Histologic Evaluation of Furcation Perforation Treated with Mineral Trioxide Aggregate and Bioaggregate

Radiographic and immuno-histochemical evaluation of root perforation repair using MTA with or without platelet-rich fibrin or concentrated growth factors as an internal matrix in dog's teeth: in vivo animal study

OBJECTIVES

To comparatively evaluate the in vivo outcome of MTA repair for contaminated and non-contaminated furcation perforations (FP) with or without PRF and CGF as a matrix in dogs' teeth.

METHODS

Ninety dog teeth were divided into five groups based on the iatrogenic FP repair approach after doing root canal treatment: negative control (without FP), positive control (FP without repair), MTA, MTA + PRF and MTA + CGF groups, where FP were repaired promptly in subdivision 1 (n = 10; non-contaminated) and after 4 weeks of oral contamination in subdivision 2 (n = 10;contaminated). After 3 months, the perforation site was assessed radiographically (vertical bone density), histologically (inflammatory cell count, epithelial proliferation, cementum and bone deposition) and immunohistochemically (OPN and TRAP antibodies localisation). Data collected were statistically analysed using SPSS software at a 0.05 significance level.

RESULTS

The MTA + PRF and MTA + CGF groups demonstrated significantly more bone formation, OPN immunolocalisation and fewer inflammatory cell counts than MTA group. MTA, MTA + PRF and MTA + CGF groups showed significantly favourable radiographic, histological and immunohistochemical healing features than the positive control, especially in non-contaminated subdivisions, that significantly showed better features than the contaminated subdivisions (P < 0.001).

CONCLUSION

The use CGF and PRF as a matrix beneath MTA in FP repair in dog's teeth is promising as it could increase hard and soft tissue regeneration in non-contaminated and contaminated perforations.

CLINICAL RELEVANCE

The repair of FP is challenging especially when associated with contaminated inter-radicular bone loss. Radiographic, histological and immunohistochemical comprehensive evaluation of the root and surrounding attachment apparatus response to different perforation repair protocols could give a predictable clinical outcome.

Inflammatory response and immunohistochemical characterization of experimental calcium silicate-based perforation repair material

This study compares the immunohistochemical reaction of a new experimental tricalcium silicate perforation repair material to mineral trioxide aggregate (MTA) and Biodentine. A total of 162 mature premolar teeth from 12 dogs were divided into three experimental groups (n = 54 teeth each) according to the evaluation period: 1, 2 and 3 months. Each group was further divided into two equal subgroups (n = 27 teeth each) according to the time of repair: immediate repair and delayed repair. Each subgroup was subdivided according to the material used into three experimental subdivisions (n = 8 teeth each): MTA, Biodentine (Septodont) and experimental material, and two control subdivisions: positive control (n = 2 teeth) and negative control (one tooth). Under general anaesthesia, access cavity was done. Cleaning and shaping were performed using ProTaper universal rotary instruments. The canals were obturated using cold lateral compaction technique with Gutta percha and Adseal sealer. Furcation perforations were created then randomly sealed using the three materials either immediately or after one month (delayed repair). Inflammatory cell count and immunohistochemical analysis of osteopontin-positive area fraction were digitally analysed using the ImageJ software. Delayed furcal perforation repair showed significantly higher inflammatory cell count than immediate repair. No significant difference in inflammatory cell count and immunohistochemical analysis was detected between the three tested materials. The immunohistochemical analysis revealed the highest immunopositive area fraction in the 3-month evaluation period. The experimental tricalcium silicate cement performed similarly to Biodentine and MTA regarding the osteopontin expression during perforation repair, suggesting it is a suitable alternative with favourable handling characters.

Does MTA provide a more favourable histological response than other materials in the repair of furcal perforations? A systematic review

BACKGROUND

There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models.

OBJECTIVES

To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models.

METHODS

This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies.

RESULTS

The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials.

DISCUSSION

This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously.

CONCLUSIONS

Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations.

REGISTRATION

PROSPERO (CRD42020181297).

Biocompatibility of NeoMTA Plus® versus MTA Angelus as delayed furcation perforation repair materials in a dog model

BACKGROUND

The biocompatibility of NeoMTA Plus® (Avlon BioMed Inc., Bradenton, Fl) as a furcal perforation repair material is not fully understood. This study compares the biocompatibility of Mineral Trioxide Aggregate (MTA Angelus) and NeoMTA Plus® as delayed furcation perforation repair materials.

METHODS

Pulpotomy and root canal obturation were performed in 72 premolars in six mongrel dogs and then a standardized furcal perforation was performed. The coronal access was left open for three weeks. After curetting, cleaning and drying of the perforations, these teeth were divided into three equal groups (N = 24 teeth/ 2 dogs each) according to the material used for perforation repair; group I: NeoMTA Plus®, group II: MTA Angelus and group III: no material (positive control). The coronal access cavities were sealed with a filling material. The inflammatory cell count and qualitative pathology (presence of calcific bridge, configuration of fibrous tissue formed, examination of tissue surrounding the furcation area, histology of intraradicular bone and the inflammatory nature of tissues) were carried out after one week (subgroup A, N = 8 teeth), one month (subgroup B, N = 8 teeth) and three months (subgroup C, N = 8 teeth). The inflammatory cell count was expressed as mean ± SD and statistically analyzed. P-value < 0.05 was considered significant.

