Antimicrobial effect of bioceramic cements on multispecies microcosm biofilm: a confocal laser microscopy study

Objectives

To assess the viability of multispecies microcosm biofilm after contact with NeoMTA Plus, Biodentine, and MTA Angelus.

Materials and methods

Fifty-four human dentin blocks (4 × 5 × 4 mm) were allocated to Hawley retainers, worn by six volunteers for 72 h. The blocks were then individually incubated in BHI broth for 21 days at 37 °C. At the end of experimental time for biofilm growth, the samples were randomly divided into four groups (n = 12): NeoMTA Plus, Biodentine, MTA Angelus, and negative control. The materials were placed in contact with the blocks. All samples were placed in cell-culture plate wells and incubated in BHI broth for 7 days at 37 °C. One sample from each volunteer (n = 6) was analyzed by SEM to describe the biofilm morphology. CLSM was performed to determine the percentage of viable biofilm biovolume. The data were statistically analyzed by one-way ANOVA and Tukey’s multiple comparison test (α = 5%).

Results

SEM showed biofilm formed by spherical and rod-shaped bacteria surrounded by an extracellular matrix. No material was able to kill all biofilm cells, and all groups had more than 50% of viable bacteria. NeoMTA Plus was significantly different from the negative control group (P < .05).

Conclusions

All tested materials were not effective against multispecies microcosm biofilm.

Clinical relevance

NeoMTA Plus, Biodentine, and MTA Angelus were not effective against multispecies microcosm biofilm. It is essential to understand that these bioceramic cements are indicated for infected clinical situations. Thus, complementary disinfection procedures should be conducted prior to filling with these materials.

     

Influence of composition on setting kinetics of new injectable and/or fast setting tricalcium silicate cements

ObjectivesNew commercial tricalcium silicate based cements were elaborated to improve handling properties and setting time. The goals of the present work were: (i) to determine the composition of the new injectable and/or fast setting calcium silicate based cements, and (ii) to investigate the impact of the differences in composition on their setting kinetics.MethodsThe materials considered were Angelus MTA™, Biodentine™, MM-MTA™, MTA-Caps™, and ProRoot MTA™ as control.Elemental composition of materials was studied by Inductively Coupled Plasma-Atomic Emission Spectroscopy and X-ray Energy Dispersive analysis, whereas phases in presence were analyzed by Micro-Raman spectroscopy and X-ray Diffraction analysis and cement surface by Scanning Electron Microscope. Setting kinetics was evaluated using rheometry.ResultsElemental analysis revealed, for all cements, the presence of three major components: calcium, silicon and oxygen. Chlorine was detected in MM-MTA, MTA-Caps and Biodentine. Different radio-opacifiers were identified: bismuth oxide in ProRoot MTA, Angelus MTA and MM-MTA, zirconium oxide in Biodentine and calcium tungstate (CaWO₄) in MTA-Caps. All cements were composed of di- and tri-calcium silicate, except Biodentine for which only the latter was detected. Major differences in setting kinetics were observed: a modulus of 8 × 10⁸ Pa is reached after 12 min for Biodentine, 150 min for MM-MTA, 230 min for Angelus MTA and 320 min for ProRoot MTA. The maximum modulus reached by MTA-Caps was 7 × 10⁸ Pa after 150 min.SignificanceEven if these cements possess some common compounds, major differences in their composition were observed between them, which directly influence their setting kinetics.     

Application of a direct pulp capping cement containing S-PRG filler

Objectives

To evaluate new pulp capping cements containing surface pre-reacted glass ionomer (S-PRG) filler and to investigate ion release kinetics and pH shift of eluates from the cement.

Materials and methods

Molars of Wistar rats were directly pulp capped using three kinds of cement containing S-PRG filler and mineral tri-oxide aggregate (MTA) was used as a control. After 1, 2, or 4 weeks, histological evaluation was performed and differences of tertiary dentin formation were analyzed. Release of Sr²⁺, BO₃³⁻, SiO₃²⁻, Na⁺, and Al³⁺ ions was determined by inductively coupled plasma-atomic emission spectrometry, and F⁻ ion release was measured using a fluoride ion selective electrode. The pH of the eluate from each cement after mixing was measured with a pH electrode.

