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Liu H, Lu L, Xu K, Shen Y. Treatment outcomes and prognostic factors of the apical barrier technique with premixed calcium silicate-based putty in necrotic permanent teeth with open apices: a retrospective cohort study with up to six years follow-up. Clin Oral Investig 2024; 28:425. [PMID: 38990402 DOI: 10.1007/s00784-024-05813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To evaluate treatment outcomes of the apical barrier technique with premixed calcium silicate-based putty for treating necrotic permanent teeth with open apices and to identify prognostic factors. MATERIALS AND METHODS Permanent teeth with necrotic pulps and open apices treated by the apical barrier technique with premixed calcium silicate-based putty, with a minimum follow-up of 12 months, were included. Treatment outcomes were based on clinical signs, symptoms, and radiographic evaluation. The treatment outcome was dichotomized into success or failure according to strict and loose criteria. The chi-square test (or Fisher's exact test) and multiple logistic regression analysis were used to evaluate possible prognostic factors associated with treatment outcomes. RESULTS Seventy-four teeth with a follow-up time of 12-72 months (mean, 25.74 ± 14.36 months) were included in the final evaluation. The success rate was 97.30% using the loose criteria and 66.22% using the strict criteria. Multiple logistic regression analysis indicated that the size of pre-operative periapical lesion (≥ 5 mm) (odds ratio [OR]: 18.96; P = 0.0153) and root canal underfilling (OR: 8.341; P = 0.0448) were significant predictors for treatment failure under the strict criteria. CONCLUSION The apical barrier technique with premixed calcium silicate-based putty is a highly successful procedure for treating necrotic permanent teeth with open apices after an observation period of up to 6 years. Treatment success under the strict criteria is primarily affected by the size of the pre-operative periapical lesion and the apical extent of root-filling. CLINICAL RELEVANCE Careful case selection and ensuring adequate root filling quality are essential to the successful outcome of the apical barrier technique with premixed calcium silicate-based putty.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Le Lu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China.
| | - Ke Xu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
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Ateş A, Kurt A, Mercantepe T. Effects of mineral trioxide aggregate and methyl sulfonyl methane on pulp exposure via RUNX2 and RANKL pathways. Odontology 2024; 112:895-905. [PMID: 38194042 DOI: 10.1007/s10266-023-00885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
The aim of this study was to determine the therapeutic effects of mineral trioxide aggregate (MTA) and methyl sulfonyl methane (MSM) on pulp damage due to pulp exposure through the RUNX2 and RANKL pathways. Seventy-two male Sprague-Dawley rats aged 4-6 months and weighing 250-300 g were divided into healthy, control, MTA, and MSM groups. After experimental applications, all rats at 2, 4, and 8 weeks were killed anesthetically with xylazine hydrochloride (Rompun, Bayer) 30 mg/kg and ketamine hydrochloride (Ketalar, Pfizer) 50 mg/kg injections (i.p.). We observed that necrotic odontoblasts, edema, inflammation, and vascular congestion findings were reduced from week 2 to week 8 in the MSM treatment group after pulp capping compared to the control group and MTA group. Similarly, we found a decrease in RUNX2 and RANKL levels in the MSM application group compared to the control and MTA groups (p < 0.05). MSM material has shown therapeutic effects on pulp capping treatment-induced pulp injury via increased RUNX2 ve RANKL expression.
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Affiliation(s)
- Altar Ateş
- Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdogan University, 53100, Rize, Turkey
| | - Ayca Kurt
- Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdogan University, 53100, Rize, Turkey.
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100, Rize, Turkey
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Bardini G, Orrù C, Ideo F, Nagendrababu V, Dummer P, Cotti E. Clinical management of external cervical resorption: A systematic review. AUST ENDOD J 2023; 49:769-787. [PMID: 37702252 DOI: 10.1111/aej.12794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified by an electronic search, 60 clinical case reports and six case series were included. No randomised clinical trials were found. Risk of bias was assessed using Joanna Briggs Institute's tools. External surgical intervention was the preferred method of accessing the lesions. Removal of resorptive tissue was most often achieved mechanically. Bioactive endodontic cements were the preferred materials for restoring teeth. The outcome measures were based on clinical and radiographic parameters. Of the cases included in the review, no specific treatment approach had a superior outcome in relation to Heithersay's classification. Furthermore, due to the absence of randomised clinical trials, and the low level of evidence associated with case reports/case series, it was not possible to define the optimum clinical treatment for external cervical resorption.
