Odontogenic Effect of a Fast-setting Pozzolan-based Pulp Capping Material

Introduction

Mineral trioxide aggregate (MTA) is widely used as a pulp capping material. Recently, a MTA-derived fast-setting pozzolan cement (Endocem; Maruchi, Wonju, Korea) was introduced in the endodontic field. Our aim in this study was to investigate the odontogenic effects of this cement in vitro and in vivo.

Methods

Human dental pulp cells (hDPCs) were cultured, and the effects of Endocem and a previously marketed MTA (ProRoot; Dentsply, Tulsa, OK) on biocompatibility were evaluated by assessing cell morphology and performing a cell viability test. Chemical composition of each material was analyzed by energy-dispersive X-ray spectroscopic analysis. Odontoblastic differentiation was analyzed by alkaline phosphatase activity and alizarin red S staining. The expression of odontogenic-related markers, namely dentin sialophosphoprotein, dentin matrix protein 1, and osteonectin, was evaluated by real-time polymerase chain reaction, Western blotting, and immunofluorescence analysis. Pinpoint pulp exposures were made on rat teeth and then capped with ProRoot or Endocem. After 4 weeks, reparative tertiary dentin formation and inflammatory responses were investigated histologically.

Results

The biocompatibility of Endocem was similar to that of ProRoot. Energy-dispersive X-ray spectroscopic analysis showed that ProRoot and Endocem contained similar elemental constituents such as calcium, oxygen, and silicon. Alkaline phosphatase activity and mineralized nodule formation increased in ProRoot- and Endocem-treated cells compared with medium only–treated cells in the control group (P < .05). The expression of odontogenic-related markers was significantly higher in the ProRoot- and Endocem-treated groups than the control group (P < .05), but there was no significant difference in the expression of these markers between the 2 experimental groups (P > .05). Four weeks after the pulp capping procedure, continuous tertiary dentin had formed directly underneath the capping materials and the pulp exposure area in all samples in the 2 treated groups. Furthermore, most specimens either had no inflammation or minor pulpal inflammation.

Conclusions

Our results indicate that ProRoot and Endocem have similar biocompatibility and odontogenic effects. Therefore, Endocem is as effective a pulp capping material as ProRoot.     

Tooth Discoloration after the Use of New Pozzolan Cement (Endocem) and Mineral Trioxide Aggregate and the Effects of Internal Bleaching

Introduction

The aim of this study was to evaluate tooth discoloration after the use of mineral trioxide aggregate (MTA) and to examine the effect of internal bleaching on discoloration associated with MTA.

Methods

Thirty-two teeth were endodontically treated. Three-millimeter plugs of MTA, ProRoot, Angelus, or Endocem were placed on the access cavities of 24 teeth. Eight teeth served as the control group. After 24 hours, the access cavities were restored, and the tooth color was recorded at baseline and at 1, 2, 4, 8, and 12 weeks. After 12 weeks, the MTA materials were removed under a microscope, and an internal bleaching treatment was performed. After removal of the MTA materials and after a 1-week bleaching treatment, the color changes were measured, and the MTA-dentin interfaces were observed under a microscope.

Results

The ProRoot and Angelus groups displayed increasing discoloration during a period of 12 weeks. The discoloration associated with ProRoot and Angelus was observed at the MTA-dentin interface and on the interior surface of the dentin. However, the Endocem groups demonstrated no significant discoloration (P < .05). No marginal discoloration was observed around the material in the Endocem group. Removal of the discolored MTA was effective for resolving the discoloration in all of the experimental groups (P < .05). However, a subsequent internal bleaching treatment was not significantly effective compared with the removal of MTA.

Conclusions

ProRoot and Angelus caused tooth discoloration. However, Endocem did not affect the contacting dentin surface. Removing the discolored MTA materials contributed more to resolving the tooth discoloration than post-treatment internal bleaching.     

Anti-inflammatory and Mineralization Effects of ProRoot MTA and Endocem MTA in Studies of Human and Rat Dental Pulps In Vitro and In Vivo

Introduction

Few studies have reported direct pulp capping in inflamed pulp conditions. The purpose of this study was to investigate the in vitro and in vivo responses of dental pulp during direct pulp capping using various pulp capping materials in inflamed conditions.

