Quantitative evaluation by glucose diffusion of microleakage in aged calcium silicate-based open-sandwich restorations

Comparative Evaluation of a New Tricalcium Silicate Cement With Calcium Hydroxide as Direct Pulp Capping Agents: A Clinical Study

Background and objectives Direct pulp capping (dPC) is a therapeutic process that involves the application of a protective chemical to an exposed pulp with the intent to facilitate the restoration and preservation of its vitality and function. Despite numerous proposed solutions, researchers have yet to find a dependable, non-absorbable bioactive pulp capping substance that constantly activates cellular healing processes, consequently preserving pulpal vitality over an extended period of time. The objective of this study was to assess and contrast the efficacy of a novel tricalcium silicate cement and calcium hydroxide in preserving the long-term health of the dental pulp following dPC using clinical and radiographic observations. Materials and methods A total of 60 individuals with symptoms of reversible pulpitis associated with deep carious lesions were chosen for dPC in the study. Two groups comprising 30 patients each underwent dPC using the novel tricalcium silicate cement (experimental group) and calcium hydroxide (control group) out of the total number of patients. A thin protective covering of self-curing glass ionomer base was applied on top of the capping material. The dentist provided instant permanent restoration employing direct posterior composite resin. Follow-up examinations were conducted three, six, nine, and 12 months after the procedure, during which assessments were performed using clinical and radiographic parameters. Results The minimum age of the study group was 16, and its maximum age was 34 (22.35 ± 2.3 years). The control group consisted of 12 males and 18 females, while the Biodentine group consisted of 13 males and 17 females. The age and gender distribution were determined to have insignificant statistical differences across the groups. The pain score exhibited statistical significance at both the three-month and six-month follow-up visits (p < 0.05). The pain score at the 12-month follow-up was 0.38 ± 0.52 in the case group and 0.42 ± 0.61 in the control group (p = 0.79). The average Periapical Index (PAI) score for the Dycal and Biodentin groups after the 12-month follow-up was 1.38 ± 0.97 and 1 ± 0.3, respectively. This difference was found to be statistically significant (p = 0.044). In addition, there was a statistically significant difference in the PAI score at the three-month, six-month, and nine-month follow-ups (p < 0.01). During the entirety of the follow-up duration, one individual in the Biodentine group had tenderness upon percussion, a negative reaction for pulp vitality, pulpal changes, and a widening of the periodontal space. Statistically significant differences were observed in pulpal changes and tenderness on percussion during the nine-month and 12-month follow-up periods (p < 0.05). After 12 months, the rate of success in the group treated with Dycal was 91.3%, while the success percentage in the group treated with Biodentine was 98.55%. This difference in outcomes was determined to be statistically significant (λ2 = 5.46; p = 0.019). Conclusion The study findings indicate that Biodentine, a novel tricalcium silicate cement, outperforms calcium hydroxide in preserving pulp vitality over the long term following dPC. The Biodentine group attained an overall success rate of 98.55%, whereas the Dycal group had a success rate of 91.3% following 12 months of subsequent follow-up visits.

Effect of Different Adhesive Strategies on the Microshear Bond Strength of Calcium-Silicate-Based Materials

Aim:

To evaluate the microshear bond strength (µSBS) of mineral trioxide aggregate and Biodentine to various resin-based materials using different adhesive strategies.

Materials and Methods:

Three resin-based materials—a self-adhering resin composite with or without acid etching (Vertise flow; Kerr, Orange, CA, USA), a conventional flowable composite with a total-etch adhesive (Filtek Ultimate Flowable; 3M ESPE, St. Paul, MN, USA), and a flowable resin-modified glass ionomer cement (RMGIC) without any surface modification (Ionoseal; VOCO GmbH, Cuxhaven, Germany)—and two calcium-silicate-based materials—Biodentine and BIOfactor mineral trioxide aggregate (MTA)—were tested. A total of 100 cylindrical acrylic molds were prepared. Biodentine and BIOfactor MTA were prepared and placed into the central holes on the molds. Specimens were divided into two main groups according to materials and into five subgroups ( n = 10). µSBS were evaluated using a µSBS testing device. The failure modes were examined under a stereomicroscope with magnification. They were categorized as adhesive, cohesive, or mixed. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey test. The significance level was taken as α = 0.05.

Results:

It was observed that both calcium-silicate-based material type and resin-based material type influenced the µSBS significantly according to two-way ANOVA. Biodentine exhibited higher bond strength values than MTA. However, no statistically significant interaction was demonstrated between these factors ( P = .396). The µSBS values of intermediate materials to Biodentine and MTA were listed from the lowest to the highest as follows: RMGIC < Acid Etch + RMGIC < SARC (self-adhering resin composite) < FC (flowable composite) < Acid Etch + SARC.

Conclusion:

Self-adhering composites can be used on calcium-silicate-based materials in vital pulp treatments because of their mechanical properties. Acid-etching ensures high µSBS values. Although the µSBS of Biodentine were higher than MTA according to this study’s results, there was no statistically significant difference in µSBS of FC and acid-etched SARC to MTA.