Results

One of S-PRG cements promoted tertiary dentin formation to the same extent as the control (p > 0.05) and it showed a tendency of less inflammatory response. This cement released more BO₃³⁻ and SiO₃²⁻, but less Sr²⁺, Na⁺, and F⁻ than other S-PRG specimens. Each cement recovered nearly neutral compared with glass ionomer cement.

Conclusions

S-PRG cement induced tertiary dentin formation based on multiple ion releases, suggesting that it is suitable as a pulp capping material.

Clinical relevance

This new material can be an alternative pulp capping agent to MTA.

     

Remineralization effects of conventional and experimental ion-releasing materials in chemically or bacterially-induced dentin caries lesions

Objectives

The aim of this study was to evaluate the remineralization effects of conventional and experimental ion-releasing materials on different artificial dentin carious lesions.

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Objectives

This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.

Materials and methods

A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s exact test, respectively.

Results

After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).

Conclusion

Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.

Clinical relevance

Direct pulp capping can be done successfully with this type of calcium silicate cement.

     

Coronal discoloration induced by calcium silicate-based cements used in full pulpotomy in mature permanent molars: a randomized clinical trial

Objectives

This study aimed to randomly compare in vivo coronal discoloration at 6 and 12 months after full pulpotomy in mature permanent molars using MTA, Biodentine, and TotalFill and to investigate the effect of variables such as remaining buccal wall thickness and time to achieve hemostasis.

Materials and methods

One hundred eight teeth that met the inclusion criteria received full pulpotomy and were randomly divided into 3 groups via a block randomization technique according to the calcium silicate cement (CSC): ProRoot WMTA, TotalFill, or Biodentine. Assessment of tooth color was carried out using a spectrophotometric device (VITA Easyshade Compact) after composite placement (T0), at 6- and 12-month follow-up. Buccal wall thickness and time to hemostasis were recorded. The primary outcome measure (color change ΔE) was calculated, and the results were analyzed by three-way ANOVA and crosstabulations in relation to material type and effect of variables.

Results

Four cases were excluded after pulpotomy failure; 81 teeth were evaluated at 6 months and 95 teeth at 12 months. All CSCs caused tooth discoloration (defined as ΔE > 3.7); MTA significantly caused the highest color change at 6- and 12-month follow-up (76% (19/25) and 87.5% (28/32), respectively) compared to Biodentine (41% (9/22), 48% (13/27)) and TotalFill (44% (15/34), 53% (19/53)) (p = 0.022, p = 0.002), while no significant difference was found between the Biodentine and TotalFill groups (p = 0.813, p = 0.8). Buccal wall thickness (above or below 2.7 mm) had a significant effect on the degree of discoloration (p = 0.004).

Conclusions

The 3 CSCs caused tooth discoloration based on the threshold of ΔE > 3; the remaining buccal wall thickness was a significant factor. The use of Biodentine and TotalFill instead of MTA is encouraged to minimize discoloration.

Clinical relevance

While experimental studies report coronal discoloration after CSCs use, clinical data is lacking. This study assessed discoloration using a spectrophotometric device. The use of materials with lower discoloration potential in pulpotomy is encouraged.

Trial registration

The study was registered with clinical trial registration number: NCT04346849 on 14.4.2020.

     

A randomized clinical trial on the use of medical Portland cement,MTA and calcium hydroxide in indirect pulp treatment

Objectives

Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin–pulp complex of permanent and primary teeth treated with two-step IPT.

Materials and methods

In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n?=?31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment.

Results

The IPT had a high success rate of 90.3 % regardless of the material used (p?=?0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p?<?0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p?=?0.01/Mutans Strep. p?=?0.07).

Conclusions

The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement.

Clinical relevance

The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.     

Glass-ionomer and calcium silicate-based cements interactions with human dentine in health and disease: Two-photon fluorescence microscopy and Raman spectroscopy analysis.

