Root end filling materials: a review

The Management of Open Apex Using a Bioactive Material: A Case Report

The management of teeth with open apices poses unique challenges in endodontics, requiring effective strategies to promote continued root development and maintain pulp vitality. This abstract explores the utilization of bioactive materials in the treatment of open apices, specifically focusing on their role in achieving optimal outcomes. Bioactive materials, such as Biodentine (Septodont, Saint-Maur-des-Fossés, France), have gained prominence for their favourable physiochemical properties, biocompatibility, and ability to stimulate dentinogenesis. The application of a bioactive material as an apical plug not only addresses immediate concerns but also contributes to long-term health and stability. This abstract reviews relevant literature, discusses clinical cases, and emphasizes the importance of tailoring treatment plans to the individual characteristics of open apex cases. The findings underscore the promising role of bioactive materials in reshaping the landscape of endodontic interventions for teeth with open apices, highlighting their potential to enhance both clinical and radiographic success.

Effect of Fluorohydroxyapatite on Biological and Physical Properties of MTA Angelus

Objectives

This study aimed to assess the effect of addition of fluorohydroxyapatite (FHI) on biological and physical properties of mineral trioxide aggregate (MTA) Angelus.

Materials and Methods

In this in vitro, experimental study, nano-FHI powder was first synthesized, and the morphology and chemical structure of particles were evaluated by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). Three groups were evaluated in this study: MTA Angelus, MTA modified with 10% FHA, and MTA modified with 15% FHA. After mixing, the materials were applied to ring molds (10 mm diameter, 1 mm height), and the setting time of the three groups was evaluated according to ISO6876 and ASTMC266-03 with a Gillmore needle. The pH was measured using a pH meter at 24 and 48 hours and 7 days after mixing. The cytotoxicity of the materials was assessed in freshly mixed form and after 1 and 7 days using the methyl thiazolyl tetrazolium (MTT) assay according to ISO10993-5. Data were analyzed by one-way and repeated measures ANOVA and Tukey's test (alpha = 0.05).

Results

The addition of FHA to MTA significantly decreased the initial setting time (P < 0.05) and had no significant effect on cell viability (compared with pure MTA Angelus) at 1 and 7 days. However, modified MTA groups in freshly mixed form showed significantly lower cell viability (P < 0.05). The pH remained alkaline at all time points.

Conclusion

Addition of 15% FHA to MTA Angelus decreased its setting time with no adverse effect on cell viability (except for fresh form) or pH.

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.

Antibacterial Activity and Sustained Effectiveness of Calcium Silicate-Based Cement as a Root-End Filling Material against Enterococcus faecalis

Several calcium silicate cement (CSC) types with improved handling properties have been developed lately for root-end filling applications. While sealing ability is important, a high biocompatibility and antimicrobial effects are critical. This study aimed to conduct a comparative evaluation of the antimicrobial efficacy and sustained antibacterial effectiveness against Enterococcus faecalis (E. faecalis) of commercially available CSCs mixed with distilled water (DW) and chlorhexidine (CHX). Various products, viz., ProRoot mixed with DW (PRW) or with CHX (PRC), Endocem mixed with DW (EW) or with CHX (EC), and Endocem premixed (EP) syringe type, were used. While antibacterial activity against E. faecalis was evaluated using a direct contact method, the specimens were stored in a shaking incubator for 30 d for antibacterial sustainability. The cytotoxicity was evaluated using a cell counting kit-8 assay in human periodontal ligament stem cells. The antibacterial activities of EP, EW, and EC were greater than those of PRC and PRW (p < 0.05). The antibacterial sustainability of EP was the highest without cytotoxicity for up to 30 days (p < 0.05). In conclusion, the pre-mixed injectable type EP was most effective in terms of antibacterial activity and sustained antibacterial effectiveness without cytotoxicity.

Radiopacity evaluation of calcium silicate cements

BACKGROUND

The aim of this study was to compare the radiopacity of calcium silicate cements using a digital imaging method.

METHODS

Four calcium silicate cements, NeoMTA 2, OrthoMTA, ProRoot MTA, and Biodentine, were used in this study. Disk-shaped samples were prepared from each material and placed on a plexiglass plate. An aluminum step-wedge was placed alongside the samples on a digital sensor and exposed to 70 kVp and 8 mA from 30 cm away for 0.32 s. The greyness values ​​of the tested materials were measured digitally with the system software and compared with those of the step-wedge to determine the equivalent aluminum thickness.

RESULTS

The radiopacity values, expressed in equivalent millimetres of aluminum, of the studied materials ProRoot MTA, OrthoMTA, NeoMTA 2, and Biodentine were 4.32 ± 0.17 mm Al, 3.92 ± 0.09 mm Al, 3.83 ± 0.07 mm Al, and 2.29 ± 0.21 mm Al, respectively. Statistically significant differences were found between the mean radiographic density values of the tested materials (p < 0.05).

CONCLUSION

ProRoot MTA was the most radiopaque root canal filling material among the tested materials. All materials, except Biodentine, were found to be compliant with the minimum radiopacity requirements of ISO 6876 and ADA 57 standards.

Mechanism of action of Bioactive Endodontic Materials

A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.

Effects of calcium silicate cements on neuronal conductivity

Objectives

This study evaluated alterations in neuronal conductivity related to calcium silicate cements (CSCs) by investigating compound action potentials (cAPs) in rat sciatic nerves.