Comparison of Clinical and Radiographic Success between MTA and Biodentine in Pulpotomy of Primary Mandibular Second Molars with Irreversible Pulpitis: A Randomized Double-Blind Clinical Trial

Introduction

Among the new therapeutic materials, MTA and Biodentine are recommended for pulpotomy and sealing the pulp. Considering the similar characteristics of these two materials and considering that their effects on the treatment of primary second molars with irreversible pulpitis have not been compared properly, this study aimed to compare clinical and radiographic success between MTA and Biodentine in pulpotomy of primary mandibular second molars with irreversible pulpitis.

Materials and Methods

This study was conducted as a randomized double-blind clinical trial. Participants were selected according to inclusion criteria and 52 samples were randomly selected using random numbers table in group A. Then, patients in the next group B were matched with the first group in terms of age range and sex. In group A, the remaining pulp was covered with 2 mm MTA+ and in group B with 3 mm Biodentine. Participants were called for clinical evaluation every three months for 12 months (long-term follow-up). Radiographic evaluations were in the sixth and twelfth months.

Results

Fischer's exact test showed that there was no significant difference between MTA and Biodentine in terms of clinical and radiographic success rates (P value = 1). According to the results of the Kaplan-Meier test, the survival rate in both pulp treatment methods was similar in symptomatic teeth.

Conclusions

The results of this study showed that Biodentine properties are similar to MTA, and both materials show high clinical and radiographic success rates in long-term follow-up.

Physicochemical properties of three bioceramic cements

This study aimed to compare the physicochemical properties of MTA Angelus (MTA-A), MTA Repair HP (MTA-HP), and Biodentine (BD). Setting times (n = 7) were determined in accordance with ASTM C266-15. Solubility (n = 11), pH (n = 10), and calcium ion release (n = 10) were evaluated up to 28 days in accordance with ANSI/ADA specification no. 57. Radiopacity was assessed by ANSI/ADA (n = 10) and the tissue simulator method (n = 10). In both methods, the specimens were radiographed using an aluminum stepwedge and the digital radiographs were analyzed in Adobe Photoshop, determining the mean grayscale pixel values of the materials, of the 3-mm aluminum stepwedge, and of the dentin, the latter of which was analyzed on the tissue simulator. The data obtained from each test were statistically analyzed and compared (p < 0.05). MTA-A presented longer final setting time compared with the other materials. There were no significant differences in the mass values of materials during the experiment. All materials presented an alkaline pH. BD promoted greater calcium ion release in most of the experimental periods. All materials presented appropriate radiopacity. BD showed lower radiopacity than MTA-A in the tissue simulator method. All groups presented higher radiopacity in the tissue simulator when compared with the ANSI/ADA method. MTA-A, MTA-HP, and BD showed appropriate physicochemical properties and radiopacity, and were considered suitable to be used in clinical practice.

Direct pulp capping of carious immature tooth using bioactive material: A case report

The management of deep carious lesions in immature tooth and the preservation of its pulp vitality is a real challenge in daily dental practice. Bioactive cements are of interest to deal with such cases. Our case report describes the immediate management and the follow-up of an extensive carious lesion on an immature first right mandibular molar with pulp exposure by direct pulp capping using Biodentine. A 6-month clinical and radiographic follow up showed that the tooth was vital, with dentine-bridge formation in the pulp chamber with continuous root formation. This procedure allowed the protection of pulp complex, preserving at the same time its functional and biologic activities due to the capacities of Biodentine as an effective pulp capping material to induce pulp cells to form hard tissue. The aim of this article is to discuss through the report of this clinical case, the indications, advantages and disadvantages of different procedures and biomaterials used for direct pulp capping.

Minimal Intervention in Dentistry: A Literature Review on Biodentine as a Bioactive Pulp Capping Material

Root canal treatment has been the treatment of choice for carious pulp exposures. In the perspective of minimally invasive dentistry and preventive endodontics, a direct pulp capping procedure with a reliable bioactive material may be considered an alternative approach provided that the pulp status is favorable. However, the treatment of pulp exposure by pulp capping is still a controversial issue with no clear literature available on this topic, leaving the concerned practitioner more confused than satisfied. Biodentine is a relatively new bioactive material explored for vital pulp therapy procedures. This article discusses its role in direct pulp capping procedures. A thorough literature search of the database was done using PubMed, Google Scholar, and Scopus using the keywords preventive endodontics, calcium silicate cement, direct pulp capping, Biodentine, and vital pulp therapy. Reference mining of the articles that were identified was used to locate other papers and enrich the findings. No limits were imposed on the year of publication, but only articles in English were considered. This paper is aimed at reviewing the current literature on Biodentine as a direct pulp capping material. The review will provide a better understanding of Biodentine's properties and can aid in the decision-making process for maintaining the vitality of exposed dental pulp with minimal intervention.

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

Aim

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

Material and method

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

Result

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

Conclusion

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

Interface between calcium silicate cement and adhesive systems according to adhesive families and cement maturation

Objectives

This study aimed to evaluate the interface between a calcium silicate cement (CSC), Biodentine and dental adhesives in terms of sealing ability.

