Coronal microleakage of three different dental biomaterials as intra-orifice barrier during nonvital bleaching

Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

The sealing ability of different endodontic biomaterials as an intra-orifice barrier: evaluation with high-performance liquid chromatography

Objective

This study evaluated the sealing ability of different biomaterials as intra-orifice barriers in the internal bleaching of discolored teeth with the walking bleaching technique. The release of hydroxyl ions from the bleaching materials can cause cervical root resorption, making it necessary to use intra-orifice barrier materials to prevent this issue.

Materials and methods

In the current study, the high-performance liquid chromatography (HPLC) method was used to measure the released hydroxyl ions. The study included 90 single-rooted and single-canal premolars, which were divided into four groups based on the intra-orifice barrier materials used (mineral trioxide aggregate [MTA], calcium-enriched mixture [CEM], Biodentine, and MTA+PG) and the type of bleaching material (sodium perborate + water or sodium perborate + hydrogen peroxide 30%). Two control groups were also considered in this study: a positive control group, where sodium perborate and hydrogen peroxide were placed inside the pulp chamber without any intra-orifice barriers; and a negative control group, where no bleaching agent or surgical obstruction was used, and the root surface was covered with wax up to the cemento-enamel junction (CEJ) level.

Results

The results showed that there was a significant difference in the concentration of hydroxyl ions released among the studied groups. The amount of hydroxyl ion released was highest in the positive control group and lowest in the CEM group. Among the intra-orifice barrier materials used, CEM cement was found to be the most appropriate material for use in the step-by-step internal bleaching method.

Conclusions

The study highlights the importance of using appropriate intra-orifice barrier materials to prevent root cervical resorption in internal bleaching procedures.

Effect of Different Protective Bases on pH Changes and Hydrogen Peroxide Microleakage During Intracoronal Bleaching

Objectives: This study aimed to evaluate the pH changes and penetration of hydrogen peroxide into radicular dentin when different protective bases were used with and without a bonding agent. Materials and Methods: In this in-vitro experimental study, 70 single-rooted bovine teeth were instrumented and obturated with gutta-percha. The gutta-percha was removed 3mm below the cementoenamel junction (CEJ) and the teeth were divided into seven groups (n=10). In each group, 2mm base (1mm apical to the CEJ) was applied as follows: TheraCal LC, TheraCal LC plus SE Bond, Lime-Lite, Lime-Lite plus SE Bond, Ionoseal, Ionoseal plus SE Bond, and resin-modified glass ionomer (RMGI). The teeth were placed in vials containing distilled water, and pH values and molar concentration of the medium surrounding the teeth were recorded immediately after internal bleaching with 35% hydrogen peroxide. The pH values were also recorded at 1, 7, and 14 days following renewal of the medium. Data were analyzed with t-test, one-way ANOVA, and Kruskal-Wallis test. Results: After bleaching, the medium pH became acidic in all groups. There were no significant differences among groups in the mean pH of the medium after bleaching (P=0.189). Moreover, there were no significant differences among the study groups with respect to hydrogen peroxide concentration (P=0.895). Conclusion: Intra-orifice barriers such as light-cure resin-modified calcium hydroxide, light-cure resin-reinforced glass ionomer, and light-cure calcium silicate can be as effective as RMGI in providing coronal seal during intracoronal bleaching.

Evaluation of the penetration of intracoronal bleaching agents into the cervical region using different intraorifice barriers

Background

The present study aimed to make a comparison between the effects of 35% hydrogen peroxide gel (HP) and sodium perborate with distilled water (SP) bleaching agents on the sealing characteristics of glass ionomer cement (GIC), TheraBase, ProRoot MTA and Biodentine intraorifice barriers.

Methods

One hundred and twelve single-rooted mandibular human premolar teeth extracted from young patients (14–25 years) were chosen. Root cement and cementoenamel junction (CEJ) of teeth were examined under a stereomicroscope at 10 × magnification to ensure there was no cement defect or dentin gap in CEJ. After the endodontic access cavities were opened on the occlusal surfaces of the teeth, the working length was determined. Instrumentation of each root canal was performed with a ProTaper Gold rotary system in the determined working length and filled with gutta-percha + AH Plus with a single cone technique using. Root fillings were removed 3 mm short of the CEJ and sealed with one of the following intraorifice barrier materials (n = 30/group): 1. GIC; 2. TheraBase; 3. ProProot-MTA; 4. Biodentine. In each of the sub-groups, either HP or SP was used to perform intracoronal bleaching on days 1, 4, and 7. All outer surfaces of the specimens except the 3 mm cervical region were covered with nail polish and modeling wax layers. Specimens were immersed in a 5 ml Eppendorf tube that contained 2 mL of distilled water. The penetration of peroxide release was measured using the colorimetric ferric thiocyanate method. Statistical analysis of the data was performed with Three-way ANOVA and Tukey’s test (P = 0.05).

