Clinical application of calcium silicate-based bioceramics in endodontics

Pulp treatment is extremely common in endodontics, with the main purpose of eliminating clinical symptoms and preserving tooth physiological function. However, the effect of dental pulp treatment is closely related to the methods and materials used in the process of treatment. Plenty of studies about calcium silicate-based bioceramics which are widely applied in various endodontic operations have been reported because of their significant biocompatibility and bioactivity. Although most of these materials have superior physical and chemical properties, the differences between them can also have an impact on the success rate of different clinical practices. Therefore, this review is focused on the applications of several common calcium silicate-based bioceramics, including Mineral trioxide aggregate (MTA), Biodentine, Bioaggregate, iRoot BP Plus in usual endodontic treatment, such as dental pulp capping, root perforation repair, regenerative endodontic procedures (REPs), apexification, root-end filling and root canal treatment (RCT). Besides, the efficacy of these bioceramics mentioned above in human trials is also compared, which aims to provide clinical guidance for their clinical application in endodontics.

Clinical applications of calcium silicate-based materials: a narrative review

Calcium silicate-based materials are hydrophilic materials with biocompatibility and bioactivity properties. Despite many advantages, they might present some problems related to discolouration, setting time, manipulation and solubility depending on the composition of the product and the type of clinical application. Calcium silicate-based materials can be evaluated under two types according to their intended use: calcium silicate-based cements (CSCs) and calcium silicate-based sealers (CSSs). CSCs can be used in many endodontic procedures including perforation repair, resorption repair, apical barriers, guided endodontic repair, vital pulp treatment, endodontic surgery, root fractures and root canal filling as a core obturation material. CSSs are available for use with gutta-percha to obturate root canals using cold and warm techniques, including the sealer-based obturation technique. The purpose of this review is to evaluate the available literature on CSCs and CSSs and to provide up-to-date information and recommendations for their clinical applications.

Kan kontaminasyonunun farklı kök ucu dolgu materyallerinin dentine bağlanma dayanımına etkisi

Amaç: Bu in vitro çalışmanın amacı, kan kontaminasyonunun farklı kök ucu dolgu materyallerinin dentine bağlanma dayanımına etkisinin değerlendirilmesiydi. Gereç ve Yöntem: Bu çalışmada tek köklü 90 adet maksiler santral diş kullanıldı. Dişlere endodontik tedavi uygulandıktan sonra kök uçları rezeke edildi ve kök ucu kaviteleri hazırlandı. Öncelikle örnekler, kavitelerin kanla kontaminasyonuna göre (+/-) 2 gruba ayrıldı. Daha sonra kök ucu dolgu malzemelerine göre üç alt gruba ayrıldı: MTA Repair HP, RetroMTA, MTA Flow (n=15). Bu malzemeler üreticinin talimatları doğrultusunda kaviteye yerleştirildi. Örnekler 21 gün boyunca 37 °C’de %100 nemli ortamda bekletildi. 1.0±0.1 mm kesitler elde edildikten sonra itme-bağlanma dayanımı testi gerçekleştirildi. Başarısızlık tipini değerlendirmek için her kesit stereomikroskop altında incelendi. Veriler tek yönlü varyans analizi ve bağımsız örneklem t-testi kullanılarak analiz edildi. Bulgular: Bağlanma dayanımı, kan kontaminasyonunun varlığından önemli ölçüde olumsuz yönde etkilendi (p<0.05). En yüksek bağlanma dayanımı MTA Flow (-) grubunda, en düşük bağlanma dayanımı ise MTA Repair HP (+) grubunda gözlendi (p<0.05). Hem kanla kontamine olan grupta hem de kanla kontamine olmayan grupta MTA Repair HP en düşük bağlanma dayanımını gösterirken (p<0.001), MTA Flow ve RetroMTA arasında anlamlı farklılık bulunmadı (p>0.05). Sonuç: Kan kontaminasyonu dentine bağlanma dayanımını azalttı. Materyaller arasında en yüksek bağlanma dayanımını MTA Flow gösterdi.

Push-out bond strength of the calcium silicate-based endodontic cements in the presence of blood: A systematic review and meta-analysis of in vitro studies

OBJECTIVES

The push-out bond strength (POBS) of calcium silicate-based cements (CSCs) to the dentinal wall is considered one of the essential physical properties for clinical success. The presence of blood in the treatment area affects the POBS of these types of cement. This study aimed to evaluate the impact of blood contamination on the bond strength of CSCs and dentinal walls.

MATERIAL AND METHODS

This systematic review was performed by searching electronic databases (MEDLINE-PubMed, Scopus, and EMBASE) to include relevant in vitro studies published between 1992 and April 2020. Two reviewers independently evaluated the selected studies and extracted data on the type of studied CSCs, evaluated area of the teeth, sample size, the dimension of a prepared area, slice thickness, storage duration, the setting of the universal testing machine (UTM), effects of blood contamination on POBS of CSCs and their failure modes. The bond strength of evaluated CSCs in studies was used for network meta-analysis.

