bioactive effect of strontium.

Filling ability of three bioceramic root-end filling materials: A micro-computed tomography analysis

This study aimed at evaluating the volume of gaps and voids, and the total porosity percentage of three calcium-silicate-based materials in mandibular molars apicoectomy by Micro-CT analysis. Thirty-three mesial roots of extracted human mandibular molars were instrumented and obturated. The apical 3mm of each root was resected and prepared. Root-end cavities were filled with EndoSequence BC Putty (BC); ProRoot MTA (MTA) and Biodentine (BIO). Samples were scanned using a Micro-CT scanner and the tridimensional images reconstructed. Percentage of gaps (VG%) and of voids (VV%) were obtained. Porosity percentage (Po%) was also assessed. Data were analysed using Student's t-test (P < 0.05). All materials presented gaps and voids. VG% was 2.006 (BC), 1.882 (MTA) and 1.450 (BIO), and VV% was 0.039 (BC), 0.021 (MTA) and 0.024 (BIO) with no statistical difference. Po% were 56.73 (BC), 51.94 (MTA) and 50.45 (BIO), with BC being statistically (P > 0.05) more porous.

Mineral trioxide aggregate apexification: a 20-year case review

Apexification strategies in traumatised non-vital immature permanent teeth can promote root-end closure and continued root development. However, traumatic injuries may compromise the integrity of generative cells of the apical papilla responsible for root maturation. This report describes the long-term treatment outcome of mineral trioxide aggregate (MTA) apexification managed with late-term surgical intervention. A seven-year-old male reported with swelling and suppuration associated with a traumatised maxillary left central incisor (#21). After palliative treatment and MTA apexification procedures, the incisor demonstrated normal function during a 14.5-year period with radiographic evidence of atypical radicular elongation. Seventeen years after initial treatment, the patient presented with mid-plate buccal swelling and surgical treatment was completed involving root resection, biopsy of a spherical mineralised tissue specimen and placement of MTA root-end filling. Periapical healing and normal tooth function was evident at the 20-year review.

Comparative apical sealing evaluation of two bioceramic endodontic sealers

AIM

The current study aims to evaluate, using scanning electronic microscopy, the sealing ability of two bioceramic endodontic sealers, one consecrated and one experimental.

METHODS

Twenty monoradicular teeth were included in the study. The teeth were endodontically prepared at the working length. The shaping and cleaning involved the use of chelating gel MM EDTA 19% and continuous irrigation with sodium hypochlorite 2.5%. The radicular filling was performed using gutta-percha in association with a sealer. Ten teeth were filled with consecrated endodontic filling material and the others ten with the experimental bioceramic based sealer.

RESULTS

The evaluation of the sealers using SEM analysis allowed the identification and the measurement of gaps on the radicular dentin/sealer interface and the degree of apical sealing ability. No significant statistical difference was observed between the gap dimensions in the three areas for the tested bioceramic materials (p<0.005). In the apical region a homogenous layer with extensions intersecting the hybrid layer was observed when the experimental bioceramic sealer was used. In case of teeth filled with commercial sealer, peripheral hybrid extended areas were identified.

CONCLUSIONS

The two bioceramic sealers presented similar apical sealing. Gaps were identified in both sealers but also the presence of hybrid layer was identified.

Bacterial leakage and marginal adaptation of various bioceramics as apical plug in open apex model

AIM

The aim of the present study was to investigate bacterial leakage and marginal adaptation of bioceramic apical plugs.

METHODS

Extracted human mandibular premolars were prepared to simulate open apex using No. 4 Peeso reamer in retrograde direction. In total, 150 specimens were divided into 10 groups by obturation with five bioceramics in two thicknesses. Groups 1, 3, 5, 7, and 9 were obturated with ProRootMTA, Biodentine, TotalFill BC RRM paste, TotalFill BC RRM putty, and RetroMTA at 3 mm, and groups 2, 4, 6, 8, and 10 were obturated with the same materials at 4 mm. Ten specimens in each group were evaluated for bacterial leakage of Enterococcus faecalis for 75 days. Five specimens from each group were sectioned to investigate the gap area under scanning electron microscope.

RESULTS

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited less bacterial leakage and lower mean percentage of gap area than those of the other groups. TotalFill BC RRM paste showed the highest leakage for both the 3- and 4-mm groups.

CONCLUSION

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited the best sealing ability and marginal adaptation of apical plugs.

