Calcium silicate-based cements and functional impacts of various constituents

Evaluation of Setting Time, Flowability, Film Thickness, and Radiopacity of Experimental Monocalcium Silicate-Based Root Canal Sealers

Introduction

This study aimed to evaluate the efficacy of a formulation of premixed calcium silicate-based sealer (CSBS) with monocalcium silicate (Mono-CS) as the main component. Its properties were compared with those of a control group (iRoot SP) according to ISO 6876/2012 standards for root canal sealers.

Materials and Methods

The CSBS formulation consisted of two components (powder and liquid). The powder was a mixture of Mono-CS, a radiopacifier, and a thickening agent, and the liquid components were nonaqueous liquid agent and setting accelerator. Three formulation groups with different powder-liquid ratios were prepared: group A, 2 : 1; group B, 3 : 1; and group C, 2 : 1, which also contained calcium chloride as a setting accelerator. The setting time, flow rate, film thickness, and radiopacity of the three CSBS groups and the control group were evaluated and compared. Each test was repeated five times for each group.

Results

The minimum values of setting time (i.e., working time, initial setting time, and final setting time) were ranked in order of significance as group B, the control group, group C, and group A. The control group had the lowest film thickness at 20 μm, with a nonsignificant difference to group C. The flow rates in group A, group C, and the control group were >20 mm. Furthermore, the experimental groups showed a similar amount of radiopacity as the control group (p  > 0.05).

Conclusion

Mono-CS and calcium chloride can be used in the formulation of root canal sealers, and their properties, including working time, initial setting time, final setting time, flow rate, film thickness, and radiopacity, are consistent with those of iRoot SP and ISO 6876/2012 standards.

Bioactive Biosilicate Cements in Pediatric Dentistry - A Review of the Latest Materials

Pediatric dentistry plays a critical role in ensuring the oral health and well-being of children and adolescents. The quest for effective dental materials that are safe, biocompatible, and capable of promoting natural remineralization has led to the emergence of biosilicate cements as a promising advancement in this field. Biosilicate cements are bioactive materials composed of amorphous silica, calcium oxide, phosphorus pentoxide, and other trace elements. The bioactivity of biosilicate cements allows them to interact with living tissues, promoting remineralization and stimulating the formation of hydroxyapatite, a vital component of teeth and bones. Their ability to release essential ions, such as calcium, phosphate, and fluoride, supports the natural healing processes, aiding in the preservation of pulp vitality and reducing the risk of secondary caries. Biosilicate cements offer versatility in pediatric dentistry, finding application indirect pulp capping, indirect pulp capping, and small-sized restorations. Their rapid setting time proves advantageous when treating young patients with limited cooperation. Furthermore, the continuous release of fluoride contributes to caries prevention and enhances the long-term oral health of children. While the advantages of biosilicate cements in pediatric dentistry are promising, this manuscript also discusses the limitations and challenges associated with their use. Some biosilicate cements may have different handling characteristics compared to traditional materials, necessitating adaptations in clinical techniques. In addition, long-term clinical data on the performance of these materials in pediatric patients are still limited, requiring further research to establish their efficacy and longevity. This manuscript explores the potential of biosilicate cements in pediatric dentistry.

Stereomicroscopic evaluation of sealing ability of four different root canal sealers: an in-vitro study

AIM

To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study.

MATERIAL/METHOD

80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey's test.

RESULT

The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey's test reveals that the difference was statistically non-significant between group III and group IV.

CONCLUSION

It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C).

Advances and challenges in regenerative dentistry: A systematic review of calcium phosphate and silicate-based materials on human dental pulp stem cells

Conventional dentistry faces limitations in preserving tooth health due to the finite lifespan of restorative materials. Regenerative dentistry, utilizing stem cells and bioactive materials, offers a promising approach for regenerating dental tissues. Human dental pulp stem cells (hDPSCs) and bioactive materials like calcium phosphate (CaP) and silicate-based materials have shown potential for dental tissue regeneration. This systematic review aims to investigate the effects of CaP and silicate-based materials on hDPSCs through in vitro studies published since 2015. Following the PRISMA guidelines, a comprehensive search strategy was implemented in PubMed MedLine, Cochrane, and ScienceDirect databases. Eligibility criteria were established using the PICOS scheme. Data extraction and risk of bias (RoB) assessment were conducted, with the included studies assessed for bias using the Office of Health and Translation (OHAT) RoB tool. The research has been registered at OSF Registries. Ten in vitro studies met the eligibility criteria out of 1088 initial studies. Methodological heterogeneity and the use of self-synthesized biomaterials with limited generalizability were observed in the included study. The findings highlight the positive effect of CaP and silicate-based materials on hDPSCs viability, adhesion, migration, proliferation, and differentiation. While the overall RoB assessment indicated satisfactory credibility of the reviewed studies, the limited number of studies and methodological heterogeneity pose challenges for quantitative research. In conclusion, this systematic review provides valuable insights into the effects of CaP and silicate-based materials on hDPSCs. Further research is awaited to enhance our understanding and optimize regenerative dental treatments using bioactive materials and hDPSCs, which promise to improve patient outcomes.

Evaluation of Cytotoxicity, Cell Attachment, and Elemental Characterization of Three Calcium Silicate-Based Sealers

We investigated three calcium silicate-based sealers with respect to their chemical characterization, cytotoxicity, and attachment to RAW264.7 cells. BioRoot RCS (BR), Bio-C Sealer (BC), and Sealer Plus BC (SPBC) were assessed using Fourier transform infrared spectroscopy (FTIR), X-ray fluorescence spectroscopy (XRF), and energy-dispersive X-ray spectroscopy (EDX) (n = 4) for elemental characterization, and using scanning electron microscopy (SEM) to evaluate cell morphology and adhesion. Cytotoxicity was determined at different dilutions (1:1, 1:2, and 1:5) using the succinate dehydrogenase activity (MTT assay). Statistical analysis was performed for normal distribution using the Shapiro-Wilk test and for homoscedasticity using Levene's test, and one-way ANOVA, Tukey's/Dunnett's post hoc tests for cell viability and XRF (α = 0.05). Calcium silicate hydrate and calcium hydroxide were detected by FTIR in all groups. EDX detected a higher calcium content for BR and SPBC and aluminum only in the premixed sealers. XRF detected the highest calcium release in BR (p < 0.05). The surface morphology showed irregular precipitates for all the sealers. SPBC at a 1:2 dilution resulted in the lowest cell viability compared to BR (p < 0.05) and BC (p < 0.05). The calcium silicate-based sealers produced a statistically significant reduction in cellular viability at a 1:1 dilution compared to the control group (p < 0.0001). All the sealers maintained viability above 70%.