Materials and Methods

Sciatic nerves were placed in a Tyrode bath and cAPs were recorded before, during, and after the application of test materials for 60-minute control, application, and recovery measurements, respectively. Freshly prepared ProRoot MTA, MTA Angelus, Biodentine, Endosequence RRM-Putty, BioAggregate, and RetroMTA were directly applied onto the nerves. Biopac LabPro version 3.7 was used to record and analyze cAPs. The data were statistically analyzed.

Results

None of the CSCs totally blocked cAPs. RetroMTA, Biodentine, and MTA Angelus caused no significant alteration in cAPs (p > 0.05). Significantly lower cAPs were observed in recovery measurements for BioAggregate than in the control condition (p < 0.05). ProRoot MTA significantly but transiently reduced cAPs in the application period compared to the control period (p < 0.05). Endosequence RRM-Putty significantly reduced cAPs.

Conclusions

Various CSCs may alter cAPs to some extent, but none of the CSCs irreversibly blocked them. The usage of fast-setting CSCs during apexification or regeneration of immature teeth seems safer than slow-setting CSCs due to their more favorable neuronal effects.

Comparison of the sealing ability of various bioceramic materials for endodontic surgery

Objectives

Endosequence Bioceramic Root Repair Material (BC-RRM) is used in endodontic microsurgery. It is available as a paste and a putty. However, no studies to date have examined the sealing ability of these forms alone or in combination as root-end filling materials. Hence, this study aimed to compare the sealing properties of these 2 forms of BC-RRM.

Materials and Methods

Forty-two extracted upper anterior teeth were divided into 3 experimental groups, a positive and negative control. After the root canal treatment, the root ends were resected, retroprepared and retrofilled with either putty, paste + putty or mineral trioxide aggregate (MTA). The teeth were mounted in tubes so the apical 3 mm was submerged in Brain Heart Infusion (BHI) broth. The coronal portions of the canals were inoculated with Enterococcus faecalis and BHI broth and incubated for 30 days. The broth in the tubes was analyzed for colony forming units to check for leakage of bacteria from the canal. The teeth from the groups were sectioned and analyzed using scanning electron microscopy (SEM). The Kruskal-Wallis test and analysis of variance were used to analyze the data with a significance level p < 0.05.

Results

The BC-RRM and MTA groups showed similar sealing ability. The positive control showed leakage in all samples. The SEM imaging showed the presence of bacteria in all experimental groups at the material-tooth interface.

Conclusions

No significant differences were noted in the experimental groups, providing sufficient evidence that any combination could be effectively used during endodontic microsurgery.

Bioactive Materials for Direct and Indirect Restorations: Concepts and Applications

Currently, minimally invasive restorations could be made in dentistry applying adhesive materials and adhesion principles to the dental structures. Following this philosophy, endodontic interventions have been avoided largely, preserving hard tissues, and maintaining dental vitality. Advances in biologically favorable bioactive materials enabled clinicans to induce repair and regeneration of dental tissues. Such materials are primarily used for pulp protection and cementation of indirect restorations. This review highlights current bioactive materials available, principles of bioactivity and their mechanisms of action.

A Novel Self-Mineralizing Antibacterial Tissue Repair Varnish to Condition Root-end Dentin in Endodontic Microsurgery

INTRODUCTION

A novel 2-part varnish system containing chitosan nanoparticles (part 1) and chitosan-grafted hydroxyapatite precursor nanocomplex (part 2) was developed to condition the root-end dentin using the principle of biomineralization while rendering both antimicrobial efficacy and bioactivity. This in vitro study aimed to characterize and assess the effectiveness of the chitosan nanoparticles and chitosan-grafted hydroxyapatite precursor nanocomplex containing self-mineralizing antibacterial tissue repair varnish to condition as well as seal root-end dentin during endodontic microsurgery.

METHODS

In phase 1, the antibacterial properties and cellular response of the varnish were characterized. The antibacterial activity and cellular responses were evaluated using Enterococcus faecalis and periodontal ligament (PDL) fibroblasts, respectively. In phase 2, a resected root-end model was used to apply the 2-part varnish and examine the dentin-varnish interface using transmission electron microscopy. The percentage of root end sealed with time was determined using scanning electron microscopy (n = 6/time point). Statistical analysis was performed using 1-way analysis of variance where applicable.

RESULTS

The part 1 and 2 of the varnish displayed significant antibacterial activity and reduced bacterial adherence/survival (P < .01). The attachment and spreading of PDL fibroblasts on the varnish-conditioned dentin was enhanced compared with unconditioned dentin (P < .01). In the resected root-end model, the 2-part varnish displayed a biomineralized varnish layer with close interaction with the subsurface dentin. Root-end coverage with the biomineralized layer increased with incubation time (P < .01), reaching approximately 95% coverage after 24 hours.

CONCLUSIONS

The 2-part varnish system effectively conditioned/sealed the root end with a biomineralized layer while reducing bacterial load and promoting PDL fibroblast attachment. This therapeutic modification of root-end dentin could provide optimal conditions to enhance healing and improve prognosis in teeth with root-end cracks after endodontic microsurgery.

A long-term treatment outcome of intentional replantation in Taiwanese population

BACKGROUND/PURPOSE

Intentional replantation was a conventional treatment option in surgical endodontics but usually be seen as a last resort. Therefore, the purpose of this study was to evaluate the long-term treatment outcome of intentional replantation in Taiwanese population, including the survival rates and the related prognostic factors.