Clinical and Molecular Perspectives of Reparative Dentin Formation: Lessons Learned from Pulp-Capping Materials and the Emerging Roles of Calcium

The long-term use of calcium hydroxide and the recent increase in the use of hydraulic calcium-silicate cements as direct pulp-capping materials provide important clues in terms of how reparative dentin may be induced to form a "biological seal" to protect the underlying pulp tissues. In this review article, we discuss clinical and molecular perspectives of reparative dentin formation based on evidence learned from the use of these pulp-capping materials. We also discuss the emerging role of calcium as an odontoinductive component in these pulp-capping materials.

Crack Formation Following Root-End Preparation in Roots with the Butterfly Effect

Objective:

To investigate apical cracks in roots that exhibit the butterfly effect and that have undergone apical resection and ultrasonic root-end cavity preparation. The effect of the obturation material was also studied.

Methods:

Forty extracted single-rooted teeth were decoronated at the cemento-enamel junction. Roots were viewed under a light microscope and coded according to the presence or absence of the butterfly effect. Canals were prepared using ProTaper Next instruments to size X3 and assigned to two obturation groups (gutta-percha and AH Plus, and ProRoot MTA alone). Each contained twenty roots (10 with the butterfly effect and 10 without the butterfly effect). Roots were resected perpendicular to their long axis, 3 mm from the apex, and cavities were cut using ultrasonic retrotips. Resin replicas were used for crack imaging from scanning electron micrographs. Statistical analyses were performed using Stata 13.1 (StataCorp, College Station, TX, USA).

Results:

Cracks occurred more frequently in teeth with the butterfly effect (80%), with this difference being significant (P=0.001). Most cracks (73%) ran buccolingually. Teeth obturated with MTA developed fewer cracks compared to those obturated with GP and sealer.

Conclusion:

Root-ends with the butterfly effect had a significantly higher number of buccolingual cracks following resection and ultrasonic root-end preparation. This might explain the development of some vertical root fractures, which usually run buccolingually. Canal obturation with MTA may be protective.

Bone tissue reaction, setting time, solubility, and pH of root repair materials

OBJECTIVES

This study aims to compare the bone tissue reaction, setting time, solubility, and pH of NeoMTA Plus, Biodentine (BD), and MTA Angelus (MTA-A).

MATERIALS AND METHODS

Initial and final setting times (n = 7) and solubility up to 7 days (n = 11) were evaluated in accordance with ASTM C266-15 and ANSI/ADA Specification No. 57, respectively. pH (n = 10) was measured up to 28 days. Bone tissue reactions in 48 rats' femur were histologically analyzed after 7, 30, and 90 days. ANOVA and Tukey's tests compared setting time, solubility, and pH data; bone reactions data were compared by Kruskal-Wallis and Dunn's tests.

RESULTS

NeoMTA Plus had longer initial and final setting times than MTA-A and BD (P < 0.05). At 7 days, BD showed the highest solubility, similar to NeoMTA Plus (P > 0.05) and different from MTA-A (P < 0.05). NeoMTA Plus had a progressive mass loss over time; at 7 days, it was significantly different from the initial mass (P < 0.05). BD showed higher pH in the periods assessed when compared to the other materials (P < 0.05). Bone tissue repair had no differences between groups in each experimental period (P > 0.05). All groups presented no difference from 30 to 90 days (P > 0.05) and had better bone repair at 90 days than at 7 days (P < 0.05).

CONCLUSIONS

NeoMTA Plus, BD, and MTA-A showed satisfactory setting time, high mass loss, alkaline pH, and allowed bone repair.

CLINICAL RELEVANCE

Calcium silicate-based cements are indicated for multiple clinical situations. NeoMTA Plus and BD showed satisfactory physical-chemical and biological properties, being considered as alternatives to MTA-A, as root repair materials for clinical use.

Evaluation of bioceramics and zirconia-reinforced glass ionomer cement in repair of furcation perforations: An in vitro study

Aim:

The aim and objective of this study was to evaluate and compare the sealing ability of EndoSequence BC RRM-fast set putty, Proroot mineral trioxide aggregate (MTA), and Zirconomer in the repair of furcal perforation by measuring dye leakage under stereomicroscope.

Methodology:

A standard access cavity was made on forty-eight extracted mandibular and maxillary first molars followed by creating a furcal perforation in the center of the pulp chamber by using No. 4 round bur (creating a perforation of 2 mm diameter). Teeth were categorized into 4 groups containing 12 samples in each group based on material used for furcation repair. Group 1 – Endosequence BC RRM-fast set putty; Group 2 – Zirconomer; Group 3-MTA (positive control); Group 4 – negative control. All groups were covered with two layers of clear varnish except for 2 mm around the perforation region. All the teeth were immersed in 2% methylene blue dye for 48 h for dye penetration. Teeth were sectioned buccolingually using a diamond disk. The sectioned teeth were examined under stereomicroscope with ×10 magnification for dye penetration.

