Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis.

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

Chemical analysis of n-propyl gallate used as pre-treatment for resin-dentin bond strength: In vitro study.

This study aimed to evaluate the effect of n-propyl gallate as pre-treatment for resin-dentin bond strength. The dentin pre-treatments evaluated included propyl gallate of concentrations 0.1% (w/v), 1.0% (w/v), and 10.0% (w/v), as well as glutaraldehyde 5.0% (v/v), and distilled water as a control treatment. Dentin specimens were prepared for Fourier Transformed Infrared Spectroscopy (FT-IR) (n = 3/pre-treatment). Pre-treatments were actively applied to dentin blocks before performing the adhesive procedure to composite resin. Microtensile bond strength to dentin (µTBS) (n = 8/pre-treatment) was determined after 24 h and 6 months of storage. Data were submitted to a two-way ANOVA, followed by Tukey's post hoc test. As for FT-IR, propyl gallate 1%-treated specimens presented higher water, carbonate, collagen, and amide absorbance rates compared to other tested groups, while specimens pre-treated with glutaraldehyde and distilled water presented similar absorbance curves. Regarding µTBS, all concentrations of propyl gallate resulted in statistically significant higher bond strength values than distilled water at 24 h. After 6 months of storage, propyl gallate 0.1% was the only group that maintained µTBS over time. Propyl gallate 0.1% might be a suitable dentinal pre-treatment due to being able to present chemical bonds with demineralized dentin and providing resin-dentin bond stability after 6 months of storage.

Biocompatibility and bioactive potential of NeoPUTTY calcium silicate-based cement: An in vivo study in rats.

AIM: To evaluate the inflammatory reaction and the ability to induce mineralization activity of a new repair material, NeoPUTTY (NPutty; NuSmile, USA), in comparison with Bio-C Repair (BC; Angelus, Brazil) and MTA Repair HP (MTA HP; Angelus, Brazil). METHODOLOGY: Polyethylene tubes were filled with materials or kept empty (control group, CG) and implanted in subcutaneous tissue of rats for 7, 15, 30, and 60 days (n = 6/group). Capsule thickness, number of inflammatory cells (ICs), fibroblasts, collagen content, and von Kossa analysis were performed. Unstained sections were evaluated under polarized light and by immunohistochemistry for osteocalcin (OCN). Data were submitted to two-way anova followed by Tukey's test (p ≤ .05), except for OCN. OCN data were submitted to Kruskal-Wallis and Dunn and Friedman post hoc tests followed by the Nemenyi test at a significance level of 5%. RESULTS: At 7, 15, and 30 days, thick capsules containing numerous ICs were seen around the materials. At 60 days, a moderate inflammatory reaction was observed for NPutty, BC while MTA HP presented thin capsules with moderate inflammatory cells. In all periods, NPutty specimens contained the highest values of ICs (p < .05). From 7 to 60 days, the number of ICs reduced significantly while an increase in the number of fibroblasts and birefringent collagen content was observed. At 7 and 15 days, no significant difference was observed in the immunoexpression of OCN (p > .05). At 30 and 60 days, NPutty showed the lowest values of OCN (p < .05). At 60 days, a similar immunoexpression was observed for BC and MTA HP (p > .05). In all time intervals, capsules around NPutty, BC, and MTA HP showed von Kossa-positive and birefringent structures. CONCLUSIONS: Despite the greater inflammatory reaction promoted by NeoPutty than BC and MTA HP, the reduction in the thickness of capsules, the increase in the number of fibroblasts, and the reduction in the number of ICs indicate that this bioceramic material is biocompatible Furthermore, NeoPutty presents the ability to induce mineralization activity.

Evaluation of the antibacterial activity of dental adhesive containing biogenic silver nanoparticles decorated nanographene oxide nanocomposites (Ag@nGO NCs) and effect on bond strength to dentine.

