Evaluation of bioceramics and zirconia-reinforced glass ionomer cement in repair of furcation perforations: An in vitro study

How Irrigants Affect Mineral Trioxide Aggregate (MTA) Sealing in Furcal Perforations: An In Vitro Study

Objective This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) on ProRoot mineral trioxide aggregate (MTA) used for treating furcal perforations, compared to no solution application, using the dye penetration (DP) method. Materials and methods The study included 36 intact mandibular molars in the furcal area (FA) with well-spaced roots. Using dental operating microscopes, perforations were created at the FA of the molars with a 1.2 mm diameter. Subsequently, ProRoot MTA (Dentsply, Germany) was applied to seal the perforations. After 24 hours, the samples were randomly assigned to three groups: Group A (n = 12), irrigated with 5.25% NaOCl; Group B (n = 12), irrigated with 2% CHX; and Group C (n = 12), without irrigation (control group). Specimens' pulp chambers were immersed in 2% methylene blue for 24 hours. Buccal-lingual sections were performed, and the depth of marginal dye leakage was assessed using a stereomicroscope at 20x magnification. Data analysis employed the one-way analysis of variance (ANOVA) test and Bonferroni post-hoc test (α = 0.05). Results The study revealed significant differences in DP values between groups (p-value < 0.01). DP values in the control group (no irrigation) were lower than both NaOCl (p < 0.05) and CHX (p < 0.01) groups. Furthermore, DP values in the CHX group were higher than those in the NaOCl group (p < 0.01), suggesting the order: no irrigation < NaOCl < CHX (p < 0.05). Conclusions The sealing ability of MTA was compromised when irrigated with 2% CHX and 5.25% NaOCl. CHX significantly impacted the marginal leakage and sealing ability of MTA. Care should be taken when resuming endodontic treatment after the application of MTA in cases of furcal perforations as the use of CHX and NaOCl may affect the marginal leakage of MTA.

Evaluation of compressive and diametral tensile strength of novel bioactive material with conventional glass ionomer cement and silver amalgam: An in vitro study

Aim

The aim of this study was to compare the compressive and tensile strength of two different brands of conventional glass ionomer cement (GIC), with new zirconia-reinforced GIC and silver amalgam.

Materials and Methodology

Eighty specimens with 20 samples in each group were prepared (Group 1-Fuji IX GIC, Group 2-FX-II Shofu GIC, Group 3-Amalgam, and Group 4-Zirconia-reinforced glass ionomer [Zirconomer]) for compressive strength (CS) using cylinder molds with dimensions 6.0 mm diameter × 12.0 mm height. Eighty specimens using cylinder molds with dimensions 6.0 mm diameter × 3.0 mm height were prepared for testing diametral tensile strength (DTS). CS test was carried out using Micro Universal Testing Machine (Mecmesin, PPT Group, UK) having a crosshead speed of 1.0 mm/min. DTS was determined using Instron universal testing machine at a crosshead speed of 1.0 mm/min. The data were submitted to two-way analysis of varianceand post hoc Tukey tests (alpha = 0.05). The mean CS value was more for Group III (256.2), followed by Group IV (181.2 Megapascals [MPa]), Group II (129.8 MPa), and the least was Group I (117.9 MPa).

Result

The mean DTS value was high in Group III (73.7 MPa), followed by Group IV (58.0 MPa), Group II (36.0 MPa), and the least was seen in Group I (23.2 MPa).

Conclusion

It can be concluded that although Zirconomer has mechanical properties greater than that of unmodified GICs, additional studies are essential to evaluate its long-time ability.

A Study on Nanoleakage of Apical Retrograde Filling of Premixed Calcium Silicate-Based Cement Using a Lid Technique