Results

In the HP groups, GIC showed the greatest peroxide release when compared with other tested groups on day 1 (P < 0.05). Biodentine and ProRoot MTA displayed a significantly lower peroxide leakage when compared to GIC and TheraBase on days 1 and 4 (P < 0.05). While GIC and TheraBase were used, HP observed higher peroxide penetration when compared with SP on days 1 and 4 (P < 0.05).

Conclusions

Peroxide diffusion was significantly influenced by the kind of intracoronal bleaching agents and intraorifice barrier materials used.

Assessment of Oxygen Expansion during Internal Bleaching with Enamel and Dentin: A Comparative In Vitro Study

Internal bleaching is a conservative, non-invasive, and simple treatment that is frequently performed in daily clinical practice. The present in vitro study analyzes the oxygen expansion of different bleaching agents resulting from the oxidation reaction when interacting with enamel and dentin. Enamel and dentin were crushed separately until obtaining a fine powder with particles of an approximate size between 0.06 and 0.2 mm. Each enamel and dentin sample were mixed with 37% carbamide peroxide (CP 37%), 30% hydrogen peroxide (HP 30%), sodium perborate (SP) combined with HP 30% (HP 30% + SP) and SP with distilled water (SP). A total of 280 1 mm diameter glass tubes were used with 70 for each bleaching agent (30 for powdered enamel evaluation, 30 for powdered dentin evaluation, and 10 controls). The bleaching agents were placed in the prepared tubes immediately after mixing the components. As expansion occurred, the oil inside the tube was displaced, through which the resulting expansion was evaluated and measured for 10 days. A significant expansion was observed that varied in magnitude according to the bleaching agent and the tooth structure used. Student's t test and Welch's ANOVA were used to analyze the data obtained. The highest mean expansion of both enamel and dentin was observed with 30% HP (66.6 mm for enamel, 94.5 mm for dentin) followed by HP 30% + SP (48.6 mm for enamel, 52.7 mm for dentin), CP 37% (38.4 mm for enamel, 52.6 mm for dentin) and finally SP with water (12.7 mm for enamel, 4.4 mm for dentin). It was observed that the expansion in the SP group with enamel was significantly lower than in the rest of the groups, while that registered for HP 30% was significantly higher. (p < 0.001). The results with dentin were similar, with a significantly lower expansion for SP and higher for HP 30% (p < 0.001). The oxygen expansion observed as a result of the interaction between bleaching agents and dental tissues could contribute to improving our understanding of bleaching and its results. These results suggest that bleaching agents react with the organic component of the tooth structure.

Comparison of MTA, CEM Cement, and Biodentine as Coronal Plug during Internal Bleaching: An In Vitro Study

BACKGROUND

Internal bleaching is a choice of treatment in discolored endodontically treated teeth. Cervical root resorption is one of the important complications of this treatment. A suggested procedure to prevent this type of resorption is using a coronal barrier under the bleaching materials. The aim of the study was to compare the microleakage of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, and Biodentine.

MATERIALS AND METHODS

In this in vitro study, a total of 60 single canal incisors were included. They were randomly divided into three experimental groups (n = 16), one positive control group (n = 6), and one negative control group (n = 6). Coronal portion of the canals in the experimental groups was sealed with 3 mm of MTA, CEM cement, or Biodentine as a coronal barrier. After 3 days, specimens were bleached. A fresh Enterococcus faecalis suspension was added to the samples. The culture tubes were observed for 45 days, and the daily turbidity was recorded. Statistical analysis was accomplished by the Kaplan-Meier test and SPSS 22.

RESULTS

All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. Results showed no significant difference between MTA, CEM cement, and Biodentine groups. (P value = 0.304, 0.695, and 0.217). The bacterial microleakage for the two groups also did not show significant differences.

CONCLUSIONS

CEM cement and Biodentine showed promising results as coronal plug, and clinical studies are needed to test these materials with MTA for avoiding microleakage in internal bleaching treatment.

Evaluation of Three Different Bleaching Agents in Permanent and Primary Teeth: An In Vitro Study

Aim

To evaluate the effectiveness of three different bleaching agents in permanent and primary teeth.

Materials and methods

The study was done on 60 freshly extracted single-rooted teeth (30 permanent and 30 primary incisors) with intact coronal portion. The teeth were artificially stained with whole blood as the staining medium in a high-speed centrifuge. The discolorations were determined by the use of 3D Master Vita shade guide. The conventional endodontic treatment procedures were completed in all the test samples. The test samples were divided into group I (permanent teeth) and group II (primary teeth). The test samples were further divided into three subgroups according to the experimental materials used for bleaching [group IA—10% carbamide peroxide (CP), group IIB—9.5% hydrogen peroxide (HP), and group IIIC—10% sodium perborate (SP)]. The samples were evaluated at 7 days and 14 days after the completion of intracoronal bleaching procedure.

