Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial.

OBJECTIVES: The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars. MATERIALS AND METHODS: A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05). RESULTS: After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001). CONCLUSION: The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

Advanced Materials for Clinical Endodontic Applications: Current Status and Future Directions.

Endodontics has significantly evolved in recent years, with advancements in instruments, biomaterials and nanomaterials science playing a pivotal role [...].

Effect of Intracoronal Sealing Biomaterials on the Histological Outcome of Endodontic Revitalisation in Immature Sheep Teeth-A Pilot Study.

The influence of intracoronal sealing biomaterials on the newly formed regenerative tissue after endodontic revitalisation therapy remains unexplored. The objective of this study was to compare the gene expression profiles of two different tricalcium silicate-based biomaterials alongside the histological outcomes of endodontic revitalisation therapy in immature sheep teeth. The messenger RNA expression of TGF-ß, BMP2, BGLAP, VEGFA, WNT5A, MMP1, TNF-α and SMAD6 was evaluated after 1 day with qRT-PCR. For evaluation of histological outcomes, revitalisation therapy was performed using Biodentine (n = 4) or ProRoot white mineral trioxide aggregate (WMTA) (n = 4) in immature sheep according to the European Society of Endodontology position statement. After 6 months' follow-up, one tooth in the Biodentine group was lost to avulsion. Histologically, extent of inflammation, presence or absence of tissue with cellularity and vascularity inside the pulp space, area of tissue with cellularity and vascularity, length of odontoblast lining attached to the dentinal wall, number and area of blood vessels and area of empty root canal space were measured by two independent investigators. All continuous data were subjected to statistical analysis using Wilcoxon matched-pairs signed rank test at a significance level of p < 0.05. Biodentine and ProRoot WMTA upregulated the genes responsible for odontoblast differentiation, mineralisation and angiogenesis. Biodentine induced the formation of a significantly larger area of neoformed tissue with cellularity, vascularity and increased length of odontoblast lining attached to the dentinal walls compared to ProRoot WMTA (p < 0.05), but future studies with larger sample size and adequate power as estimated by the results of this pilot study would confirm the effect of intracoronal sealing biomaterials on the histological outcome of endodontic revitalisation.

Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials.

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments­30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank's balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days.

Discoloration Potential of Biodentine: A Systematic Review.

The aim of this systematic review is to investigate the teeth discoloration potential of Biodentine. An electronic search in six databases (PubMed, Cochrane Library, LILACS, SCIELO, Web of Science, and Scopus) was conducted by three independent reviewers to identify eligible articles. The following search terms were used: ((discolo*, staining potential, color, colour, or spectrophotomet*), (teeth or tooth), and (Biodentine)). Methodology following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines was adopted for this investigation. At the end of the selection process, 30 articles were identified as eligible, of which 14 in vitro studies were included in this systematic review. Nine of the included studies evaluated the discoloration potential of Biodentine in the presence of blood. Within the limitations of this review, teeth discoloration using Biodentine is highly expected when material is placed in direct contact with blood during dental procedures. In the absence of blood, Biodentine causes less teeth color changes than MTA-based materials, but it is still unclear what clinically relevant results could be expected regarding the discoloration frequency and intensity induced by Biodentine.

Fracture Resistance of Equine Cheek Teeth With and Without Occlusal Fissures: A Standardized ex vivo Model.

Background: Ex vivo fracture models are frequently used in human dentistry to provide insights in the fracture mechanisms of teeth. Equine cheek teeth fractures are an important dental pathology, but there has been no research performed to examine the fracture resistance ex vivo. Objective: To evaluate the fracture resistance of equine cheek teeth and identify anatomical predictors that might influence fracture resistance in healthy teeth. It was further evaluated if the presence of a fissure caused a decrease in fracture resistance. Study design: Ex vivo experimental design. Methods: Individual cheek teeth were subjected to a compression load in a universal testing machine until fracture occurred. Testing was performed in two study groups. A first group of healthy cheek teeth was tested to examine anatomical predictors on fracture resistance. A second group comprised cheek teeth with occlusal fissures and an equal number of age- and size-matched fissure-free teeth as controls. The effect of possible predictors on fracture resistance was investigated by regression analysis. Results: In the first group, fracture resistance was significantly influenced by the location on the tooth where testing was performed in both maxillary (p < 0.001) and mandibular teeth (p < 0.001). Additional significantly associated factors were Triadan number in mandibular (p = 0.009) and the mesiodistal length of the occlusal surface of maxillary teeth (p = 0.01). Experimentally induced crown fractures that extended below the simulated bone level were more frequently associated with pulp horn exposure (p < 0.001). In the second group, significant lower fracture loads were recorded in teeth with fissures (mandibular p = 0.006; maxillary p < 0.001), compared to fissure-free teeth. Main limitations: This ex vivo model does not imitate the in vivo masticatory forces and lacks the shock-absorbing properties of the periodontal ligament. Conclusions: The methodology used in this study provides an ex vivo experimental set-up to test fracture resistance of equine cheek teeth enabling evidence-based research to examine the potentially weakening effects of tooth pathology and its treatments. Crown resistance to fracture differed along the occlusal surface of healthy equine cheek teeth, and the presence of fissures further decreased fracture resistance.