Materials and Methods

Microleakage test: 160 standardized class II cavities were prepared on 80 extracted human molars. The cavities were filled with Biodentine and then divided into 2 experimental groups according to the time of restoration: composite resin obturation 15 minutes after Biodentine handling (D0); restoration after 7 days (D7). Each group was then divided into 8 subgroups (n = 5) according to the adhesive system used: etch-and-rinse adhesive (Prime & Bond); self-etch adhesive 2 steps (Optibond XTR and Clearfil SE Bond); self-etch adhesive 1 step (Xeno III, G-aenial Bond, and Clearfil Tri-S Bond); and universal used as etch-and-rinse or self-etch (ScotchBond Universal ER or SE). After thermocycling, the teeth were immersed in a silver nitrate solution, stained, longitudinally sectioned, and the Biodentine/adhesive percolation was quantified. Scanning electron microscopic observations: Biodentine/adhesive interfaces were observed.

Results

A tendency towards less microleakage was observed when Biodentine was etched (2.47%) and when restorations were done without delay (D0: 4.31%, D7: 6.78%), but this was not significant. The adhesives containing 10-methacryloyloxydecyl dihydrogen phosphate monomer showed the most stable results at both times studied. All Biodentine/adhesive interfaces were homogeneous and regular.

Conclusions

The good sealing of the CSC/adhesive interface is not a function of the system adhesive family used or the cement maturation before restoration. Biodentine can be used as a dentine substitute.

Effect of Endocrowns on Fracture Strength and Microleakage of Endodontically Treated Primary Molar Teeth

Objectives:

Optimal restoration of endodontically treated teeth is very important for the durability of the endodontic treatment. The focus of this study was to evaluate the fracture strength and microleakage of composite endocrowns compared with Class II composite restorations in endodontically treated primary molar teeth.

Materials and Methods:

48 extracted second primary molars were divided into 2 groups. Group 1 (control): teeth with Class II and endodontic access cavities restored with G-aenial composite; group 2: endocrown restorations with G-aenial composite. After completing restorative procedures, teeth were subjected to thermal cycling (500 cycles). Compressive loading was applied to half of the samples, although the other half were immersed in 0.5% basic fucsin solution for 24 h, sectioned, and examined for dye penetration under stereomicroscope. Data were subjected to statistical analysis by the Mann-Whitney U test (α = 0.05).

Results:

The fracture strength of endocrowns (1741 ± 379.35 N) was significantly higher than that of the control group (1126.5 ± 405.39 N) ( P < .05). No statistical difference was found in microleakage between the 2 groups ( P > .05).

Conclusion:

Endocrown preparation increases the fracture strength of the final composite restoration when used in primary molar teeth. Composite endocrown restorations can be a practical and an esthetic option for restoring endodontically treated primary molar teeth.

Reparative Mineralized Tissue Characterization after Direct Pulp Capping with Calcium-Silicate-Based Cements

Nowadays, the preservation of dental pulp vitality is an integral part of our daily therapies. The success of these treatments depends on the clinical situation as well as the biomaterials used. Mineral Trioxide aggregate and Biodentine^TM are commonly used as pulp capping materials. One objective of vital pulp therapy is the repair/regeneration of the pulp. In addition to the initial inflammatory status of the pulp, the nature and quality of the new mineralized tissue obtained after pulp capping directly influence the success of the treatment. In order to characterize the reparative dentin, in the current study, the chemical composition and microstructure of the dentin bridge after direct pulp capping using Biodentine™ and mineral trioxide aggregate (MTA) was studied by using Raman microspectroscopy and scanning electron microscopy, respectively. The results showed that the reparative dentin bridge observed in both groups presented dentin tubules and chemical composition similar to primary dentin. With the limitations of this study, the calcium-silicate-based cements used as pulp capping materials provide an optimal environment for pulp healing, resulting in a reparative dentin resembling on certain points of the primary dentin and the regeneration of the pulp.

The reliability and concurrent validity of a new iPhone® application for measuring active lumbar spine flexion and extension range of motion in patients with low back pain

Objective: To investigate the reliability and validity of an iPhone® application (iHandy® Level) for measuring active lumbar flexion-extension range of motion (ROM) in chronic nonspecific low back pain (CNLBP) patients. Methods: Fifteen CNLBP patients were recruited. The participants stood in a relaxed position and the T12-L1 and S1-S2 spinal levels were identified through palpation and were marked on the skin. Two blinded examiners used a gravity-based inclinometer and the application in order to measure ROM. The instruments were lined up appropriately and the participants were asked to perform maximum lumbar flexion following by maximum extension. First, each examiner placed the instruments over the T12-L1 level and then over the S1-S2 level during the movements. In order to calculate flexion-extension ROM, the measurement which was obtained from T12-L1 was subtracted from S1-S2. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used in order to determine the intrarater and inter-rater reliability, respectively. The Spearman's correlation coefficients (r_s ) and Bland-Altman plots were used in order to examine the validity. Results: Fair-to-excellent intrarater (ICC = 0.39-0.89) and moderate-to-good inter-rater reliability (ICC = 0.55-0.77) were observed using the inclinometer. Moreover, poor-to-good intrarater (ICC = 0.30-70) and inter-rater (ICC = 0.13-0.70) reliability were found with the application. The Spearman's correlation coefficients demonstrated low-to-moderate associations between the measures of the two instruments (r_s ≥ 0.22). The Bland-Altman plots indicated that there was a significant difference between the instruments for measuring flexion ROM. The difference was not significant for measuring extension ROM. Conclusion: The iHandy® Level application does not have sufficient validity for measuring active lumbar flexion ROM in CNLBP patients.