Physicochemical, mechanical and biological properties of nano-calcium silicate-based cements: a systematic review

This systematic review evaluated the effects of nano-sized cement particles on the properties of calcium silicate-based cements (CSCs). Using defined keywords, a literature search was conducted to identify studies that investigated properties of nano-calcium silicate-based cements (NCSCs). A total of 17 studies fulfilled the inclusion criteria. Results indicated that NCSC formulations have favourable physical (setting time, pH and solubility), mechanical (push out bond strength, compressive strength and indentation hardness) and biological (bone regeneration and foreign body reaction) properties compared with commonly used CSCs. However, the characterization and verification for the nano-particle size of NCSCs were deficient in some studies. Furthermore, the nanosizing was not limited to the cement particles and a number of additives were present. In conclusion, the evidence available for the properties of CSC particles in the nano-range is deficient-such properties could be a result of additives which may have enhanced the properties of the material.

Efficacy of Chitosan Scaffolded Calcium Silicate-based Cements for Treating Internal Resorption Defects with Perforation: In Vitro Study

AIM

The present study aimed to evaluate the efficacy of chitosan scaffold combined with calcium silicate cements in the management of internal resorption with perforation.

MATERIALS AND METHODS

Internal resorption cavities were simulated in 20 human permanent maxillary incisors that were then divided into two groups: group I - biodentine and group II - chitosan scaffold combined with biodentine. The samples were evaluated for the mineralization activity at the end of the 7th day and 14th day using scanning electron microscopy-energy dispersive X-ray (SEM-EDX) analysis. The data were recorded, tabulated, and then statistically analyzed.

RESULTS

From the SEM-EDX analysis, the mean score of calcium and phosphorus ion uptake by the material was obtained. Statistical analysis by nonparametric Mann-Whitney test showed that there was statistically significant difference in calcium ion uptake at the end of the 7th day (p = 0.016) and at the end of 14th day (p = 0.043) between the group biodentine and group chitosan scaffold combined with biodentine (p < 0.05).

CONCLUSION

In this present study, the use of chitosan scaffolds combined with biodentine showed a statistically significant difference in the mineralization activity when compared with pure biodentine. These scaffolded biomaterials exhibited greater potential for mineralization in vitro which can be efficiently used for the management of teeth with internal resorption with perforation. Further clinical trials are required for the understanding of their behavior in real-world scenarios.

CLINICAL SIGNIFICANCE

Calcium silicate cements have often exhibited defective hard tissue barrier formation and hence there is a pressing need to search for newer biomaterials that can overcome these shortcomings. Scaffolded biomaterials provide a controlled microcellular environment for bioactivity, and they were found to be efficient in the remineralization of tooth structure. The present study findings indicate that these chitosan scaffolds can be efficiently used in combination with calcium silicate cements for the management of internal resorption with perforation to enhance the treatment outcome.

Comparative Evaluation of Physicomechanical Properties and Antimicrobial Activity of White Portland Micro- and Nanoparticulate Peruvian Cement, Mineral Trioxide Aggregate, and Neomineral Trioxide Aggregate

AIM

To compare the surface microhardness, compressive strength, and antimicrobial activity of white Portland nanoparticle and microparticle Peruvian cement, mineral trioxide aggregate (MTA), and neomineral trioxide aggregate (NeoMTA) at 24 hours and 28 days.

MATERIALS AND METHODS

Twenty specimens were prepared for each group of cement microparticulated powder (PCm), nanoparticulated cement (PCn), MTA, and NeoMTA to be evaluated at two different times, 24 hours and 28 days for the surface microhardness test and compressive strength. For the antimicrobial activity tests, another 20 specimens were prepared for each group of cement where they were subdivided into two subgroups according to the different periods at 24 hours and 48 hours. For the surface microhardness and compressive strength, the specimens, and the cement groups were mixed according to the manufacturer's instructions and transferred to a cylindrical polyethylene mold of 6-mm diameter and 4-mm height. The compressive strength test was conducted using a universal testing machine. Moreover, the agar diffusion technique was to evaluate the antibacterial and antifungal activity of the American Type Culture Collection (ATCC) Enterococcus faecalis and Candida albicans. Finally, the data were statistically analyzed.

RESULTS

The highest microhardness values for the 24-hour subgroup were recorded for NeoMTA cement (16.99 ± 2.02), followed by MTA, PCn, and PCm, respectively. As for the 28-day subgroup, PCn cement (41.64 ± 3.20) presented the highest microhardness, followed by NeoMTA, PCm, and MTA, respectively, with statistically significant differences among them. The compressive strength of both subgroups 24 hours and 28 days exhibited the highest mean for PCn (41.3 ± 4.29, 65.74 ± 3.06), followed by PCm, NeoMTA, and the lowest value for MTA cement. Finally, for the antimicrobial activity, the highest mean for the 24-hours and 48-hours subgroup was recorded for NeoMTA cement (17.6 ± 1.26, 17.8 ± 1.44), followed by PCn, PCm, and the lowest value for MTA, with significant differences between them.

CLINICAL SIGNIFICANCE

It is highly recommended, Portland cement (PC) as a viable substitute since it has very similar components and properties, but at a lower cost.

CONCLUSION

Regardless of the evaluation time, PCn produced higher surface microhardness and compressive strength; however, NeoMTA showed higher antimicrobial activity.