METHODS

Subjects included 215 teeth from 199 patients who had received intentional replantation in a Taiwan medical center. Patients at age under 20 years and those follow-up periods less than 6 months were excluded. The replanted teeth were followed up for a period of 6 months-120 months. Post-treatment assessments, including tooth survival and functional status, were evaluated using both clinical and radiographic examinations.

RESULTS

Kaplan-Meier survival analysis revealed the overall tooth survival rate at 4 years was 82.8%. In bivariate analysis, both root-end filling material and enamel matrix derivative (EMD) applications were found to be significant (P < 0.05). The multivariate analysis revealed that age and the presence of a sinus tract or abscess might be the predictors of treatment outcome in intentional replantation.

CONCLUSION

Intentional replantation, operated with improved modern technique, is a reliable and viable treatment with a high long-term survival rate (82.8%). If replanted teeth are diagnosed as acute or chronic apical abscess at the pre-operative examination, the risk of failure is measured 2.7 times higher than those diagnosed with other conditions. Application of EMD on the root surface of a replanted tooth may promote the formation and regeneration of periodontal apparatus, therefore increasing the functioning rate and improving the treatment outcome.

Spectrophotometric analysis evaluating apical microleakage in retrograde filling using GIC, MTA and biodentine: an in-vitro study

BACKGROUND

The present study compares the apical microleakage of three different root-end filling materials in which the retrograde cavity is prepared by two different burs.

METHODS

Eighty extracted single rooted maxillary and mandibular premolars were taken. Root canal treatment was completed. Apical 3 mm of all the teeth were resected with diamond disk. The tooth were divided into four groups with two subgroups for each group containing 10 tooth (N = 10) as: Group IA (Negative Control and IB (Positive Control); Group IIA and IIB: Prepared with round carbide bur and round diamond bur respectively, filled with GIC; Group IIIA and IIIB: Prepared with round carbide bur and round diamond bur respectively, filled with MTA; Group IVA and IVB: Prepared with round carbide bur and round diamond bur, filled with Biodentine. After applying two coats of nail varnish leaving apical 3 mm (except for negative control group) all teeth were immersed in 2% methylene blue for 3 days and again in 65% nitric acid for next 3 days for extraction of dye. The obtained solution was then transferred to eppendorf tube and centrifuged in microcentrifuges at 14,000 revolution per minutes (RPM) for 5 min. Optical density or absorbance of the supernatant solution was measured with UV spectrophotometer at 550 nm.

RESULTS

The absorbance of the supernatant solution after dye extraction is decreasing in the order of positive control> GIC > MTA > Biodentine> negative control group. The significant difference was observed between GIC and MTA (p = 0.0001) and GIC and Biodentine (p = 0.0001) with two different burs but statistically non-significant difference was observed between MTA and Biodentine with Carbide bur (p = 0.127) and Diamond bur (p = 0.496) respectively.

CONCLUSIONS

Within the limitations of the present study, it can be concluded that Biodentine and MTA showed less microleakage as compared to GIC. There is no significant difference between mean microleakage of MTA and Biodentine. However, the mean OD of the Biodentine was least of all evaluated materials. Preparation of the root-end using round carbide bur as well as round diamond burs showed comparable microleakage for all three filling materials.

Effects of the cathepsin K inhibitor with mineral trioxide aggregate cements on osteoclastic activity

Objectives

Root resorption is an unexpected complication after replantation procedures. Combining anti-osteoclastic medicaments with retrograde root filling materials may avert this resorptive activity. The purpose of this study was to assess effects of a cathepsin K inhibitor with calcium silicate-based cements on osteoclastic activity.

Methods

MC3T3-E1 cells were cultured for biocompatibility analyses. RAW 264.7 cells were cultured in the presence of the receptor activator of nuclear factor-kappa B and lipopolysaccharide, followed by treatment with Biodentine (BIOD) or ProRoot MTA with or without medicaments (Odanacatib [ODN], a cathepsin inhibitor and alendronate, a bisphosphonate). After drug treatment, the cell counting kit-8 assay and Alizarin red staining were performed to evaluate biocompatibility in MC3T3-E1 cells. Reverse-transcription polymerase chain reaction, tartrate-resistant acid phosphatase (TRAP) staining and enzyme-linked immunosorbent assays were performed in RAW 264.7 cells to determine the expression levels of inflammatory cytokines, interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α) and prostaglandin E2 (PGE2). Data were analyzed by one-way analysis of variance and Tukey's post hoc test (p < 0.05).

Results

Biocompatibility results showed that there were no significant differences among any of the groups. RAW 264.7 cells treated with BIOD and ODN showed the lowest levels of TNF-α and PGE2. Treatments with BIOD + ODN were more potent suppressors of inflammatory cytokine expression (p < 0.05).

Conclusion

The cathepsin K inhibitor with calcium silicate-based cement inhibits osteoclastic activity. This may have clinical application in preventing inflammatory root resorption in replanted teeth.

Histology of NeoMTA Plus and Quick-Set2 in Contact with Pulp and Periradicular Tissues in a Canine Model

INTRODUCTION

NeoMTA Plus (Avalon Biomed Inc, Bradenton, FL) is a tricalcium silicate material similar to the first mineral trioxide aggregate product, ProRoot MTA (Dentsply Sirona, York, PA), but with improvements such as decreased setting time, increased ion release, increased water sorption, and nonstaining radiopacifiers. Quick-Set2 (Avalon Biomed Inc) is a newly formulated calcium aluminosilicate material that has a faster setting time and increased acid resistance and is nonstaining. The purpose of this study was to compare the healing of pulpal and periapical tissues in dogs after exposure to NeoMTA Plus and Quick-Set2 after pulpotomy and root-end surgery procedures.

