Properties of an Accelerated Mineral Trioxide Aggregate–like Root-end Filling Material

The purpose of the study was to examine the physicochemical properties of mineral trioxide aggregate (MTA)-like cements prepared from SiO₂, CaO, and Al₂O₃ as matrices, and ZnO, MgO, and Fe₂O₃ as additives. The MTA-like cements showed a significantly (p < 0.05) faster setting time (<14 minutes) than MTA when mixed with water, although there was a significant decrease (p < 0.05) in diametral tensile strength, ranging from 0.9 to 3.1 MPa in comparison to MTA (4.4 MPa). The addition of ZnO, MgO, and Fe₂O₃ to the MTA-like cement led to a significantly (p < 0.05) higher strength than MTA-like cement without additives. The pH values of the MTA-like cements were changed from an initial 11 to a high of 13, similar to the results of MTA. Future characterization of the examined MTA-like cement with shortened setting time is needed before it is considered a viable candidate for dental root-end–filling applications.     

Mercury Intrusion Porosimetry and Assessment of Cement-dentin Interface of Anti–washout-type Mineral Trioxide Aggregate

Introduction

One of the disadvantages of mineral trioxide aggregate (MTA) is washout (ie, the tendency of freshly prepared cement paste to disintegrate upon early contact with physiological fluids). A novel MTA (MTA Plus; Prevest Denpro, Jammu City, India) exhibits low washout and superior physical properties when mixed with a gel instead of water. When used as a root-end filler, MTA is in contact with both bone and root dentin. This study aimed to investigate the porosity and interfacial characteristics of the novel MTA mixed with water or antiwashout gel.

Methods

Porosity was evaluated after 1 or 28 days of immersion in Hank's balanced salt solution using mercury intrusion porosimetry. The root dentin to material interface was investigated using a scanning electron microscope and energy-dispersive X-ray spectroscopy complete with line scans and elemental maps.

Results

Anti–washout-type MTA Plus was found to have lower initial porosity than MTA Plus mixed with water although this trend was reversed after 28 days of immersion in physiological fluid. Both materials exhibited good marginal adaptation. The diffusion of silicon, calcium, and phosphorus across the cement/dentin interface was observed.

Conclusions

MTA Plus mixed with antiwashout gel was found to have lower initial porosity than MTA Plus mixed with water. Both materials exhibited good marginal adaptation and the diffusion of silicon, calcium, and phosphorous across the cement/dentin interface. Thus, the anti–washout-type MTA can be considered to be a suitable substitute for ordinary MTA in all its indications.     

Identification of a Calcium-sensing Receptor in Human Dental Pulp Cells That Regulates Mineral Trioxide Aggregate–induced Mineralization

IntroductionThe purpose of this study was to verify the expression of the calcium-sensing receptor (CaSR) and its role in mineral trioxide aggregate (MTA)-induced odontoblastic differentiation and mineralization in human dental pulp cells (hDPCs).MethodsThe expression of CaSR in human dental pulp tissue and hDPCs was detected using immunohistochemical and immunofluorescent assays. Then, hDPCs were cultured in specific medium supplemented with defined concentrations of MTA dilute alone or in combination with calcimimetic R-568 (a positive allosteric modulator of CaSR [Tocris Bioscience, Bristol, UK]), and cell viability was monitored by Cell Counting Kit-8 (Dojindo Molecular Technologies, Kumamoto, Japan) analysis. Alkaline phosphatase activity, alizarin red S staining, quantitative real-time polymerase chain reaction, and Western blot were used to investigate the gene/protein expression of odontoblastic-associated markers and CaSR in medium supplemented with different combinations of diluted MTA, R-568, and calcilytic Calhex 231 (a negative allosteric modulator of CaSR [Sigma-Aldrich, St Louis, MO]).ResultsCaSR was slightly expressed in the central pulp tissue, whereas it was strongly expressed in the odontoblast layer, plasma membrane, and cytoplasm of hDPCs. Cell Counting Kit-8 assay indicated maximum cell viability in cultures treated with 1:8 diluted MTA additives. Compared with undifferentiated controls, the cells at the early stage of odontoblastic differentiation exhibited lower CaSR protein expression. The combination of 1:8 diluted MTA with 0.1 and 1.0 μmol/L R-568 led to significantly increased cell vitality but decreased alkaline phosphatase activity and mineralized deposit formation, and this negative effect could be attenuated by 1.0 μmol/L Calhex 231 supplementation. Quantitative polymerase chain reaction results showed a significant up-regulation of RUNX2, DSPP, DMP-1, and OCN gene expression in the 1 μmol/L R-568–treated hDPCs. Western blot analysis indicated that the treatment by MTA and R-568 alone or their combination gave no clear trend on the protein levels of CaSR and dentin sialophosphoprotein, whereas Calhex 231 can increase their expressions. In addition, the up-regulation of Akt phosphorylation was observed in R-568– and Calhex 231–treated hDPCs.ConclusionsOur data indicated that CaSR is expressed in human dental pulp and hDPCs and that it can negatively or positively regulate MTA-induced mineralization of hDPCs via the phosphoinositide 3-kinase/Akt pathway in a ligand-dependent manner, suggesting a therapeutic target for modulating reparative dentin formation.     