This study aimed to compare the nanoleakage of retrograde fillings with premixed calcium silicate-based putty and mineral trioxide aggregate (MTA), using two different techniques (traditional and Lid). Sixty-four extracted human teeth were decoronated, then root canals and ends were instrumented for retrograde filling and divided into four groups according to the retrograde filling technique: the traditional and the Lid technique. Each group (n = 15) was filled with Ceraseal + Well-Root putty, Well-Root putty, Ceraseal + ProRoot MTA, and ProRoot MTA. The nanoleakage was evaluated using the Nanoflow device (IB Systems) on days 1, 3, 7, 15 and 30. Data were collected twice per second at the nanoscale (nL/s) and calculated after archiving the stabilization of fluid flow. The Kruskal-Wallis and Mann-Whitney U-tests were used for statistical analysis. All groups showed enhanced sealing ability over time. Regardless of filling materials, the Well-Root putty, Ceraseal+Well-Root putty, and Ceraseal+ProRoot MTA groups indicated less nanoleakage than the ProRoot MTA group in the first week of evaluation (p < 0.05). Although all groups did not show significant differences after 2 weeks, the Ceraseal+ProRoot MTA group leaked less than ProRoot MTA on Days 3 and 7 (p < 0.05). The scanning electron microscopic examined good adaptation to the cavity wall, which was similar to nanoleakage results. Premixed calcium silicate-based putty retrograde filling material alone and using the "lid technique" were shown to be faster and less prone to nanoleakage when compared to MTA.

A Spectrophotometric comparative evaluation of the sealing ability of various perforation repair materials with a novel eggshell modified GIC

Objectives

The objective of this study was to evaluate and compare the sealing ability of mineral trioxide aggregate (MTA), Biodentine, glass ionomer cement, and glass ionomer cement modified with Chicken Eggshell Powder when used as furcation perforation repair material.

Materials and Methods

In the present study, 80 human lower first molars were used. Collected teeth had no caries or restoration, and none had fused roots. Every molar had an endodontic access cavity made utilizing a high-speed, long-shank round bur for the initial entry and an Endo-Z for lateral extension and finishing the cavity walls. Each canal's orifice was covered with a temporary filling material. The pulpal floor and cavity walls of every molar were thoroughly coated with two successive coats of clear nail polish. A significant perforation was made between the orifices to the furcation area using a high-speed long shank round bur #4. The perforation centered between the mesial and distal orifice. They were divided into four experimental groups: Group I: 20 molars were repaired using MTA, Group II: 20 molars with Biodentine, Group III: 20 molars were repaired with glass ionomer cement, and Group IV was repaired using glass ionomer cement modified with 7% chicken eggshell powder. Moist cotton pellets were placed over the repair materials, and molars were kept in 100% humidity for 24 h to allow materials to set. Then, according to each group, molars were put in Petri dishes. Methylene blue dye was applied inside the access cavity of all samples for 24 h. Molars were placed under running tap water for 30 min to remove all residues of methylene blue, and then varnish was removed with a Parker blade #15 and polishing discs. Molars were placed in vials containing 1 mL of concentrated (65 wt%) nitric acid for 3 days. Vials were centrifuged at 14,000 rpm for 5 min. The supernatant from each sample was transferred in a quantity of 200 L to a 96-well plate. Sample absorbance was read by an automatic microplate spectrophotometer at 550 nm using concentrated nitric acid as a blank. Statistical analysis was performed using one-way analysis of variance. When the analysis of variance test was significant, the pairwise comparison of the means was done using a Duncan post hoc test. The significance level was set at P < 0.05. Statistical analysis was performed with SPSS 14.0 (SPSS Inc., Chicago, IL, USA) for Windows (Microsoft, Redmond, WA, USA).

Results

The highest dye absorbance was seen in Group III, followed by Groups IV, II, and I.

Conclusion

Within the limitations of study it was concluded that maximum sealing ability was seen in Biodentine followed by MTA, Glass Ionomer Cement modified with 7% Chicken Eggshell powder and Glass Ionomer Cement.

Evaluation of coronal microleakage of intra-orifice barrier materials in endodontically treated teeth: A systematic review

Background

Endodontic success depends on complete sealing of the root canal orifice to prevent re-infection and re-Contamination of the treated teeth through microleakage. Intra-orifice barrier material provides a seal against micro-organisms, its by-products thus, preventing microleakage and subsequent endodontic failure. Several studies have been done to evaluate microleakage after placing various materials as IOB, but still there is no standardization for the same. Thus, this systematic review was conducted to evaluate the microleakage associated with mineral trioxide aggregate (MTA), composite, and glass ionomer cement (GIC) when used as IOB material.