METHODS

Seventy-two teeth (36 for each procedure) in 6 beagle dogs received pulpotomy or root-end surgery using either NeoMTA Plus or Quick-Set2. The dogs were sacrificed at 90 days, and the teeth and surrounding tissues were prepared for histologic evaluation. Sixty teeth were evaluated and scored histologically (29 with pulpotomies and 31 with root-end resections). Specimens were scored for inflammation, quality and thickness of dentin bridging, pulp tissue response, cementum and periodontal ligament formation, and apical bone healing.

RESULTS

Both materials displayed favorable healing at 90 days. The only significant difference was the quality of dentin bridge formation in pulpotomies using NeoMTA Plus compared with Quick-Set2.

CONCLUSIONS

Quick-Set2 and NeoMTA Plus had similar effects on inflammation, pulp response, periodontal ligament and cementum formation, and apical tissue healing in dogs. NeoMTA Plus had superior dentin bridge quality compared with Quick-Set2.

Synthesis of a Ca3 SiO5 -Ca2 SiO4 -Ca3 Al2 O6 cement system with rapid setting capacity by spray-pyrolysis coupled with sol-gel method

A modified mineral-trioxide-aggregate (mMTA) with rapid setting capacity was newly synthesized by spray-pyrolysis following a sol-gel reaction. Its faster setting capacity and initially higher compressive strength compared with Portland cement (PC) were evaluated. The precursor solution of the mMTA was prepared through condensation following hydrolysis among Ca(NO₃ )₂ ·4H₂ O, Si(OC₂ H₅ )₄ , and Al(NO₃ )₃ ·9H₂ O under nitric acid. The mMTA powder was then synthesized by spray-pyrolysis at 1500°C. The particle shape was spherical with an average particle size of 0.8 ± 0.3 μm, while PC particles were irregular and 3.9 ± 3.0 μm in size. The mMTA consisted of mostly Ca₃ SiO₅ , Ca₃ Al₂ O₆ , and partial Ca₂ SiO₄ phases, while the PC comprised mainly Ca₃ SiO₅ , Ca₂ SiO₄ , and partial Ca₃ Al₂ O₆ phases. The final setting times of mMTA and PC measured under 95% relative humidity were about 11 min and 3 h, respectively. The early stage of setting in mMTA was dominated by the rapid formation of hexagonal-plate-like Ca₃ Al₂ O₆ ·6H₂ O crystals, while that in PC was dominated by needle-like calcium-silicate-hydrate gels and columnar-shaped Ca(OH)₂ crystals. The late stage of setting in mMTA was dominated by calcium-silicate-hydrate gels and Ca(OH)₂ crystals, while that in PC was dominated by Ca₃ Al₂ O₆ ·6H₂ O crystals. The compressive strengths of mMTA and PC after 30 min of setting were 4.5 and 0.2 MPa, respectively. The results suggest that mMTA has potential to be used as a filling material for accidental pulp-exposure or pulpal floor perforation cases that require rapid setting capacity and initial good strength. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1440-1451, 2019.

Cytocompatibility of Biodentine and iRoot FS with human periodontal ligament cells: an in vitro study

AIM

To evaluate the cytocompatibility of Biodentine and iRoot FS with human periodontal ligament cells (hPDLCs).

METHODOLOGY

Human periodontal ligament cells were characterized by flow cytometry and immunocytochemical analysis. Human periodontal ligament cell adhesion was assessed by scanning electron microscopy at day 3; proliferation by live/dead assay at days 1, 3 and 7; and osteogenic differentiation by alkaline phosphatase (ALP) activity staining, ALP quantification analysis and qRT-PCR at days 7 and 14. Data were analysed with anova and independent sample t-tests with SPSS 21.0.

RESULTS

Both iRoot FS and Biodentine increased the adhesion of hPDLCs at day 3. Compared to Biodentine, iRoot FS positively increased hPDLC proliferation on days 3 (P = 0.03) and 7 (P = 0.00). Osteogenic marker ALP was observed consistently in all samples, with iRoot FS having significantly higher ALP activity at day 14 (P = 0.00). Compared with Biodentine, iRoot FS significantly increased the mRNA level of ALP, COL1 and Runx2, and OCN increased only on day 14 (P < 0.05).

CONCLUSIONS

iRoot FS had a positive effect on the adhesion, proliferation and biomineralization of hPDLCs compared with Biodentine.

Biological response of commercially available different tricalcium silicate-based cements and pozzolan cement

This study evaluated four root repair materials for cytotoxicity and cell attachment in vitro. Cell viability was determined at 24 hr, 3 days and 7 days by using a 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay with material extracts. Cell adhesion was examined with a scanning electron microscope on the surface of materials at 24 and 48 hr. Angelus MTA displayed the lowest cell viabilities at all-day incubations. Endocem had high biocompatibility on the first day. After culturing for 3 days and 7 days, the cell viabilities of Biodentine, Endocem and MM-MTA had similar results, and their cell viability was significantly higher than that of Angelus. No definite relation was found between the incubation time and the relative cell viability in any group. In scanning electron micrographs, the cells were attached to the material surface for all materials, although the cells in the Biodentine group were attached better than the other groups on the second day. Cell viability and cell attachment was lower in the Angelus group. Endocem, Biodentine and MM-MTA were similar in biocompatibility and cytotoxicity.