Ion Release,Porosity, Solubility,and Bioactivity of MTA Plus Tricalcium Silicate

Introduction

The aim of this study was to evaluate MTA Plus (Prevest Denpro Limited, Jammu, India, for Avalon Biomed Inc) material's properties, namely calcium release, the pH change, solubility, water sorption, porosity, surface morphology, and apatite-forming ability after immersion in simulated body fluid.

Methods

Two tricalcium silicate powders (MTA Plus and ProRoot MTA; Dentsply Tulsa Specialties, Tulsa, OK) and Dycal (Dentsply Caulk, Milford, DE) were tested. After incubation at 37°C and 99% relative humidity, calcium and hydroxyl ion release were tested up to 28 days in deionized water at 37°C. Water absorption, interconnected pores, apparent porosity, and solubility were measured after 24 hours of immersion in deionized water at 37°C. The morphologic and elemental analysis of the materials' surfaces were examined using an environmental scanning electron microscope/energy dispersive x-ray analysis after storage at 37°C for 1–28 days in simulated body fluid using the ISO 23317 method.

Results

All 3 materials created an alkaline pH within 3 hours, which continued for 28 days. MTA Plus had a higher ion release than ProRoot MTA and Dycal; the use of the MTA Plus gel enhanced the initial calcium release and the increase of the pH. Both MTA materials were more porous, water soluble, and water sorptive than Dycal and more bioactive. After aging in simulated body fluid, MTA Plus material caused precipitation of an apparent calcium phosphate layer.

Conclusions

MTA Plus showed improved reactivity and prolonged capability to release calcium and increase the local pH to alkaline values in comparison with ProRoot MTA. These pronounced ion-releasing properties are interlinked with its noticeable porosity, water sorption, and solubility and with the formation of calcium phosphorus minerals. The finer calcium silicate powder may explain the higher ion release, water sorption, porosity, and solubility of MTA Plus compared with ProRoot MTA. For clinicians, MTA Plus represents a lower-cost bioactive tricalcium silicate material with interesting chemical-physical properties that could be a convenient alternative to the conventional calcium silicate mineral trioxide aggregate–like cements.     

Heavy metal analysis of ortho MTA and ProRoot MTA

Introduction

Recently, several kinds of mineral trioxide aggregate (MTA)-based products have been introduced in endodontics. Ortho MTA (BioMTA, Seoul, Republic of Korea) is one of those products, which was developed for retrograde filling, perforation repair, orthograde root canal obturation, and direct pulp capping. The inclusion of heavy metals in MTA-based materials is of concern because they come into direct contact with hard and soft tissues. The aim of this study was to investigate and compare the levels of arsenic (As), chromium (Cr), hexavalent chromium (Cr⁶⁺), and lead (Pb) in Ortho MTA and ProRoot MTA.

Methods

One gram of each MTA was digested using a mixture of hydrochloric and nitric acids and filtered. The As, Cr, and Pb in the resulting filtrates were analyzed by inductively coupled plasma-optical emission spectrometry. The level of Cr⁶⁺ was measured by the methods suggested in the Korean Standard L 5221. The results were statistically analyzed using the Mann-Whitney U test.

Results

The concentration of As in ProRoot MTA was 1.16 ppm, but As was not detected in Ortho MTA. Cr⁶⁺ and Pb were not detected in either MTA. Ortho MTA contained significantly less Cr than ProRoot MTA (P < .05).

Conclusions

Ortho MTA and ProRoot MTA meet the ISO specification 9917-1 regarding the safety limits of As and Pb and are safe biomaterials when the purity of As, Cr⁶⁺, and Pb is considered.     

Cytotoxicity of Newly Developed Ortho MTA Root-end Filling Materials

Introduction

Various materials have been advocated for use as root-end filling materials. The purpose of the present in vitro study was to compare the cytotoxicity of 4 root-end filling materials: glass ionomer cement (GIC; Fuji II, GC Corp, Tokyo, Japan), reinforced zinc oxide–eugenol cement (IRM; Dentsply Tulsa Dental, Tulsa, OK), and 2 types of mineral trioxide aggregate.