The Osteogenic Assessment of Mineral Trioxide Aggregate–based Endodontic Sealers in an Organotypic Ex Vivo Bone Development Model

IntroductionMineral trioxide aggregate (MTA)-based sealers are endodontic materials with widespread success in distinct clinical applications, potentially embracing direct contact with the bone tissue. Bone response to these materials has been traditionally addressed in vitro. Nonetheless, translational data are limited by the absence of native cell-to-cell and cell-to-matrix interactions that hinder the representativeness of the analysis. Ex vivo organotypic systems, relying on the culture of explanted biological tissues, preserve the cell/tissue composition, reproducing the spatial and organizational in situ complexity. This study was grounded on an innovative research approach, relying on the assessment of an ex vivo organotypic bone tissue culture system to address the osteogenic response to 3 distinct MTA-based sealers.MethodsEmbryonic chick femurs were isolated and grown ex vivo for 11 days in the presence of MTA Plus (Avalon Biomed Inc, Bradenton, FL), ProRoot MTA (Dentsply Tulsa Dental, Hohnson City, Germany), Biodentine (Septodont, Saint Maurdes Fosses, France), or AH Plus (Dentsply Sirona, Konstanz, Germany); the latter was used as a control material. Femurs were characterized by histologic, histochemical, and histomorphometric analysis. Gene expression assessment of relevant osteogenic markers was conducted by quantitative polymerase chain reaction.ResultsAll MTA-based sealers presented an enhanced osteogenic performance compared with AH Plus. Histochemical and histomorphometric analyses support the increased activation of the osteogenic program by MTA-based sealers, with enhanced collagenous matrix deposition and tissue mineralization. Gene expression analysis supported the enhanced activation of the osteogenic program. Comparatively, ProRoot MTA induced the highest osteogenic functionality on the characterized femurs.ConclusionsMTA-based sealers enhanced the osteogenic activity within the assayed organotypic bone model, which was found to be a sensitive system for the assessment of osteogenic modulation mediated by endodontic sealers.     

Initial Transient Accumulation of M2 Macrophage–associated Molecule-expressing Cells after Pulpotomy with Mineral Trioxide Aggregate in Rat Molars

Introduction

M2 (alternatively activated) macrophages are known to participate in wound healing and tissue repair. This study aimed to analyze the temporospatial changes in the distribution and density of M2 macrophage–associated molecule-expressing cells after pulpotomy with mineral trioxide aggregate (MTA) in rat molars to ascertain the role played by M2 macrophages in the healing of MTA-capped pulp tissue.

Methods

The maxillary first molars of 8-week-old Wistar rats were pulpotomized and capped with MTA. After 1–14 days, the teeth were examined after hematoxylin-eosin staining or immunoperoxidase staining of CD68 (a general macrophage marker) and M2 macrophage markers (CD163 and CD204). The density of positively stained cells was enumerated in the surface and inner regions (0–100 μm and 300–400 μm, respectively, from the wound surface).