Investigation of the hydration process and biological activity of a novel nanosilver incorporated dicalcium silicate based retrograde filling material

Background

Although several materials have been used for retrograde filling following apical surgeries, there is no consensus on a single best material. Tricalcium silicate-based types of cement have been developed as root-end filling materials mainly due to tricalcium silicate's hydraulic properties. However, its unfavorable setting characteristics and minimal antimicrobial properties have necessitated the introduction of new additives into the existing commercially available materials. To design an affordable product based on a dicalcium silicate with a shorter set time, minimal cytotoxic complications, and enhanced antibacterial activity, we developed a new endodontic cement from pure raw materials, intending to satisfy the prerequisites of ideal retrograde material.

Methods

The composition of the experimental calcium silicate-based cement included the addition of calcium chloride and silver nanoparticles in varying concentrations. Structural characterization was carried out using energy dispersive analysis by X-rays using scanning electron microscope (EDAX SEM) and hydration characteristics were performed using an X-ray diffractometer (XRD). The experimental material was further evaluated for biocompatibility using MTT ([3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide)assay and antibacterial activity was evaluated using an agar diffusion test against Enterococcus faecalis.

Results

The structural characterization and hydration characteristics revealed that the experimental cement was dicalcium silicate based with favorable biocompatibility and enhanced antibacterial activity. Tricalcium silicate based mineral trioxide aggregate (MTA) also had favourable biocompatibility, however, its antibacterial activity was significantly decreased when compared to the novel cement.

Conclusion

All hydraulic cements that are available in the dental market are predominantly tricalcium silicate-based materials. There has been no evidence in the literature to date wherein it has been explored whether a dicalcium silicate-based hydraulic cement can solely be used in root-end cavities. The findings of the study revealed a dicalcium silicate based retrograde filling material with favourable biocompatibility exhibited immediately as well as in the set samples. Incorporation of silver nanoparticles boosted the antibacterial activity when compared to that of ProRoot MTA. This material could potentially reinstate the usual hype created with tricalcium silicate types of cement since dicalcium silicate cements also exhibit similar properties.

Mechanism of action of Bioactive Endodontic Materials

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.

Physicochemical Properties and Inductive Effect of Calcium Strontium Silicate on the Differentiation of Human Dental Pulp Stem Cells for Vital Pulp Therapies: An In Vitro Study

The development of biomaterials that exhibit profound bioactivity and stimulate stem cell differentiation is imperative for the success and prognosis of vital pulp therapies. The objectives were to (1) synthesize calcium strontium silicate (CSR) ceramic through the sol−gel process (2) investigate its physicochemical properties, bioactivity, cytocompatibility, and its stimulatory effect on the differentiation of human dental pulp stem cells (HDPSC). Calcium silicate (CS) and calcium strontium silicate (CSR) were synthesized by the sol−gel method and characterized by x-ray diffraction (XRD). Setting time, compressive strength, and pH were measured. The in vitro apatite formation was evaluated by SEM-EDX and FTIR. The NIH/3T3 cell viability was assessed using an MTT assay. The differentiation of HDPSC was evaluated using alkaline phosphatase activity (ALP), and Alizarin red staining (ARS). Ion release of Ca, Sr, and Si was measured using inductive coupled plasma optical emission spectroscopy (ICP-OES). XRD showed the synthesis of (CaSrSiO4). The initial and final setting times were significantly shorter in CSR (5 ± 0.75 min, 29 ± 1.9 min) than in CS (8 ± 0.77 min, 31 ± 1.39 min), respectively (p < 0.05). No significant difference in compressive strength was found between CS and CSR (p > 0.05). CSR demonstrated higher apatite formation and cell viability than CS. The ALP activity was significantly higher in CSR 1.16 ± 0.12 than CS 0.92 ± 0.15 after 14 d of culture (p < 0.05). ARS showed higher mineralization in CSR than CS after 14 and 21 d culture times. CSR revealed enhanced differentiation of HDPSC, physicochemical properties, and bioactivity compared to CS.

Sealing Ability and Adaptability of Nano Mineral Trioxide Aggregate as a Root-End Filling Material

Aim: Comparison between Nano MTA & MTA as a root-end filling materials regarding adaptability and sealing ability. Materials and Methods: Forty extracted human maxillary incisors with straight roots were used. After root canals preparation and obturation, the apical 3 mm of each root was resected perpendicular to the long axis of the tooth. Root end cavities were prepared to a depth of 3mm parallel to the long axis of the tooth. The teeth were randomly divided into two main equal groups of 20 samples each according to the root-end filling material used either MTA or Nano MTA. Ten samples from each group were sectioned longitudinally into two equal halves to measure the sealing ability and another ten samples from each group were sectioned transversally to obtain 1 mm thick section to measure the adaptability of both materials. All samples were photographed under the SEM at three different magnifications (×1000). The gap thickness between the root end filling material and the retro cavity dentine walls were measured at seven selected points at the material-dentine interface in micrometers (µm). Results: Nano MTA and MTA showed no statistically significant difference in the gap thickness between dentin-material interface in both longitudinal and transverse sections. Regarding the sealing ability, the mean value in MTA was (3.27±0.77), while the mean in Nano-MTA was (3.15±0.71). Regarding the adaptability, the mean value in MTA was (2.46±0.60), while the mean in Nano-MTA was (2.05±0.712). Both materials showed good sealing ability and good adaptation to the dentinal wall. Conclusion: Nano MTA revealed good sealing ability and adaptability comparable to MTA when used as a retrograde filling material.

Sol-gel bioactive glass containing biomaterials for restorative dentistry: A review

OBJECTIVE

Bioactive glasses (BAGs) have been researched extensively for dentistry due to their favourable biocompatibility and hard tissue bonding ability. However, the specific application of BAGs produced through sol-gel synthesis in restorative dentistry has not been reviewed previously. This review provides a comprehensive account of the principles behind sol-gel derived BAGs and their investigation for dental tissue restoration materials.

METHODS

A search for in vitro and in vivo studies was performed using the databases Web of Science®, Medline®, Scopus® and Google Scholar®. Articles published over the past 20 years were selected and data on the BAG composition and morphology was extracted. Analysis of the effect of specific BAG additives on the properties of experimental dental materials was also performed.