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Affiliation(s)
- Giulia Bardini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Cristiano Orrù
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Paul Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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El Hachem C, Chedid JCA, Nehme W, Kaloustian MK, Ghosn N, Rabineau M, Kharouf N, Haikel Y, Mancino D. The Contribution of Various In Vitro Methodologies to Comprehending the Filling Ability of Root Canal Pastes in Primary Teeth. Bioengineering (Basel) 2023; 10:818. [PMID: 37508845 PMCID: PMC10376379 DOI: 10.3390/bioengineering10070818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
A void-free obturation during root canal treatment on primary teeth is currently very difficult to attain. In this study, the pulpectomy filling abilities of Bio-C Pulpecto (Angelus, Basil, Londrina, Paraná, Brazil) and of zinc oxide eugenol, or "ZOE" (DenPro, Prevest, New York, NY, USA), were compared using several in vitro techniques. Therefore, 30 primary anterior teeth were used in the present in vitro study. Analysis of variance (ANOVA), including a multiple comparison procedure (Holm-Sidak method, Dunn's Method, or Tukey test), was used. On micro-CT, Bio-C Pulpecto exhibited higher void percentages than did ZOE (10.3 ± 3.8%, and 3.5 ± 1.3%), respectively (p < 0.05). With digital microscopy, higher total void percentages were found in the BC (13.2 ± 26.7%) group compared to the ZOE (2.7 ± 2.8%) group (p < 0.05). With the CLSM, mean tubular penetration depths were higher for Bio-C Pulpecto than for ZOE in all canal thirds (p < 0.05). SEM images demonstrated no tags into dentinal tubules in either group throughout the three thirds. Moreover, higher statistically significant flowability was found for Bio-C (2.657 ± 0.06 mm) compared to ZOE (1.8 ± 0.13 mm) (p < 0.05). The findings of this study indicate that neither ZOE nor Bio-C Pulpecto appears to meet the criteria for an ideal root canal filling paste for primary teeth. This study laid the groundwork for future research by determining how micro-CT, digital microscopy, SEM, and CLSM contribute to our understanding of the filling process of primary teeth. More thorough research on the mechanism of root canal obturation on primary teeth is required to achieve a long-term successful root canal therapy in young children.
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Affiliation(s)
- Claire El Hachem
- Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Jean Claude Abou Chedid
- Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Walid Nehme
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, 155 5th Street, San Francisco, CA 94103, USA
| | - Marc Krikor Kaloustian
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Nabil Ghosn
- Craniofacial Research Laboratory, Faculty of Dental Medicine, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Morgane Rabineau
- Faculté de Chirurgie Dentaire, Fédération de Médecine Translationnelle de Strasbourg and Fédération des Matériaux et Nanoscience d'Alsace, Université de Strasbourg, 67000 Strasbourg, France
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
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Wannakajeepiboon M, Sathorn C, Kornsuthisopon C, Santiwong B, Wasanapiarnpong T, Linsuwanont P. Evaluation of the chemical, physical, and biological properties of a newly developed bioceramic cement derived from cockle shells: an in vitro study. BMC Oral Health 2023; 23:354. [PMID: 37270491 DOI: 10.1186/s12903-023-03073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Tricalcium silicate is the main component of commercial bioceramic cements that are widely used in endodontic treatment. Calcium carbonate, which is manufactured from limestone, is one of the substrates of tricalcium silicate. To avoid the environmental impact of mining, calcium carbonate can be obtained from biological sources, such as shelled mollusks, one of which is cockle shell. The aim of this study was to evaluate and compare the chemical, physical, and biological properties of a newly developed bioceramic cement derived from cockle shell (BioCement) with those of a commercial tricalcium silicate cement (Biodentine). METHODS BioCement was prepared from cockle shells and rice husk ash and its chemical composition was determined by X-ray diffraction and X-ray fluorescence spectroscopy. The physical properties were evaluated following the International Organization for Standardization (ISO) 9917-1;2007 and 6876;2012. The pH was tested after 3 h to 8 weeks. The biological properties were assessed using extraction medium from BioCement and Biodentine on human dental pulp cells (hDPCs) in vitro. The 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5[(phenylamino)carbonyl]-2 H-tetrazolium hydroxide assay was used to evaluate cell cytotoxicity following ISO 10993-5;2009. Cell migration was examined using a wound healing assay. Alizarin red staining was performed to detect osteogenic differentiation. The data were tested for a normal distribution. Once confirmed, the physical properties and pH data were analyzed using the independent t-test, and the biological property data were analyzed using one way ANOVA and Tukey's multiple comparisons test at a 5% significance level. RESULTS The main components of BioCement and Biodentine were calcium and silicon. BioCement's and Biodentine's setting time and compressive strength were not different. The radiopacity of BioCement and Biodentine was 5.00 and 3.92 mmAl, respectively (p < 0.05). BioCement's solubility was significantly higher than Biodentine. Both materials exhibited alkalinity (pH ranged from 9 to 12) and demonstrated > 90% cell viability with cell proliferation. The highest mineralization was found in the BioCement group at 7 days (p < 0.05). CONCLUSIONS BioCement exhibited acceptable chemical and physical properties and was biocompatible to human dental pulp cells. BioCement promotes pulp cell migration and osteogenic differentiation.