Solubility, porosity and fluid uptake of calcium silicate-based cements

Objective:

To evaluate the absorption/fluid uptake, solubility and porosity of White mineral trioxide aggregate (MTA) Angelus, Biodentine (BIO), and zinc oxide-eugenol (ZOE).

Material and Methods:

Solubility was evaluated after immersion in distilled water for 7 and 30 days. Porosity was evaluated using digital inverted microscope, scanning electron microscope (SEM) and micro-computed tomography (micro-CT). For the fluid uptake test, specimens were immersed in Hank's balanced salt solution (HBSS) for 1, 7, 14 and 28 days. Fluid absorption, solubility and porosity of the materials were measured after each period. Statistical evaluation was performed using one-way analysis of variance (ANOVA) and Tukey tests, with a significance level at 5%.

Results:

After 7 and 30 days, BIO showed the highest solubility (p<0.05). All methods demonstrated that MTA had total porosity higher than BIO and ZOE (p<0.05). Micro-CT analysis showed that MTA had the highest porosity at the initial period, after its setting time (p<0.05). After 7 and 30 days, ZOE had porosity lower than MTA and BIO (p<0.05). Absorption was similar among the materials (p>0.05), and higher fluid uptake and solubility were observed for MTA in the fluid uptake test (p<0.05).

Conclusions:

BIO had the highest solubility in the conventional test and MTA had higher porosity and fluid uptake. ZOE had lower values of solubility, porosity and fluid uptake. Solubility, porosity and fluid uptake are related, and the tests used provided complementary data.

Effect of Various Bleaching Agents on the Surface Composition and Bond Strength of a Calcium Silicate-based Cement

This study aimed to evaluate the morphological and elemental changes that occur on the surface of calcium silicate-based cement (CSC) and to analyze the bond strength of composite resin to CSC after application of various bleaching agents. One hundred twenty-five CSC blocks (Biodentine) were prepared and randomly divided into five groups according to the bleaching agent applied over the material surface (n=25): SP-DW (sodium perborate-distilled water mixture), SP-HP (sodium perborate-3% hydrogen peroxide [H₂O₂] mixture), CP (37% carbamide peroxide gel), HP (35% H₂O₂ gel), and a control group (no bleaching agent). After 1 week, scanning electron microscopy provided an analysis of the surface morphology and elemental composition for 10 specimens from each group. Composite resin was placed at the center of each cement surface in the remaining specimens (n=15). A universal testing machine determined shear bond strength (SBS) and fracture patterns were identified with a dental operating microscope. Data were analyzed using one-way analysis of variance and Tukey HSD tests. The cement surface in the CP and HP groups presented changes in structure and elemental distribution compared with the remaining groups. The former groups exhibited a decrease in the calcium level and an increase in the silicon level and presented significantly fewer SBS values than the remaining groups ( p<0.05). Most failures were adhesive in the CP and HP groups, while they were predominantly cohesive in the remaining groups. The bleaching agents with higher concentration induced deterioration of the cement surface and negatively affected the bond strength of the composite resin to CSC. The use of CSC is recommended as a cervical barrier when intracoronal bleaching is performed with a mixture of sodium perborate with water or 3% H₂O₂.

Analysis of sealing ability of endodontic cements apical plugs

Background

It is unknown whether the bioactivity of Biodentine characterized by the precipitation of hydroxyapatite and formation of tags into the dentinal tubules improve its sealing ability as an apical plug. Aim: To evaluate the sealing ability provided by Biodentine and mineral trioxide aggregate (MTA) apical plugs, with or without phosphate-buffered saline (PBS) intracanal dressing, using a glucose leakage method.

Material and Methods

The space of the canal of 100 root segments with about 12 mm long was shaped using Gates-Glidden. After created an apical retrograde cavity, the root segments were randomly divided into 4 groups (n = 25): G1 - Biodentine; G2 - Biodentine + PBS intracanal dressing; G3 - MTA and G4 - MTA + PBS intracanal dressing. All access openings were filled with temporary cement and all root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage. The amount of glucose leakage was quantified by a spectrophotometer and the data were analyzed using chi-square test (p<0.05).

Results

Traces of the glucose were observed in a higher of samples that received Biodentine apical plug (p<0.05). The exposure to intracanal PBS did not influence the sealing provided by Biodentine and MTA.

