Effect of addition of nano-hydroxyapatite on physico-chemical and antibiofilm properties of calcium silicate cements

Application of Nanomaterials in Endodontics

Recent advancements in nanotechnology have introduced a myriad of potential applications in dentistry, with nanomaterials playing an increasing role in endodontics. These nanomaterials exhibit distinctive mechanical and chemical properties, rendering them suitable for various dental applications in endodontics, including obturating materials, sealers, retro-filling agents, and root-repair materials. Certain nanomaterials demonstrate versatile functionalities in endodontics, such as antimicrobial properties that bolster the eradication of bacteria within root canals during endodontic procedures. Moreover, they offer promise in drug delivery, facilitating targeted and controlled release of therapeutic agents to enhance tissue regeneration and repair, which can be used for endodontic tissue repair or regeneration. This review outlines the diverse applications of nanomaterials in endodontics, encompassing endodontic medicaments, irrigants, obturating materials, sealers, retro-filling agents, root-repair materials, as well as pulpal repair and regeneration. The integration of nanomaterials into endodontics stands poised to revolutionize treatment methodologies, presenting substantial potential advancements in the field. Our review aims to provide guidance for the effective translation of nanotechnologies into endodontic practice, serving as an invaluable resource for researchers, clinicians, and professionals in the fields of materials science and dentistry.

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.

Potent Antibacterial and Antibiofilm Activities of a Synthetic Remineralizing Preparation of Nano-Hydroxyapatite Against Cariogenic Streptococcus mutans Using an Ex-vivo Animal Model

Aim

The aim to this study is to evaluate the biocompatibility and antibiofilm actions of two nano-hydroxy apatite (NHA).

Methodology

Nano-hydroxy apatites are biomaterials use in direct contact with living tissues. Therefore, they should be tested for their safety beside assessment of their minimum inhibitory (MIC) and minimum bactericidal concentration (MBC) using broth microdilution method. One hundred and twenty extracted bovine incisors were collected and cleaned to ensure the absence of any defects. Enamel blocks with different size (2 × 2 × 3 mm) and (5 × 5 × 2 mm) were prepared from their labial surfaces using an isomet saw. Enamel blocks are used for detecting the suitable concentration will be used in the following experiments using energy dispersive X-ray analysis (EDX). The remaining enamel blocks divided into 5 equal groups to detect inhibitory effect against bacterial adhesion to the initial enamel caries like lesions using viable count technique beside the antibiofilm activity against mature biofilm of Streptococcus mutans (S. mutans) using confocal laser microscopy. The remaining enamel blocks were used as a representing data for detecting surface topography for each group by using the scanning electron microscopy (SEM).

Result

The data showed safety of NHA suspensions. Additionally, only NHA suspension of large nanoparticle size (NHA-LPS) had MIC of 1.25 mg/ml against S. mutans. Also, have the higher percentages of Ca and P in the enamel blocks. Furthermore, the lowest level of bacterial adhesion was recorded in (group III) treated by NHA-LPS which was non-significantly different with the positive control group V. Biofilm thickness in group IV treated with NHA-small particle size (SPS) recorded high biofilm thickness followed by group III. Interestingly, group III showed greater killing effect against mature biofilm which is slightly higher than the positive control group V. In group III, surface topography revealed very smooth enamel surface with closed pores. Accordingly, NHA-LPS suspension had antiadhesive, antibacterial, and antibiofilm effect against cariogenic S. mutans representing a promising possibility to be recommended for safe effective remineralization.

Development and Analysis of a Hydroxyapatite Supplemented Calcium Silicate Cement for Endodontic Treatment

Aim: To develop an endodontic cement using bovine bone-derived hydroxyapatite (BHA), Portland cement (PC), and a radiopacifier. Methods: BHA was manufactured from waste bovine bone and milled to form a powder. The cements were developed by the addition of BHA (10%/20%/30%/40% wt), 35% wt, zirconium oxide (radiopacifier) to Portland cement (PC). A 10% nanohydroxyapatite (NHA) cement containing PC and a radiopacifier, and a cement containing PC (PC65) and a radiopacifier were also manufactured as controls. The cements were characterised to evaluate their compressive strength, setting time, radiopacity, solubility, and pH. The biocompatibility was assessed using Saos-2 cells where ProRoot MTA acted as the control. Compressive strength, solubility and pH were evaluated over a 4-week curing period. Results: The compressive strength (CS) of all cements increased with the extended curing times, with a significant CS increase in all groups from day 1 to day 28. The BHA 10% exhibited significantly higher CS compared with the other cements at all time points investigated. The BHA 10% and 20% groups exhibited significantly longer setting times than BHA 30%, 40% and PC65. The addition of ZrO₂ in concentrations above 20% wt and Ta₂O₅ at 30% wt resulted in a radiopacity equal to, or exceeding that of, ProRoot MTA. The experimental cements exhibited relatively low cytotoxicity, solubility and an alkaline pH. Conclusions: The addition of 10% and 20% BHA to an experimental PC-based cement containing 35% ZrO₂ improved the material’s mechanical strength while enabling similar radiopacity and biocompatibility to ProRoot MTA. Although BHA is a cost-effective, biomimetic additive that can improve the properties of calcium silicate endodontic cements, further studies are now warranted to determine its clinical potential.