RESULTS

A majority of BAG particles investigated were spheres ranging in size from 5 nm to ~650 µm. Sol-gel BAGs are mainly applied in the treatment of hypersensitive dentine and for pulp-dentine tissue engineering, while a handful have been used in target drug delivery. BAG fillers are promising additives that result in improved biological properties, antibacterial effects, hardness, acid buffering and remineralization. Unfortunately, some detrimental effects on optical properties have been observed with BAG addition. Additionally, in vivo data, investigations into radiopacity and standardization of test protocols are identified as areas for improvement and further studies.

SIGNIFICANCE

Future work should consider the pertinent issues raised in order to improve the quality of available data and expand knowledge in this area of dental biomaterials research and development.

In vitro bioactivity of newly introduced dual-cured resin-modified calcium silicate cement

Background:

This study was designed to investigate the in vitro bioactivity of a new dual cured calcium silicate cement (TheraCal PT) compared to its light cured (TheraCal LC) and chemically set (Biodentine) counterparts.

Materials and Methods:

The study is an in vitro original research article. Prepared cements discs were immersed in deionized water. Ca²+ release was evaluated using inductively coupled plasma-optical emission spectrometry while pH was assessed using a pH meter after 1, 14, and 28 days. Discs for surface characterization were immersed in phosphate-buffered saline (PBS) and were examined using an environmental scanning electron microscope with energy dispersive X-ray (ESEM/EDX), immediately after setting and at 1, 14, and 28 days intervals after that. Attenuated total reflectance (ATR)/Fourier transform infrared (FTIR) and Raman spectroscopy analyses were performed after setting and after 28 days storage in PBS. Statistical analysis was performed using the two-way repeated measure analysis of variance test followed by Bonferroni test for multiple comparisons (P < 0.05).

Results:

Biodentine exhibited the highest mean values for Ca²+ release (792,639,278 ppm) and pH (10.99, 12.7, 11.54) at all time intervals. ESEM/EDX displayed a continuous layer of calcium phosphate formed by Biodentine and TheraCal LC while TheraCal PT developed scarce interrupted precipitates after immersion in PBS. ATR/FTIR and Raman spectroscopy for the formed precipitates confirmed the presence of phosphate and Ca (OH) ₂ in Biodentine, TheraCal LC and TheraCal PT.

Conclusion:

TheraCal PT exhibited limited in vitro bioactivity which may limit its prognosis in clinical applications for vital pulp therapy. TheraCal LC is considered a potential bioactive calcium silicate cement despite its lower Ca²+ release compared to Biodentine. Highest bioactivity was observed in Biodentine.

A novel degradable tricalcium silicate/calcium polyphosphate/polyvinyl alcohol organic-inorganic composite cement for bone filling

In this study, tricalcium silicate (C₃S) calcium/polyphosphate/polyvinyl alcohol organic-inorganic self-setting composites were successfully designed. A variety of tests were conducted to characterize their self-setting properties, mechanical properties, degradation properties, and related biological properties. The composite bone cements showed a short setting time (5.5-37.5 min) with a 5:5-6:4 ratio of C₃S/CPP to maintain a stable compressive strength (28 MPa). In addition, PVA effectively reduced the brittleness of the inorganic phase. Degradation experiments confirmed the sustainable surface degradation of bone cement. A maximum degradation rate of 49% was reached within 56 days, and the structure remained intact without collapse. Culturing MC3T3 cells with bone cement extracts revealed that the composite bone cements had excellent biological properties in vitro. The original extract showed a proliferation promotion effect on cells, whereas most of the other original extracts of degradable bone cements were toxic to the cells. Meanwhile, extracellular matrix mineralization and alkaline phosphatase expression showed remarkable effects on cell differentiation. In addition, a good level of adhesion of cells to the surfaces of materials was observed. Taken together, these results indicate that C₃S/CPP/PVA composite bone cements have great potential in bone defect filling for fast curing.

Effect of different manipulations on the physical, chemical and microstructural characteristics of Biodentine

OBJECTIVE

The water to powder ratio and method of mixing is important for the properties of hydraulic cements. For this purpose a number of clinicians prefer premixed materials. Dental manufacturing companies provide predosed materials, however the manufacturer instructions are not always adhered to. The aim of this research is to investigate physical and chemical alterations of the tricalcium silicate-based cement Biodentine when manipulated according to the manufacturer's instructions (control) or changing the doses and mixing of the material components.

METHODS

6 groups were constituted according to different mixing and dosing of powder and liquid. The hydrated cements were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR). Calcium ion concentration of the leachate was also investigated. Assessment of the physical characteristics included setting time and microhardness.

RESULTS

Microstructural differences were visible only in the Biodentine mixed manually with water, in which early hydration rate was also affected, with lower calcium ion release. Increase of Biodentine liquid increased the calcium ion release, but also increased the setting time. Manual manipulation required more liquid (both water and Biodentine liquid) added to the mixture to guarantee a similar consistency to the control. A decrease in setting time was also noted. All groups showed higher values of microhardness at 24 h compared to the freshly set materials. In the freshly set materials, there was an overall decrease in microhardness in all groups when compared to group control, particularly significant when increasing the dosage of Biodentine liquid.

SIGNIFICANCE

When mixing Biodentine, altering the mixing procedure in terms of type and amount of liquid added to the powder and mixing device chosen has an effect on the physical, chemical and mechanical characteristics and surface topography of the material, when compared to Biodentine mixed according to the manufacturer's recommendations. Hence, the manufacturer's instructions should be strictly followed.

The pH and Bismuth Oxide Particle Size can Affect Diametral Tensile Strength of Mineral Trioxide Aggregate

OBJECTIVE

The aim of the present study was to evaluate the effect of different pHs (4.4, 5.4, 6.4, 7.4, 8.4, and 9.4) and three different particle sizes of bismuth oxide on diametral tensile strength (DTS) of white Mineral Trioxide Aggregate (WMTA).