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Affiliation(s)
- Monthip Wannakajeepiboon
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chankhrit Sathorn
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- School of Dentistry and Medical Sciences, Charles Sturt University, Parramatta, NSW, Australia
| | - Chatvadee Kornsuthisopon
- Dental Stem Cell Biology Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Busayarat Santiwong
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | - Pairoj Linsuwanont
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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6
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Riyahi AM. Bioceramics utilization for the repair of internal resorption of the root: A case report. World J Clin Cases 2022; 10:11185-11189. [PMID: 36338206 PMCID: PMC9631136 DOI: 10.12998/wjcc.v10.i30.11185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/05/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The objective of this work is displaying a successful treatment for an internal resorption case under operating microscope using bioceramic material.
CASE SUMMARY Periapical radiograph showed radiolucent lesion representing large internal resorption of the root. The respective defect was obturated using endoscquence bioceramic material follow up at the month 18 after treatment revealed no abnormal finings clinically and radiographically.
CONCLUSION New generations bioceramics have many advantages that internal root resorption cases can benefit from. The use of operating microscope helps to apply obturating materials with precision. However, long term study on a large sample is required in future studies.
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Liu H, Lu J, Jiang Q, Haapasalo M, Qian J, Tay FR, Shen Y. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioact Mater 2022; 12:257-277. [PMID: 35310382 PMCID: PMC8897058 DOI: 10.1016/j.bioactmat.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Regenerative endodontic procedures have been rapidly evolving over the past two decades and are employed extensively in clinical endodontics. These procedures have been perceived as valuable adjuvants to conventional strategies in the treatment of necrotic immature permanent teeth that were deemed to have poor prognosis. As a component biological triad of tissue engineering (i.e., stem cells, growth factors and scaffolds), biomaterial scaffolds have demonstrated clinical potential as an armamentarium in regenerative endodontic procedures and achieved remarkable advancements. The aim of the present review is to provide a broad overview of biomaterials employed for scaffolding in regenerative endodontics. The favorable properties and limitations of biomaterials organized in naturally derived, host-derived and synthetic material categories were discussed. Preclinical and clinical studies published over the past five years on the performance of biomaterial scaffolds, as well as current challenges and future perspectives for the application of biomaterials for scaffolding and clinical evaluation of biomaterial scaffolds in regenerative endodontic procedures were addressed in depth. Overview of biomaterials for scaffolding in regenerative endodontics are presented. Findings of preclinical and clinical studies on the performance of biomaterial scaffolds are summarized. Challenges and future prospects in biomaterial scaffolds are discussed.
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8
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S C, R RC, R R, D D, Balakumar S. Unravelling the effects of ibuprofen-acetaminophen infused copper-bioglass towards the creation of root canal sealant. Biomed Mater 2022; 17. [PMID: 35259739 DOI: 10.1088/1748-605x/ac5b83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/08/2022] [Indexed: 11/11/2022]
Abstract
Impact towards the tuneable characteristics of bioactive glasses (BAG) has been explored; as there is no root canal sealant till date with ideal characteristics competent enough to manoeuvre the perplexing root canal architecture. Combeite, calcite and traces of cuprorivaite crystalline phases were validated for material formation, in which Cu 2P [XPS] peak authenticating the presence of copper in bioglass network (Cu-BAG). Spherical and platelet-like morphologies were observed and the grain size of Cu-BAG (~100 nm) was lesser as compared to BAG (~ 1 µm). These particle distributions impacted the porosity, and dominant non-bridging oxygens in Cu-BAG influences ionic dissolution, which subsequently enhanced the mineralization. These bioactive materials were loaded with acetaminophen and ibuprofen, corresponding organic moieties was confirmed through FT-IR. These drugs loaded bioactive materials exhibited tremendous anti-inflammatory and anti-microbial behavior with better sealing ability. Drug loaded bioglass paste filled in biomechanically prepared root canal was estimated for sealing potential, mineralization, micro leakage, and fracture resistance properties. Hydroxyl apatite growth was noted on the sealants, flower like protuberance confirmed the sealing potential of the prepared material. Bioglass exhibited promising characteristics required in a root canal sealant. This investigation is a step further towards tailoring the properties of bioactive materials as promising candidates in root canal obturation and thereof.