Portland Cement: An Overview as a Root Repair Material

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

Physicochemical and biological properties of new tricalcium silicate-based repair material doped with fluoride ions and zirconium oxide as radiopacifier

This study evaluated the physicochemical and biological properties of novel reparative materials composed of pure tricalcium silicate (Ca₃ SiO₅ ), Ca₃ SiO₅ doped with fluoride ions (Ca₃ SiO₅ -F) and their association with ZrO₂ (Ca₃ SiO₅  + ZrO₂ , Ca₃ SiO₅ -F + ZrO₂ ), in comparison with Biodentine (BIO). Setting time radiopacity, pH, solubility, and dimensional change were evaluated based on ISO 6876 Standard. Volumetric change and flow/filling were assessed by microcomputed tomography (micro-CT). Biological properties were evaluated by the MTT assay 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), Neutral Red (NR), cell migration, alkaline phosphatase activity (ALP), and Alizarin Red Staining (ARS) assays. Statistical analysis was performed by ANOVA, Tukey, or Bonferroni tests (α = .05). Ca₃ SiO₅ -F + ZrO₂ had higher radiopacity, shorter setting time, and lower solubility and volumetric loss than BIO (p < .05). Ca₃ SiO₅ -F + ZrO₂ had flow and filling capacity similar to BIO (p > .05). All the cements evaluated had an alkaline pH. Ca₃ SiO₅ -F + ZrO₂ demonstrated cell viability similar to negative control (p > .05), increase in ALP activity in 7 days, mineralized nodule production in 21 days and repair capacity according to cell migration. In conclusion, Ca₃ SiO₅ -F + ZrO₂ had adequate setting time, radiopacity, solubility, and dimensional change. This material presented low volumetric change besides flow and filling capacity in micro-CT assessment. In addition, Ca₃ SiO₅ -F + ZrO₂ was biocompatible and bioactive, suggesting its use as reparative material.

Antimicrobial Activity of Calcium Silicate-Based Dental Materials: A Literature Review

Endodontic biomaterials have significantly improved dental treatment techniques in several aspects now that they can be used for vital pulp treatments, as temporary intracanal medication, in definitive fillings, in apical surgeries, and for regenerative procedures. Calcium silicate-based cement is a class of dental material that is used in endodontics in direct contact with the dental structures, connective tissue, and bone. Because the material interacts with biological tissues and stimulates biomineralization processes, its properties are of major importance. The main challenge in endodontic treatments is the elimination of biofilms that are present in the root canal system anatomical complexities, as it remains even after chemical-mechanical preparation and disinfection procedures. Thus, an additional challenge for these biomaterials is to exert antimicrobial activity while maintaining their biological properties in parallel. This article reviews the literature for studies considering the antimicrobial properties of calcium silicate-based dental biomaterials used in endodontic practice. Considering the reviewed studies, it can be affirmed that the reduced antimicrobial effect exhibited by calcium silicate-based endodontic materials clearly emphasizes that all clinical procedures prior to their use must be carefully performed. Future studies for the evaluation of these materials, and especially newly proposed materials, under poly-microbial biofilms associated with endodontic diseases will be necessary.