Results

The CP group showed lowest shade values, and SP group showed the highest shade values after 14 days in both permanent and primary teeth. The CP showed the significant difference in the shade at 7 days and 14 days in permanent teeth. No statistically significant difference was observed between the three experimental at the 7 days and 14 days in the primary teeth.

Conclusion

The CP is effective in permanent teeth after 7 days and 14 days of intracoronal bleaching. The three experimental materials are equally effective in the primary teeth bleaching after 7 days and 14 days.

How to cite this article

Behl M, Patnana AK, Khanna V. Evaluation of Three Different Bleaching Agents in Permanent and Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(2):130–135.

Delayed miniature pulpotomy in a symptomatic mature molar

This case report describes miniature pulpotomy (MP) with calcium-enriched mixture (CEM) cement, 1 week after carious pulpal exposure of a symptomatic mature molar. A 24-year-old woman was referred with complaining of severe lingering pain on the second upper left molar; a dental history revealed that the tooth had been prepared 1 week ago, but on pulp exposure, her dentist just dressed the cavity. After anesthesia/isolation in the same session, the temporary restoration was removed, the previously pulpal exposure was observed, and MP was carried out. Hemorrhage was effectively controlled using 5.25% NaOCl, the clot free pulpal wound was completely covered employing CEM cement, and the cavity was permanently restored by resin composite. The patient's pain gradually relieved within 24 h. The tooth was functional and able to respond to vitality tests in regular clinical follow-ups. At 15-month follow-up, a dentinal bridge was observed under the capping biomaterial, radiographically; moreover, no calcification or apical pathosis was detected. MP with CEM cement might be a treatment option for the management of exposed dental pulp with a clinical diagnosis of irreversible pulpitis, although further trials with larger sample size and longer follow-ups are recommended.

The Effect of Final Rinse Agitation with Ultrasonic or 808 nm Diode Laser on Coronal Microleakage of Root-canal Treated Teeth

INTRODUCTION

This in vitro study aimed at comparing the effect of agitating the final irrigant solutions of root canal by ultrasonic or using 808 nm Diode laser on the apical seal of canal.

METHODS AND MATERIALS

A total of 90 extracted human maxillary central incisors were prepared up to size #45 and were randomly assigned to 4 experimental groups (n=20) and two control groups (n=5) respectively, as follows: I): 3 mL of 5.25% NaOCl was agitated as final irrigant solution with ultrasonic for 30 sec. The ultrasonic tip was 1 mm shorter than the working length, II): 3 mL of 5.25% NaOCl was agitated as final irrigant with 808 nm Diode laser for 30 sec. Fiber tip, placed in 1 mm shorter from working length was spirally moved coronally, III): 3 mL of 17% EDTA was agitated as final irrigant with 808 nm Diode laser for 30 sec and was applied similar to group II, IV): 3 mL of 17% EDTA was stimulated as final irrigant with ultrasonic for 30 sec and was applied similar to I. Apical seal was assessed by Dual Chamber technique using Bovine Serum Albumin protein. Kruskal-Wallis and Mann Whitney tests were used with significance level lower than 0.05% for statistical analysis.

RESULTS

The average leakage in the negative control, positive control, and groups I, II, III, IV were: 0.00, 13.5±5.1, 1.72±2.9, 5.12±5.6, 3.36±3.7, 2.4±4.2, respectively. Statistical analysis showed significant difference between groups (P<0.05). There was a significant difference between groups 1 and 2 in terms of protein leakage.

CONCLUSION

Agitating 5.25% sodium hypochlorite solution as the final irrigant with ultrasonic is more effective in apical leakage reduction compared to other groups.

A novel technique of sculpting Biodentine in the restoration of iatrogenic dentin loss

Excessive tooth structure loss is a common iatrogenic error encountered during endodontic practice. Conservative treatment planning is essential to maintain the structural integrity in such teeth. This case report elucidates a novel approach in sculpting Biodentine as a dentin substitute followed by internal bleaching and restoration with fiber-reinforced composite.

Importance and methodologies of endodontic microleakage studies: A systematic review

INTRODUCTION

It is very important to obtain a tight seal in obturated root canal, making it necessary to conduct clinical or laboratory studies on the sealability of endodontic materials. Different methodologies have been historically used to assess microleakage of different endodontic materials. The aim of the present study was to comprehensively review different material testing methods used in microleakage studies, their interpretation and importance in endodontic literature.

MATERIAL AND METHODS

A systematic search was conducted in Medline, Cochrane, and Web of Science databases. In addition, the reference lists of review articles on the topic were searched. No language restriction was applied. Two independent reviewers screened the article.