Methods

This study used MG-63 cells derived from a human osteosarcoma. To quantitatively evaluate the cytotoxicity of test materials, the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay was used. The cells were exposed to the extracts and incubated. Cell viability was recorded by measuring the optical density of each test well in reference to controls. Each specimen was examined by scanning electron microscopy for the observation of cell morphology.

Results

The XTT assay showed that the cell viability of ProRoot MTA (Dentsply Tulsa Dental) was higher than that of GIC and Ortho MTA (BioMTA, Seoul, Republic of Korea) at all time points. IRM showed significantly lower cell viability than the other groups. The scanning electron microscopic analysis revealed that elongated, dense, and almost confluent cells were observed in the cultures of GIC, Ortho MTA, and ProRoot MTA specimens. In contrast, cells on the surface of IRM were rounded in shape, and the numbers and the density of the cells were smaller than that in the other groups.

Conclusions

ProRoot MTA and GIC showed good biocompatibility in this study. However, Ortho MTA showed lower biocompatibility compared with ProRoot MTA and GIC.     

Acid and Microhardness of Mineral Trioxide Aggregate and Mineral Trioxide Aggregate–like Materials

Introduction

The aim of this study was to compare the surface microhardness of BioAggregate, ProRoot MTA, and CEM Cement when exposed to an acidic environment or phosphate-buffered saline (PBS) as a synthetic tissue fluid.

Methods

Ninety cylindrical molds made of polymethyl methacrylate with an internal diameter of 6 mm and height of 4 mm (according to ASTM E384 standard for microhardness tests) were fabricated and filled with BioAggregate (n = 30), tooth-colored ProRoot MTA (n = 30), or CEM Cement (n = 30). Each group was then divided into 3 subgroups of 10 specimens consisting of those exposed to distilled water, exposed to PBS (pH = 7.4), or exposed to butyric acid (pH = 5.4). After 1 week the Vickers surface microhardness test was performed. Statistical analysis included 2-way analysis of variance, followed by post hoc Dunnett T3 in cases with lack of homoscedasticity and Tukey honestly significant difference in cases with homoscedasticity.

Results

The indentations obtained from the CEM Cement specimens exposed to an acidic pH were not readable because of incomplete setting. There was a significant difference between the microhardness of the materials regardless of the environmental conditions (P < .001). In all the environmental conditions, MTA had significantly higher and CEM Cement had significantly lower microhardness values (P < .001). All experimental cements had significantly higher microhardness values when exposed to PBS (P < .001) and had significantly lower microhardness values when exposed to butyric acid (P < .001).

Conclusions

The surface microhardness of BioAggregate, ProRoot MTA, and CEM Cement was reduced significantly by exposure to butyric acid and increased significantly by exposure to PBS. In all environmental conditions, MTA had significantly higher microhardness values.     

Ion Release,Microstructural, and Biological Properties of iRoot BP Plus and ProRoot MTA Exposed to an Acidic Environment

Introduction

This study evaluated how exposing the novel calcium silicate nanoparticulate bioceramic iRoot BP Plus (Innovative Bioceramix, Vancouver, Canada) to an acidic environment affects ion release from this material and alters MC3T3-E1 preosteoblast viability on and attachment to this material. These factors were compared against those of ProRoot MTA under similar conditions.

Comparative Micro–computed Tomographic Evaluation of the Sealing Quality of ProRoot MTA and MTA Angelus Apical Plugs Placed with Various Techniques

Introduction

This study compared the effects of different mixing and placement techniques on sealing of ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland) and MTA Angelus (Soluçoes Odontologicas, Londrina, Brazil) apical plugs using micro–computed tomographic (micro-CT) imaging.

Effect of Various Mixing and Placement Techniques on the Flexural Strength and Porosity of Mineral Trioxide Aggregate

Introduction

The aim of this study was to evaluate the effect of mechanical and manual mixing as well as the effect of ultrasonic agitation during placement on the flexural strength and porosity of mineral trioxide aggregate (MTA).