Effect of Oral Tissue Fluids on Compressive Strength of MTA and Biodentine: An In vitro Study

INTRODUCTION

Over the past many years various root end filling materials have been used which have been tested for their physical properties but each of them had certain limitations. In clinical practice, root end filling materials are exposed to oral tissue fluids which may compromise their longevity.

AIM

The aim of this study was to investigate the effects of oral tissue fluids on compressive strength of Mineral Trioxide Aggregate (MTA) and biodentine.

MATERIALS AND METHODS

MTA and biodentine cylinders measuring 6 mm × 4 mm were prepared using acrylic blocks. They were divided into six groups; (Group 1) (MTA) (n=3), (Group 2) MTA contaminated with saliva, (MTA-S) (n=3), Group 3: MTA contaminated with blood, MTA-B (n=3), Group 4: Biodentine (BD), Group 5: Biodentine contaminated with saliva (BD-S) (n=5), Group 6: Biodentine contaminated with blood (BD-B) (n=5). The mould was contaminated with saliva and blood and incubated at 37°C at 100% humidity for three days and compressive strength (MPa) was measured using universal testing machine and the data was analyzed statistically using one-way ANOVA test.

RESULTS

There was no significant difference in the compressive strength between the three groups i.e., MTA, MTA-S, MTA-B (p > 0.05). However, there was higher compressive strength in the MTA-B group when compared to MTA and MTA-S. Also, there was no statistical significant difference between BD, BD-S, BD-B (p>0.05).

CONCLUSION

This study showed that the compressive strength of MTA and biodentine was not adversely affected by contamination with oral tissue fluids like blood and saliva.

Modern Endodontic Microsurgery Concepts: A Clinical Update

Increased use of the surgical operating microscope in endodontic surgery has elucidated many shortcomings of previous techniques and along with microsurgical instruments and new more biologically acceptable root-end filling materials has started the new microsurgical era in surgical endodontics. Endodontic microsurgery is a minimally invasive technique that results in less postoperative pain and edema and faster wound healing. It offers a significantly higher success rate than traditional apical surgery technique. The components, key concepts and procedural steps of endodontic microsurgery as well as the prognosis and predictability of modern root-end procedures are presented in this review.

Radicular Perforation Repair with Mineral Trioxide Aggregate: A Case Report with 10-Year Follow-up

Background:

Iatrogenic complications such as accidental perforation of the root or the floor of the pulp chamber may occur.

Case Report:

Patient was referred for root canal retreatment of the mandibular left second molar with periapical lesion evidenced through radiographic examination. During post removal, iatrogenic perforation occurred at the mesial face of the distal root. After clinical localization of the perforation and bleeding control, MTA was applied. In a second appointment, the root canal filling was removed and the chemical-surgical retreatment of the canals was performed, followed by the obturation with gutta-percha and sealer. Patient returned after three days reporting no pain. After 6 months, 3, 7 and 10 years of follow-up.

Conclusion:

Absence of pain, normal periodontal probing and lack of radiolucent area at the region of perforation and the periapices were detected, which evidenced the successful repair of the tooth.

Root-end Filling Materials Alter Fibroblast Differentiation

Root-end filling materials are commonly used following endodontic surgical procedures; however, their effect on adjacent soft tissues is poorly understood. We predict that, due to the differences in their chemical composition, these materials will have profoundly different effects on the survival and differentiation of fibroblasts. Many of the root-end filling materials examined were initially cytotoxic to both PDL and gingival fibroblasts in co-culture experiments; however, this was reduced after the materials were washed in either mineral trioxide aggregate (MTA) or hybrid ionomere composite resin (HICR) for 2 wks. Additionally, PDL fibroblasts displayed enhanced proliferation on MTA and survival on amalgam when compared with gingival fibroblasts. MTA preferentially induced alkaline phosphatase expression and activity in both PDL and gingival fibroblasts. In contrast, HICR inhibited alkaline phosphatase expression and activity. In addition, MTA and HICR repressed pleiotrophin in PDL fibroblasts, while HICR repressed periostin in both fibroblasts. Thus, root-end filling materials differentially affect periodontal fibroblast differentiation. Abbreviations: mineral trioxide aggregate (MTA), zinc-oxide eugenol cement (ZOEC), hybrid ionomer composite resin (HICR), reverse-transcriptase polymerase chain-reaction (RT-PCR).

Apical Microleakage of four Materials after Root End Resection (In Vitro Study)

Hermetic sealing of the apical area after root end resection is essential to the success of endodontic surgery. To compare microleakage after root end resection of the two bioceramic sealers without retrograde filling - Total Fill BC Sealer and MTA Fillapex, and two materials for retrograde filling-MTA and Biodentine, using the method of penetration of dye - 2% methylene blue. Forty eight extracted single-rooted human teeth were used in this study. The resection was made at 3 mm from the root tip at an angle of 90 degree to the long axis of the tooth. The teeth were divided into 4 groups: 1st group (n = 9) - root canal obturation with Total Fill BC Sealer without retrograde filling; 2nd group (n = 8) - root canal obturation with MTA Fillapex without retrograde filling. 3rd group (n = 10) - retrograde ultrasonic cavity preparation and filling with MTA. 4th group (n = 8) - retrograde ultrasonic cavity preparation and filling with Biodentine. The outer surface of the root was covered with two layers of varnish, with the exception of the apical 3 mm and then immersed in 2% methylene blue for 72 h. The degree of penetration of the dye is measured in millimeters. The data was entered and processed with the statistical package IBM SPSS Statistics 22.0. We reject the null hypothesis when p < 0.05. With significantly higher value is the arithmetic mean of the group with the root canal obturation with Total Fill BC Sealer without retrograde filling - 2,01 mm; versus a retrograde filling with MTA - 0,68 mm and Biodentin - 0,51 mm; and no statistically significant difference with the group root canal obturation with MTA Fillapex - 1,76 mm. In the four material microleakage dye was observed, but to varying degrees.