Correction: Rajasekharan, S., et al. Effect of Exposed Surface Area, Volume and Environmental pH on the Calcium Ion Release of Three Commercially Available Tricalcium Silicate Based Dental Cements. Materials 2018, 11, 123.

The authors wish to make the following correction to the paper [...].

The calcium dynamics of human dental pulp stem cells stimulated with tricalcium silicate-based cements determine their differentiation and mineralization outcome.

Calcium (Ca2+) signalling plays an indispensable role in dental pulp and dentin regeneration, but the Ca2+ responses of human dental pulp stem cells (hDPSCs) stimulated with tricalcium silicate-based (TCS-based) dental biomaterials remains largely unexplored. The objective of the present study was to identify and correlate extracellular Ca2+ concentration, intracellular Ca2+ dynamics, pH, cytotoxicity, gene expression and mineralization ability of human dental pulp stem cells (hDPSCs) stimulated with two different TCS-based biomaterials: Biodentine and ProRoot white MTA. The hDPSCs were exposed to the biomaterials, brought in contact with the overlaying medium, with subsequent measurements of extracellular Ca2+ and pH, and intracellular Ca2+ changes. Messenger RNA expression (BGLAP, TGF-ß, MMP1 and BMP2), cytotoxicity (MTT and TUNEL) and mineralization potential (Alizarin red and Von Kossa staining) were then evaluated. Biodentine released significantly more Ca2+ in the α-MEM medium than ProRoot WMTA but this had no cytotoxic impact on hDPSCs. The larger Biodentine-linked Ca2+ release resulted in altered intracellular Ca2+ dynamics, which attained a higher maximum amplitude, faster rise time and increased area under the curve of the Ca2+ changes compared to ProRoot WMTA. Experiments with intracellular Ca2+ chelation, demonstrated that the biomaterial-triggered Ca2+ dynamics affected stem cell-related gene expression, cellular differentiation and mineralization potential. In conclusion, biomaterial-specific Ca2+ dynamics in hDPSCs determine differentiation and mineralization outcomes, with increased Ca2+ dynamics enhancing mineralization.

Flowable Urethane Dimethacrylate-Based Filler for Root Canal Obturation in Primary Molars: A Pilot SEM and microCT Assessment.

Pulpectomy in deciduous teeth involves endodontic access opening, root canal debridement and obturation with an appropriate filling material. EndoREZ (ER) is the urethane dimethacrylate-based filler, which can be used for root canal obturation in permanent and primary teeth. This observation aimed to evaluate the behavior of the ER as a filler in root canals of two primary molars after the physiological resorption process using the scanning electron microscopy (SEM) and micro-computed tomography (µCT) in second lower molars after their natural exfoliation. The SEM analysis revealed a non-uniform, porous and lacunary structure of ER, visually similar to the resorbed surface of the dentine. The µCT observations demonstrated the differences in the resorption level of the root and material surfaces. The preliminary observations suggest that ER is resorbed faster than root tissues and can therefore be a suitable material for the root canal filling in primary teeth. However, more investigations are needed to support these preliminary findings.

Transcriptomic profiling of human dental pulp cells treated with tricalcium silicate-based cements by RNA sequencing.