Methods

White ProRoot MTA and white MTA Angelus were used. One gram of each powder was mixed with a 0.34-g aliquot of distilled water. Specimens were mixed either by mechanical mixing of capsules for 30 seconds at 4500 rpm or by a saturation technique and application of a condensation pressure of 3.22 MPa for 1 minute. The mixed slurries of all materials were loaded into 2 × 2 × 25 mm molds for testing flexural strength and 3 × 4 mm molds for evaluation of porosity. Half of the specimens were placed in the stainless steel molds by using indirect ultrasonic activation. All specimens were incubated for 4 days. Micro–computed tomography was used to determine the porosity of each specimen, and a 3-point bending test was used to evaluate flexural strength. Tukey honestly significant difference and independent t tests were carried out to compare the means at a significance level of P < .05.

Results

Irrespective of mixing and placement techniques applied, the flexural strength values of ProRoot MTA were significantly greater than those of MTA Angelus (P < .05). A medium negative correlation was found between flexural strength values and total porosity percentage.

Conclusions

Although mechanical mixing of encapsulated cements was quicker and provided more consistent mixes, this technique along with ultrasonic agitation was not associated with a significant advantage in terms of flexural strength and total porosity over manual mixing.     

Evaluation of Compressive Strength of Hydraulic Silicate-based Root-end Filling Materials

Introduction

Hydraulic silicate cements such as mineral trioxide aggregate (MTA) have many clinical advantages. Newer hydraulic silicate materials have been developed that improve on the limitations of mineral trioxide aggregate such as the long setting time and difficult handling characteristics. The purpose of this study was to examine the effect of saline and fetal bovine serum (FBS) on the setting and compressive strength of the following hydraulic silicate cements: ProRoot MTA (white WMTA; Dentsply International, Tulsa Dental Specialties, Johnson City, TN), EndoSequence Root Repair Material (Brasseler USA, Savannah, GA), MTA Plus (MTAP; Avalon Biomed Inc, Bradenton, FL), and QuickSet (QS; Avalon Biomed Inc, Bradenton, FL).

Methods

Samples of root-end filling materials were compacted into polyethylene molds. Samples were exposed to FBS or saline for 7 days. A universal testing machine was used to determine the compressive strengths.

Results

QS had significantly lower compressive strength than all other materials (P < .001). White MTA and MTAP mixed with liquid had lower compressive strengths after exposure to FBS compared with saline (P = .003). ERRM, MTAP mixed with gel, and QS were not affected by the exposure to FBS.

Conclusions

New silicate-based root-end filling materials, other than QS, have compressive strength similar to MTA. Within the limits of this study, premixed materials and those mixed with antiwashout gel maintain their compressive strength when exposed to biological fluids.     

Effect of Acid Etching Procedures on the Compressive Strength of 4 Calcium Silicate–based Endodontic Cements

Introduction

The purpose of this study was to evaluate the effect of acid etching on the compressive strength of 4 calcium silicate–based cements.

Methods

One gram of each corresponding powder of ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN), MTA Angelus (Angelus, Londrina, PR, Brazil), and CEM cement (BioniqueDent, Tehran, Iran) and a 0.33-g aliquot of liquid were placed in a plastic mixing capsule that was then mechanically mixed for 30 seconds at 4500 rpm in an amalgamator. For the preparation of Biodentine (Septodont, Saint Maur-des-Fossés, France), the liquid provided was added to the powder within the plastic capsule supplied by the manufacturer and then mechanically mixed for 30 seconds at 4500 rpm using the amalgamator. The resulting slurries were then placed incrementally into 40 cylindrical molds to give a total of 160 specimens that were incubated at 37°C for a week. Twenty specimens of each material were then subjected to the acid etch procedure. The compressive strength of the samples was then calculated in megapascals using a universal testing machine. The results were then subjected to 2-way analysis of variance analysis of variance followed by the Tukey post hoc test.

Results

The application of acid etch significantly reduced (P < .0001) the compressive strength of Angelus MTA and CEM cement; however, it did not reduce the compressive strength of ProRoot MTA or Biodentine. Regardless of the acid etch application, Biodentine showed significantly higher compressive strength values than the other materials (P < .0001), whereas CEM cement had the lowest compressive strength values. There was no significant difference between CEM cement and MTA Angelus. The compressive strength of ProRoot MTA was significantly lower (P < .0001) than Biodentine but significantly higher (P < .0001) than MTA Angelus and CEM cement in both the test and control groups.