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Affiliation(s)
- Chitra S
- Saveetha University Saveetha Dental College, Department of Biomaterials, Saveetha Dental College and Hospitals, Chennai, Chennai, Tamil Nadu, 600077, INDIA
| | - Riju Chandran R
- University of Madras - Guindy Campus, National Centre for Nanoscience and Nanotechnology,, University of Madras,, Chennai, Chennai, Tamil Nadu, 600025, INDIA
| | - Ramya R
- Saveetha University Saveetha Dental College, Department of Oral Pathology, Chennai, Tamil Nadu, 600077, INDIA
| | - Durgalakshmi D
- Anna University Chennai, Department of Medical Physics, Chennai, Tamil Nadu, 600025, INDIA
| | - S Balakumar
- National Centre for Nanoscience and Nanotechnology, University of Madras, Guindy Campus, Chennai-25, Chennai, Tamil Nadu, 600025, INDIA
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Irinakis E, Haapasalo M, Shen Y, Aleksejuniene J. External cervical resorption - Treatment outcomes and determinants: a retrospective cohort study with up to 10 years of follow-up. Int Endod J 2022; 55:441-452. [PMID: 35243651 DOI: 10.1111/iej.13717] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
AIM To assess long-term external cervical resorption (ECR) treatment outcomes in relation to both local and treatment-related determinants. METHODOLOGY Information was available for 76 patients (98 teeth) who were diagnosed with ECR during the period from 2008 to 2018 at the University of British Columbia graduate endodontics clinic. The ECR patients were followed-up, and a clinical and radiographic examination was conducted. Chi-Square test compared failure rates among different subgroups. The survival analysis was used to evaluate the overall ECR survival/failure rates in relation to several local and treatment-related determinants. RESULTS Overall, 67 patients (89 teeth) were followed-up. The mean follow-up time was 3.9 years, and the minimum was 1 year. Twenty-four teeth failed (19 extracted, 5 not functional), and the overall probability of failure was 50.0% 8 years after the diagnosis. Significant (p < 0.05) local ECR determinants were tooth location and the Heithersay classification, and treatment-related determinants were root canal treatment (RCT) and the ECR repair combined with RCT. Treatment outcomes for Heithersay class 1 and 2 cases were better than for class 3 and 4 cases. CONCLUSIONS Higher failure rates were associated with posterior tooth location and higher Heithersay class, while RCT and ECR repair combined with RCT were associated with lower failure rates.
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Affiliation(s)
- E Irinakis
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - M Haapasalo
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - Y Shen
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - J Aleksejuniene
- Department of Oral Health Sciences Faculty of Dentistry, The University of British Columbia, Vancouver, Canada
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Pinheiro LS, Kopper PMP, Quintana RM, Scarparo RK, Grecca FS. Does MTA provide a more favourable histological response than other materials in the repair of furcal perforations? A systematic review. Int Endod J 2021; 54:2195-2218. [PMID: 34418122 DOI: 10.1111/iej.13617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/20/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models. OBJECTIVES To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models. METHODS This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies. RESULTS The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials. DISCUSSION This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously. CONCLUSIONS Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations. REGISTRATION PROSPERO (CRD42020181297).
