In vitro comparative study of sealing ability of Diadent BioAggregate and other root-end filling materials

Bioceramics in Endodontics: Updates and Future Perspectives

Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.

Present status and future directions: Root resorption

Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.

In vivo Biocompatibility and Bioactivity of Calcium Silicate-Based Bioceramics in Endodontics

Endodontic therapy aims to preserve or repair the activity and function of pulp and periapical tissues. Due to their excellent biological features, a substantial number of calcium silicate-based bioceramics have been introduced into endodontics and simultaneously increased the success rate of endodontic treatment. The present manuscript describes the in vivo biocompatibility and bioactivity of four types of calcium silicate-based bioceramics in endodontics.

Comparison between iRoot BP Plus (EndoSequence Root Repair Material) and Mineral Trioxide Aggregate as Pulp-capping Agents: A Systematic Review

INTRODUCTION

iRoot BP Plus, also known as EndoSequence root repair material (EERM) is a premixed bioceramic thick/putty. According to its instruction manual, iRoot BP Plus is composed of tricalcium silicate, zirconium oxide, tantalum pentoxide, dicalcium silicate, calcium sulfate, calcium phosphate monobasic, and filler agents. This systematic review was carried out to evaluate and present the iRoot BP Plus material as a pulp-capping agent.

MATERIALS AND METHODS

A systematic search for articles with the scope of the selection criteria undergoing for data extraction was conducted through electronic databases. Studies on evaluation of the cytotoxicity, bioactivity, and dentinal bridge formation of iRoot BP, iRoot BP Plus, ERRM putty, or ERRM paste (ERRM) on variant human cells were selected for in vitro models, and dentinal bridge formation on human and animals teeth for in vivo models were selected.

RESULTS

A total of 22 articles were discussed in the review, 14 in vitro studies, five in vivo studies, and three articles with both studies. Methyl thiazol tetrazolium was the most used method for evaluating cytotoxicity. As for dentinal bridge formation, histological assessment and micro-Computed tomography were used. Human dental pulp cells (hDPCs) were the most investigated for in vitro models and rats for in vivo models. Except for one study, all studies involved in this review were primarily examining the material and comparing it to different types of mineral trioxide aggregate.

CONCLUSION

iRoot BP, iRoot BP Plus, and ERRM are biocompatible materials that enhance hDPCs and other variant human cells proliferation, migration, attachment adhesion, mineralization, and dentinal bridge formation.

Effect of Oral Tissue Fluids on Compressive Strength of MTA and Biodentine: An In vitro Study

INTRODUCTION

Over the past many years various root end filling materials have been used which have been tested for their physical properties but each of them had certain limitations. In clinical practice, root end filling materials are exposed to oral tissue fluids which may compromise their longevity.

AIM

The aim of this study was to investigate the effects of oral tissue fluids on compressive strength of Mineral Trioxide Aggregate (MTA) and biodentine.

MATERIALS AND METHODS

MTA and biodentine cylinders measuring 6 mm × 4 mm were prepared using acrylic blocks. They were divided into six groups; (Group 1) (MTA) (n=3), (Group 2) MTA contaminated with saliva, (MTA-S) (n=3), Group 3: MTA contaminated with blood, MTA-B (n=3), Group 4: Biodentine (BD), Group 5: Biodentine contaminated with saliva (BD-S) (n=5), Group 6: Biodentine contaminated with blood (BD-B) (n=5). The mould was contaminated with saliva and blood and incubated at 37°C at 100% humidity for three days and compressive strength (MPa) was measured using universal testing machine and the data was analyzed statistically using one-way ANOVA test.

RESULTS

There was no significant difference in the compressive strength between the three groups i.e., MTA, MTA-S, MTA-B (p > 0.05). However, there was higher compressive strength in the MTA-B group when compared to MTA and MTA-S. Also, there was no statistical significant difference between BD, BD-S, BD-B (p>0.05).

CONCLUSION

This study showed that the compressive strength of MTA and biodentine was not adversely affected by contamination with oral tissue fluids like blood and saliva.