Materials and Methods

Protocol was formulated in accordance with PRISMA checklist 2020 and registered on PROSPERO (CRD42021226225). Electronic search from databases such as Medline/PubMed, Scopus, EBSCOhost, Embase, Google Scholar, and Cochrane were performed from the year 2000-2020. In vitro and ex vivo studies evaluating coronal microleakage after placing IOB material using methylene blue dye penetration test under a stereomicroscope were included. A total of 5 studies were included in the systematic review. After assessing the risk of bias using customized criteria referred from JBI critical appraisal tool, characteristics of the included studies, reason for exclusion of the studies, and data extraction sheet were prepared.

Results

All studies included in this systematic review reported that placement of an IOB material significantly reduces microleakage as compared to control groups. MTA used as an IOB showed less microleakage than composite and GIC.

Conclusion

MTA as IOB material demonstrated the least microleakage in vitro studies. However, in this systematic review, only in vitro studies were included. Thus, more studies in the form of randomized control trials are required to give a conclusive and definitive result.

Comparative evaluation of microleakage and hardness of newer posterior restorative materials

Background

The physical properties of restorative materials are critical when restoring posterior teeth. Restorative materials are continuously evolving in the quest for creating long lasting restorations.

Aim and objective

To compare and evaluate microleakage and hardness of three different posterior restorative materials: Cention N, Zirconomer Improved and Solare Sculpt.

Materials and methods

For micro leakage evaluation, 40 extracted human third molars were randomly divided into three experimental groups of 10 teeth each and two control group of 5 teeth each. Standardized box shaped class II cavity preparation was done in Group I, II, III and V. In Group V, cavity was prepared but left unrestored. No cavities were prepared in Group IV. Cavities in Group I, II, and III were restored with Cention N, Zirconomer Improved, Solare Sculpt respectively. Teeth were thermocycled together for 500 cycles. All the samples were placed in 2% methylene blue for 24 h. Microleakage evaluation was done using stereomicroscope. For hardness evaluation ten standardized discs of each material were prepared and evaluated using vicker's hardness test.

Results

All the groups showed some amount of microleakage. The mean micro-leakage score was significantly more among Group II compared to Group I. There was no significant difference in mean micro-leakage score between Groups I and III. The mean hardness value was significantly more among Groups I and II compared to Group III.

Conclusion

No material was able to completely eliminate microleakage. Cention N showed high hardness among the materials tested.

Efficacy of Mineral Trioxide Aggregate Repair High Plasticity, Biodentine, and EndoSequence Root Repair Material Putty as Apical Barriers in Immature Permanent Teeth: An In Vitro Bacterial Leakage Study

AIM

To assess the microleakage of mineral trioxide aggregate (MTA) repair high plasticity (HP), EndoSequence root repair material (ESRRM) putty, and Biodentine, when used as an apical plug in immature permanent teeth.

MATERIALS AND METHODS

In an in vitro model, 55 extracted maxillary incisors were decoronated and resected 3 mm apically to obtain standardized 15-mm root blocks, which were then cleaned and shaped. All samples had a 1.1-mm standardized, prepared artificial open apex. The teeth were arbitrarily designated into three experimental groups (n = 15) and two control (positive/negative) groups (n = 5). In the experimental groups, orthograde 4-mm thick apical plugs of Biodentine (group I), ESRRM putty (group II), and MTA repair HP (group III) were placed. Positive control samples were left vacant while negative control samples were filled with Biodentine. The bacterial leakage method was used to appraise the sealing efficiency of the cements.

RESULTS

Statistical package for the social sciences (SPSS) software, version 21.0, was used for data analysis. Post hoc Tukey's test, one-way analysis of variance (ANOVA), and repeated measures of ANOVA were used for intergroup and intragroup comparisons. On day 1, there was a significant difference between the groups, with group II showing the least and group 1 showing the maximum microleakage. No significant difference among the groups was seen at other observational periods. There was a tendency for leakage to increase significantly from day 1 to 7, then decrease till the end of the experimental period.

CONCLUSION

It was concluded that the three materials evaluated, with time, exhibited comparable apical microleakage when treating teeth with open apices.

CLINICAL SIGNIFICANCE

MTA repair HP can be used as an apical plug material in open apices with similar success as ESRRM putty and marginally better outcome than Biodentine.