METHODS

Thirty cylindrical moulds were divided into six groups of five; WMTA was mixed, placed inside the moulds, and wrapped in pieces of gauze soaked in synthetic tissue fluid (STF) with pH values of either 4.4, 5.4, 6.4, 7.4, 8.4, 9.4. For bismuth oxide, eighteen similar molds were divided into three groups of six (n=6). Then bismuth oxide with three particle sizes, including fine (120 nm), medium (200 nm), and coarse (10 μm), were provided and added to the Portland cement, which did not have any bismuth oxide to create WMTA. Then WMTA was mixed, placed inside cylindrical molds. After incubation at 95% humidity for 48 hours, samples were subjected to DTS testing by an Instron Universal testing machine with a crosshead speed of 1 mm/min. Then, one sample from each group was subjected to scanning electron microscope (SEM) analysis. Data were analysed by ANOVA and Tukey tests (α=0.05).

RESULTS

The comparison of DTS in pH groups were: 8.4>7.4>9.4>6.4>5.4>4.4 (P<0.05); and in bismuth oxide groups were: fine particles > medium particles > coarse particles (P<0.05). Acidic pH, negatively affected the distribution of Ca2+ and Si4+ ions, while bismuth oxide with fine particles enhanced it.

CONCLUSION

Acidic pH can decline the DTS of MTA significantly. However, reducing the particle size of bismuth oxide can increase the DTS of MTA significantly.

Biological assessment of a new ready-to-use hydraulic sealer

Objectives

This study compared the cytotoxicity, biocompatibility, and tenascin immunolabeling of a new ready-to-use hydraulic sealer (Bio-C Sealer) with MTA-Fillapex and white MTA-Angelus.

Materials and Methods

L929 fibroblasts were cultivated and exposed to undiluted and diluted material extracts. Polyethylene tubes with or without (the control) the materials were implanted into the dorsa of rats. At 7 days and 30 days, the rats were euthanized, and the specimens were prepared for analysis; inflammation and immunolabeling were measured, and statistical analysis was performed (p < 0.05).

Results

MTA-Fillapex exhibited greater cytotoxicity than the other materials at all time points (p < 0.05). The undiluted Bio-C Sealer exhibited greater cytocompatibility at 6 and 48 hours than white MTA-Angelus, with higher cell viability than in the control (p < 0.05). White MTA-Angelus displayed higher cell viability than the control at 24 hours, and the one-half dilution displayed similar results at both 6 and 48 hours (p < 0.05). At 7 days and 30 days, the groups exhibited moderate inflammation with thick fibrous capsules and mild inflammation with thin fibrous capsules, respectively (p > 0.05). At 7 days, moderate to strong immunolabeling was observed (p > 0.05). After 30 days, the control and MTA-Fillapex groups exhibited strong immunolabeling, the white MTA-Angelus group exhibited moderate immunolabeling (p > 0.05), and the Bio-C Sealer group exhibited low-to-moderate immunolabeling, differing significantly from the control (p < 0.05).

Conclusions

Bio-C Sealer and white MTA-Angelus exhibited greater cytocompatibility than MTA-Fillapex; all materials displayed adequate biocompatibility and induced tenascin immunolabeling.

Electrosprayed calcium silicate nanoparticle-coated titanium implant with improved antibacterial activity and osteogenesis

To ensure clinical success, the implant and the surrounding bone tissue must not only be integrated, but also must not be suspected of infection. In this work, an antibacterial and bioactive nanostructured calcium silicate (CaSi) layer on titanium substrate by an electrospray deposition method was prepared, followed by annealing at 700, 750 and 800 °C to improve the bonding strength of the CaSi coating. The phase composition, microstructure and bonding strength of the CaSi coatings were examined. Human mesenchymal stem cells (hMSCs), Gram-negative Escherichia coli (E. coli) and Gram-positive Staphylococcus aureus (S. aureus) species were used to analyze the osteogenic and antibacterial activity of the coatings, respectively. Experimental results showed that the as-prepared CaSi coating was mainly composted of β-dicalcium silicate phase with a particle size of about 300 nm. After annealing, the thickness of the oxidation reaction layer increased obviously from 0.3 μm to 1 μm with increase in temperature, which was confirmed by the cross-sectional morphology and element depth profile. The bonding strength of the coating annealed at 750 °C (19.0 MPa) was significantly higher (p < 0.05) than that of the as-prepared coating (4.4 MPa) and the ISO 13,779 standard (15 MPa). The results of antibacterial efficacy and stem cell osteogenesis consistently elaborated that the 750 °C-annealed coating had higher activity than the as-prepared coating and the Ti control. It is concluded that after annealing at 750 °C, the CaSi nanoparticle-coated Ti implant had good bond strength, osteogenic and antibacterial activity.

A laboratory study to test the responses of human dental pulp stem cells to extracts from three dental pulp capping biomaterials

AIM

This laboratory study aimed to investigate the effects of three endodontic biomaterials; MTA-HP, iRoot-BP-Plus and ACTIVA on the proliferation, adhesion and osteogenic differentiation of human Dental Pulp Stem Cells (hDPSCs).

METHODOLOGY

The hDPSCs were isolated from the dental pulps of 21 patients scheduled for surgical extraction of their impacted third molars. The MTT assay was used for assessing cellular proliferation. Ninety-six-well plates were used and the experiment was repeated four times under the same condition and the assay was done in triplicate. Four groups were assigned in which the hDPSCs were cultured in complete media only and considered as negative control. Whilst in the 2^nd , 3^rd and 4^th groups, the cells were treated with CM supplemented with 1.5 μl MTA-HP (CM-MTA, iRoot-BP-Plus (CM-BP), and ACTIVA(CM-AC) extracts, respectively. Attachment adhesion and growth morphology of hDPSCs were observed using SEM and the osteogenic differentiation assay was evaluated by Alizarin red stain test (ARS). The data of proliferation and osteogenic differentiation were analysed using two-way ANOVA followed by Tukey's post hoc multiple comparison test. A p-value < 0.05 was considered significant to analyse the differences amongst the means of groups.