Design and evaluation of multifunctional antibacterial ion-doped β-dicalcium silicate cements favorable for root canal sealing

Cu or Zn-doping dicalcium silicate-based cements exhibit multifunctional physiochemical and biological performances and meet some challenging criteria in root canal treatment.

The use of lasers for direct pulp capping

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

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.

Radiopacity for Contemporary Luting Cements Using Digital Radiography under Various Exposure Conditions

PURPOSE

This study examined the radiopacity of contemporary luting cements using direct digital radiography under a range of exposure conditions.

MATERIALS AND METHODS

Disc specimens (N = 80, n = 10 per group, ø5 mm × 1 mm) were prepared from 8 resin-based luting cements (BisCem Clearfil SA Luting, Duolink, Maxcem Elite Multilink Speed, Panavia F 2.0, RelyX Unicem Clicker, V-link). The specimens were radiographed using a charge-coupled device sensor along with an 11-step aluminum step wedge (1.5-mm incremental steps) and 1-mm-thick tooth cut using five tube voltage/exposure time setups (60 kVp, 0.10/0.08 seconds; 70 kVp, 0.10/0.08/0.06 seconds) at 4 mA and 30 cm. The radiopacity of the specimens was compared with that of the aluminum step wedge and human enamel and dentin using NIH ImageJ software (available at http://rsb.info.nih.gov/ij/). A linear regression model for the aluminum step wedge was constructed, and the data were analyzed by ANOVA and Duncan post hoc test.

RESULTS

Maxcem Elite (5.142 to 5.441) showed the highest radiopacity of all materials, followed in order by Multilink Speed (3.731 to 3.396) and V-link (2.763 to 3.103). The radiopacity of Panavia F 2.0 (2.025 to 2.429), BisCem (1.825 to 2.218), Clearfil SA Luting (1.692 to 2.145), Duolink (1.707 to 1.993), and RelyX Unicem Clicker (1.586 to 1.979) were between enamel (2.117 to 2.330) and dentin (1.302 to 1.685). The radiopacity of 70 kVp conditions was higher than that of the 60 kVp conditions.

CONCLUSIONS

The radiopacities of the tested luting materials were greater than those of dentin or aluminum, satisfying the criteria of the International Organization for Standardization, and they differed significantly from each other in the exposure setups.

Sealing ability of root-end filling materials

BACKGROUND

The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators.

MATERIALS AND METHODS

Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance.

RESULTS

The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups.

CONCLUSIONS

All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.

Preliminary study of light-cured hydrogel for endodontic drug delivery vehicle

AIM

Direct pulp capping is the treatment of an exposed vital pulp with a dental material to facilitate the formation of reparative dentin and maintenance of vital pulp. A bioengineered drug delivery vehicle has the potential to increase the success rate of pulp capping. The aim of this study was to develop an injectable and light-curing drug delivery vehicle for endodontic treatment including direct pulp capping.

METHODS

Polyethylene glycol-maleate-citrate (PEGMC) hydrogel was synthesized as a drug delivery vehicle that is composed of PEGMC (45% w/v), acrylic acid (AA) (5% w/v), 2,2'-azobis(2-methylpropionamidine) dihydrochloride (AAPH) (0.1% w/v), and deionized water. The association between prehydrogel-solution volume and visible light-curing was examined. The cytotoxicity of the hydrogel was tested using L929 cells in a cell culture system. Ca(2+) release from the hydrogel was determined using calcium hydroxide as the incorporated medicine.

RESULTS

The results showed that the light-curing time for hydrogel is comparable to composite resin. The hydrogel had cell toxicity similar to adhesive systems. Moreover, controlled Ca(2+) release was obtained from the calcium hydroxide incorporated hydrogel.

CONCLUSIONS

The data suggest that hydrogel should be explored further as a promising drug delivery vehicle for vital pulp therapy and regenerative endodontics.

Evaluation of cytotoxicity, antimicrobial activity and physicochemical properties of a calcium aluminate-based endodontic material

A calcium aluminate-based endodontic material, EndoBinder, has been developed in order to reduce MTA negative characteristics, preserving its biological properties and clinical applications.

OBJECTIVES

The aim of this study was to evaluate the cytotoxicity, antimicrobial activity, pH, solubility and water sorption of EndoBinder and to compare them with those of white MTA (WMTA).

MATERIAL AND METHODS

Cytotoxicity was assessed through a multiparametric analysis employing 3T3 cells. Antimicrobial activity against Enterococcus faecalis (ATCC 29212), Staphylococcus aureus. (ATCC 25923) and Candida albicans (ATCC 10556) was determined by the agar diffusion method. pH was measured at periods of 3, 24, 72 and 168 hours. Solubility and water sorption evaluation were performed following ISO requirements. Data were statistically analyzed by ANOVA and Tukey`s test with a significance level of 5%.

