Endodontic management of root perforating internal replacement resorption

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.

Tannic acid speeds up the setting of mineral trioxide aggregate cements and improves its surface and bulk properties

HYPOTHESIS

The setting time and mechanical properties of cements are a major technical concern for a long time in civil engineering. More recently those practical problems became a major concern for biomedical applications -in bone surgery and in dentistry- in particular concerning the setting time which should be minimized. The possibility to add organic additives to interact with the different constituting ions in cements constitutes a way to modify the setting kinetics. We made the assumption that a hydrolysable polyphenol like tannic acid could modify the setting time and the physical properties of Mineral Trioxide Aggregate (MTA).

EXPERIMENTS

Tannic acid is added in variable proportions to the water used to set MTA. The formation of the hybrid organic-mineral cements is investigated using a combination of structural, chemical and mechanical methods. X-ray tomography was also used to investigate the changes in porosity and pore size distribution upon incorporation of tannic acid in MTA based cements. The hydrophilicity of the cements was evaluated by measuring the permeation kinetics of small water droplets.

FINDINGS

We found that tannic acid allowed to reduce markedly the setting time of MTA based cements. The obtained cements have an increased hydrophilicity and display excellent resistance to compression. The number of pores but not the average pore size is also affected. The possible roles of tannic acid in modifying the cement properties are discussed.

Evaluation of Root Perforation Treatments with Mineral Trioxide Aggregate: A Retrospective Case Series Study

This study aimed to evaluate the long-term clinical success of the use of mineral trioxide aggregate (MTA) as a sealant material in root perforation treatments. Therefore, the dental records of 53 patients were analyzed, and treatment data was collected (age, gender, tooth location, jaw, presence or absence of radiolucent lesion, fallow up time and final radiographic/clinical assessment). All procedures were performed by a single specialist. Two examiners analyzed three radiographs from the records of each patient and classified the treatments as successful or unsuccessful. Data was analyzed statistically using parametric chi-square (P≤0.05). The examiners classified 69.8% of the cases as successful, with a follow-up time of 1-16.25 years (average: 6 years). The presence of initial radiolucent lesion was observed in 79.2% of the teeth, with a higher index of treatment in maxillary teeth (62.3%). However, the majority of successful cases were located in the maxilla (73.0%), while most unsuccessful ones were located in the mandible (62.5%) (P=0.014). There was no statistically significant difference regarding presence of previous lesions in successful (75.7%) and unsuccessful cases (87.5%) (P=0.330). In the present study, root perforations sealed with MTA had a success rate of 69.8% within 1-16.25 years. The presence of initial injury did not influence the prognosis, and maxillary teeth presented a higher success rate.