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Estrela C, Cintra LTA, Duarte MAH, Rossi-Fedele G, Gavini G, Sousa-Neto MD. Mechanism of action of Bioactive Endodontic Materials. Braz Dent J 2023; 34:1-11. [PMID: 36888836 PMCID: PMC10027099 DOI: 10.1590/0103-6440202305278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/06/2023] [Indexed: 03/08/2023] Open
Abstract
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.
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Affiliation(s)
- Carlos Estrela
- School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | | | | | | | - Giulio Gavini
- School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Sivieri-Araujo G, Strazzi-Sahyon HB, Jacomassi DP, Dos Santos PH, Cintra LTA, Kurachi C, Bagnato VS. Effects of methylene blue and curcumin photosensitizers on the color stability of endodontically treated intraradicular dentin. Photodiagnosis Photodyn Ther 2021; 37:102650. [PMID: 34838697 DOI: 10.1016/j.pdpdt.2021.102650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Photodynamic therapy with photosensitizers can reduce the microbial load. However, few studies have evaluated the effects of photosensitizers on the color stability of endodontically treated intraradicular dentin. This in vitro study investigated the effects of methylene blue and curcumin photosensitizers used in photodynamic therapy on the color stability of intraradicular dentin. METHODS Sixty human incisors were divided into three experimental groups according to the photosensitizer solutions used and their concentrations: methylene blue (25 mg/L), curcumin (1000 mg/L), and curcumin (1500 mg/L). The color stability of endodontically treated intraradicular dentin was evaluated using a portable reflectance spectrophotometer before and after the samples been storage in 2 mL of the photosensitizer solutions during 5 min (n = 20). Color stability data were subjected to a normality test, and statistical analysis was performed using the one-way analysis of variance and Tukey least significant difference test (α = 0.05). RESULTS Samples treated with 25 mg/L methylene blue photosensitizer showed a higher level of color alteration than those stored in 1000 mg/L curcumin (p = .03322). However, there was no significant difference in the color alteration profiles between the samples treated with 25 mg/L methylene blue and 1500 mg/L curcumin (p = .36428). Furthermore, there was no difference in the color alteration profiles between the dentin samples immersed in 1000 mg/L and 1500 mg/L curcumin photosensitizer solutions (p = .45321). CONCLUSIONS Methylene blue and curcumin photosensitizers influenced the color stability of endodontically treated intraradicular dentin, and this color alteration exceeded the clinical acceptability threshold. Samples treated with 25 mg/L methylene blue showed the highest level of color alteration.
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Affiliation(s)
- Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Denis Pablo Jacomassi
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
| | - Paulo Henrique Dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Cristina Kurachi
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
| | - Vanderlei Salvador Bagnato
- Optic Group, Physics Institute of São Carlos - IFSC, University of São Paulo - USP, São Carlos, SP, Brazil.
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Krug R, Ortmann C, Reich S, Hahn B, Krastl G, Soliman S. Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study. Clin Oral Investig 2021; 26:375-383. [PMID: 34151389 PMCID: PMC8791895 DOI: 10.1007/s00784-021-04009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022]
Abstract
Objectives To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. Materials and methods Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro–Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). Results Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. Conclusions Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. Clinical relevance APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.
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Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | | | | | - B Hahn
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - G Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - S Soliman
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Tooth Discoloration after Regenerative Endodontic Procedures with Calcium Silicate-Based Cements—An Ex Vivo Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10175793] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim of the present ex vivo study was to assess and compare coronal discoloration induced by four endodontic biomaterials used in regenerative endodontic procedures (REPs). Root resection was executed horizontally, 2 mm apical to the cementoenamel junction, in all fifty-four teeth. After accessing the pulp chamber, specimens were randomly divided in groups and filled with either saline solution or blood, followed by calcium silicate-based cements (CSCs) placement: ProRoot mineral trioxide aggregate (MTA) (Dentsply Sirona), Biodentine (Septodont), TotalFill BC (FKG), or pulp capping material (PCM) (Coltène). Color change (ΔE) was assessed using the L* a* b* system at five different timepoints (before and immediately after biomaterial application, 72 h, 7 days, and 6 months). The significance level for statistical analysis was set at p < 0.05. There are statistically significant differences regarding ΔE over time (p < 0.001). Statistical differences are found considering material (p < 0.001), treatment (p = 0.007), or both (p = 0.002). If solely the material or treatment is considered, regardless of time, statistically significant differences are detected (p < 0.001). After a six-month period of evaluation, blood exposure might be a critical factor in biomaterials’ color variation. Biodentine presents the lowest discoloration potential, followed by TotalFill and PCM, albeit without statistically significant differences. MTA exhibited the greatest color variation. The selection of biomaterial should consider the material’s discoloration potential.