RESULTS

EndoBinder and WMTA were non-cytotoxic in all tested periods and with the different cell viability parameters. There was no statistical differences between both materials (P>.05). All tested materials were inhibitory by direct contact against all microbial strains tested. EndoBinder and WMTA presented alkaline pH in all tested times with higher values of pH for WMTA (P<.05). Both materials showed values complying with the solubility minimum requirements. However, EndoBinder showed lower solubility than WMTA (P<.05). No statistical differences were observed regarding water sorption (P>.05).

CONCLUSION

Under these experimental conditions, we concluded that the calcium aluminate-based endodontic material EndoBinder demonstrated suitable biological and physicochemical properties, so it can be suggested as a material of choice in root resorption, perforations and root-end filling.

The Influence of Root-End Filling Materials on Bone Healing - An Experimental Study

AIMS

The aim of this experimental study is to assess the bone healing phenomenon produced in the presence of several dental materials: a polycarboxylate cement, a glass-ionomer cement, a composite resin and MTA (mineral trioxide aggregate) based cement.

METHODS

The biocompatibility of four root-end fillings materials, used in periapical surgery was investigated after intra-osseous implantation of the materials in rats' calvaria. Tissue reaction was studied at 2, 4, 6, 8, 10 and 12 weeks after implantation. We took into consideration the presence of inflammatory cells (polymorphonuclear leukocytes, macrophages, plasma cells, lymphocytes and giant cells) and classified the aspects of the histological samples according to the following scale: 0 - no inflammation, 1 - mild, isolated inflammation, 2 - moderate, localized inflammatory reaction, 3 - severe, diffuse and intense inflammatory reaction.

RESULTS

The inflammatory reaction was present at the six intervals for all the tested materials, but at 12 week interval, the reaction was minimal in all cases. Also, a dissolution reaction was observed for all the materials, less intense for glass-ionomer cement and polycarboxilate cement.

CONCLUSIONS

At the end of the experimental period, glass-ionomer cement and polycarboxilate cement suffered a lesser dissolution reaction as compared to the second group of tested materials.

Comparison of the radiopacities of different root-end filling and repair materials

This study evaluated the radiopacity of 3 repair materials, Biodentine, MM-MTA, and MTA Angelus. Standardized cylindrical rings were prepared. Samples of Biodentine MM-MTA and MTA Angelus were prepared (n = 10 in each group), filled into the rings, and preserved at 37°C until setting. A 1 mm thick dentin slice was used as control. All set specimens were removed and radiographed along with the dentine slice and a graduated aluminium step wedge. Digital images were transferred to the computer using a software. The radiographic densities of the specimens were determined, and the values were converted into millimetres of aluminium (mm Al). One-way ANOVA was used for intergroup comparison, whereas Tukey HSD test was used for detecting the group with the difference. The mean radiopacities of Biodentine, MTA Angelus, and MM-MTA were 2.8 ± 0.48, 4.72 ± 0.45, and 5.18 ± 0.51 mm Al, respectively. The radiopacity of Biodentine was significantly lower compared to other materials (P = 0.001), whereas no significant difference was noted between MTA Angelus and MM-MTA (P = 0.109). All materials had significantly higher radiopacities compared to dentine. The relatively lower radiopacity of Biodentine can be improved to achieve more reliable results in procedures such as retrograde fillings.

Effects of various mixing techniques on physical properties of white mineral trioxide aggregate

INTRODUCTION

The aim of this study was to evaluate the effects of three different mixing techniques on surface microhardness, initial setting time, and phase formation of white mineral trioxide aggregate.

METHODS

Twenty-one cylindrical glass tubes were selected and divided into three groups of seven in each (n = 7). White mineral trioxide aggregate (WMTA) in groups A, B, and C were mixed by conventional, trituration, and ultrasonic techniques, respectively. Cements were mixed and packed into the glass tubes and incubated at 37°C for 3 days. After incubation, samples were subjected to microhardness evaluation, and four specimens from each group were prepared and observed under a scanning electron microscopy and X-ray diffraction. For setting time assessment, WMTA was mixed in three parts again, and Gilmore needle test was performed until the initial setting time of cement. Data were analyzed by one-way anova and post hoc Tukey's test.

RESULTS

Samples mixed by trituration technique significantly showed the highest microhardness (P < 0.001) and the lowest setting time, while the ultrasonically mixed specimens significantly revealed the highest setting time in comparison with other groups (P < 0.001). Samples mixed by trituration technique showed the highest uniformity in the bulk and highest amount of hydrated calcium silicate (CS) phases, while the lowest value was observed in ultrasonically mixed cements, which also showed the highest amount of anhydrated CS phases.

CONCLUSION

Trituration and conventional techniques were more suitable mixing methods for mineral trioxide aggregate in comparison with ultrasonic technique. Trituration resulted in better hydration and crystallization, which prevents clustering of powder and reduces voids and setting time of mixed cement.

Root-end filling with cement-based materials: An in vitro analysis of bacterial and dye microleakage

Background:

One ideal property of a root-end filling material is its apical sealing ability. The aim of this in vitro study was to assess bacterial and dye microleakage of white and gray mineral trioxide aggregate (WMTA and GMTA), Portland cement and calcium-enriched mixture (CEM) cement used as root-end filling material, and to assess the agreement between these two test methods.