Conclusions

The Biodentine had lower sealing ability than MTA. The interaction with PBS intracanal dressing did not improve the sealing ability provided by sealers. Key words:Apexification, dental cements, dental leakage, glucose, pressure.

Comparison of sealing ability of ProRoot mineral trioxide aggregate, biodentine, and ortho mineral trioxide aggregate for canal obturation by the fluid infiltration technique

BACKGROUND

Adequate seal of the root canal is necessary to prevent recontamination and ensure the long-term clinical success. The aim of this study was to evaluate the sealing ability of ProRoot mineral trioxide aggregate (MTA), Biodentine, and Ortho MTA as the root canal obturation materials using the fluid infiltration method.

MATERIALS AND METHODS

In this invitro study a total of 66 extracted human mandibular premolars were randomly divided into five groups according to the material used for the root canal obturation. Group I - ProRoot MTA (20 samples), Group II - Biodentine (20 samples), Group III - Ortho MTA (20 samples), Group IV - negative group (3 samples), and Group V-positive group (3 samples). MTA, Biodentine, and Ortho MTA were applied using a cotton-tipped K-file #30 and hand plugger into the root canals of each group. In Group 4 (negative control), no filling material was used. In Group 5 (positive control), a single gutta-percha size #40 was inserted into the root canal without using a sealer. The teeth were mounted and exposed to the fluid infiltrarion system. Statistical analysis was performed using Kruskal-Wallis test the level of significance was set at α = 0.05.

RESULTS

Mean values of microleakage in MTA ProRoot, Biodentine and Ortho MTA groups were 1.83 ± 0.62, 1.95 ± 1.27 and 1.72 ± 0.83 μL in 8 minutes. No statistically significant difference was observed between the sealing ability of ProRoot MTA, Biodentine, and Ortho MTA (P = 0.091).

CONCLUSION

Within the limitations of this study, microleakage values were similar to MTA ProRoot, Biodentine, and Ortho MTA using the fluid infiltration technique.

Evaluation of physicochemical properties of root-end filling materials using conventional and Micro-CT tests

Objective

To evaluate solubility, dimensional stability, filling ability and volumetric change of root-end filling materials using conventional tests and new Micro-CT-based methods.

Material and Methods

7.

Results

The results suggested correlated or complementary data between the proposed tests. At 7 days, BIO showed higher solubility and at 30 days, showed higher volumetric change in comparison with MTA (p<0.05). With regard to volumetric change, the tested materials were similar (p>0.05) at 7 days. At 30 days, they presented similar solubility. BIO and MTA showed higher dimensional stability than ZOE (p<0.05). ZOE and BIO showed higher filling ability (p<0.05).

Conclusions

ZOE presented a higher dimensional change, and BIO had greater solubility after 7 days. BIO presented filling ability and dimensional stability, but greater volumetric change than MTA after 30 days. Micro-CT can provide important data on the physicochemical properties of materials complementing conventional tests.

Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial

INTRODUCTION

Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy.

METHODS

In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance.

RESULTS

Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001).

CONCLUSIONS

Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes.

Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars

AIM

To compare the clinical and radiographic success rates of three different pulpotomy agents in primary molars after 18 months.

METHODS

The study was carried out with 51 primary molars of children aged 5-9 years old. The teeth were randomly assigned to the experimental or control groups. After coronal pulp removal and haemostasis, the remaining pulp tissue was covered with Biodentine^® or mineral trioxide aggregate in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 min and after removal the pulp tissue was covered with zinc oxide-eugenol (ZOE) paste. All teeth were immediately restored with reinforced ZOE base and resin modified glass-ionomer cement, and later with pre-formed metal crowns. Follow-up assessments were carried out after 3, 6, 12 and 18 months.

RESULTS

Forty-five teeth were available for follow up at the end of 18 months. All of the available teeth for mineral trioxide aggregate and Biodentine^® were clinically successful, as were 73.3% of the FC group. Radiographic success rate for the formocresol group at 18 months follow up was 73.3, 100% for mineral trioxide aggregate and 86.6% for Biodentine^® group.

CONCLUSION

Mineral Trioxide aggregate and Biodentine^® showed more favourable results than formocresol.

Dentin remineralizing ability and enhanced antibacterial activity of strontium and hydroxyl ion co-releasing radiopaque hydroxyapatite cement

Dental caries is an infection of the mineralized tooth structures that advances when acid secreted by bacterial action on dietary carbohydrates diffuses and dissolves the tooth mineral leading to demineralization. During treatment, clinicians often remove only the superficial infected tooth structures and retain a part of affected carious dentin to prevent excessive dentin loss and pulp exposure. Calcium hydroxide is used to treat the affected dentin because it is alkaline, induces pulp-dentin remineralization and decreases bacterial infection. Presence of strontium ions has also been reported to exhibit anticariogenic activity, and promote enamel and dentin remineralization. The objective of the present study was to develop novel hydroxyapatite cement from tetracalcium phosphate which gradually releases hydroxyl and strontium ions to exhibit antibacterial activity. Its potential to remineralize the dentin sections collected from extracted human molar tooth was studied in detail. The pH of all the experimental cements exhibited a gradual increase to ~10.5 in 10 days with 10% strontium substituted tetracalcium phosphate cement (10SC) showing the highest pH value which was sustained for 6 weeks. 10SC showed better antibacterial property against S. aureus and E. coli at the end of 1 week compared to other cements studied. It also exhibited the highest radiopacity equivalent to 4.8 mm of Al standard. 10SC treated dentin section showed better remineralization ability and highest elastic modulus. We can conclude that the hydroxyl and strontium ions releasing tetracalcium phosphate cement exhibits good antibacterial property, radiopacity and has the potential to encourage dentin remineralization.