Results:

Endosequence showed less microleakage than MTA but not statistically significant. Zirconomer showed statistically significant higher microleakage.

Conclusion:

Endosequence and MTA showed less microleakage hence can be used as furcation repair materials. Due to higher microleakage, Zirconomer should be avoided as furcation repair material. Due to its favorable cost, ready availability, and almost similar outcome as bioceramics, MTA is considered as an alternative to Endosequence and is the gold standard in furcation repair.

Push-out bond strength of different tricalcium silicate-based filling materials to root dentin

The aim of this study was to evaluate the bond strength of different triccalcium silicate cements to retrograde cavity using a push out test. Thirty maxillary central incisors were shaped using #80 hand files and sectioned transversally. Root slices were obtained from the apical 4 mm after eliminating the apical extremity. The specimens were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. The samples were divided into three groups according to the root-end filling material (n = 10): MTA Angelus, ProRoot MTA and Biodentine. A gutta-percha cone (#80) was tugged-back at the limit between the canal and the root-end cavity. The root-end cavity was filled and the gutta-percha cone was removed after complete setting of the materials. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and push out testing was performed at a crosshead speed of 1.0 mm/min. There was no statistically significant difference in resistance to push out by the materials tested (p > 0.01). MTA Angelus and ProRoot MTA showed predominantly mixed failure while Biodentine exhibited mixed and cohesive failures. The tricalcium silicate-based root-end filling materials showed similar bond strength retrograde cavity.

Adaptation of mineral trioxide aggregate to dentine walls compared with other root-end filling materials: A systematic review

This systematic review analysed the literature comparing marginal adaptation of mineral trioxide aggregate (MTA) with other filling materials in root-end cavities. The PubMed, Ovid, Web of Science, SCOPUS, and Cochrane library databases were searched using appropriate keywords related to root-end filling materials and adaptation. Of 38 articles assessed, 20 met the inclusion criteria. No in vivo study was identified. In 10 studies, MTA gave the best marginal adaptation results, but no significant differences were found between MTA and any of the tested filling materials in seven studies. There was great variability in the study designs including analysed surface, unit of gap measurement and magnification amount during analysis. On the basis of available evidence, MTA presented good marginal adaptation to dentine walls. This review identified the need for the development of standardised methods to evaluate the adaptation property of root-end filling materials in ex vivo studies as well as in clinical studies evaluating outcome.

Chemical Composition and Porosity Characteristics of Various Calcium Silicate-Based Endodontic Cements

Chemical composition and porosity characteristics of calcium silicate-based endodontic cements are important determinants of their clinical performance. Therefore, the aim of this study was to investigate the chemical composition and porosity characteristics of various calcium silicate-based endodontic cements: MTA-angelus, Bioaggregate, Biodentine, Micromega MTA, Ortho MTA, and ProRoot MTA. The specific surface area, pore volume, and pore diameter were measured by the porosimetry analysis of N2 adsorption/desorption isotherms. Chemical composition and powder analysis by scanning electron microscope (SEM) and energy dispersive spectroscopy (EDS) were also carried out on these endodontic cements. Biodentine and MTA-angelus showed the smallest pore volume and pore diameter, respectively. Specific surface area was the largest in MTA-angelus. SEM and EDS analysis showed that Bioaggregate and Biodentine contained homogenous, round and small particles, which did not contain bismuth oxide.

Interaction of backfilling techniques and MTA plugs with additives: Fracture strength and adaptation analyses

The aims were to evaluate the effects of different additives on the adaptation of mineral trioxide aggregate (MTA) plugs before and after different backfilling techniques and analyze the interference of filling procedures on the fracture resistance of simulated immature teeth. The apical parts of 60 teeth were filled with MTA mixed with distilled water (DW), propylene glycol (PG) or calcium chloride (CaCl₂) and backfilled with cold lateral condensation (CLC) or warm vertical compaction (WVC). The specimens were subjected to adaptation analysis and fracture testing. CaCl₂ addition resulted in poor marginal adaptation, while PG addition significantly decreased the fracture values (p<0.05). WVC technique negatively affected the marginal adaptation of MTA-CaCl₂ plugs and decreased the fracture values of teeth with MTA-PG plugs (p<0.05). Mixing MTA with DW can be recommended as apical plug when the remaining root canal space is going to be filled with either CLC or WVC techniques.