RESULTS

Both CM-MTA and CM-BP groups were associated with a significant increase in hDPSC proliferation in comparison with CM-AC and CM groups (p = 0.001). hDPSCs exhibited a greater cellular attachment to iRoot-BP-Plus surfaces followed by MTA-HP, whilst less attachment was observed in the ACTIVA group. Moreover, at day 7 there was a significant difference in formation of mineralizing nodules; CM-BP, CM-MTA and CM-AC groups respectively (p = 0.001). Whilst there was no significance of difference between CM-AC and CM groups (p > 0.05).

CONCLUSIONS

In a laboratory setting, ACTIVA, MTA-HP and iRoot-BP-Plus promoted hDPSCs proliferation, mineralization and attachment, which may explain their in-situ success as endodontic biomaterials.

A Comparative Study of Surface Hardness between Two Bioceramic Materials in an Experimental Apexification Model under Wet and Dry Conditions

Background:

The placement of a wet cotton pellet against Mineral Trioxide Aggregate (MTA) is often recommended to ensure the completion of its setting reaction.

Objective:

This study aimed to evaluate the setting behaviour of MTA Angelus and NeoMTA by comparing their hardness after placing them in dry and moist conditions.

Methodology:

A simulated open apex was created on 40 polyvinyl tubes. The apical 4 mm of the tubes was filled with the two materials, NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) and MTA Angelus (Angelus, Londrina, PR, Brazil) (n=20 per group). Both groups were subdivided into two subgroups based on the dry and wet conditions (n=10 per group). A wet cotton pellet was placed above the two materials in the wet group, and the coronal segment was sealed using Type II Glass ionomer cement (GC corporation Tokyo, Japan). Gutta-percha was placed against the test materials in the dry group with the coronal segment sealed with amalgam. Samples were placed in an oasis soaked in phosphate-buffered saline for seven days in 100% humidity and at 37°C. Microhardness was measured independently at 4 and 2 mm from the apex. Hardness was compared between materials and conditions, applying analysis of variance (a = .05).

Results:

The presence of dry or wet conditions had no significant effect on material hardness. MTA Angelus showed significantly higher hardness values compared with NeoMTA Plus.

Conclusion:

The moisture of the periapical environment can compensate for the absence of a wet cotton pellet and is adequate for the setting of the materials.

Biocompatibility of a High-Plasticity, Calcium Silicate-Based, Ready-to-Use Material

The Bio-C Sealer is a recently developed high-plasticity, calcium-silicate-based, ready-to-use material. In the present study, chemical elements of the materials were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). The biocompatibility of the Bio-C Sealer was investigated using cytotoxicity tests and histological responses in the roots of dogs’ teeth. XRD, SEM, and FTIR produced hydrated calcium silicate in the presence of water molecules. In addition, FTIR showed the formation of calcium hydroxide and polyethylene glycol, a dispersing agent. The 1:4 dilutions of Bio-C Sealer presented weaker cytotoxicity than the Calcipex II in an in vitro system using the V-79 cell line. After 90 d, the periradicular tissue response of beagle dog roots was histologically evaluated. Absence of periradicular inflammation was reported in 17 of the 18 roots assessed with the Bio-C Sealer, whereas mature vertical periodontal ligament fibers were observed in the apical root ends filled with the Bio-C Sealer. Based on these results and previous investigations, the Bio-C Sealer is recommended as an effective root-end filling material. These results are relevant for clinicians considering the use of Bio-C Sealer for treating their patients.

Pulp repair response after the use of a dentin-pulp biostimulation membrane (BBio) in primary teeth: study protocol for a randomized clinical trial

Background

Vital pulp therapy aims at maintaining the pulp tissue injured but vital. Thus, the use of capping materials that induce tissue regeneration is a great current trend. This study aims to evaluate clinically and radiographically the pulp repair after the use of dentin-pulp biostimulation membrane in primary teeth.

Methods

Four hundred and sixty-eight teeth from children aged between 5 and 9 years old, both genders, with deep caries lesion with pulp involvement, but no furcal impairment and any sign of necrosis will be selected. The vital pulp therapy will be performed with mineral trioxide aggregate (control group) and dentin-pulp biostimulation chitosan membrane (BBio group). The clinical and radiographic outcomes will be assessed at 12 and 24 months after treatment. The thickness of the dentin barrier will be verified through Image J2 software. The Wilcoxon signed rank test and Mann-Whitney test will respectively compare the intra- and intergroup clinical and radiographic outcomes. Paired t test and independent t test will respectively compare the intra- and intergroup radiographic measurements. The logistic regression will be applied, and the degrees of this association will be measured using odds ratio (OR) and 95% confidence interval (95% CI).

Discussion

Therefore, this study protocol aims at new perspectives of vital pulp therapy of primary teeth by employing new easy-handling, low-cost material to keep viable the pulp tissue capable of regenerating and maintain the physiological process of deciduous tooth exfoliation.

Trial registration

Brazilian Registry of Clinical Trials RBR-6vr58b. Registered on 17 February 2019.

Effect of Tricalcium Silicate on Direct Pulp Capping: Experimental Study in Rats

Objectives Conduct a histological comparison of the pulp response to different materials, with a focus on the continuity and morphology of the mineralized barrier after direct pulp capping.

Materials and Methods  One hundred and eight maxillary first molars of 54 Wistar rats were subject to direct pulp capping and divided into three groups according to the materials used: calcium hydroxide (CH), mineral trioxide aggregate (MTA), and Biodentine. All cavities were sealed, and the animals were euthanized at 7, 14, and 21 days. Descriptive histological evaluation of the inflammation and formation of the mineralized barrier was performed.

Statistical Analysis  Statistical analyses were performed using the Kruskal–Wallis test, which was complemented by the Dunn test; differences with p < 0.05 were considered statistically significant.

Results  The results showed that MTA and Biodentine elicited less intense inflammatory reactions than CH. With respect to the formation and quality of the dentin barrier formed, differences were observed at 21 days between the analyzed groups; the best results being obtained following treatment with MTA and Biodentine.