Conclusions

When the application of acid etchants is required, Biodentine and ProRoot MTA seem to be better options than MTA Angelus or CEM cement.     

Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial

Introduction

Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy.

A comparative study of the effects of three root-end filling materials on proliferation and adherence of human periodontal ligament fibroblasts

Introduction

The present in vitro study was conducted with the aim of evaluating and comparing the cytotoxic effects of three root-end filling materials, ProRoot mineral trioxide aggregate (ProRoot MTA; Dentsply Tulsa Dental, Memphis, TN), MTA Angelus (Angelus, Londrina, Brazil), and a modified zinc oxide-eugenol cement (Super-EBA; Bosworth Co, Skokie, IL) on human periodontal ligament (PDL) fibroblasts.

Methods

PDL cells were cultured in an mineral trioxide aggregate (MTA)- or a Super-EBA-conditioned medium to assess the viability as determined by the trypan blue exclusion assay. The proliferation of the cells was recorded, and the cellular morphology was observed by confocal microscopy. Moreover, PDL cell aggregates were cultured on the substrate surfaces to assess cell adhesion.

Results

ProRoot MTA was found to be the most biocompatible material, whereas Super-EBA was found to be the most cytotoxic material because it significantly inhibited the cell growth and adherence on its. In the presence of ProRoot MTA, the PDL cell proliferation was almost unaltered. MTA Angelus was found to be more cytotoxic than ProRoot MTA, offering, however, excellent scaffold properties for the adhesion of cell aggregates.

Conclusions

Under the conditions of the present study, it seems that commercially available forms of MTA may behave in different ways regarding their proliferative effect on human PDL fibroblasts. ProRoot MTA appears to be the most biocompatible of the three tested materials when considering use for root-end endodontic microsurgery.     

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.

Evaluation of the cytotoxic effects of a new Harvard MTA compared to MTA Flow and ProRoot MTA on human gingival fibroblasts

BackgroundBiocompatibility is an essential property for any dental root repair material that may interact with the surrounding periodontal tissues. We hypothesise that the three mineral trioxide aggregate (MTA) restorative brands ProRoot MTA, MTA Flow and Harvard MTA have similar biocompatibility. To test this hypothesis, we compared the cytotoxic effects of these materials on human gingival fibroblast (GF).MethodsMTA cements were prepared, and after completion of setting, they were incubated in Dulbecco's Modified Eagle Medium for 1 day or 4 days to obtain low and high concentrations of MTA elutes respectively. The elutes of MTA supplemented with fetal bovine serum were added to GF and incubated for 3 days at 37 °C and 5% CO2. Untreated cells were used as control. The cell viability was assessed using a 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay at 24, 48 and 72 h.ResultsAfter 24 h, the MTT assay showed that both 1- and 4-day elutes of MTA flow and Harvard MTA reduced cell viability significantly compared to control (P < 0.05). After 48 h, the 1-day elute of ProRoot MTA induced GF proliferation (P = 0.0136) while MTA flow and Harvard MTA were similar to control. After 72 h, the 1-day elute of ProRoot MTA and Harvard MTA induced GF proliferation, while the elute of MTA flow was comparable to control. The 4-day elute of Harvard MTA continued to be cytotoxic to GF after 24 h, 48 h, and 72 h incubation, while the 4-day elute of ProRoot MTA and MTA flow were similar to control.ConclusionProRoot MTA and MTA Flow showed comparable biocompatibility. However, the 4-day elute of Harvard MTA was cytotoxic to GF. Further studied are required to assess the cell viability after direct contact with these materials versus eluent in vitro and compare these sealers in the clinical setting.     

Cytotoxicity comparison of mineral trioxide aggregates and EndoSequence bioceramic root repair materials

Introduction

The purpose of this bench top evidence level 5 in vitro study was to compare the cytotoxic effect of 2 brands of white mineral trioxide aggregate cement (ProRoot MTA and MTA-Angelus), Brasseler EndoSequence Root Repair Material, and Brasseler EndoSequence Root Repair Putty by using human dermal fibroblasts.