Biological evaluation of a new pulp capping material developed from Portland cement

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n=24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n=8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement+10% calcium hydroxide+20% bismuth oxide (Port Cal) and subgroup 3: Portland cement+bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively.

A Comparative Evaluation of Sealing Ability of New MTA Based Sealers with Conventional Resin Based Sealer: An In-vitro Study

INTRODUCTION

Root canal obturation is the most important step in the root canal treatment that aims to obtain a complete hermetic seal and to prevent the re-growth of microorganisms in the root canal system. To accomplish this, many endodontic obturation materials and sealers are being used.

AIM

To evaluate and compare the apical microleakage of a resin based sealer; Adseal with Mineral Trioxide Aggregate (MTA) based sealers; Pro root MTA and MTA Fillapex.

MATERIALS AND METHODS

Total 75 extracted human single rooted teeth were taken and decoronated at cemento-enamel junction. The access cavities and biomechanical preparation were performed using endodontic rotary system. The teeth were randomly divided into five groups with n=15; Group I - Gutta-percha and Adseal sealer; Group II - Gutta-percha and MTA Fillapex; Group III- Gutta-percha and Pro root MTA; Group IV- Gutta-percha without sealer (positive control group); Group V- Root canal remained empty (negative control). All the specimens were stored at 37(0)C with 100% humidity for one week. All root surfaces except the apical 2mm were covered with two layers of nail varnish and then immersed in an aqueous solution of 2% methylene blue dye for 72 hours. Roots were longitudinally split using a diamond disk. Linear apical dye penetration was measured under Stereomicroscope at 40X magnification.

STATISTICAL ANALYSIS

The data obtained was subjected to statistical analysis using paried t-test, ANOVA for interclass comparison, with SPSS statistical software (version 20.0).

RESULTS

The intraobserver reliability was found to be insignificant in each of the triplicate study of all the three study samples. MTA Fillapex group showed maxmium apical microleakage followed by Pro root MTA and Adseal sealer.

CONCLUSION

The results concluded that Adseal sealer showed minimal dye penetration followed by Pro root MTA and MTA Fillapex. Thus, concluding that Adseal sealer is better in apical sealing than Pro root MTA and MTA Fillapex.

"Evaluation of shear bond strength of a composite resin to white mineral trioxide aggregate with three different bonding systems"-An in vitro analysis

Background

Mineral trioxide aggregate (MTA) is a biomaterial that has been investigated for endodontic applications. With the increased use of MTA in pulp capping, pulpotomy, perforation repair, apexification and obturation, the material that would be placed over MTA as a final restoration is an important matter. As composite resins are one of the most widely used final restorative materials, this study was conducted to evaluate the shear bond strength of a composite resin to white mineral trioxide aggregate (WMTA) using three different bonding systems namely the two-step etch and rinse adhesive, the self-etching primer and the All-in-one system.

Material and Methods

Forty five specimens of white MTA (Angelus) were prepared and randomly divided into three groups of 15 specimens each depending on the bonding systems used respectively. In Group A, a Two-step etch and rinse adhesive or ‘total-etch adhesive’, Adper Single Bond 2 (3M/ESPE) and Filtek Z350 (3M ESPE, St Paul, MN) were placed over WMTA. In group B, a Two-step self-etching primer system, Clearfil SE Bond (Kuraray, Medical Inc) and Filtek Z350 were used. In Group C, an All-in-one system, G Bond (GC corporation, Tokyo, Japan) and Filtek Z350 were used. The shear bond strength was measured for all the specimens. The data obtained was subjected to One way Analysis of Variance (ANOVA) and Scheffe’s post hoc test.

Results

The results suggested that the Two-step etch and rinse adhesive when used to bond a composite resin to white MTA gave better bond strength values and the All-in-one exhibited the least bond strength values.

Conclusions

The placement of composite used with a Two-step etch and rinse adhesive over WMTA as a final restoration may be appropriate.

Key words:Composite resins, dentin bonding agents, mineral trioxide aggregate, shear bond strength.