Conclusion  MTA and Biodentine induced formation of a more continuous and uniform mineralized barrier with less intense pulp response than CH.

Strategies for Using Polydopamine to Induce Biomineralization of Hydroxyapatite on Implant Materials for Bone Tissue Engineering

In the field of tissue engineering, there are several issues to consider when designing biomaterials for implants, including cellular interaction, good biocompatibility, and biochemical activity. Biomimetic mineralization has gained considerable attention as an emerging approach for the synthesis of biocompatible materials with complex shapes, categorized organization, controlled shape, and size in aqueous environments. Understanding biomineralization strategies could enhance opportunities for novel biomimetic mineralization approaches. In this regard, mussel-inspired biomaterials have recently attracted many researchers due to appealing features, such as strong adhesive properties on moist surfaces, improved cell adhesion, and immobilization of bioactive molecules via catechol chemistry. This molecular designed approach has been a key point in combining new functionalities into accessible biomaterials for biomedical applications. Polydopamine (PDA) has emerged as a promising material for biomaterial functionalization, considering its simple molecular structure, independence of target materials, cell interactions for adhesion, and robust reactivity for resulting functionalization. In this review, we highlight the strategies for using PDA to induce the biomineralization of hydroxyapatite (HA) on the surface of various implant materials with good mechanical strength and corrosion resistance. We also discuss the interactions between the PDA-HA coating, and several cell types that are intricate in many biomedical applications, involving bone defect repair, bone regeneration, cell attachment, and antibacterial activity.

Mechanical Properties and Microstructure of Fibre-Reinforced Clay Blended with By-Product Cementitious Materials

Clayey soils endure adverse changes in strength and volume due to seasonal changes in moisture content and temperature. It has been well recognised that high cement content has been successfully employed in improving the mechanical properties of clayey soils for geotechnical infrastructural purposes. However, the environmental setbacks regarding the use of high cement content in soil reinforcement have necessitated the need for a greener soil reinforcement technique by incorporating industrial by-product materials and synthetic fibres with a reduced amount of cement content in soil-cement mixtures. Therefore, this study presents an experimental study to investigate the mechanical performance of polypropylene and glass fibre-reinforced cement-clay mixtures blended with ground granulated blast slag (GGBS), lime and micro silica for different mix compositions and curing conditions. The unconfined compressive strength, linear expansion and microstructural analysis of the reinforced soils have been studied. The results show that an increase in polypropylene and glass fibre contents caused an increase in unconfined compressive strength but brought on the reduction of linear expansion of the investigated clay from 7.92% to 0.2% at fibre content up to 0.8% for cement-clay mixture reinforced with 5% Portland cement (PC). The use of 0.4–0.8% polypropylene and glass fibre contents in reinforcing cement-clay mixture at 5% cement content causes an increase in unconfined compressive strength (UCS) values above the minimum UCS target value according to American Society for Testing and Materials (ASTM) 4609 after 7 and 14 days curing at 20 °C to 50 °C temperature. Therefore, this new clean production of fibre-reinforced cement-clay mixture blended with industrial by-product materials has great potential for a wide range of applications in subgrade reinforcement.

Effect of a bioactive cement on the microbial community in carious dentin after selective caries removal - An in-vivo study

OBJECTIVES

Selective caries removal in deep lesions means that soft carious affected dentin is left in the center of the cavity. Thus, using a tricalcium silicate cement Biodentine™ (Septodont, Paris) to seal the remaining soft dentin could have an antibacterial effect. This in-vivo study aimed to do quantitative and qualitative analyses on the bacterial composition within carious dentin before and after selective caries removal when applying Biodentine.

METHODS

Eleven patients with deep primary carious lesions at two posterior teeth without pulpal symptoms were included. Carious dentin was selectively removed and sampled with a sterile round bur (Komet No. 18) at baseline visit and eight weeks later. On the first visit, one lesion per patient, the remaining carious dentin was covered with Biodentine before adhesive restoration. Caries samples were investigated by microbial cultivation, molecular analysis and amplicon deep-sequencing of 16S rRNA genes. Bacterial DNA from intact cells was differentiated from cell-free DNA by DNase degradation prior to DNA isolation.

RESULTS

Reduction of cell-derived as well as cell-free bacterial DNA eight weeks after selective caries removal was significantly higher when Biodentine was applied. Lactobacillus was most abundant within the microbial community of deep carious dentin lesions at the first visit. After intervention with Biodentine application, Lactobacillus was diminished to a high degree. In general, the diversity in samples, as well as bacterial composition differed interindividually as well as intraindividually.

CONCLUSION AND CLINICAL SIGNIFICANCE

Despite the heterogenous and diversity of microbial composition in patients, Biodentine can have beneficial antibacterial effects when applied to residual carious dentin, offering an alternative and safe treatment option. The study is officially registered with German Clinical Trials Register (DRKS00011067).

Bioactive injectable polymethylmethacrylate/silicate bioceramic hybrid cements for percutaneous vertebroplasty and kyphoplasty

Polymethylmethacrylate (PMMA) cement has been widely used to fill and stabilize hard tissue defects in clinical surgery, especially in percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). However, the dense body of pure PMMA in defects has no ability to promote bone regeneration. We herein aim to fabricate novel PMMA/silicate bioceramic hybrid cements by adding bioactive calcium silicate (CS) particles into PMMA to endow PMMA/CS hybrid cements with bioactivity and biodegradability without losing the excellent mechanical strength and injectability. Following comprehensive characterization of the physicochemical properties and in vitro bioactivity study, our results showed compared with PMMA cement, the constructed PMMA/CS hybrid cements possessed significantly lower curing temperatures and simultaneously retained the acceptable mechanical strength and injectability. Moreover, obvious bioactive ion release and hydroxyapatite formation could be detected and observed after the PMMA/CS hybrid cements were soaked in simulated body fluid, indicating their pronounced bioactivity. A further in vivo study of the PMMA/CS hybrid cements on goat vertebral body defect models reflected that the PMMA/CS hybrid cements could be biodegraded well and could significantly promote new bone formation in defects 6 months of post-injection. Our results suggest that PMMA/CS hybrid cements may be promising candidates for PVP and PKP in clinic.