Methods

The cells were cultured in recommended culture conditions and exposed to the tested materials. The cytotoxic effects were recorded at an observation period of 24 hours by using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-based colorimetric assay. Results were analyzed by using one-way analysis of variance with significance of p < .05.

Results

All materials tested demonstrated cell viability ≥91.8%. Overall, there was no statistically significant difference in cell viability of ProRoot MTA, MTA-Angelus, and Brasseler EndoSequence Root Repair Material. However, there was a statistically significant difference negatively associated with the cell viability of human dermal fibroblasts in association with the Brasseler EndoSequence Root Repair Putty.

Conclusions

The Brasseler EndoSequence Root Repair Materials were shown to have similar cytotoxicity levels to those of ProRoot MTA and MTA-Angelus.     

Assessment of Color Stability of White Mineral Trioxide Aggregate Angelus and Bismuth Oxide in Contact with Tooth Structure

Introduction

Dental discoloration with use of materials containing bismuth oxide has been reported. It is postulated that the discoloration is a result of chemical interaction of bismuth oxide with dentin. The aim of the study was to analyze dental color alteration and the chemical interaction of bismuth oxide with the main components present in composite (methacrylate) and in dentin (collagen).

Methods

Fifty bovine teeth were prepared and filled with white mineral trioxide aggregate (MTA) Angelus, Portland cement (PC) with 20% zirconium oxide, or PC with 20% calcium tungstate and then sealed with composite. Triple antibiotic paste and unfilled samples were the positive and negative controls, respectively. The specimens were stored in separate flasks immersed in tap water at 37°C with ambient light blocked out. The color assessment was performed with a spectrophotometer at different intervals, namely before filling and 24 hours, 15 days, and 30 days after filling. The color change and the luminosity were calculated. The statistical analysis was performed by using nonparametric Kruskal-Wallis and Dunn tests (P < .05). The interaction of the bismuth oxide, zirconium oxide, and calcium tungstate with collagen and methacrylate was assessed by placing the materials in contact, followed by color assessment.

Results

The analysis of color change values showed that all the materials presented color alteration after the evaluated periods. Statistically higher luminosity was verified for PC/20% zirconium oxide in comparison with white MTA Angelus (P < .05). The teeth filled with white MTA Angelus demonstrated a grayish discoloration with evident dentin staining. Bismuth oxide exhibited a color change when in contact with collagen.

Conclusions

The color of white MTA Angelus was altered in contact with dental structures. Collagen, which is present in dentin matrix, reacted with bismuth oxide, resulting in a grayish discoloration. The use of an alternative radiopacifier to replace bismuth in white MTA is indicated.     

Influence of a bioceramic root end material and mineral trioxide aggregates on fibroblasts and osteoblasts

Objective

The biocompatibility of materials used in endodontic treatment is of high importance, because they can come in contact with periradicular tissues and there is a risk of possible systemic toxicity. The aim of the present study was to investigate the in vitro reaction to a bioceramic based root end material in comparison to mineral trioxide aggregates (MTA) as the established gold standard.

Design

The root end materials grey MTA Angelus (GMTA), white MTA Angelus (WMTA), ProRoot MTA, and EndoSequence Root Repair Material (ERRM) were incubated with human periodontal ligament fibroblasts and osteoblasts (10⁴ cells/ml) for up to 96 h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. In addition, fluorescence staining was carried out to visually monitor cell growth and morphology.

Results

For most of the observational time period of up to 96 h, there was no statistically significant difference between the proliferation rates of the control cells and those in contact with ERRM. In contrast, the mineral trioxide based materials caused from 24 to 96 h significantly lower proliferation rates in comparison to the controls (p < 0.001). For proliferation rates of cells in contact with MTAs and ERRM significant differences were observed throughout the whole observation time for the osteoblasts, but only up to 24 h for the human periodontal ligament fibroblasts.

Conclusion

Within the limits of this study the results suggest that the bioceramic root end material is biocompatible, but needs to be investigated in clinical studies before it can be recommended as retrograde sealer in endodontic practice.