Cavity Adaptation of Water-Based Restoratives Placed as Liners under a Resin Composite

Purpose. To investigate the cavity adaptation of mineral trioxide (ProRoot MTA/MT), tricalcium silicate (Biodentine/BD), and glass ionomer (Equia Fil/EF) cements used as liners and the interfacial integrity between those liners and a composite resin placed as the main restorative material. Materials and Methods. Standardized class I cavities (n: 8 per group) were prepared in upper premolars. Cavities were lined with a 1 mm thick layer of each of the tested materials and restored with Optibond FL adhesive and Herculite Precis composite resin. Cavity adaptation of the restorations was investigated by computerized X-ray microtomography. The regions of interest (ROI) were set at the cavity-liner (CL) interface and the liner-resin (LR) interface. The percentage void volume fraction (%VVF) in the ROI was calculated. The specimens were then sectioned and the interfaces were evaluated by reflection optical microscopy, to measure the % length (%LD) of the interfacial gaps. Selected samples were further evaluated by scanning electron microscopy. Statistical analysis was performed by two-way ANOVA and Student-Newman-Keuls multiple comparison test (a = 0.05). Results. MT showed significantly higher %VVF and %LD values in CL interfaces than BD and EF (p < 0.05). No significant differences were found among the materials for the same values at the LR interfaces. Conclusions. When used as a composite liner, ProRoot MTA showed inferior cavity adaptation at dentin/liner interface when compared to Biodentine and Equia Fil.

A comparative evaluation of sealing ability of four root end filling materials using fluid filtration method: An in vitro study

Aim of the Study

The aim of this study was to compare and evaluate the sealing ability of four root end filling materials mineral trioxide aggregate (MTA)-Plus, Biodentine, MTA (MTA Angelus) and glass ionomer cement (GIC) using fluid filtration method.

Materials and Methods

Forty-four extracted, human single-rooted teeth were collected. The crown of each tooth was decoronated 2 mm above the cementoenamel junction. Canals were negotiated, instrumented, obturated using lateral compaction method. The access cavities were sealed with Cavit. Root end resection and apical root end cavity preparations of 4 mm were made in each specimen. The selected roots were then randomly divided into four groups (n = 11) and restored as follows. Group 1 - GIC, Group 2 - MTA (MTA Angelus), Group 3 - Biodentine, and Group 4 - MTA Plus. The apical microleakage of each specimen was assessed using fluid filtration method at 72 h, 1 month and 3 months. Microleakage in each specimen was recorded in mm (millimeter) and converted to μl/min/cm H₂O.

Results

MTA Angelus showed least microleakage followed by Biodentine and MTA Plus. Least sealing ability was seen with GIC. There was statistically significant difference between all the materials at various time intervals.

Conclusion

MTA Angelus showed superior sealing ability as a retrograde filling material followed by Biodentine and MTA Plus.

Bacterial Leakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture and Biodentine as Furcation Perforation Repair Materials in Primary Molars

Introduction:

Adequate seal of iatrogenically perforated area within the root canal system can improve the long term treatment prognosis. This in vitro study evaluated the sealing ability of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine in repair of furcation perforation in primary molars.

Methods and Materials:

A total of 61 freshly extracted primary mandibular second molars were randomly divided into three groups (n=17) and 10 teeth were put in negative (without perforation, n=5) and positive (perforated without repair, n=5) control groups. Turbidity was used as the criteria of bacterial leakage, when detected in the model of dual-chamber leakage. Data were analyzed using the Chi-Square and Kaplan-Meier survival analysis in SPSS software. The level of significance was set at 0.05.

Results:

All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. There was no significant difference between the number of turbidity samples in repaired teeth with all test materials (P=0.13). No significant difference was also detected in the mean survival time (P>0.05).

Conclusion:

CEM cement and Biodentine showed promising results as perforation repair materials and can be recommended as suitable alternatives of MTA for repair of furcation perforation of primary molars.

Evaluation of reparative dentin formation of ProRoot MTA, Biodentine and BioAggregate using micro-CT and immunohistochemistry

Objectives

The purpose of this study was to assess the ability of two new calcium silicate-based pulp-capping materials (Biodentine and BioAggregate) to induce healing in a rat pulp injury model and to compare them with mineral trioxide aggregate (MTA).

Materials and Methods

Eighteen rats were anesthetized, cavities were prepared and the pulp was capped with either of ProRoot MTA, Biodentine, or BioAggregate. The specimens were scanned using a high-resolution micro-computed tomography (micro-CT) system and were prepared and evaluated histologically and immunohistochemically using dentin sialoprotein (DSP).