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Fagogeni I, Metlerska J, Lipski M, Falgowski T, Maciej G, Nowicka A. Materials used in regenerative endodontic procedures and their impact on tooth discoloration. J Oral Sci 2019; 61:379-385. [PMID: 31378754 DOI: 10.2334/josnusd.18-0467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
There is some evidence of tooth discoloration after regenerative endodontic procedures. The aim of this review is to determine which materials used in regenerative procedures induce tooth discoloration. The authors searched six digital databases in February 2018: PubMed, Google Scholar, the Cochrane Library, Scopus, Web of Science, and Lilacs. As a result, 353 studies were found. Eleven studies that met the established criteria were selected. Analysis of the selected studies showed that most materials used in regenerative endodontic procedures have the potential to stain tooth tissues. To decrease tooth discoloration, sealing dentin with a dentin-bonding agent before the placement of a disinfectant paste and barrier materials should be considered. Only a small number of in vitro studies have been performed; therefore, further studies on this topic are warranted.
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Affiliation(s)
- Irini Fagogeni
- Faculty of Dentistry, Pomeranian Medical University in Szczecin
| | | | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics,Pomeranian Medical University in Szczecin
| | | | - Górski Maciej
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin
| | - Alicja Nowicka
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin
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Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J 2017; 51:284-317. [PMID: 28846134 DOI: 10.1111/iej.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Tooth Discoloration Induced by Different Calcium Silicate–based Cements: A Systematic Review of In Vitro Studies. J Endod 2017; 43:1593-1601. [DOI: 10.1016/j.joen.2017.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/30/2017] [Accepted: 04/02/2017] [Indexed: 11/22/2022]
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Ramos JC, Palma PJ, Nascimento R, Caramelo F, Messias A, Vinagre A, Santos JM. 1-year In Vitro Evaluation of Tooth Discoloration Induced by 2 Calcium Silicate–based Cements. J Endod 2016; 42:1403-7. [DOI: 10.1016/j.joen.2016.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Dettwiler CA, Walter M, Zaugg LK, Lenherr P, Weiger R, Krastl G. In vitroassessment of the tooth staining potential of endodontic materials in a bovine tooth model. Dent Traumatol 2016; 32:480-487. [DOI: 10.1111/edt.12285] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Christian A. Dettwiler
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Mirella Walter
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Lucia K. Zaugg
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Patrik Lenherr
- Department of Reconstructive Dentistry and Temporomandibular Disorders; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology; University of Würzburg; Würzburg Germany
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Voveraityte V, Gleizniene S, Lodiene G, Grabliauskiene Z, Machiulskiene V. Spectrophotometric analysis of tooth discolouration induced by mineral trioxide aggregate after final irrigation with sodium hypochlorite: An in vitro
study. AUST ENDOD J 2016; 43:11-15. [DOI: 10.1111/aej.12149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Valdone Voveraityte
- Department of Dental and Oral Pathology; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Simona Gleizniene
- Department of Dental and Oral Pathology; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Greta Lodiene
- Department of Dental and Oral Pathology; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Zivile Grabliauskiene
- Department of Dental and Oral Pathology; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Vita Machiulskiene
- Department of Dental and Oral Pathology; Faculty of Odontology; Lithuanian University of Health Sciences; Kaunas Lithuania
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Guimarães BM, Tartari T, Marciano MA, Vivan RR, Mondeli RFL, Camilleri J, Duarte MAH. Color Stability, Radiopacity, and Chemical Characteristics of White Mineral Trioxide Aggregate Associated with 2 Different Vehicles in Contact with Blood. J Endod 2015; 41:947-52. [DOI: 10.1016/j.joen.2015.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/07/2015] [Indexed: 11/27/2022]
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Berger T, Baratz AZ, Gutmann JL. In vitro investigations into the etiology of mineral trioxide tooth staining. J Conserv Dent 2014; 17:526-30. [PMID: 25506138 PMCID: PMC4252924 DOI: 10.4103/0972-0707.144584] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022] Open
Abstract
Aim: To investigate the role of bismuth oxide, a constituent of contemporary mineral trioxide aggregate (MTA) materials, and its response to various solutions that may contribute to the potential discoloration that occurs following MTA applications within the scope of endodontics. Setting and Design: Laboratory assessment of chemical reactions with white ProRoot® MTA and white Portland cement (WPC). Materials and Methods: Set specimens and freshly mixed specimens of white ProRoot® MTA and white ProRoot® MTA powder, along with specimens of WPC were exposed to distilled water, phosphate buffered saline (PBS), 10% formalin, hydroxyethylmethacrylate (HEMA), sodium hypochlorite, sodium hydroxide (NaOH) base, and hydrochloric acid (HCl) acid. Specimens were visually inspected periodically for color changes. Results: All forms of ProRoot MTA showed discoloration when exposed to 10% formalin within 30 min, as opposed to WPC, and were completely blackened at 4 days. Bismuth oxide alone and with calcium oxide also turned black within 30 min after exposure to 10% formalin. No discoloration was seen when exposed to the other solutions. Conclusions: Exposing MTA in various forms to a variety of liquids has determined that bismuth oxidein combination with other chemical moieties is the prime cause of staining observed by clinicians.
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Affiliation(s)
- Todd Berger
- Department of Research and Development, Dentsply Tulsa Dental Specialties, Tulsa, Oklahoma, USA
| | - Adam Z Baratz
- Department of Research and Development, Dentsply Tulsa Dental Specialties, Tulsa, Oklahoma, USA
| | - James L Gutmann
- Department of Restorative Sciences/Endodontics, Texas A&M University Baylor College of Dentistry, Dallas, Texas, USA
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