OBJECTIVES: Tricalcium silicate (TCS)-based biomaterials induce differentiation of human dental pulp cells (hDPCs) into odontoblasts/osteoblasts, which is regulated by the interplay between various intracellular pathways and their resultant secretome. The aim of this study was to compare the transcriptome-wide effects by next-generation RNA sequencing of custom-prepared hDPCs stimulated with TCS-based biomaterials: ProRoot white MTA (WMTA) (Dentsply, Tulsa; Tulsa, OK) and Biodentine (Septodont, Saint Maur des Fosses, France). METHODS: Self-isolated hDPCs were seeded in a 6-well plate at a density of 5 × 105 cells per well. ProRoot white MTA and Biodentine were then placed in transwell inserts with a pore size of 0.4 µm and inserted in the well plate. RNA sequencing was performed after 3 and 7 days treatment. For post-validation, RT-PCR analyses were done on some of the RNA samples used for RNA sequencing. RESULTS: Our RNA sequencing results for the first time identified 7533 differentially expressed genes (DEGs) between different treatments and the number of DEGs in Biodentine was higher than ProRoot WMTA at both 3 and 7 days. Despite their differential gene expression, both the TCS-based biomaterial treatments showed gene expressions mainly involved in odontoblast differentiation, angiogenesis, neurogenesis, dentinogenesis, and tooth mineralization. CONCLUSIONS: The results of the present study illustrate that several important signalling pathways are induced by hDPCs stimulated with TCS-based biomaterials. CLINICAL RELEVANCE: The differential expression of the genes associated with odontogenesis, angiogenesis, neurogenesis, dentinogenesis, and mineralization may affect the prognosis of teeth treated with Biodentine or ProRoot white MTA.

Effect of Exposed Surface Area, Volume and Environmental pH on the Calcium Ion Release of Three Commercially Available Tricalcium Silicate Based Dental Cements.

Tricalcium silicate cements (TSC) are used in dental traumatology and endodontics for their bioactivity which is mostly attributed to formation of calcium hydroxide during TSC hydration and its subsequent release of calcium and hydroxide ions. The aim of this study was to determine the effect of volume (Vol), exposed surface area (ESA) and pH of surrounding medium on calcium ion release. Three commercially available hydraulic alkaline dental cements were mixed and condensed into cylindrical tubes of varying length and diameter (n = 6/group). For the effect of ESA and Vol, tubes were immersed in 10 mL of deionized water. To analyze the effect of environmental pH, the tubes were randomly immersed in 10 mL of buffer solutions with varying pH (10.4, 7.4 or 4.4). The solutions were collected and renewed at various time intervals. pH and/or calcium ion release was measured using a pH glass electrode and atomic absorption spectrophotometer respectively. The change of pH, short-term calcium ion release and rate at which calcium ion release reaches maximum were dependent on ESA (p < 0.05) while maximum calcium ion release was dependent on Vol of TSC (p < 0.05). Maximum calcium ion release was significantly higher in acidic solution followed by neutral and alkaline solution (p < 0.05).

Performance of Willem's dental age estimation method in children: A systematic review and meta-analysis.

Through numerous validation and method comparison studies on different populations, the Willems method exhibited a superior accuracy. This article aims to systematically examine how accurate the application of Willems dental age method on children of different age groups and its performance based on various populations and regions. A strategic literature search of PubMed, MEDLINE, Web of Science, EMBASE and hand searching were used to identify the studies published up to September 2014 that estimated the dental age using the Willems method (modified Demirjian), with a populations, intervention, comparisons and outcomes (PICO) search strategy using MeSH keywords, focusing on the question: How much Willems method deviates from the chronological age in estimating age in children? Standardized mean differences were calculated for difference of dental age to chronological age by using random effects model. Subgroup analyses were performed to evaluate potential heterogeneity. Of 116 titles retrieved based on the standardized search strategy, only 19 articles fulfilled the inclusion criteria for quantitative analysis. The pooled estimates were separately kept as underestimation (n=7) and overestimation (n=12) of chronological age groups for both genders according to primary studies. On absolute values, females (underestimated by 0.13; 95% CI: 0.09-0.18 and overestimated by 0.27; 95% CI: 0.17-0.36) exhibited better accuracy than males (underestimated by 0.28; 95% CI: 0.14-0.42 and overestimated by 0.33; 95% CI: 0.22-0.44). For comparison purposes, the overall pooled estimate overestimated the age by 0.10 (95% CI: -0.06 to 0.26) and 0.09 (95% CI: -0.09 to 0.19) for males and females, respectively. There was no significant difference between the young and older child in subgroup analysis using omnibus test. The mean age between different regions exhibited no statistically significant. The use of Willems method is appropriate to estimate age in children considering its accuracy among different populations, investigators and age groups.