In vitro evaluation of the apical seal of two different retrograde filling materials

To determine whether the selection of retrograde filling material or the choice of instruments in root tip resection influences the seal of the retrograde root filling. Seventy-two single-rooted teeth were used. Root resection was performed using a Lindemann bone cutter, a Lindemann bone cutter with A-shaped cutting design or a diamond-coated bur. Retro-cavities were prepared by piezo-tips and filled with Super-EBA or MTA. Teeth were made transparent and dye penetration was assessed. Teeth filled with MTA, irrespective of the resection instrument, showed no measurable dye penetration. All groups filled with Super-EBA showed an apical leakage. There were no significant differences between the three groups filled with Super-EBA (P = 0.09). The comparison of MTA versus Super-EBA showed significant superiority in apical seal in favour of MTA (P < 0.0001). To use MTA as a retrograde filling material showed superior results in terms of the tightness of the apical seal as compared to Super-EBA.

Scanning electron microscopy (SEM) evaluation of sealing ability of MTA and EndoSequence as root-end filling materials with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents

AIM

The purpose of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA) and EndoSequence with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents using scanning electron microscopy (SEM).

MATERIALS AND METHODS

Forty human single rooted teeth were taken. Crowns were decoronated and canals were obturated. Apically roots were resected and retrograde cavities were done. Based on the type of retrograde material placed and the type of smear layer removal agent used for retrograde cavities, they were divided into four groups (N = 10): Group I chitosan with EndoSequence, group II chitosan with MTA, group III CMC with EndoSequence, and Group IV CMC with MTA. All the samples were longitudinally sectioned, and the SEM analysis was done for marginal adaptation.

STATISTICAL ANALYSIS

Kruskal-Wallis and Mann-Witney analysis tests.

RESULTS

SEM images showed the presence of less gaps in group III, i.e., CMC with EndoSequence when compared to other groups with statistically significant difference.

CONCLUSION

Within the limited scope of this study, it was concluded that EndoSequence as retrograde material showed better marginal sealing ability.

Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine

Objective:

The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine.

Materials and Methods:

Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant.

Results:

No significant difference was observed among the MTA, BA, and biodentine experimental groups.

Conclusion:

All the three materials tested, may be used as effective strengthening agents for immature teeth.

An ex-vivo comparative study of root-end marginal adaptation using grey mineral trioxide aggregate, white mineral trioxide aggregate, and Portland cement under scanning electron microscopy

Context:

Where nonsurgical endodontic intervention is not possible, or it will not solve the problem, surgical endodontic treatment must be considered. A major cause of surgical endodontic failures is an inadequate apical seal, so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical.

Aims:

The aim of the present ex-vivo study was to compare and evaluate the three root-end filling materials of mineral trioxide aggregate (MTA) family (white MTA [WMTA], grey MTA [GMTA] and Portland cement [PC]) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy (SEM).

Materials and Methods:

Sixty human single-rooted teeth were decoronated, instrumented, and obturated with Gutta-percha. After the root-end resection and apical cavity preparation, the teeth were randomly divided into three-experimental groups (each containing 20 teeth) and each group was filled with their respective experimental materials. After longitudinal sectioning of root, SEM examination was done to determine the overall gap between retrograde materials and cavity walls in terms of length and width of the gap (maximum) at the interface. Descriptive statistical analysis was performed to calculate the means with corresponding standard errors, median and ranges along with an analysis of variance and Tukey's test.

Results:

The least overall gap was observed in GMTA followed by PC and WMTA. While after statistically analyzing the various data obtained from different groups, there was no significant difference among these three groups in terms of marginal adaptation.

Conclusion:

GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA. Being biocompatible and cheaper, the PC may be an alternative but not a substitute for MTA.

New methodology to evaluate bond strength of root-end filling materials

This study evaluated the bond strength of root-end filling materials to root-end cavities using a new methodology. Twenty maxillary central incisors were subjected to biomechanical preparation (#80 hand file) and sectioned transversally 2 mm short of the apex and 4 mm coronally to this point. The root cylinders were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. Two groups (n=10) were formed according to the root-end filling material: MTA and Super EBA. A gutta-percha cone (#80) was tug-backed at the limit between the canal and the root-end cavity. The cavity was filled and the gutta-percha cone was removed after complete setting of the sealer. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and run at a crosshead speed of 1.0 mm/min for pushing out the root-end filling material. Data were analyzed by ANOVA (α=5%). Super EBA (6.03±1.31) presented higher bond strength (MPa) than MTA (1.81±0.45) (p>0.05). There was a predominance of cohesive failures for Super EBA and mixed for MTA. The protocol of specimen preparation is effective and introduces a specific methodology for assessing bond strength of root-end filling materials to dentin. Among the materials, Super EBA presented the highest bond strength.