A novel, doped calcium silicate bioceramic synthesized by sol-gel method: Investigation of setting time and biological properties

The aim of the current study was to synthesize a fast-setting ion-doped calcium silicate bioceramic by the sol-gel method and to characterize its in vitro apatite-forming ability and cell viability. Calcium silicate (CS), doped calcium silicate with zinc and magnesium, with Ca/Zn molar ratios of 6.7:1 (DCS1), and 4.5:1 (DCS2), were synthesized by the sol-gel method. Matreva white MTA (WMTA, Matreva, CA, Egypt) was used as a control. The synthesized powders were characterized by x-ray diffraction. Setting time was measured using the Gilmore needle indentation technique. The in vitro apatite-forming ability of the materials was evaluated by scanning electron microscope and energy dispersive X-ray. NIH3T3-E1 cells viability was tested using MTT assay. The ion release of Ca, Si, Zn, and Mg was measured using inductive coupled plasma-optical emission spectroscopy (ICP-OES). One-way ANOVA was used to analyze setting time results. The Tukey's HSD post hoc test was used to establish significance (p < 0.001). For nonparametric data, the Kruskal-Wallis H test with Dunn's correction for post hoc comparison was used (p < 0.05). CS, DCS1, and DCS2 showed a significant decrease in setting time 33 ± 1.63 min, 28 ± 1.63 min, and 41.75 ± 2.87 min, respectively, compared to WMTA 91 ± 3.16 min (p < 0.001). DCS1 showed the highest apatite-forming ability and cell viability compared to the other groups. Ca and Si ions release decreased in both DCS1 and DCS2. The physical and biological properties of CS can be successfully improved by the sol-gel synthesis and ions doping. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:56-66, 2020.

Curcumin in tissue engineering: A traditional remedy for modern medicine

Curcumin is the principal polyphenolic compound present in turmeric with broad applications in tissue engineering and regenerative medicine. It has some important inherent properties with the potential to facilitate tissue healing, including anti-inflammatory, anti-oxidant, and antibacterial activities. Therefore, curcumin has been used for the treatment of various damaged tissues, especially wound injuries. There are different forms of curcumin, among which nano-formulations are of a great importance in regenerative medicine. It is also important to design sophisticated delivery systems for controlled/localized delivery of curcumin to the target tissues and organs. Although there are many reports on the advantages of this compound, further research is required to fully explore its clinical usage. The review describes the physicochemical and biological properties of curcumin and the current state of the evidence on its applications in tissue engineering. © 2018 BioFactors, 45(2):135-151, 2019.

FTIR characterization of the setting reaction of biodentine™

OBJECTIVE

To provide insight of the setting reactions of Biodentine™, a hydraulic calcium silicate cement, based upon observations using Fourier Transform Infra-Red (FTIR) spectroscopy.

METHODS

FTIR spectra of components before and during the setting reaction were taken using the attenuated total reflectance (ATR) technique. Measurements over wavelengths 600-4000cm^-1 were taken at regular intervals for two days.

RESULTS

FTIR spectrum of Biodentine™ powder revealed a number of peaks from 650 to 1100cm^-1 and a plateau from 1400 to 1500cm^-1, indicative of SiO and CO₃-bonding, while the mixing fluid exhibited water peaks. Results following mixing displayed three distinct regimes; (i) incubation phase, during the first 35min, when minimal change occurred, (ii) rapid transitory stage, between 35 and 90min, when major changes occurred, and (iii) slow sustained reaction stage for remaining 45h. Incubation appears to be associated with the presence of CO₃-peaks. The transition region indicates formation of CaOH and Jennite OH-peaks, anticipated intermediate reaction phases. At 90min, the end of second stage, CaOH and Jennite are replaced by a dominant Portlandite (Ca(OH)₂)-peak and minor presence of Tobermorite, another anticipated intermediate phase, and water reduction. During the following 45h Portlandite and Tobermorite decline while the water peak increases.

SIGNIFICANCE

FTIR can be used to follow the chemical reactions in dental cements and provides insight into the relatively slow setting reactions of hydraulic calcium silicate cements.

A comparative study on the in vitro formation of hydroxyapatite, cytotoxicity and antibacterial activity of 58S bioactive glass substituted by Li and Sr

Lithium and strontium up to 10 mol% have been substituted for calcium in 58S bioactive glasses in order to enhance specific biological properties such as proliferation, alkaline phosphatase (ALP) activity of cells as well as antibacterial activity. In-vitro formation of hydroxyapatite was studied using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), inductively coupled plasma atomic emission spectrometry (ICP-AES) and scanning electron microscopy (SEM). Substitution of either Li or Sr for Ca in the composition had a retarding effect on the bioactivity while Li decreased and Sr increased the rate of ion release in the simulated body fluid solution. The dissolution rate showed to be inversely proportional to oxygen density of the bioactive glasses. The proposed mechanisms for the lowered bioactivity are a lower supersaturation degree for nucleation of apatite in Li substituted bioactive glasses and blocking of the active growth sites of calcium phosphate by Sr²⁺ in Sr substituted bioactive glasses. The proliferation rate and alkaline phosphate activity of osteoblast cell line MC3T3-E1 treated with Li and Sr bioactive glasses were studied. 3-(4,5dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and alkaline phosphate assay showed that all synthesized bioactive glasses with exception of 58S with 10 mol% SrO, exhibited statistically significant increase in both cell proliferation and alkaline phosphatase activity. Finally, 58S bioactive glass with 5 mol% Li₂O substitution for CaO was considered as a potential biomaterial in bone repair/regeneration therapies with enhanced biocompatibility, and alkaline phosphate activity, with a negligible loss in the bioactivity compared to the 58S bioglass. At the same time this composition had the highest antibacterial activity against methicillin-resistant Staphylococcus aureus bacteria among all synthesized Li and Sr substituted bioactive glasses.