RESULTS

Microleakage is considered the single most important risk factor responsible for apical periodontitis. Dye penetration, dye diffusion, bacterial and endototoxin infiltration, fluid filtration, glucose, caffeine and protein infiltration, radioisotope penetration, animal studies, and electrochemical or 3D evaluation are different methodologies used to assess dental leakage. 91 out of 177 articles in the primary search were included in the study. These methods are very divergent in their viewpoints; that is why their results cannot be easily compared. It is necessary to standardize microleakage detection methods in order to more correctly evaluate the phenomena that are found between the root canal wall and the root canal filling materials.

CONCLUSIONS

All the methods are useful if studies are performed strictly with large sample sizes and proper control groups and if the technique can be standardized. Furthermore, more evaluations of the reliability of the methods are strongly recommended. Key words:Dental leakage, review, root canal, material testing methods, data interpretation.

In Vitro Sealing Properties of Calcium-Enriched Mixture and Mineral Trioxide Aggregate Orifice Barriers during Intra-Coronal Bleaching

Introduction:

This study aimed at evaluating the sealing properties of calcium-enriched mixture (CEM) compared to mineral trioxide aggregate (MTA) as a cervical barriers in intra-coronal bleaching.

Methods and Materials:

In this in vitro study, endodontic treatment was performed on 60 extracted human incisors and canines without canal calcification, caries, restorations, resorption or cracks. The teeth were then randomly divided into two experimental groups and two control groups (n=15). Then, CEM cement and MTA were applied as 3-mm intra-orifice barriers in the test groups; a mixture of sodium perborate and 30% hydrogen peroxide bleaching agents were placed within the pulp chamber for one week. Dye penetration method was used to evaluate the sealing ability of agents. Statistical analysis was performed using SPSS software. The Kendall coefficient was used to evaluate inter-observer agreement. The chi-squared test was used for statistical analysis.

Results:

The results showed that the penetration rates of CEM and MTA were the same as positive control group, with no significant differences (P=0.673 and P=0.408, respectively). However, there was a significant difference between the negative control group and CEM and MTA groups (P=0.001 for both groups). In addition, the sealing ability of MTA and CEM cement were not significantly different (P=0.682).

Conclusion:

During intra-coronal bleaching procedures CEM cement can be used as a cervical barrier with sealing properties comparable to that of MTA.

In Vitro Microleakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture Cement and Biodentine Intra-Orifice Barriers

Introduction:

This in vitro study compared the coronal microleakage of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine as intra-orifice barriers.

Methods and Materials:

The study was conducted on 76 extracted single-canal human teeth. Their root canals were prepared using ProTaper rotary files and filled with gutta percha and AH-26 sealer using lateral condensation technique. Coronal 3 mm of the gutta percha was removed from the root canals and replaced randomly with MTA, CEM cement or Biodentine in the three experimental groups (n=22). A positive and a negative control group were also included (n=5). The entire root surfaces of all teeth were covered with two layers of nail varnish in such a way that only the access openings were not coated. In the negative control group, the access opening was also coated with nail varnish. All teeth were immersed in India ink and after clearing, the samples were evaluated under a stereomicroscope under ×10 magnification to assess the degree of dye penetration. The data were analyzed using the Kruskal-Wallis test. The level of significance was set at 0.05.

Results:

The negative control group showed no leakage while the positive control group showed significantly higher microleakage than the test groups (P>0.05). CEM cement had the lowest (0.175±0.068 mm) and MTA showed the highest dye penetration (0.238±0.159 mm) among the experimental groups; although these differences were not statistically significant (P=0.313).

Conclusion:

CEM cement exhibited the least microleakage as an intra-orifice barrier in endodontically treated teeth.

Bacterial Leakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture and Biodentine as Furcation Perforation Repair Materials in Primary Molars

Introduction:

Adequate seal of iatrogenically perforated area within the root canal system can improve the long term treatment prognosis. This in vitro study evaluated the sealing ability of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine in repair of furcation perforation in primary molars.

Methods and Materials:

A total of 61 freshly extracted primary mandibular second molars were randomly divided into three groups (n=17) and 10 teeth were put in negative (without perforation, n=5) and positive (perforated without repair, n=5) control groups. Turbidity was used as the criteria of bacterial leakage, when detected in the model of dual-chamber leakage. Data were analyzed using the Chi-Square and Kaplan-Meier survival analysis in SPSS software. The level of significance was set at 0.05.

Results:

All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. There was no significant difference between the number of turbidity samples in repaired teeth with all test materials (P=0.13). No significant difference was also detected in the mean survival time (P>0.05).

Conclusion:

CEM cement and Biodentine showed promising results as perforation repair materials and can be recommended as suitable alternatives of MTA for repair of furcation perforation of primary molars.