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Affiliation(s)
- Lucas Siqueira Pinheiro
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Patricia Maria Poli Kopper
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ramiro Martins Quintana
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fabiana Soares Grecca
- Postgraduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Abdelmotelb MA, Gomaa YF, Khattab NMA, Elheeny AAH. Premixed bioceramics versus mineral trioxide aggregate in furcal perforation repair of primary molars: in vitro and in vivo study. Clin Oral Investig 2021; 25:4915-4925. [PMID: 33483869 DOI: 10.1007/s00784-021-03800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The current study was carried out to (1) evaluate premixed bioceramic (BC) and mineral trioxide aggregate (MTA) sealing properties in a laboratory and (2) compare the performance of these two materials in repairing an immediate iatrogenic furcal perforation of primary molars both clinically and radiographically. MATERIALS AND METHODS In vitro sections including eighty mandibular second primary molars were sorted into 4 equal groups: (1) an intact furcation area group, (2) an artificial perforation group (unrepaired), (3) an artificial perforation group repaired with MTA, and (4) an artificial perforation group repaired with premixed BC. The dye extraction method was used to assess the sealing ability of the material. Clinically, the study was designed as an equivalent parallel randomized controlled trial. Seventy-six mandibular second primary molars with immediate furcal perforation were sealed with MTA and premixed BC. Teeth were evaluated clinically and radiographically at 3, 6, and 12 months. RESULTS Although the difference was statistically insignificant (p = 0.058), the premixed BC group had better sealing ability than the MTA group [mean difference = 0.020; 95% CI (-0.001, 0.040)]. Clinically and radiographically, the two materials had an equivalent success rate in the first 3 months [ARR = 0.05; 95% CI (-0.07, 0.17)] but inequivalent success rates at 6 and 12 months with premixed BC performing better than MTA. CONCLUSIONS The present findings confirm that premixed BC is a promising material that can be used to repair a furcal perforation of primary molars. Premixed BC has better sealing properties and better performance at the clinical and radiographic levels than MTA. CLINICAL RELEVANCE (1) Accidental furcal perforation in primary molars is one of the worst problems that results in diminishing the lifetime expectancy of primary teeth if not properly treated. Though new BC repair materials have been introduced to enhance healing and tissue inductive properties, there is an obvious shortage in clinical trials covering this area. The present study is a premier study that assesses a recently introduced premixed BC material in the furcal perforation of primary teeth and compares its outcomes with those of the widely used MTA. TRIAL REGISTRATION ClinicalTrials.gov PRS reference #NCT04137861.
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Affiliation(s)
| | - Yasser Fathi Gomaa
- Dental Biomaterials, Faculty of Dentistry, Minia University, Minya, Egypt
| | | | - Ahmad Abdel Hamid Elheeny
- Paediatric and Community Dentistry, Faculty of Dentistry, Minia University, Ard Shalaby, El Minia, Minya, 61519, Egypt.
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12
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Azim AA, Wang HH, Serebro M. Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars. J Endod 2020; 47:648-657. [PMID: 33045265 DOI: 10.1016/j.joen.2020.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 12/21/2022]
Abstract
Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.
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Affiliation(s)
- Adham A Azim
- School of Dental Medicine, University at Buffalo, Buffalo, New York.
| | - Howard H Wang
- School of Dental Medicine, University at Buffalo, Buffalo, New York
| | - Maksim Serebro
- School of Dental Medicine, University at Buffalo, Buffalo, New York
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Osteogenic Potential of Fast Set Bioceramic Cements: Molecular and In Vitro Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, pre-mixed bioceramics in fast set formulations have been increasingly utilized in clinical practice as an alternative to mineral trioxide aggregate (MTA) for their shorter setting time and better handling properties. However, the impact on their osteogenic potential, due to modifications in chemical composition to promote a fast setting, is still unclear. This molecular and in vitro study compared the osteogenic potential of root repairing material putty fast set (FSP) with root-repairing material putty (RRMPU), root-repairing material paste (RRMPA), Biodentine™ and MTA. The null hypothesis tested was that there are no differences among the tricalcium silicate materials in terms of osteogenic potential. Standardized discs were cultured with MG-63 human osteoblastic-like cells to assess biocompatibility, the activity of alkaline phosphatase (ALP) and osteogenic potential. Biocompatibility was evaluated at baseline and after 24 and 48 h. Osteogenic differentiation was assessed after 15 days. Data were analyzed with one-way ANOVAs and Tukey’s post-hoc test (p < 0.05). All materials showed biocompatibility and bioactivity. ALP activity, which induces mineral nodule deposition, increased in all the cements tested, with a significant increase in RRMPU (p < 0.001) and FSP (p < 0.001) samples versus MTA. In vitro mineralization was significantly increased for RRMPU (p < 0.0001), FSP (p = 0.00012) and Biodentine™ (p < 0.0001) versus MTA. The bioceramics tested showed higher levels of biocompatibility and bioactivity than MTA; a higher capacity for mineralization was observed with RRMPU and FSP versus MTA.