Results

On micro-CT analysis, the ProRoot MTA and Biodentine groups showed significantly thicker hard tissue formation (p < 0.05). On H&E staining, ProRoot MTA showed complete dentin bridge formation with normal pulpal histology. In the Biodentine and BioAggregate groups, a thick, homogeneous hard tissue barrier was observed. The ProRoot MTA specimens showed strong immunopositive reaction for DSP.

Conclusions

Our results suggest that calcium silicate-based pulp-capping materials induce favorable effects on reparative processes during vital pulp therapy and that both Biodentine and BioAggregate could be considered as alternatives to ProRoot MTA.

Evaluation of effect of addition of 2% chlorhexidine on the sealing ability of Biodentine: An in vitro study

Aim:

To evaluate the effect of the addition of 2% chlorhexidine on the sealing ability of Biodentine.

Materials and Methods:

Forty-six extracted human premolar teeth with single canal and apical foramen were selected, cleaned, and decoronated to standardize the length of 17 mm. Canals were prepared using ProTaper rotary files till size F4. The samples were divided into 2 experimental groups of 20 samples each on the basis of absence/presence of 2% chlorhexidine in liquid: Group B_M = Biodentine mixed with the provided liquid, Group B_C = Biodentine mixed with 2% chlorhexidine in provided liquid. Three samples, each were assigned to control groups: Group B_P (positive control) = No root end filling was placed, Group B_N (negative control) = Root ends were filled as in Group B_M, and entire external surface was coated with sticky wax. The samples were then evaluated for the apical sealing using fluid filtration method.

Results:

Results were analyzed using Student's t-test (P ≤ 0.05). Group B_C showed the better sealing ability (3.06) as compared to Group B_M (3.85). However, the difference was statistically insignificant (P > 0.05).

Conclusion:

Addition of 2% chlorhexidine to the liquid enhanced the sealing ability of Biodentine.

Calcium silicate-based cements: composition, properties, and clinical applications

Mineral trioxide aggregate (MTA) is a calcium silicate-based cement (CSC) commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Despite the superior laboratory and clinical performance of MTA in comparison with previous endodontic repair cements, such as Ca(OH)₂ , MTA has poor handling properties and a long setting time. New CSC have been commercially launched and marketed to overcome the limitations of MTA. The aim of the present review was to explore the available literature on new CSC products, and to give evidence-based recommendations for the clinical use of these materials. Within the limitations of the available data in the literature regarding the properties and performance of the new CSC, the newer products could be promising alternatives to MTA; however, further research is required to support this assumption.

Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars

Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient's age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth.

Comparative Scanning Electron Microscopic Study of the Marginal Adaptation of Four Root-End Filling Materials in Presence and Absence of Blood

OBJECTIVES

The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate (MTA), calcium enriched mixture (CEM) cement, Biodentine and BioAggregate in presence of normal saline and human blood.

MATERIALS AND METHODS

In this in-vitro experimental study, 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha. After resecting the root-end, apical cavity preparation was done and the teeth were randomly divided into 4 groups (N=20)(a total of 8 subgroups). Root-end filling materials were placed in 3mm root-end cavities prepared ultrasonically. Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood. After 4 days, epoxy resin replicas of the apical portion of samples were fabricated and scanning electron microscopy (SEM) analysis was performed to find gaps in the adaptation of the root-end filling materials at their interface with dentin. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance.

RESULTS

There were no significant differences in marginal adaptation of the 8 tested groups (P>0.05).

CONCLUSION

Based on the results, blood contamination does not affect the marginal adaptation of MTA, CEM cement, Biodentine or BioAggregate.

A review on biodentine, a contemporary dentine replacement and repair material

Biodentine is a calcium-silicate based material that has drawn attention in recent years and has been advocated to be used in various clinical applications, such as root perforations, apexification, resorptions, retrograde fillings, pulp capping procedures, and dentine replacement. There has been considerable research performed on this material since its launching; however, there is scarce number of review articles that collates information and data obtained from these studies. Therefore, this review article was prepared to provide the reader with a general picture regarding the findings about various characteristics of the material. The results of a PubMed search were classified and presented along with some critical comments where necessary. The review initially focuses on various physical properties of the material with subheadings and continues with biocompatibility. Another section includes the review of studies on Biodentine as a vital pulp treatment material and the article is finalized with the summary of some case reports where the material has been used.

Apical Sealing Ability of a Novel Material: Analysis by Fluid Filtration Technique

AIM

The aim of this study is to evaluate the sealing ability of Biodentine(TM), which is new calcium-silicate based dental cement and has endodontic indications similar to those of MTA.