Gene Expression Profiling and Molecular Signaling of Various Cells in Response to Tricalcium Silicate Cements: A Systematic Review.

INTRODUCTION: The aim of this study was to present a systematic review investigating the gene expression of various cells (other than dental pulp cells) in response to different variants of tricalcium silicate cements (TSCs). METHODS: A systematic search of the literature was performed by 2 independent reviewers followed by article selection and data extraction. Studies analyzing any cell type except dental pulp stem cells and any variant of tricalcium silicate cement either as the experimental or as the control group were included. RESULTS: A total of 41 relevant articles were included in this review. Among the included studies, ProRoot MTA (Dentsply, Tulsa, OK) was the most commonly studied (69.1%) TSC variant, and 11 cell types were identified, with 13 articles investigating gene expression in osteoblasts. A total of 39 different genes/molecules expressed were found in the selected studies. The experimental group (irrespective of the TSC variant) was identified to express significantly increased gene expression compared with the control group (untreated) in all included studies. Recent studies have provided useful insight into the gene expression and molecular signaling of various cells in response to TSCs, and new elements have been supplied on the pathways activated in this process. CONCLUSIONS: TSCs are capable of eliciting a favorable cellular response in periapical regeneration.

Gene Expression Profiling and Molecular Signaling of Dental Pulp Cells in Response to Tricalcium Silicate Cements: A Systematic Review.

INTRODUCTION: Signaling molecules and responding dental pulp stem cells are the 2 main control keys of dentin regeneration/dentinogenesis. The aim of this study was to present a systematic review investigating the gene expression of various dental pulp cells in response to different variants of tricalcium silicate cements. METHODS: A systematic search of the literature was performed by 2 independent reviewers followed by article selection and data extraction. Studies analyzing all sorts of dental pulp cells (DPCs) and any variant of tricalcium silicate cement either as the experimental or as the control group were included. RESULTS: A total of 39 articles were included in the review. Among the included studies, ProRoot MTA (Dentsply, Tulsa Dental, OK) was the most commonly used tricalcium silicate cement variant. The extracellular signal regulated kinase/mitogen-activated protein kinase pathway was the most commonly activated pathway to be identified, and similarly, dentin sialophosphoprotein osteocalcin dentin matrix acidic phosphoprotein 1, alkaline phosphatase, bone sialoprotein, osteopontin, type I collagen, and Runx2 were the most commonly expressed genes in that order of frequency. CONCLUSIONS: Biodentine (Septodont Ltd, Saint Maur des Faussés, France), Bioaggregate (Innovative Bioceramix, Vancouver, BC, Canada), and mineral trioxide aggregate stimulate the osteogenic/odontogenic capacity of DPCs by proliferation, angiogenesis, and biomineralization through the activation of the extracellular signal regulated kinase ½, nuclear factor E2 related factor 2, p38, c-Jun N-terminal kinase mitogen-activated protein kinase, p42/p44 mitogen-activated protein kinase, nuclear factor kappa B, and fibroblast growth factor receptor pathways. When DPCs are placed into direct contact with tricalcium silicate cements, they show higher levels of gene activation, which in turn could translate into more effective pulpal repair and faster and more predictable formation of reparative dentin.

Laser-assisted pulpotomy in primary teeth: a systematic review.

OBJECTIVE: The purpose of this systematic review was to identify high-quality articles comparing laser with conventional pulpotomy procedures, and to assess whether laser treatment may offer an appreciable benefit over conventional approaches. METHODS: A systematic search was implemented for MEDLINE, WEB of SCIENCE and Cochrane's CENTRAL databases (1980-2012) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles (Κ = 0.89) using specific study design-related quality assessment forms (Dutch Cochrane Collaboration). RESULTS: Seven articles met the inclusion criteria, of which five randomized control trials (RCT) and two case series (CS), involving Nd:YAG, Er:YAG, CO2 and 632/980 nm diode lasers. Although heterogeneity between pulpotomy studies was high, odds ratios (OR) were generally <1, indicating that laser is less successful than conventional pulpotomy techniques. CONCLUSION: Given the paucity and high heterogeneity of high-quality articles, general recommendations for the clinical use of laser in pulpotomy in primary teeth can yet not be formulated.