ObjectivesTo investigate the potential mineralising effects of calcium silicate-based dentine replacement material (Biodentine?) in comparison with glass-ionomer cement (GIC) (Fuji IX?) on different human dentine substrates using a multimodal non-invasive optical assessment.MethodsCements were applied on artificially demineralised or naturally carious dentine and stored for 4 weeks in phosphate-rich media +/- tetracycline used for mineralisation labelling. Interfacial dentine was examined from the same sample and location before and after aging using two-photon fluorescence microscopy, fluorescence lifetime imaging (FLIM) and second harmonic generation (SHG) imaging. Additionally, Raman spectroscopy was used to detect changes in the mineral content of dentine.ResultsSignificant changes in the fluorescence intensity and lifetime were detected in partially demineralised dentine and caries-affected dentine underneath both tested cements, after storage (p < 0.001). This was associated with a significant increase in the mineral content as indicated by the increased intensity of the phosphate Raman peak located at 959 cm^?1 (p < 0.0001). Caries-infected dentine showed significant fluorescence changes under Biodentine? after storage (p < 0.001), but not under GIC (p = 0.44). Tetracycline binding induced a reduction in the fluorescence lifetime with comparable increase in the fluorescence intensity in both cements’ groups within the affected dentine (p < 0.001). SignificanceTwo-photon fluorescence microscopy can be used efficiently for non-destructive in-vitro dentine caries characterisation providing a technique for studying the same dentine-cement interface over time and detect changes. Biodentine? demonstrated comparable remineralising potential to GIC, in addition to inducing remineralisation of caries-infected dentine. This may suggest using Biodentine? as part of minimally invasive operative dentistry (MID) in caries management.     

Remineralization capacity of carious and non-carious white spot lesions: clinical evaluation using ICDAS and SS-OCT

Objectives

To assess the remineralization capacity of carious, non-carious, and combined white spot lesions (WSLs) using the ICDAS and SS-OCT.

Materials and methods

This clinical trial was based on a quasi-experimental design. Forty-two healthy subjects (median age 26.6 years), who visited university hospital and had at least one WSL with an ICDAS score of 2 or 1, were recruited. The subjects chewed a non-blind sugar-free gum containing bioavailable calcium and fluoride for 3 months. The remineralization capacities of carious and non-carious 121 WSLs were assessed using ICDAS by two calibrated non-blind examiners and optical boundary depth (BD) by SS-OCT at a monthly recall. The outcome variables, transitions of ICDAS score, mean BD, and mean BD recovery rate (RR%), were statistically analyzed using the chi-square test, two way-repeated measures ANOVA, and Wilcoxon rank sum test, respectively (alpha = 0.05).

Results

Based on the visual inspection, OCT images at the baseline, 72 WSLs were purely carious, 20 were non-carious (developmental) lesions, while 29 were combined (carious-developmental). The responses of WSLs over time showed to be highly variable. There was a significant difference in transitions of ICDAS scores after 3 months between carious and non-carious WSLs (p < 0.05) and non-carious and combined WSLs (p < 0.05). Carious and combined WSLs underwent significant changes in the mean BD between baseline (161.8 ± 56.8 μm) and 2 months (130.7 ± 57.4 μm) or 3 months (119.1 ± 57.5 μm) (p < 0.05), while there was no significant difference between baseline (132.2 ± 26.2 μm) and 2 months (122.8 ± 24.1 μm) or 3 months (119.8 ± 22.6 μm) in non-carious WSLs (p > 0.05). There was a significant difference in mean RR% after 2 and 3 months between carious and non-carious WSLs (p < 0.05).

Conclusions

The remineralization capacity of WSL was variable among the cases and subjects, and depended on the WSLs history, etiology (carious, non-carious, or combined lesion) and structure (histological pattern).

Clinical relevance

Carious WSLs showed the highest remineralization potential.

     

Stresses in Teeth with External Cervical Resorption Defects Restored with Different Biomimetic Cements: A Finite Element Analysis

IntroductionThis study compared the stress distributions in teeth with simulated external cervical resorption defects restored with different restorative materials and identified areas of high stress concentration.MethodsA maxillary central incisor created in a scanned model using HyperWorks software (Altair Engineering Inc, Troy, MI) served as the control. External cervical resorption defects based on Shanon Patel’s classification were created (1Bd/2Bd/3Bd) in the scanned model. The defects were restored using mineral trioxide aggregate, Biodentine, glass ionomer cement, and Bioaggregate. On all the models, a force of 100 N was applied on the palatal aspect 2 mm incisal to the cingulum directed at 45° along the long axis of the tooth.ResultsThe stresses generated in dentin and cementum are less, with a restorative material having a high Young’s modulus. For the 1Bd defect, MTA and Bioaggregate showed least stresses in dentin and cementum, respectively, whereas Biodentine had consistently lower stresses in dentin and cementum. Larger defects like 2Bd and 3Bd restored with Bioaggregate exhibited minimum stresses in dentin and cementum.ConclusionsBioaggregate and Biodentine replace dentin with maximum stress and maximum strain. Elastic moduli similar to or higher than dentin are preferred for restoring cervical third resorptive lesions of the tooth.     