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The Influence of Brushing Movement on Geometrical Shaping Outcomes: A Micro-CT Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10144805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brushing motion has been proposed for endodontic single-file reciprocating systems to eliminate coronal interferences, but it may hesitate in a less conservative root canal shaping. The aim of the study was to compare the maintenance of the original root canal anatomy using the WaveOne Gold (WOG) technique with or without a brushing motion. Sixty extracted human mandibular first molars were selected. Manual canal scouting and mechanical glide path were performed. Samples were randomized into two groups (n = 30): WOG Primary was used to shape the mesio-lingual canals without (NB group) or with (B group) an intentional brushing motion. Specimens were scanned with micro-computed tomography (micro-CT) before and after instrumentation in order to match the volumes. Increases in canal volume and surface area were measured. Centroid shift and thickness of removed dentine from the inner curvature were assessed at the furcation, 1.5 mm and 3 mm apically from the furcation, and in relation to the point of maximum curvature. Data were analyzed by one-way ANOVA and post-hoc Student–Newmann–Keuls tests (p < 0.05). No brushing technique resulted in being significantly associated with a better maintenance of the canal anatomy, especially in the coronal third (p < 0.05). When using the WOG system, a no-brushing technique resulted in less invasive shaping, reducing the risk of stripping.
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Are Zirconia Bioceramics and Ceramics Intended to Come in Contact with Skin Inert? MATERIALS 2020; 13:ma13071697. [PMID: 32260495 PMCID: PMC7178696 DOI: 10.3390/ma13071697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Abstract
Generally speaking, ceramic materials are insensitive to corrosion, compared to most other materials. The present study questions the fact that ceramics are inert. Two major aspects are to be considered: the stability of zirconia over time, the stable tetragonal phase transforming into an unstable monoclinic form; the multitude of manufacturing methods, using various additives, sintering additives, oxides mixing, impurities, grain boundaries, and porosities which strongly influence the corrosion behavior and chemical degradation. In case of the investigated ceramics two paths were pursued:a) Dissolutions of ceramics in a mixture of HNO3 60% and HF 40% ultrapure medium.b) Release of cations from ceramics in various mediums:dental bioceramics in a 0.07 M HCl medium and a 0.1% NaF+0.1% KF medium; ceramics used in jewelry and watchmaking applications in a HCl 0.07 M medium and an artificial sweat medium. By inductively coupled plasma-optical emission spectrometry/mass spectrometry (ICP-OES/MS), traces of significant chemical elements were assessed: Hf, Cr, Y, As, Pb, Al, Fe, Cu, Se, Sb, La, Ni, Co, Sb, Ta, Te, Ba, Sm, Nb, Hg, Cd, Sr, As and Se. In ceramics used in jewelry and watchmaking applications the concentrations found vary from one ceramic to another, including toxic elements such as Te, Ba, As, Pb, Sm, Hg and Cd, therefore being technical zirconia ceramics which are not intended for the medical field. For ceramics used in jewelry and watchmaking applications a screening identification test for Ni, Co, Cu and Fe with strips of type Merckoquant® (Merck, Kenilworth, NJ, USA) was also performed. The obtained data prove that the zirconia ceramics in question are far from being "inert".
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Šimundić Munitić M, Poklepović Peričić T, Utrobičić A, Bago I, Puljak L. Antimicrobial efficacy of commercially available endodontic bioceramic root canal sealers: A systematic review. PLoS One 2019; 14:e0223575. [PMID: 31622387 PMCID: PMC6797114 DOI: 10.1371/journal.pone.0223575] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background Recently, a new generation of bioceramic root canal sealers has been introduced onto the market. Many in vitro studies have investigated the antimicrobial properties of these sealers, but their comparative efficacy in antimicrobial activity is still unknown. Methodology Three electronic databases were searched: MEDLINE and Embase via the OvidSP platform, and Web of Science, up to June 25, 2019. Studies were included irrespective of study design, type of publication and language. Reporting quality was assessed by two authors independently. Meta-analysis was not performed due to studies being highly heterogeneous. Results We included 37 studies that analysed the antimicrobial effects of bioceramic sealers. Most of them used a planktonic cell model, with the exception of nine studies which used biofilms. It was not possible to make direct comparison of results from studies and to give a clear conclusion about the comparative antimicrobial activity of these materials because the studies used heterogeneous sources and ages of microorganisms, setting and contact times of sealers, and antimicrobial tests. Furthermore, some materials showed completely different results when tested with different methods. Conclusions In conclusion, multiple in vitro studies have shown that bioceramic sealers may have various degrees of antimicrobial activity. However, it is still impossible to make conclusions about their comparative efficacy and to recommend the use of one over another in clinical practice because the studies available were conducted in different ways, which makes meta-analysis futile. A uniform methodological approach, consistent definitions and studies on humans are urgently needed in this field of research so that recommendations for practice can be made.