RESULTS

Initial searches identified 292 articles, while only 13 articles met the inclusion criteria. Full texts of these articles were evaluated, and data extraction was performed. The effect of blood contamination on bond strength to the dentinal wall was assessed in various CSCs such as PMTA, Biodentine, and AMTA. The network meta-analysis results showed that the bond strength of Biodentine was significantly higher than other types of cement in blood presence (p < .05).

CONCLUSIONS

Based on the current systematic review, despite controversies among the result of the different articles and the lack of data for some CSCs like bioaggregate, it could be concluded that the bond strength of Biodentine to the dentinal wall is better than other evaluated CSCs in the presence of blood.

A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study

Aim and objective

The present study was conducted to evaluate the marginal adaptability of mineral trioxide aggregate (MTA) as a root-end filling material when manipulated using two different IV fluids intended for pediatric usage; in the presence of blood and salivary contamination.

Materials and methods

Sixty single-rooted teeth were selected. Conventional endodontic root canal preparation was performed on all specimens followed by root-end resection and retrograde cavity preparation. The roots were randomly divided into two groups (n = 30). In the specimens of group I, fresh blood was used as a contaminant and in group II artificial saliva was used as a contaminant. In both groups, MTA (e-MTA, Kids-e-Dental®) manipulated using either Ringer's lactate IV fluid (n = 15) or Tetraspan IV fluid (n = 15) was used for root-end filling in blood or artificial saliva-coated retrocavities. Furthermore, these roots were placed in beakers pooled with fresh phlebotomized blood or artificial saliva. After incubating for 48 hours, the roots were divided longitudinally to expose the retrofilled cavities and were then sputter-coated with gold-platinum dust. To assess the marginal adaptation of MTA to radicular dentin "maximum gap width" and "gap perimeter" were measured in images obtained from scanning electron microscopy of root specimens. SPSS 21 was employed for statistical analysis at (p < 0.05). Mann-Whitney U test and ANOVA were used for analyzing the data obtained.

Results

The gap width was more among samples exposed to blood (p < 0.05) than artificial saliva. No significant difference was reported in the gap perimeter when cavities were filled with MTA mixed with either IV fluids (p > 0.05).

Conclusion

Exposure to blood during setting had a negative effect on gap width when retrocavities were filled with MTA using Tetraspan. No effect was seen on the arch perimeter in retrocavities filled with MTA mixed with Ringer's lactate or Tetraspan.

Clinical significance

For avoiding failure, it is critical to select a biocompatible root-end filling material with high sealing ability. Hence, by doing the same, the clinical situation can be simulated.

How to cite this article

Mody A, Arora R, Chauhan P, et al. A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):674-680.

Evaluation of the Dislodgement Resistance of a New Pozzolan-Based Cement (EndoSeal MTA) Compared to ProRoot MTA and Biodentine in the Presence and Absence of Blood

INTRODUCTION

This in vitro study investigated the dislodgement resistance of EndoSeal MTA, a new pozzolan-containing calcium silicate-based material, in comparison with ProRoot MTA and Biodentine in the presence and absence of contamination with blood.

METHODS

Standard furcal perforations were created in 180 human mandibular first molars. The teeth were randomly allocated to 12 groups of 15 each. ProRoot MTA, Biodentine, and EndoSeal MTA were used to repair the perforations. In half of the samples, the walls of the perforated areas were contaminated with blood, whereas saline was injected into the other half. A push-out test was performed using a universal testing machine after 24 hours or 7 days. To evaluate failure patterns, the samples were split into half and were examined under a stereomicroscope at a 20x magnification. Data were analyzed using three-way analysis of variance, Tukey test, and Student's t-test.

RESULTS

At both time intervals and in the presence and absence of contamination with blood, ProRoot MTA and Biodentine had significantly higher retention values than EndoSeal MTA (p < 0.001). Contamination with blood had no effect on EndoSeal MTA; however, it negatively affected the dislodgement resistance of Biodentine at 24 hours and ProRoot MTA at both time intervals (p < 0.05). Time significantly affected only the bond strength of the uncontaminated groups (p > 0.001). The most common type of failure was mixed for ProRoot MTA and Biodentine, whereas it was cohesive for EndoSeal MTA.

CONCLUSIONS

ProRoot MTA and Biodentine showed higher values of bond strength than EndoSeal MTA and may thus be better options for the repair of root perforations.

Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: An in vitro study

Aim

The purpose of this study was to evaluate the effect of 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate (MTA).