Evaluation of shear bond strength of two resin-based composites and glass ionomer cement to pure tricalcium silicate-based cement (Biodentine?)

Objectives

Tricalcium silicate is the major constituent phase in mineral trioxide aggregate (MTA). It is thus postulated that pure tricalcium silicate can replace the Portland cement component of MTA. The aim of this study was to evaluate bond strength of methacrylate-based (MB) composites, silorane-based (SB) composites, and glass ionomer cement (GIC) to Biodentine^® and mineral trioxide aggregate (MTA).

Material and Methods

Acrylic blocks (n=90, 2 mm high, 5 mm diameter central hole) were prepared. In 45 of the samples, the holes were fully filled with Biodentine^® and in the other 45 samples, the holes were fully filled with MTA. The Biodentine^® and the MTA samples were randomly divided into 3 subgroups of 15 specimens each: Group-1: MB composite; Group-2: SB composite; and Group-3: GIC. For the shear bond strength (SBS) test, each block was secured in a universal testing machine.

Results

The highest (17.7±6.2 MPa) and the lowest (5.8±3.2 MPa) bond strength values were recorded for the MB composite-Biodentine^® and the GIC-MTA, respectively. Although the MB composite showed significantly higher bond strength to Biodentine (17.7±6.2) than it did to MTA (8.9±5.7) (p<0.001), the SB composite (SB and MTA=7.4±3.3; SB and Biodentine^®=8.0±3,6) and GIC (GIC and MTA=5.8±3.2; GIC and Biodentine=6.7±2.6) showed similar bond strength performance with MTA compared with Biodentine (p=0.73 and p=0.38, respectively).

Conclusions

The new pure tricalcium-based pulp capping, repair, and endodontic material showed higher shear bond scores compared to MTA when used with the MB composite.     

Effect of temporary cements on the microtensile bond strength of self-etching and self-adhesive resin cement

Objective. The aim of this study was to evaluate the microtensile bond strength (µTBS) of self-etching and self-adhesive resin cement systems to dentin affected by the presence of remnants of either eugenol-containing or eugenol-free temporary cements. Materials and methods. Thirty extracted teeth were obtained and a flat dentin surface was exposed on each tooth. Acrylic blocks were fabricated and cemented either with one of two temporary cements, one zinc oxide eugenol (ZOE) and one eugenol free (ZOE-free), or without cement (control). After cementation, specimens were stored in water at 37°C for 1 week. The restorations and remnants of temporary cements were removed and dentin surfaces were cleaned with pumice. Resin composite blocks were cemented to the bonded dentin surfaces with one of two resin cements, either self-etching (Panavia F 2.0) or self-adhesive (RelyX U-100). After 24 h, the specimens were sectioned to obtain beams for submission to µTBS. The fracture mode was evaluated under a stereoscopic loupe and a scanning electron microscope (SEM). Data from µTBS were submitted to two-way repeated-measure ANOVA and the Tukey test (alpha = 0.05). Results. The cross-product interaction was statistically significant (p < 0.0003). The presence of temporary cements reduced the bond strength to Panavia self-etching resin cements only (p < 0.05). Fracture occurred predominantly at the dentin–adhesive interface. Conclusions. The presence of eugenol-containing temporary cements did not interfere in the bond strength to dentin of self-adhesive resin cements.     

The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars

Objectives

This ex vivo study was performed to investigate the effect of radiotherapy (RT) delivery time on fracture resistance of mandibular premolars filled with Biodentine or gutta-percha/sealer (GPS).

Materials and methods

Seventy-two mandibular premolars were used in this study. Randomly selected 24 teeth were kept intact for the control groups (with and without irradiation). Then, the remaining 48 teeth were randomly assigned into 4 groups (n = 12) according to RT delivery time (irradiated before or after root canal treatment) and obturation materials as follows: Group RT + GPS, Group: GPS + RT, Group RT + Biodentine and Group Biodentine + RT. The samples were either initially endodontically treated and then irradiated or initially irradiated and then endodontically treated with one of the abovementioned materials. The samples were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy in 30 fractions over 6 weeks. The roots were embedded in self-polymerizing acrylic resin. The fracture resistance was evaluated in a universal testing machine. Data was analyzed by one-way ANOVA and Games-Howell post hoc test at p < 0.05.