Comparison of the Potential Discoloration Effect of Bioaggregate, Biodentine, and White Mineral Trioxide Aggregate on Bovine Teeth: In Vitro Research

INTRODUCTION

Tricalcium silicate cements can be used for pulp capping, pulpotomies, apical barrier formation in teeth with open apices, repair of root perforations, regenerative endodontics, and root canal filling. The aim of this study was to evaluate and compare the discoloration potential of 3 different tricalcium cements using a bovine tooth model.

METHODS

Forty bovine anterior teeth have been used for the study. Crowns separated from the roots were randomly divided into 4 groups: the BioAggregate (IBC, Vancouver, Canada) group, the Biodentine (Septodont, Saint Maur des Fosses, France) group, the mineral trioxide aggregate Angelus (Angelus, Londrina, PR, Brazil) group, and the only blood group. Materials have been placed to the standardized cavities on the lingual surfaces of the crowns, and their contact with blood has been provided. The color values of the samples were measured with a digital tooth shade determinator (VITA Easyshade; VITA Zahnfabrik, Bad Sackingen, Germany) before the placement of the materials, after the placement of the materials, in the 24th hour, in the first week, in the first month, in the third month, and in the first year. The mean value of all groups was compared using the Tukey multiple comparison test (α = 0.05).

RESULTS

All groups displayed increasing discoloration during a period of the first year. The "only blood group" showed the highest color change values, and it was followed as BioAggregate, mineral trioxide aggregate Angelus, and Biodentine, respectively. Statistically significant differences were found for Biodentine when compared with the only blood and BioAggregate groups (P < .05).

CONCLUSIONS

Considering the results of the study, Biodentine is found to have the least discoloration potential among the tested materials.

Calcium silicate-based cements: composition, properties, and clinical applications

Mineral trioxide aggregate (MTA) is a calcium silicate-based cement (CSC) commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Despite the superior laboratory and clinical performance of MTA in comparison with previous endodontic repair cements, such as Ca(OH)₂ , MTA has poor handling properties and a long setting time. New CSC have been commercially launched and marketed to overcome the limitations of MTA. The aim of the present review was to explore the available literature on new CSC products, and to give evidence-based recommendations for the clinical use of these materials. Within the limitations of the available data in the literature regarding the properties and performance of the new CSC, the newer products could be promising alternatives to MTA; however, further research is required to support this assumption.

Sealing ability of three root-end filling materials prepared using an erbium: Yttrium aluminium garnet laser and endosonic tip evaluated by confocal laser scanning microscopy

Aims:

(1) To compare the sealing ability of mineral trioxide aggregate (MTA), Biodentine, and Chitra-calcium phosphate cement (CPC) when used as root-end filling, evaluated under confocal laser scanning microscope using Rhodamine B dye. (2) To evaluate effect of ultrasonic retroprep tip and an erbium:yttrium aluminium garnet (Er:YAG) laser on the integrity of three different root-end filling materials.

Materials and Methods:

The root canals of 80 extracted teeth were instrumented and obturated with gutta-percha. The apical 3 mm of each tooth was resected and 3 mm root-end preparation was made using ultrasonic tip (n = 30) and Er:YAG laser (n = 30). MTA, Biodentine, and Chitra-CPC were used to restore 10 teeth each. The samples were coated with varnish and after drying, they were immersed in Rhodamine B dye for 24 h. The teeth were then rinsed, sectioned longitudinally, and observed under confocal laser scanning microscope.

Statistical Analysis Used:

Data were analyzed using one-way analysis of variance (ANOVA) and a post-hoc Tukey's test at P < 0.05 (R software version 3.1.0).

Results:

Comparison of microleakage showed maximum peak value of 0.45 mm for Biodentine, 0.85 mm for MTA, and 1.05 mm for Chitra-CPC. The amount of dye penetration was found to be lesser in root ends prepared using Er:YAG laser when compared with ultrasonics, the difference was found to be statistically significant (P < 0.05).

Conclusions:

Root-end cavities prepared with Er:YAG laser and restored with Biodentine showed superior sealing ability compared to those prepared with ultrasonics.