RESULTS

In all subgroups, the control group exhibited the highest number of inflammatory cell count, followed by MTA Angelus group and the least inflammatory cell count was shown by NeoMTA Plus® group. There was a significant difference in the inflammatory cell count between the NeoMTA Plus® and MTA Angelus after one week (P < 0.05) while no significant differences were recorded between them after one month and three months (P > 0.05). In contrast to group II, there was no significant differences in inflammatory cell count between the subgroups in groups I and III (P > 0.05). NeoMTA Plus® exhibited better qualitative pathological features than MTA Angelus after one week and nearly similar features after one month and three months of repair.

CONCLUSION

NeoMTA Plus® has a better early biocompatibility than MTA Angelus after one week of delayed furcation perforation repair and a similar late biocompatibility after one month and three months.

Marginal adaptation, solubility and biocompatibility of TheraCal LC compared with MTA-angelus and biodentine as a furcation perforation repair material

BACKGROUND

This study evaluated the marginal adaptation, solubility and biocompatibility of TheraCal LC compared with mineral trioxide aggregate (MTA-Angelus) and Biodentine when used as a furcation perforation repair material.

METHODS

The marginal adaptation was assessed by scanning electronic microscope and presence of any gap between the dentin surface and filling material in each quadrant of the sample was analyzed at 1000 X magnification. The solubility was measured after one week by the ISO standard method. Biocompatibility was evaluated by the inflammatory response and radiography after one month and three months of repair of experimental furcation perforations in dog's teeth.

RESULTS

There were significant differences in the marginal adaptation, solubility and biocompatibility of the tested materials (P < 0.05). TheraCal LC showed the highest frequency distribution of gap presence that was followed by the MTA-Angelus then Biodentine. The least soluble material after one week was TheraCal LC that was followed by the MTA-Angelus and Biodentine. After one month and three months, TheraCal LC showed the highest inflammatory response and highest frequency distribution of radiolucency that was followed by the Biodentine then MTA-Angelus.

CONCLUSION

Unlike Biodentine, TheraCal LC is incapable of alternating the MTA in furcation perforation repair due to its poor biocompatibility and poor marginal adaptation.

Sealing ability of Biodentine versus ProRoot mineral trioxide aggregate as root-end filling materials

Aim

This study evaluated the sealing ability of ProRoot MTA and Biodentine as root-end filling materials.

Method

In total, twenty (N = 20) extracted human maxillary central incisor teeth were decontaminated, cleaned and decoronated. Instrumentation was performed according to the step back technique using #50 Flex-o-file. Then the canals were flared to #70 Flex-o-file. Obturation was performed with conventional gutta percha and a resinous sealer (AH26) using the lateral condensation technique. Resection of 3 mm of apical end of each root was achieved perpendicular to the long axis of the root. Root-end cavity was prepared in each sample ultrasonically then filled with tested materials (N = 10). Fluid filtration method was used to assess the sealing ability of each tested material at three different experimental periods; one day, one week and one month after setting. All data were tabulated and statistically analyzed with a level of significance set at P ≤ .05.

Results

At each specific time interval, the leakage mean values were not consistent among the tested materials. At one day interval, ProRoot MTA samples had a higher leakage mean value than Biodentine samples. However, this difference in leakage was not statistically significant (P > .05). At one week interval, both materials showed an increased degree of leakage mean value with no significant difference (P > .05). At one month interval, ProRoot MTA samples showed a decrease in leakage mean value, while the Biodentine samples showed a further increase in leakage mean value. This difference was statistically significant (P < .05).

Conclusion

Although the sealing ability of ProRoot MTA is superior to Biodentine, Biodentine could be considered as an acceptable alternative to ProRoot MTA in peri-radicular surgeries.

Biological evaluation of a new pulp capping material developed from Portland cement

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n=24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n=8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement+10% calcium hydroxide+20% bismuth oxide (Port Cal) and subgroup 3: Portland cement+bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively.

Regenerative potential of immature permanent non-vital teeth following different dentin surface treatments

This study evaluates the regenerative potential of immature permanent non-vital teeth following different dentin surface treatments in dogs. Periapical lesions and necrotic pulps were induced in 288 roots of 144 teeth in twelve dogs. Teeth were randomly divided into 3 equal groups according to the evaluation period. Each group was subdivided into 8 subgroups according to the treatment modalities including; blood clot, blood clot and collagen, blood clot and Ethylenediaminetetraacetic acid (EDTA), blood clot, collagen and EDTA, blood clot and Mixture Tetracycline Citric Acid and Detergent (MTAD), blood clot, collagen and MTAD, positive control and negative control. Apart from control subgroups, all infected root canals were cleaned with sodium hypochlorite solution and triple antibiotics paste before different treatment protocols. After different treatments, the root length, thickness and apical diameter were evaluated by radiographic examination. Histopathological examination was carried out to evaluate the inflammation, bone/root resorption, tissue in-growth in pulp space, new hard tissue formation and apical closure. Using EDTA solution as a surface modifier showed significantly higher levels of tissue in-growth in the pulp space after 6 weeks and 3 months. Addition of collagen as a scaffold caused significantly more bone/root resorption than the other subgroups while EDTA caused significantly lower inflammatory cell counts only after 2 weeks. Final rinse with 17% EDTA solution before blood clot induction has positive impact on tissue interaction along dentinal walls without modification of the cell type. Moreover, the use of collagen as a scaffold material and MTAD as a surface modifier did not improve the quality of the regenerative process.