Results

Radiation therapy significantly reduced fracture resistance of intact teeth (p < 0.05). The highest fracture resistance was observed in intact/non-irradiated teeth and the lowest fracture resistance in Biodentine + RT group (p < 0.05). The effect of RT delivery time was insignificant when GPS was preferred as the root canal filling material (p > 0.05); it was significant when preferring Biodentine (p < 0.05). When RT was applied to the teeth after Biodentine obturation, the fracture resistance decreased significantly compared to the teeth that were obturated with GPS after or before RT application (p < 0.05).

Conclusion

Both RT time and obturation materials (Biodentine or gutta-percha/sealer) affect the fracture resistance of the endodontically treated teeth.

Clinical relevance

Endodontic treatment could be completed with both materials after RT; however, when the endodontic treatment was initially completed and the teeth were subsequently exposed to RT, it was shown that the reinforcement effect of Biodentine decreased.

     

The effect of chlorhexidine and dimethyl sulfoxide on long-term sealing ability of two calcium silicate cements in root canal

ObjectivesTo evaluate the long-term effect of chlorhexidine (CHX) and dimethyl sulfoxide (DMSO) on the sealing ability and biomineralization of two different calcium silicate cements (CSC) in root canal.MethodsSixty human third molar root canals were obturated with ProRoot MTA or Biodentine. Before obturation the canals were irrigated with saline (control), 2% CHX or 5% DMSO. Microleakage was tested after three days and after six months. After additional six months (12 months after root filling) the roots were cut into 2 mm thick dentine discs. The discs were stored in artificial saliva for one year. The bond strength was measured with the push-out method, and the failure mode was evaluated with a stereomicroscope. The most apical disc of each tooth was used for Vickers hardness test.ResultsNo significant differences between the groups was found in initial microleakage. The leakage increased significantly during the 6-month storage in all groups except in Biodentine-CHX group and Biodentine-DMSO group. CHX and DMSO irrigation significantly increased the leakage with ProRoot MTA with time, but there was no statistically significant difference compared to the ProRoot MTA-control group at six months’ time point. CHX significantly reduced the push-out bond strength of ProRoot MTA. With Biodentine irrigation with CHX or DMSO resulted with significantly higher push-out strength compared to the Biodentine control group. Fracture analysis showed statistically significant difference in the distribution of the fractures between the groups, but neither CHX nor DMSO change the fracture pattern statistically significantly. With Vickers hardness test ProRoot MTA with and without DMSO as the final irrigant showed significantly higher dentin hardness than any Biodentine-group.SignificanceConsidering that aging increased the leakage in all groups except with Biodentine-DMSO and the differences in the push-out strength and surface microhardness data, it appears that the time-related biomineralizing effect of MTA and Biodentine does not improve sealing to dentin. CHX significantly reduced ProRoot MTA bond strength and increased pure adhesive failures with both cements.     

A Novel Accelerator for Improving the Handling Properties of Dental Filling Materials

IntroductionMineral trioxide aggregate (MTA) fulfills many of the ideal properties of a root end filling material and repair material for furcal perforation. However, its low cohesive property often makes it difficult to handle. To improve the handling properties of MTA root canal filling materials, MTA-like cement was made, and calcium lactate gluconate (CLG) aqueous solution was used to shorten the setting time and enhance the paste viscosity.MethodsCLG solution was prepared by mixing lactic acid, glucono delta lactone, and calcium oxide by wet process. The crystalline property of the CLG powder was characterized by x-ray diffraction. The MTA-like cements were prepared by mixing Portland cement/bismuth oxide/gypsum (75/20/5); ProRoot white MTA (Dentsply Tulsa Dental, Tulsa, OK) was used as a control group. The influence of various liquid phases on initial setting time, handling properties, and pH value were investigated by a Vicat needle, questionnaire of operational hand feel, and pH meter, respectively.ResultsBy using 23.1wt% CLG solutions as a liquid phase, the setting time of white MTA was significantly decreased from 155.5 ± 5.0 to 12.3 ± 2.5 minutes. The pH values for hydrated white MTA with deionized water and 23.1 wt% CLG solutions were 12.29 ± 0.02 and 11.81 ± 0.04 at 72 hours.ConclusionsThe results suggest that the addition of amorphous CLG-based liquid phase provides improvement in sealing ability as well as clinical manageability of dental filling materials.     