METHODS

The study sample consists of 21extracted human mandibular anterior teeth. The teeth were submitted to root-end preparation and instrumented up to file #40 by step back technique and randomly divided into 3 study groups (n=7): White MTA Angelus(TM) (Angelus, Angelus Odontológica, Londrina, PR, Brazil), Biodentine(TM) (Septodont, SeptodontSpecialités, Saint-MaurdesFosses, France) and the controls. The length of dye penetration between the filling material and tooth structure was measured in millimetres, using a calibrated stereo microscope (Leica MZ75, Germany) at 20× magnification under the same conditions. One-way Analysis of Variance (ANOVA) was used to indicate differences between the experimental groups and the controls. In addition, Tukey Multiple Comparisons Test was used to indicate differences within each group.

RESULTS

The results showed that none of the groups were completely sealed. The mean and standard deviation for dye penetration in Biodentine(TM) group was 0.63±0.20 and in MTA Angelus(TM) group, it was 0.26±0.25. Regarding the comparisons between each group, significant differences were not observed (P=0.0193). The comparison between materials only found a significant difference only between MTA Angelus(TM) and Biodentine(TM) (P<0.05).

CONCLUSIONS

This study evaluated the possibility of Biodentine(TM)'s sealing ability and marginal adaptation, since no studies are available on Biodentine. However, further in vitro and in vivo investigations should be conducted to determine the suitability of Biodentine(TM) for clinical application.

A biocompatible and bioactive replacement for dentine: is this a reality? The properties and uses of a novel calcium-based cement

As part of the continuing evolution towards conservative dentistry there has been a drive to push further and investigate the possibility of inducing the repair and regeneration of lost dental hard tissue. Until recently, the prospect of repair and regeneration had been confined to laboratory studies and hypothesised scientific models. In 2009, a new product was launched claiming to be a revolutionary material capable of offering a bioactive and biocompatible replacement for dentine. The calcium-based cement is reported to preserve pulp vitality, promote pulp healing and provide a natural substitute for dentine through bioactive stimulation of the dentino-pulpal complex. Its clinical indications are extensive, described as a restorative material suitable for use wherever dentine replacement is required. In this article the physical, mechanical, chemical and biological properties of this novel material are presented, together with the results of experimental laboratory-based investigations and on-going clinical in vivo investigations.

Spheroid model study comparing the biocompatibility of Biodentine and MTA

The primary objective of this study was to assess the biological effects of a new dentine substitute based on Ca₃SiO₅ (Biodentine™) for use in pulp-capping treatment, on pseudo-odontoblastic (MDPC-23) and pulp (Od-21) cells. The secondary objective was to evaluate the effects of Biodentine and mineral trioxide aggregate (MTA) on gene expression in cultured spheroids. We used the acid phosphatase assay to compare the biocompatibility of Biodentine and MTA. Cell differentiation was investigated by RT-qPCR. We investigated the expression of genes involved in odontogenic differentiation (Runx2), matrix secretion (Col1a1, Spp1) and mineralisation (Alp). ANOVA and PLSD tests were used for data analysis. MDPC-23 cells cultured in the presence of MTA had higher levels of viability than those cultured in the presence of Biodentine and control cells on day 7 (P = 0.0065 and P = 0.0126, respectively). For Od-21 cells, proliferation rates on day 7 were significantly lower in the presence of Biodentine or MTA than for control (P < 0.0001). Col1a1 expression levels were slightly lower in cells cultured in the presence of MTA than in those cultured in the presence of Biodentine and in control cells. Biodentine and MTA may modify the proliferation of pulp cell lines. Their effects may fluctuate over time, depending on the cell line considered. The observed similarity between Biodentine and MTA validates the indication for direct pulp-capping claimed by the manufacturers.

Investigation of Biodentine as dentine replacement material

OBJECTIVE

Biodentine was compared to glass ionomer and resin modified cements in an "open sandwich" restoration.

METHODS

Fuji IX, Vitrebond and Biodentine were characterised using various techniques. The effect of etching with 35% phosphoric acid was investigated by assessment of surface topography, Fourier transform infrared (FT-IR) spectroscopy, surface micro-hardness and micro-leakage using tagged carboxylated-modified fluorescent microspheres and tracing the presence of these particles with a confocal microscope.

RESULTS

Acid etching resulted in erosion of the material surface with exposure of the glass particles in the glass ionomer-based materials. Biodentine exhibited a reduction in the chlorine peak and the calcium-silicon ratio. There was no difference in the micro-hardness in etched and un-etched materials. The FT-IR plots did not show any chemical changes caused by etching for all the materials investigated. Both Vitrebond and Fuji IX exhibited no leakage at the dentine to material interface while Biodentine exhibited leakage both when it was etched and also when the surface was left unprepared. The sandwich technique was effective and prevented micro-leakage with glass ionomer-based materials but micro-leakage occurred with Biodentine.

CONCLUSIONS

Biodentine demonstrated both structural and chemical changes when etched with 37% phosphoric acid. Biodentine exhibited a lower calcium to silicon ratio and a reduction in the chloride peak height when etched. When used as a dentine replacement material in the sandwich technique overlayed with composite, significant leakage occurred at the dentine to material interface. On the other hand materials based on glass ionomer cement were etched successfully and no chemical and physical changes or micro-leakage were detected when the materials were used as bases under composite restorations. The micro-hardness of all the materials was unaffected by etching.