Development and evaluation of reparative tricalcium silicate-ZrO2 -Biosilicate composites

Biosilicate is a bioactive glass-ceramic used in medical and dental applications. This study evaluated novel reparative materials composed of pure tricalcium silicate (TCS), 30% zirconium oxide (ZrO₂ ) and 10 or 20% biosilicate, in comparison with Biodentine. Setting time was evaluated based on ISO 6876 standard, radiopacity by radiographic analysis, solubility by mass loss, and pH by using a pH meter. Cytotoxicity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and NR assays. Alkaline phosphatase (ALP) activity and alizarin red were used to evaluate cell bioactivity. Antimicrobial activity was assessed on Enterococcus faecalis by the direct contact test. The data were submitted to analysis of variance (ANOVA)/Tukey; Bonferroni and Kruskal-Wallis, and Dunn tests (α = 0.05). The association of Biosilicate with TCS + ZrO₂ had appropriate setting time, radiopacity, and solubility, alkaline pH, and antimicrobial activity. TCS and Biodentine showed higher ALP activity in 14 days than the control (serum-free medium). All cements produced mineralized nodules. In conclusion, Biosilicate + TCS ZrO₂ decreased the setting time and increased the radiopacity in comparison to TCS. Biosilicate + TCS ZrO2 presented lower solubility and higher radiopacity than Biodentine. In addition, these experimental cements promoted antimicrobial activity and mineralization nodules formation, suggesting their potential for clinical use.

Pivotal Local Drug Delivery Systems in Endodontics; A Review of Literature

Endodontic pathosis is preliminary caused by bacteria and their by-products that interact with pulpal and periradicular host tissues. The purge of the root canal system (RCS) from bacteria is a necessity for successful endodontic treatment. Different approaches have been considered to reduce the number of microorganisms and confront microbiota in the radicular area; namely chemomechanical preparation and intracanal medication. However, various studies have shown that, due to the intricate anatomy of RCS, bacteria can persist in distant areas and significantly decrease the degree of success in endodontic ministrations. Thereby, elimination of bacteria remains a challenge, specifically from the infectious root canals. In recent years, local drug delivery systems (LDDS), loaded with drugs and/or antibacterial agents, have been deliberated for the removal of microorganisms or as a medicinal adjunct to mechanical instrumentation. Owing to the resistant species and complexities in the structure of root canals, it seems that LDDS may be able to closely affect microorganisms and improve the success rate of endodontic treatment. Furthermore, they are capable of limiting drugs to RCS, and can achieve a more effective therapeutic dose/concentration in the target site. Furthermore, and due to successful outcomes, administration of LDDS has also been given great attention for regenerative purposes. Micro/nanoparticles, liposomes, nanofibers, sealers and so forth represent typical delivery systems used for endodontic treatments. This study addresses pivotal LDDS used in endodontics and their applications.

Effect of Adding Nano Size Silica on Setting Time and Porosity of Mineral Trioxide Aggregate

Introduction

The aim of this study was to evaluate the effect of addition of nano-silica (SiO₂) to mineral trioxide aggregate (MTA) on its setting time and porosity.

Methods and Materials

The concentration 8% of nano-silica were prepared and added to the MTA powder. After mixing with water the setting time and porosity were evaluated and compared with pure MTA. Statistical analysis was performed using the t-test. The level of significance was set at 0.001.

Results

The mean setting time of MTA+8% nano-silica (9.8±0.78) was significantly lower than MTA (23.3±2.16) ( P<0.001). Also the mean porosity by imbibition method in MTA+8% nano-silica (23.49±0.48) was significantly higher than MTA (15.69±2.10) (P<0.001). There was no significant difference in mean porosity by scanning electron microscope (SEM) method in MTA+8% nano-silica (31.26±10.73) and MTA (32.74±5.26) (P>0.001).

Conclusion

This in vitro study showed us an addition of 8% of nano-silica to MTA reduced the setting time. Although evaluation by imbibition test showed increasing of porosity in nano-silica MTA compared with pure MTA.

Mineral Trioxide Aggregate-A Review of Properties and Testing Methodologies

Mineral trioxide aggregate (MTA) restoratives and MTA sealers are commonly used in endodontics. Commonly referenced standards for testing of MTA are ISO 6876, 9917-1 and 10993. A PubMed search was performed relating to the relevant tests within each ISO and "mineral trioxide aggregate". MTA restoratives are typically tested with a mixture of tests from multiple standards. As the setting of MTA is dependent upon hydration, the results of various MTA restoratives and sealers are dependent upon the curing methodology. This includes physical properties after mixing, physical properties after setting and biocompatibility. The tests of flow, film thickness, working time and setting time can be superseded by rheology as it details how MTA hydrates. Physical property tests should replicate physiological conditions, i.e. 37 °C and submerged in physiological solution. Biocompatibility tests should involve immediate placement of samples immediately after mixing rather than being cured prior to placement as this does not replicate clinical usage. Biocompatibility tests should seek to replicate physiological conditions with MTA tested immediately after mixing.

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.