Results

MTA capping initially caused mild inflammatory changes and the formation of a degenerative layer followed by progressive new matrix formation and calcified bridging. At 1–2 days, CD68-, CD163-, and CD204-positive cells started to accumulate beneath the degenerative layer, and the density of these cells was significantly higher in the surface region than in the inner region (P < .05). From 7 days onward, the 3 types of cells displayed an almost normal distribution beneath the newly formed dentinlike matrix.

Conclusions

After the pulpotomy of rat molars with MTA, M2 macrophage–associated molecule-expressing cells transiently accumulated beneath the degenerative layer under the MTA. This suggests that M2 macrophages participate in the initial phases of the healing of MTA-capped pulp tissue.     

Evaluation of pH and Calcium Ion Release of a Dual-cure Bisphenol A Ethoxylate Dimethacrylate/Mineral Trioxide Aggregate–based Root-end Filling Material

Introduction

The incorporation of light-curable resins has been proposed for mineral trioxide aggregate (MTA) to improve its properties and reduce its setting time. The aim of the present study was to assess the pH and calcium ion release of an experimental bisphenol A ethoxylate dimethacrylate/MTA-based root-end filling material (E-MTA) in comparison with white MTA Angelus (Angelus, Londrina, PR, Brazil) (W-MTA) and to evaluate the influence of the addition of calcium chloride (CaCl₂) on these properties.

Methods

Polyethylene tubes filled with the materials were immersed in deionized water for the measurement of pH (digital pH meter) and calcium release (atomic absorption spectrophotometry). The evaluations were performed at 3 and 24 hours and 7, 15, and 30 days. Data were measured using 2-way repeated measures of variance followed by the Holm-Sidak method (P < .05).

Results

All materials presented a reduction in the pH and released calcium ions during the 30 days of the study. E-MTA showed a significantly lower calcium ion release capacity when compared with W-MTA (P < .05). The calcium release of E-MTA + 5% CaCl₂ was similar to W-MTA (P > .05).

Conclusions

The monomer bisphenol A ethoxylate dimethacrylate added to MTA formed a material with a lower capacity of calcium release than W-MTA despite maintaining a similar pH. However, the addition of CaCl₂ improved the calcium release of this material.     

Odonto/Osteogenic Differentiation of Dental Pulp Stem Cells of Type 1 Diabetic Patients with Mineral Trioxide Aggregate/1α,25-Dihydroxyvitamin D3 Combination

IntroductionVitamin D3 plays an important role in the mineralization mechanism and is often deficient in diabetic patients. The objective of this study was to investigate the odonto/osteogenic differentiation potential of the combination of mineral trioxide aggregate (MTA)/1α,25-dihydroxyvitamin D3 (VD3) on dental pulp stem cells (DPSCs) of patients with type 1 diabetes mellitus (T1DM).MethodsDPSCs isolated from donors (control and T1DM) were cultured and characterized. Cell proliferation and wound healing assays were performed. DPSCs were exposed to 4 different media: growth medium (Dulbecco's modified Eagle's medium, 10% fetal bovine serum, antibiotic, and antimycotic), differentiation medium (DM) (growth medium plus ß-glycerophosphate and ascorbic acid), DM + MTA (DM plus 0.02 mg/mL MTA), and DM + MTA + VD3 (DM + MTA and 10 nmol/L vitamin D3). Odonto/osteogenic differentiation of DPSCs was evaluated by the alizarin red test, relative real-time polymerase chain reaction (dentin sialophosphoprotein, dentin matrix protein 1, collagen type 1 alpha 1, and osteocalcin), immunocytochemistry (antibone sialoprotein II, anti–dentin matrix protein 1, and anti–collagen type 1 alpha 1), and Western blot (dentin matrix protein 1 and osteocalcin) methods.ResultsThe proliferation rates of DPSCs isolated from controls were significantly higher than DPSCs isolated from T1DM in a time-dependent manner (P < .05). Alizarin red staining and the expression of odonto/osteogenic markers showed that odonto/osteogenic differentiation was more pronounced in controls (P < .05) compared with T1DM patients. Although DM + MTA caused the odonto/osteogenic differentiation in DPSCs derived from controls, DM + MTA + VD3 resulted in the odonto/osteogenic differentiation in DPSCs of T1DM patients (P < .05).ConclusionsOdonto/osteogenic differentiation was affected by both supplements used for differentiation and the systemic disease, diabetes mellitus. The differentiation potential of T1DM-derived DPSCs was clearly increased with the VD3 supplement, although it was not as efficient as in the controls. The VD3 supplement showed a positive effect on the differentiation of T1DM DPSCs compared with MTA alone.     