Materials and Methods:

Fifty-four single-rooted teeth were used. The roots were randomly divided into four study and two control groups. After decoronation, root canals were instrumented and filled with gutta-percha and AH26 sealer. Root-ends were resected 3 mm above the root-end and 3 mm deep cavities were prepared. Root-end cavities were filled with each material. Enterococcus faecalis and methylene blue dye were used for determination of bacterial and dye leakage respectively. Data were analyzed using Fisher's Exact Test, one-way ANOVA, Kaplan-Meier analysis, and Cohen's Kappa.

Results:

There was 100% bacterial leakage in Portland cement and CEM cement, 58.3% in GMTA, and 91.7% in WMTA. GMTA showed significantly less bacterial leakage than Portland cement and CEM cement (P < 0.05). In those samples with leakage occurrence, times of observation of leakage were not significantly different; however, by survival analysis, the results of the GMTA group were significantly different from those of the CEM cement and Portland groups. The difference in complete dye leakage was not significant. There was poor agreement between dye and bacterial leakage methods.

Conclusion:

CEM cement provides leakage results comparable to other commonly used root-end filling materials such as WMTA.

Carrier-based root canal filling materials: a literature review

A review of the literature on the use of carrier based obturation materials focusing on Thermafil and Resilon based obturator (RealSeal 1) are presented in this article. The review addressed the history, apical leakage, coronal leakage, biocompatibility, sealing ability and clinical success of Thermafil and RealSeal 1. Based on the studies gathered, this review concluded that both treatment techniques (Thermafil and RealSeal 1) did not provide excellent apical sealing ability. More research should be done to try to overcome their main drawback, its sealing ability.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Rat subcutaneous tissue response to MTA Fillapex® and Portland cement

The aim of this study was to evaluate the response of rat subcutaneous tissue to MTA Fillapex® (Angelus), an experimental root canal filling material based on Portland cement and propylene glycol (PCPG), and a zinc oxide, eugenol and iodoform (ZOEI) paste. These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7 and 15 days. The specimens were stained with hematoxylin and eosin, and evaluated regarding inflammatory reaction parameters by optical microscopy. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated examiners for all experimental periods (kappa=0.96). The histological evaluation showed that all materials caused a moderate inflammatory reaction at 7 days, which subsided with time. A greater inflammatory reaction was observed at 7 days in the tubes filled with ZOEI paste. Tubes filled with MTA Fillapex presented some giant cells, macrophages and lymphocytes after 7 days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The tubes filled with PCPG showed similar results to those observed in MTA Fillapex. At 15 days, the inflammatory reaction was almost absent at the tissue, with several collagen fibers indicating normal tissue healing. Data were analyzed by the nonparametric Kruskal-Wallis test (α=0.05). Statistically significant difference (p<0.05) was found only between PCPG at 15 days and ZOEI at 7 days groups. No significant differences were observed among the other groups/periods (p>0.05). MTA Fillapex and Portland cement added with propylene glycol had greater tissue compatibility than the PCPG paste.

Evaluation of the radiopacity of luting cements by digital radiography

PURPOSE

The aim of this study was to evaluate the radiopacity of eight contemporary luting cements using direct digital radiography.

MATERIALS AND METHODS

Ten specimens, (5 mm diameter, 1 mm high) were prepared for each material tested (RelyX ARC, RelyX U100, RelyX Unicem, Nexus 2, Nexus 3, Metacem, Breeze, Adhesor zinc phosphate). The specimens were stored in a moist chamber at 37°C until completely set, then radiographed using a Kodak digital sensor and an aluminum step wedge with variable thicknesses (1 to 13 mm in 1-mm increments) used for reference. A Kodak 2100 intraoral X-ray unit was operated at 60 kV, 7 mA, and 0.20 seconds. According to international standards, the radiopacity of the specimens was compared with that of the aluminum step wedge using the equal-density area tool of the Kodak Dental Imaging software (ver. 6.7). Data were analyzed by ANOVA and Tukey's test.

RESULTS

Adhesor zinc phosphate cement showed the highest radiopacity of all materials and dentin. Breeze showed the lowest radiopacity (p < 0.05). No significant difference in radiopacity was observed between dentin and RelyX ARC, Nexus 2, or Metacem (p > 0.05). The radiopacities of Nexus 3 and RelyX Unicem were significantly higher than those of other resin cements and dentin (p < 0.05).

CONCLUSIONS

All materials showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association. Breeze had less radiopacity than dentin.

pH and Antimicrobial Activity of Portland Cement Associated with Different Radiopacifying Agents

Objective. The aim of this study was to evaluate the antimicrobial activity and pH changes induced by Portland cement (PC) alone and in association with radiopacifiers. Methods. The materials tested were pure PC, PC + bismuth oxide, PC + zirconium oxide, PC + calcium tungstate, and zinc oxide and eugenol cement (ZOE). Antimicrobial activity was evaluated by agar diffusion test using the following strains: Micrococcus luteus, Streptococcus mutans, Enterococcus faecalis, Pseudomonas aeruginosa, and Candida albicans. After 24 hours of incubation at 37°C, inhibition of bacterial growth was observed and measured. For pH analysis, material samples (n = 10) were placed in polyethylene tubes and immersed in 10 mL of distilled water. After 12, 24, 48, and 72 hours, the pH of the solutions was determined using a pH meter. Results. All microbial species were inhibited by the cements evaluated. All materials composed of PC with radiopacifying agents promoted pH increase similar to pure Portland cement. ZOE had the lowest pH values throughout all experimental periods. Conclusions. All Portland cement-based materials with the addition of different radiopacifiers (bismuth oxide, calcium tungstate, and zirconium oxide) presented antimicrobial activity and pH similar to pure Portland cement.