Materials and Methods

Midroot dentin of single-rooted human canine teeth were sectioned into 2-mm-thick slices horizontally (n = 60). The canal space of each dentin slice was enlarged with a 1.3-mm-diameter diamond bur. The samples were divided into two groups (n = 30) based on the type of perforation repair material placed, i.e., Biodentine and ProRoot MTA. The samples were wrapped in wet gauge for 10 min, and based on the type of chelating agent used for removal of smear layer, each group is further divided into three subgroups (n = 10), to be immersed into saline (control), 17% EDTA and 0.2% chitosan for 30 min, and a wet cotton pellet was placed over each test material. After 48 h of incubation, the dislodgement resistance of the samples was measured using a universal testing machine.

Statistical Analysis

Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at 0.05.

Results

Biodentine showed significantly higher pushout bond strength than ProRoot MTA. Biodentine and ProRoot MTA lost strength when exposed to 0.2% chitosan.

Conclusion

Biodentine showed considerable performance as a perforation repair material than ProRoot MTA even after being exposed to various endodontic chelating agents.

Biodentine for Furcation Perforation Repair: An Animal Study with Histological, Radiographic and Micro-Computed Tomographic Assessment

Introduction:

Biodentine has been scarcely studied as a furcation perforation (FP) repair material, mostly by in vitro methodologies. This animal study aimed to compare the histological responses, radiographic, and micro-computed tomographic (micro-CT) outcomes after FP repair with Biodentine or ProRoot MTA (MTA) in dogs’ teeth.

Methods and Materials:

Fifty teeth from five dogs were divided into 4 groups: MTA (n=20, FP repaired with ProRoot MTA), BDT (n=20, FP repaired with Biodentine), PC (n=5, positive control, FP without repair) and NC (n=5, negative control, without perforation). The animals were euthanized after 4 months. Histological assessment included inflammatory cell infiltration, hard tissue resorption, hard tissue repair, and cement repair in the furcation area. Immediate postoperative and 4 months follow-up radiographs were compared for radiolucency in the furcation region. The volume of extruded material was quantified using micro-CT images.

Results:

The tested materials showed equivalent radiographic response, together with similar hard tissue resorption and repair but, BDT group showed significantly less inflammation, lower volume of extruded material and higher cement repair than MTA group.

Conclusion:

The outcomes of this study, taken together with other favorable results in literature, are highly suggestive that Biodentine is a promising biomaterial to be used for FP repair.

Design Variability of the Push-out Bond Test in Endodontic Research: A Systematic Review

INTRODUCTION

There is limited literature on the impact of testing variables on the push-out bond test (POBT). This review identified designs of the POBT used in the endodontic literature and aimed to determine which experimental variables may influence the push-out bond strength (POBS).

METHODS

A systematic review based on PRISMA guidelines was performed by searching the PubMed, SCOPUS, and Cochrane library databases using terms including push-out and dislocation resistance and descriptions of endodontic materials. Test variables assessed included method of root preparation, timing of sectioning compared with filling, thickness, diameter and taper of sections, and plunger size and velocity. The POBS of 3 common materials (gutta-percha and AH Plus, mineral trioxide aggregate, and Biodentine) were collected from investigations, and a comparison was attempted.

RESULTS

One hundred thirty-three studies assessed the POBS of root-filling materials, 68 assessed root repair cements/root-end filling materials, and 16 assessed orifice barrier materials other than mineral trioxide aggregate. There was significant variation in all of the assessed variables, resulting in a large range of reported values for the POBS of the various materials. Because of this heterogeneity in study design, no further statistical analysis of the impact of the test variables on POBS was possible.

CONCLUSIONS

There was considerable variation in the POBT design used in endodontic research. Greater standardization is required for future research as well as accurate reporting for all test variables to assess the impact of specific design variables on POBS.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Effect of Blood Exposure on Push-Out Bond Strength of Four Calcium Silicate Based Cements

INTRODUCTION

The purpose of this study was to compare the push-out bond strength of white ProRoot Mineral Trioxide Aggregate (MTA), Biodentine, calcium-enriched mixture (CEM) cement and Endosequence Root Repair Material (ERRM) putty after exposure to blood.

METHODS AND MATERIALS

A total of 96 root dentin slices with a standardized thickness of 1.00±0.05 mm and standardized canal spaces were randomly divided into 4 main experimental groups (n=24) according to the calcium silicate based cement (CSC) used: white ProRoot MTA, CEM Cement, ERRM Putty and Biodentine. Specimens were exposed to whole fresh human blood and then subdivided into two subgroups depending on the exposure time (24 or 72 h). Push-out bond strength was measured using a universal testing machine. Failure modes were examined under a light microscope under ×10 magnification. Data were analyzed using the two-way ANOVA test.

RESULTS

Biodentine exhibited the highest values regardless of the exposure time. The lowest push-out strength values were seen in white ProRoot MTA and CEM cement in both post exposure times. After exposure to blood, the push-out bond strength of all materials increased over time. This increase was only statistically significant in white ProRoot MTA and ERRM specimens. The dominant failure mode in all CSCs was the adhesive mode.

CONCLUSION

Biodentine showed the highest values of push-out bond strength and may be better options for situations encountering higher dislocation forces in a short time after cement application.