Treatment Outcome Following Direct Pulp Capping Using Bioceramic Materials in Mature Permanent Teeth with Carious Exposure: A Pilot Retrospective Study

Introduction

The aim of this study was to investigate the sequelae of direct pulp capping (DPC) using mineral trioxide aggregate (MTA) and Biodentine in mature permanent teeth with carious exposure.

Dentin-cement interfacial interaction: calcium silicates and polyalkenoates

The interfacial properties of a new calcium-silicate-based coronal restorative material (Biodentine?) and a glass-ionomer cement (GIC) with dentin have been studied by confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), micro-Raman spectroscopy, and two-photon auto-fluorescence and second-harmonic-generation (SHG) imaging. Results indicate the formation of tag-like structures alongside an interfacial layer called the "mineral infiltration zone", where the alkaline caustic effect of the calcium silicate cement's hydration products degrades the collagenous component of the interfacial dentin. This degradation leads to the formation of a porous structure which facilitates the permeation of high concentrations of Ca(2+), OH(-), and CO(3) (2-) ions, leading to increased mineralization in this region. Comparison of the dentin-restorative interfaces shows that there is a dentin-mineral infiltration with the Biodentine, whereas polyacrylic and tartaric acids and their salts characterize the penetration of the GIC. A new type of interfacial interaction, "the mineral infiltration zone", is suggested for these calcium-silicate-based cements.     

Clinical and radiographic evaluation of vital pulp therapy in open apex teeth with MTA and ZOE

The purpose of this study was to report the success rate of using mineral trioxide aggregate (MTA) and zinc oxide eugenol (ZOE) as vital pulp therapy agents in immature permanent teeth with carious or traumatic pulp exposure. Subjects were children with permanent teeth requiring pulpotomy (apexogenesis) and without systemic diseases. Both ZOE and MTA treatments as pulpotomy agents showed clinical and radiographic success in immature permanent teeth. Although MTA was more successful, it is more expensive, and dentin bridges may develop over canal orifices, complicating future root canal therapy.     

Novel evaluation method of dentin repair by direct pulp capping using high-resolution micro-computed tomography

Objectives

We evaluated a novel micro-computed tomography (micro-CT) assessment for quality and quantity of dentin repair, which is difficult to visualize by histological analysis, after direct pulp capping under standardized cavity preparation.

Materials and methods

Standardized cavities were prepared on Wistar rats and direct pulp capping was performed using two commercial bioceramics, ProRoot MTA, and iRoot BP Plus. After 2 or 4 weeks, quality and quantity of tertiary dentin formation were evaluated using high-resolution micro-CT analyses including dentin mineral density, dentin mineral contents, compactness and integrity of tertiary dentin, and dentin volume with/without void space. Reproducibility of micro-CT analyses was confirmed by histological evaluation of the same specimen.

Results

The exposed pulp area sizes were similar between iRoot BP Plus and ProRoot MTA. Micro-CT analysis of 2-week samples showing compactness of tertiary dentin was significantly higher in iRoot BP Plus than ProRoot MTA (p?<?0.05). Tertiary dentin volume without void space, dentin mineral contents, and density were not significantly different between the groups. In 4-week samples, a significant increase was observed in dentin mineral density, compactness, and dentin volume with/without void space induced by iRoot BP Plus (p?<?0.05). Micro-CT analysis of tertiary dentin integrity demonstrated that some ProRoot MTA specimens had small defects and lacked continuity (6/512 images). No defects were observed with iRoot BP Plus.

Conclusions

Micro-CT analysis was confirmed as an accurate, objective, and inclusive approach for evaluating quality and quantity of dentin repair.

Clinical relevance

These multifaceted approaches to evaluate pulp capping materials may accelerate review processes, ultimately improving vital pulp therapy.

     

Marginal Gaps between 2 Calcium Silicate and Glass Ionomer Cements and Apical Root Dentin

Introduction

The outcome of periapical surgery has been directly improved with the introduction of novel material formulations. The aim of the study was to compare the retrograde obturation quality of the following materials: calcium silicate (Biodentine; Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (MTA+; Cerkamed Company, Stalowa Wola, Poland), and glass ionomer cement (Fuji IX; GC Corporation, Tokyo, Japan).