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Affiliation(s)
- Marija Šimundić Munitić
- Department of Endodontics and Restorative Dentistry, Dental Polyclinic Split; School of Dental Medicine, University of Split, Split, Croatia
- * E-mail:
| | - Tina Poklepović Peričić
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Split, Croatia
| | - Ana Utrobičić
- Cochrane Croatia, Central Medical Library, School of Medicine, University of Split, Split, Croatia
| | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Livia Puljak
- Department of Evidence Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Zagreb, Croatia
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Abou ElReash A, Hamama H, Abdo W, Wu Q, Zaen El-Din A, Xiaoli X. Biocompatibility of new bioactive resin composite versus calcium silicate cements: an animal study. BMC Oral Health 2019; 19:194. [PMID: 31438924 PMCID: PMC6704669 DOI: 10.1186/s12903-019-0887-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to compare the biocompatibility of three bioactive materials, namely ACTIVA bioactive restorative resin composite, iRoot BP plus and Mineral Trioxide Aggregate (MTA) Angelus-HP. Methods Seventy-five Wistar male rats were subjected to subcutaneous implantation of four polyethylene tubes; one empty tube was used as control (Group 1), and the other tubes were filled with ACTIVA (Group 2), iRoot BP (Group 3) and MTA-HP (Group 4). Then, the rats were subdivided into 3 groups according to the sacrification time into one, two and 4 weeks (n = 25 rats). Tissue specimens were submitted to histopathological and immunohistochemical analysis of α-SMA and caspase 3. Results The one-way Anova test revealed that ACTIVA group exhibited minimal inflammation in comparison to calcium silicate cements (iRoot BP and MTA-HP groups). iRoot BP group significantly revealed a more severe degree of chronic inflammation in comparison to other groups (P < 0.05). ACTIVA group showed marked regression of inflammation and fibrosis comparable to the control, while iRoot BP group revealed remarkable fibrosis and calcification, with less degrees in MTA-HP group (P < 0.05). Immunostaining of both α-SMA and caspase 3 revealed lower indexes in ACTIVA group consistent with the control (P < 0.05). Conclusions ACTIVA showed a higher degree of biocompatibility to subcutaneous tissues in comparison to both iRoot BP and MTA-HP cements in regard to decrease the intensity of inflammation, with subsequent fibrous connective tissue remodeling and better healing patterns. Clinical significance Preliminary data suggests that the application of ACTIVA in retrograde fillings.
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Affiliation(s)
- Ashraf Abou ElReash
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China
| | - Hamdi Hamama
- Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Walied Abdo
- Department of Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Qiqi Wu
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China
| | - Ahmed Zaen El-Din
- Department of Conservative Dentistry. Faculty of Oral and Dental Medicine, Delta University for Science and Technology, International Coastal Road, Gamasa City, Mansoura, Dakhliya, Egypt
| | - Xie Xiaoli
- Department of Endodontic, Xiangya School of stomatology, Central South University, Xiangya Road No 72. Kaifu, Changsha, 410078, Hunan province, China.
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Jadun S, Monaghan L, Darcey J. Endodontic microsurgery. Part two: armamentarium and technique. Br Dent J 2019; 227:101-111. [PMID: 31350492 DOI: 10.1038/s41415-019-0516-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Modern endodontic microsurgery has a high reported success rate of up to 93.5%, making it a viable treatment option in the management of periapical disease when orthograde root treatment is not possible or inappropriate. This high success rate is intimately related to advanced techniques that have allowed practitioners to overcome historical barriers to the success seen in traditional surgical endodontics. When comparing traditional root-end surgery and endodontic microsurgery there are key differences when considering the flap design, access armamentarium, size of osteotomy, instruments used and root-end material. This paper highlights such key differences and advises practitioners on the techniques and instruments used to achieve high success rates, firmly establishing non-surgical endodontic treatment as an important treatment option in well-selected cases.
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Affiliation(s)
- Sarah Jadun
- University Dental Hospital of Manchester, Oral Surgery, Higher Cambridge Street, Manchester, UK
| | - Liam Monaghan
- University Dental Hospital of Manchester, Orthodontic Department, Higher Cambridge Street, Manchester, UK
| | - James Darcey
- University Dental Hospital of Manchester, Restorative Department, Higher Cambridge Street, Manchester, UK.
