Porosity analysis of MTA and Biodentine cements for use in endodontics by using micro-computed tomography

The effect of varying thicknesses of mineral trioxide aggregate (MTA) and Biodentine as apical plugs on the fracture resistance of teeth with simulated open apices: a comparative in vitro study

Background

This study evaluates the fracture resistance of apical plugs created from Biodentine and mineral trioxide aggregate (MTA) in thicknesses of 3 and 5 mm within simulated open apex tooth models.

Methods

Fifty human maxillary central incisors were obtained from a pool of freshly extracted teeth. In order to replicate open apices without cavity preparation, ten teeth in the control group received apical-to-coronal preparation with Peeso reamers. The remaining 40 teeth were randomly assigned to four experimental groups and received either 3 or 5 mm Biodentine or MTA apical plugs.

Results

The mean fracture loads observed in this study were as follows: control group, 431.48 N (±34.55); 3 mm MTA, 774.88 N (±62.74); 5 mm MTA, 752.65 N (±73.79); 3 mm Biodentine, 918.25 N (±59.09); and 5 mm Biodentine, 903.42 N (±24.48). Specifically, teeth in the Biodentine group demonstrated considerably stronger fracture resistance compared to those in the MTA group (p < 0.001). However, no significant differences were observed between the 3 and 5 mm thicknesses (MTA: p = 0.98, Biodentine: p = 0.99), suggesting that plug thickness did not affect fracture resistance within both groups.

Conclusion

Biodentine apical plugs provided the highest fracture resistance among the materials, regardless of thickness.

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy

Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.

Void characteristics and tortuosity of calcium silicate-based cements for regenerative endodontics: a micro-computed tomography analysis

Background

Internal voids of materials can serve a hub for microorganism and affect the sealing ability. This study aimed to evaluate the sealing performance of calcium silicate-based cements in immature teeth treated with regenerative endodontics.

Methods

Twenty single root canals from immature permanent premolars were prepared using regenerative endodontic protocols. The root canals were randomly divided into two groups and sealed with mineral trioxide aggregate (MTA) and Biodentine (BD). The teeth were kept in humid environment for 7 days and scanned using micro-computed tomography. The voids within the cements were segmented and visualized using image processing, incorporating the modified Otsu algorithm. The porosity of each sample was also calculated as the ratio between the number of voxels of voids and the volume of the cements. Tortuosity was also calculated using the A-star algorithm.

Results

Voids larger than 70 μm were predominantly observed in the top and interfacial surface of cements. The others were evenly distributed. MTA and BD showed the same level of porosity and tortuosity at interfacial surfaces. In inner surfaces, MTA showed more less porosity and tortuosity compared to BD (p < 0.05).

Conclusions

There were no differences in sealing performance between MTA and BD.

The Effect of Ultrasonic Agitation on the Porosity Distribution in Apically Perforated Root Canals Filled with Different Bioceramic Materials and Techniques: A Micro-CT Assessment

The present study evaluated the effect of ultrasonic agitation on the porosity distribution of BioRoot RCS/single gutta-percha cone (BR/SC) and MTA Flow (MF) root canals fillings used as apical plugs in moderately curved and apically perforated roots. Eighty mesial root canals of mandibular first molars were enlarged up to ProTaper NEXT X5 rotary instrument 2 mm beyond the apical foramen, simulating apical perforations. Specimens were randomly divided into four experimental groups (20 canals per group) according to the material and technique used for root canal obturation: BR/SC, BR/SC with ultrasonic agitation (BR/SC-UA), MF and MF with ultrasonic agitation (MF-UA). The ultrasonic tip was passively inserted into the root canal after the injection of flowable cement and activated for 10 s. The specimens were scanned before and after obturation with a high-resolution micro-computed tomography scanner, and the porosity of the apical plugs was assessed. The differences between groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests, with the significance level set at 5%. None of the obturation materials and techniques used in this study was able to provide a pore-free root canal filling in the apical 5 mm. Considerably higher percentages of open and closed pores were observed in the MF and MF-UA groups, with the highest porosity being in the MF-UA group (p < 0.05). No significant differences were observed between the BR/SC and BR/SC-UA groups, where the quantity of open and closed pores remained similar (p > 0.05).

[Comparison of the porosity characteristics of Portland cement, mineral trioxide aggregate and Biodentine by scanning electron microscopy]

Objective

The purpose of this study was to compare the porosity characteristics of Portland cement, mineral trioxide aggregate (MTA) Angelus® and Biodentine Septodont® by scanning electron microscopy.

Materials and Methods

Cements were prepared according to the manufacturer's instructions and packed in cylindrical polyethylene tubes with an internal diameter of 10 mm and a height of 5 mm. The porosity of the samples was analyzed using scanning electron microscopy. Statistical analyses were performed using the Kruskall Wallis test. The level of significance was established at 0.05.

Results

The largest size mean diameter valus was found with Portland cement (11.07). There were significant differences between the mean pore diameters (p = 0.05). MTA Angelus® had the largest number of pores, followed by Biodentine Septodont®, and finally, Portland. There were no significant differences in the pores of the three cements (p = 0.09).

Conclusion

The results of this comparative analysis of endodontic cements showed that Portland cement has a larger pore diameter than MTA Angelus® and Biodentine Septodont®, demonstrating that these latter two cements present better resistance and permeability properties, and thereby prevent microleakage.

Influence of sodium hypochlorite and ultrasounds on surface features and chemical composition of Biodentine tricalcium silicate-based material

Biomaterials are subjected to various factors during endodontic workflow. The aim was to evaluate the influence of different concentrations of sodium hypochlorite and ultrasound activation on the features and chemical composition of Biodentine. Fifty-four Biodentine samples were divided into 3 groups based on the material setting time. They were subjected to different modes and times of 2% and 5.25% NaOCl irrigation with or without ultrasounds, 12 min (group I), 45 min (group II) and 24 h (group III) after the material mixing. Visual assessment of the sample's surface was performed using the scanning electron microscope and chemical analysis was made with energy dispersive spectroscopy. Both NaOCl irrigation and ultrasounds affected the surface of the material; however, they did not change its chemical composition. The irrigation enhanced by ultrasounds following the placement of Biodentine should be performed after a longer material setting time. The immediate use of ultrasounds is not recommended.