Direct Pulp Capping with Calcium Hydroxide,Mineral Trioxide Aggregate,and Biodentine in Permanent Young Teeth with Caries: A Randomized Clinical Trial

Introduction

Direct pulp capping treatment is intended to preserve pulp vitality, to avoid or retard root canal treatment, and, in cases with an open apex, to allow continued root development. Historically, calcium hydroxide (CH) was the gold standard material, but nowadays calcium silicate materials (CSMs) are displacing CH because of their high bioactivity, biocompatibility, sealing ability, and mechanical properties. However, more randomized clinical trials are needed to confirm the appropriateness of CSMs as replacement materials for CH in direct pulp capping procedures.

In Vitro Fracture Resistance of Roots Obturated with Epoxy Resin–based,Mineral Trioxide Aggregate–based,and Bioceramic Root Canal Sealers

Introduction

The aim of this study was to evaluate the fracture resistance of teeth filled with 3 different endodontic sealers.

Methods

Seventy-five single-rooted extracted mandibular premolars were decoronated to a length of 13 mm. The teeth were randomly divided into 5 groups (n = 15 for each group). In group 1, the teeth were left unprepared and unfilled (negative control), and in group 2, the teeth were left unobturated (positive control). The rest of the roots were prepared by using the ProTaper System up to a master apical file size of F3: group 3, bioceramic sealer (Endosequence BC sealer) + gutta-percha; group 4, mineral trioxide aggregate–based sealer (Tech Biosealer Endo) + gutta-percha; and group 5, epoxy resin–based sealer (AH Plus Jet) + gutta-percha. All root specimens were stored for 2 weeks at 100% humidity to allow the complete setting of the sealers. Each specimen was then subjected to fracture testing by using a universal testing machine at a crosshead speed of 1.0 mm/min⁻¹ until the root fractured. The force required to fracture each specimen was recorded, and the data were analyzed statistically.

Results

The fracture values of groups 3 and 5 were significantly higher than those of group 4 (P < .05). There was no significant difference between groups 3 and 5 (P > .05).

Conclusions

In contrast to Tech Biosealer Endo, Endosequence BC and AH Plus Jet sealer increased the force to fracture in root-filled single-rooted premolar teeth.     

Outcomes of Direct Pulp Capping by Using Either ProRoot Mineral Trioxide Aggregate or Biodentine in Permanent Teeth with Carious Pulp Exposure in 6- to 18-Year-Old Patients: A Randomized Controlled Trial

Introduction

This study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated.

Vitamin and Mineral Supplements: What Is the Dentist to Do?

BACKGROUND: Vitamins and minerals are essential for systemic and oral health and the prevention of nutrient deficiencies. The author reviews recommendations for their use, consumer intake patterns and considerations for dental practice. CONCLUSIONS: Vitamin and mineral supplements are designed to treat and prevent deficiency syndromes and promote health. Consumers frequently misuse them, as they are guided by the belief that these supplements will prevent diseases and cure symptoms. Scientific evidence demonstrates their limited usefulness in systemic disease prevention or treatment. The author reviews demonstrated benefits in select diseases. CLINICAL IMPLICATIONS: Being familiar with the appropriate uses of vitamin and mineral supplements, as well as nutrient-supplement and drug-supplement interactions, will give dental professionals the knowledge to question and advise patients using evidence-based resources.     

Mineral trioxide aggregate in management of immature teeth with open apices – A report of clinical cases

Injuries to immature permanent teeth due to trauma may eventually result in pulpal necrosis and the subsequent arrest of root development. These teeth are often difficult to treat as the associated open root apex hinders the placement of the root filling material. To overcome this drawback, various materials have been introduced to induce apex closure prior to endodontic treatment. One of the currently popular material for apexification is mineral trioxide aggregate due to its superior biocompatibility, good sealing ability & excellent marginal adaptability. The presented clinical cases justifies the successful nonsurgical management of traumatized upper anterior teeth with mineral trioxide aggregate (MTA).