Apical Sealing Ability of Two Calcium Silicate-Based Sealers Using a Radioactive Isotope Method: An In Vitro Apexification Model

The aim of this study was to evaluate and compare the sealing ability of two calcium silicate-based sealers (TotalFill BC RRM Fast Set Putty and White ProRoot MTA) when used as apical plugs in immature teeth through nuclear medicine. Single-rooted extracted teeth (n = 34) had their crowns and root tip sectioned to obtain 14 mm long root segments to simulate an in vitro apexification model. Were created two experimental groups, namely MTA (n = 12) and BC (n = 12), and two control groups, PG (positive group, n = 5) and NG (negative group, n = 5). On the 4th day after placing the respective apical plug, the apical portions of the teeth were submerged in a solution of sodium pertechnetate (^99mTcNaO₄) for 3 h. Statistical analysis showed a significant difference between the MTA group and the controls (p < 0.05). The BC group had a significant difference regarding the negative control (p < 0.001) but showed no statistical significance regarding the positive control (p = 0.168). There was a statistically significant difference (p = 0.009) between the BC group (7335.8 ± 2755.5) and the MTA group (4059.1 ± 1231.1), where the last showed less infiltration. Within the limitations of this study, White ProRoot MTA had a significantly better sealing ability than TotalFill BC RRM Fast Set Putty.

Premixed bioceramics: A novel pulp capping agent

The main aim of restorative dentistry is to protect the vitality of the Pulp tissue. The pin point carious expoure and iatrogenic errors warrant the need for various pulp capping procedures like Indirect Pulp Capping and Direct Pulp Capping. Pulp Capping is dressing of the dental pulp exposed due to mechanical procedure, carious lesion or traumatic injury to preserve its vitality and function. There has been constant evolution and research on materials used to cap the Pulp tissue. The different kind of chemical and biological materials has been used with varying degree of success. The prognosis based on the pulp capping material has dramatically improved with the introduction of bioactive cement. Though MTA and biodentine have shown a high success rate, their properties can be adversely affected with error in powder/liquid ratio and may present with difficulty in the handling characteristic. Premixed bioceramics have been introduced in the market and present with desirable properties as a pulp capping agent. Owing to good handling characteristics, biocompatibility, odontogenic property, and antibacterial action it is a potent pulp capping agent for clinical application. This review is aimed to discuss the introduction of premixed bioceramics, forms of premixed bioceramics available, and its physical, chemical, and biocompatible properties.

Histopathological, histoenzymological, immunohistochemical and immunofluorescence analysis of tissue response to sealing materials after furcation perforation

AIM

To evaluate in vivo tissue responses after sealing furcation perforations in dog's teeth with either Biodentine™, mineral trioxide aggregate (MTA) or gutta-percha, by means of histopathological, histoenzymological, immunohistochemical and immunofluorescence analysis.

METHODOLOGY

After root canal treatment, perforations were created in the central region of the pulp chamber floor using a round diamond bur and filled with one or other of the materials. The animals were euthanized after 120 days, and the teeth (n = 30) were processed for histopathological analysis of new mineralized tissue formation and collagen fibre reinsertion, immunohistochemical analysis of osteopontin (OPN) and alkaline phosphatase (ALP) and immunofluorescence analysis for bone morphogenetic protein (BMP-2), cementum attachment protein (CAP), bone sialoprotein (BSP), osteocalcin (OCN) and cementum protein1 (CEMP1). Histoenzymology was performed for TRAP activity and osteoclast count. Data were analysed statistically (α = 0.05) using chi-square and Kruskal-Wallis tests.

RESULTS

Gutta-percha did not induce mineralized tissue formation. MTA and Biodentine^TM formed mineralized tissue in 88% and 92% of specimens, respectively, with no significant difference (P > 0.05). Gutta-percha was associated with scattered collagen fibres parallel to the perforations. Groups treated with MTA or Biodentine^TM had partial fibre reinsertion perpendicular to the newly formed mineralized tissue. All materials induced OPN and ALP expression, weakest for gutta-percha and strongest for MTA (P < 0.05). Only MTA induced BMP-2, BSP, OCN, CAP and CEMP1 expression. Osteoclast counts were similar in all groups (P = 0.97).

CONCLUSIONS

Mineral trioxide aggregate and Biodentine^TM were biocompatible, with formation of mineralized tissue and partial reinsertion of collagen fibres. In addition, the participation of several molecules by which calcium silicate-based materials induce the formation of mineralized tissue were noted, with expression of ALP and OPN mineralization markers, without interference in the number of osteoclasts. Only MTA stimulated the expression of proteins associated with the formation of a cementum-like mineralized tissue.