Comparative Scanning Electron Microscopic Study of the Marginal Adaptation of Four Root-End Filling Materials in Presence and Absence of Blood

OBJECTIVES

The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate (MTA), calcium enriched mixture (CEM) cement, Biodentine and BioAggregate in presence of normal saline and human blood.

MATERIALS AND METHODS

In this in-vitro experimental study, 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha. After resecting the root-end, apical cavity preparation was done and the teeth were randomly divided into 4 groups (N=20)(a total of 8 subgroups). Root-end filling materials were placed in 3mm root-end cavities prepared ultrasonically. Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood. After 4 days, epoxy resin replicas of the apical portion of samples were fabricated and scanning electron microscopy (SEM) analysis was performed to find gaps in the adaptation of the root-end filling materials at their interface with dentin. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance.

RESULTS

There were no significant differences in marginal adaptation of the 8 tested groups (P>0.05).

CONCLUSION

Based on the results, blood contamination does not affect the marginal adaptation of MTA, CEM cement, Biodentine or BioAggregate.

Comparison of marginal adaptation of mineral trioxide aggregate, glass ionomer cement and intermediate restorative material as root-end filling materials, using scanning electron microscope: An in vitro study

AIM

The present study compares the marginal adaption of Mineral Trioxide Aggregate (MTA), Glass Ionomer Cement (GIC) and Intermediate Restorative Material (IRM) as root-end filling materials in extracted human teeth using Scanning Electron Microscope (SEM).

MATERIALS AND METHODS

Thirty single rooted human teeth were obturated with Gutta-percha after cleaning and shaping. Apical 3 mm of roots were resected and retrofilled with MTA, GIC and IRM. One millimeter transverse section of the retrofilled area was used to study the marginal adaptation of the restorative material with the dentin. Mounted specimens were examined using SEM at approximately 15 Kv and 10(-6) Torr under high vacuum condition. At 2000 X magnification, the gap size at the material-tooth interface was recorded at 2 points in microns.

STATISTICAL ANALYSIS

One way ANOVA Analysis of the data from the experimental group was carried out with gap size as the dependent variable, and material as independent variable.

RESULTS

The lowest mean value of gap size was recorded in MTA group (0.722 ± 0.438 μm) and the largest mean gap in GIC group (1.778 ± 0.697 μm).

CONCLUSION

MTA showed least gap size when compared to IRM and GIC suggesting a better marginal adaptation.

BioAggregate and iRoot BP Plus optimize the proliferation and mineralization ability of human dental pulp cells

AIM

To investigate the cytotoxicity of BioAggregate and iRoot BP Plus root canal sealer (iRoot BP Plus) to human dental pulp cells (hDPCs) and their effect on proliferation and mineralization of hDPCs and to compare their performance with that of mineral trioxide aggregate (MTA).

METHODOLOGY

Human dental pulp cells were seeded onto the prepared BioAggregate, iRoot BP Plus and MTA, respectively. Cell proliferation was assessed by CCK-8 cell proliferation kit on days 1, 3, 5 and 7. ALP activity was measured to evaluate the cell differentiation potential on days 1, 3, 5 and 7. The expression of odontoblastic differentiation-related genes (dentine phosphoprotein, dentine matrix protein-1 and osteocalcin) was measured by quantitative real-time polymerase chain reaction (qRT-PCR). Statistical tests used were one-way anova and post hoc Tukey's test.

RESULTS

The proliferation of hDPCs in the MTA group was suppressed throughout the culture period, whereas the BioAggregate group and the iRoot BP Plus group first significantly increased cell numbers on day 1 (P < 0.01) and then decreased on day 3 to day 7. ALP activity was enhanced in all the three groups from day 3, whilst iRoot BP Plus showed significantly higher ALP activity than MTA (P < 0.01). qRT-PCR indicated that both BioAggregate and iRoot BP Plus groups were associated with a higher upregulation of mineralization and odontoblastic differentiation-associated gene expressions as compared to MTA group (P < 0.05).

CONCLUSIONS

BioAggregate and iRoot BP Plus were nontoxic and able to induce mineralization and odontoblastic differentiation-associated gene expression in hDPCs.