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de Sousa Reis M, Scarparo RK, Steier L, de Figueiredo JAP. Periradicular inflammatory response, bone resorption, and cementum repair after sealing of furcation perforation with mineral trioxide aggregate (MTA Angelus™) or Biodentine™. Clin Oral Investig 2019; 23:4019-4027. [PMID: 30864115 DOI: 10.1007/s00784-019-02833-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study assessed tissue responses after furcation perforation and immediate sealing with either Biodentine™ or MTA Angelus™. MATERIAL AND METHODS Sixty male Wistar rats were used (n = 6 per group/period). The mandibular first molars had the furcation mechanically exposed and sealed with either MTA or Biodentine™ and restored with silver amalgam. In an additional test group, teeth were sealed only with Biodentine™. Furcation sealing with gutta-percha and silver amalgam restoration served as positive control, and healthy untreated teeth were the negative control. Histological evaluation was performed after 14 or 21 days. Kruskal-Wallis and Dunn's post hoc tests were performed to analyze the extent and intensity of tissue inflammation, bone resorption, and cementum repair (p < 0.05). RESULTS Biodentine™ and MTA presented satisfactory results, showing a milder inflammatory response when compared to the control, regardless of the material used for coronal sealing and of the experimental period evaluated (p < 0.0001). All test groups showed less bone resorption than the positive control after 21 days (p < 0.05), and such differences were more pronounced in teeth restored with silver amalgam. Cementum repair was performed in 30% of MTA and Biodentine™ samples but not carried out in any positive control specimen. CONCLUSIONS Biodentine™ and MTA promoted similar responses when used to seal furcation perforations and should therefore be regarded as a promising alternative. CLINICAL RELEVANCE Knowledge about tissue responses to restorative materials is essential for improving root perforation sealing protocols. The present results showed that both Biodentine™ and MTA promoted appropriate periradicular tissue reactions in a preclinical test for evaluating furcation perforation treatments.
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Affiliation(s)
- Magda de Sousa Reis
- School of Dentistry, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | | | - Liviu Steier
- Department of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Guo YJ, Du TF, Li HB, Shen Y, Mobuchon C, Hieawy A, Wang ZJ, Yang Y, Ma J, Haapasalo M. Physical properties and hydration behavior of a fast-setting bioceramic endodontic material. BMC Oral Health 2016; 16:23. [PMID: 26897651 PMCID: PMC4761215 DOI: 10.1186/s12903-016-0184-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the physical properties and the hydration behaviour of the fast-setting bioceramic iRoot FS Fast Set Root Repair Material (iRoot FS) and three other endodontic cements. Methods iRoot FS, Endosequence Root Repair Material Putty (ERRM Putty), gray and white mineral trioxide aggregate (G-MTA & W-MTA), and intermediate restorative material (IRM) were evaluated. The setting time was measured using ANSI/ADA standards. Microhardness was evaluated using the Vickers indentation test. Compressive strength and porosity were investigated at 7 and 28 days. Differential scanning calorimetry (DSC) was employed for the hydration test. Results iRoot FS had the shortest setting time of the four bioceramic cements (p < .001). The microhardness values of iRoot FS, ERRM Putty and MTA increased at different rates over the 28 days period. At day one, ERRM Putty had the lowest microhardness of the bioceramic cements (p < .001), but reached the same level as MTA at 4, 7 and 28 days. The microhardness of iRoot FS was lower than that of W-MTA at 7 and 28 days (p < .05). The porosity of the materials did not change after 7 days (p < .05). The compressive strength values at 28 days were significantly greater for all bioceramic groups compared to those at 7 days (p < .01). ERRM Putty had the highest compressive strength and the lowest porosity of the evaluated bioceramic cements (p < .05), followed by iRoot FS, W-MTA, and G-MTA, respectively. DSC showed that iRoot FS hydrated fastest, inducing an intense exothermic reaction. The ERRM Putty did not demonstrate a clear exothermic peak during the isothermal calorimetry test. Conclusions iRoot FS had a faster setting time and hydrating process than the other bioceramic cements tested. The mechanical properties of iRoot FS, G-MTA and W-MTA were relatively similar.
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Affiliation(s)
- Ya-Juan Guo
- Institute of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - Tian-Feng Du
- Department of Stomatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Hong-Bo Li
- Institute of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Department of Materials Engineering, The University of British Columbia, Vancouver, Canada.
| | - Christophe Mobuchon
- Department of Materials Engineering, The University of British Columbia, Vancouver, Canada
| | - Ahmed Hieawy
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Zhe-Jun Wang
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Yan Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
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