Our study aimed to evaluate the antibacterial activities and dentin bond strengths of silver nanoparticles (Ag NPs) and silver nano-graphene oxide nanocomposites (Ag@nGO NCs) produced by green and chemical synthesis methods added to the dental adhesive. Ag NPs were produced by green synthesis (biogenic) (B-Ag NPs) and chemical synthesis methods (C-Ag NPs) and deposited on nGO (nano-graphene oxide). Ag NPs and Ag@nGO NCs (0.05% w/w) were added to the primer and bond (Clearfil SE Bond). Group 1: control, Group 2: nGO, Group 3: B-Ag NPs, Group 4: B-Ag@nGO NCs, Group 5: C-Ag NPs, Group 6: C-Ag@nGO NCs. Streptococcus mutans (S. mutans) live/dead assay analysis, MTT metabolic activity test, agar disc diffusion test, lactic acid production, and colony forming units (CFUs) tests were performed. Bond strength values were determined by the microtensile bond strength test (µTBS). Failure types were determined by evaluating with SEM. Statistical analysis was performed using one-way ANOVA and two-way ANOVA (p < 0.05). There was a difference between the groups in the viable bacteria ratio and lactic acid production tests (p < 0.05). When the inhibition zone and S. mutans CFUs were evaluated, there was no difference between Group 3 and Group 4 (p > 0.05), but there was a difference between the other groups (p < 0.05). When the metabolic activity of S. mutans was evaluated, there was a difference between Group 1 and other groups, and between Group 2 and Group 5, and Group 6 (p < 0.05). There was no difference between the groups in the µTBS values (p > 0.05). As a result, although the antibacterial activity of B-Ag NPs and B-Ag@nGO Ag NPs obtained by green synthesis is lower than that of chemically synthesis obtained C-Ag NPs and C-Ag@nGO NCs, they provided higher antibacterial activity compared to the control group and did not reduce µTBS. The addition of biogenic Ag NPs to the adhesive system increased the antibacterial effect by maintaining the bond strength of the adhesive. Antibacterial adhesives can increase the restoration life by protecting the tooth-adhesive interface.

Effect of Acetylsalicylic Acid on Biological Properties of Novel Cement Based on Calcium Phosphate Doped with Ions of Strontium, Copper, and Zinc.

This study aimed to compare the biological properties of newly synthesized cements based on calcium phosphate with a commercially used cement, mineral trioxide aggregate (MTA). Strontium (Sr)-, Copper (Cu)-, and Zinc (Zn)-doped hydroxyapatite (miHAp) powder was obtained through hydrothermal synthesis and characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), and energy dispersive X-ray spectrometry (EDX). Calcium phosphate cement (CPC) was produced by mixing miHAp powder with a 20 wt.% citric acid solution, followed by the assessment of its compressive strength, setting time, and in vitro bioactivity. Acetylsalicylic acid (ASA) was added to the CPC, resulting in CPCA. Biological tests were conducted on CPC, CPCA, and MTA. The biocompatibility of the cement extracts was evaluated in vitro using human dental pulp stem cells (hDPSCs) and in vivo using a zebrafish model. Antibiofilm and antimicrobial effect (quantified by CFUs/mL) were assessed against Streptococcus mutans and Lactobacillus rhamnosus. None of the tested materials showed toxicity, while CPCA even increased hDPSCs proliferation. CPCA showed a better safety profile than MTA and CPC, and no toxic or immunomodulatory effects on the zebrafish model. CPCA exhibited similar antibiofilm effects against S. mutans and L. rhamnosus to MTA.

Investigation of mechanical properties, remineralization, antibacterial effect, and cellular toxicity of composite orthodontic adhesive combined with silver-containing nanostructured bioactive glass.

BACKGROUND: The formation of white spots, which represent early carious lesions, is a major issue with fixed orthodontics. The addition of remineralizing agents to orthodontic adhesives may prevent the formation of white spots. The aim of this study was to produce a composite orthodontic adhesive combined with nano-bioactive glass-silver (nBG@Ag) for bracket bonding to enamel and to investigate its cytotoxicity, antimicrobial activity, remineralization capability, and bond strength. METHODS: nBG@Ag was synthesized using the sol-gel method, and characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy with an attenuated total reflectance attachment (ATR-FTIR). The cytotoxicity test (MTT) and antimicrobial activity of adhesives containing 1%, 3%, and 5% (wt/wt) nBG@Ag were evaluated, and the shear bond strength of the adhesives was measured using a universal testing machine. Remineralization was assessed through microhardness testing with a Vickers microhardness tester and scanning electron microscopy (SEM). Statistical analyses were conducted using the Shapiro-Wilk test, Levene test, one-way ANOVA, Robust-Welch test, Tukey HSD method, and two-way ANOVA. RESULTS: The biocompatibility of the adhesives was found to be high, as confirmed by the lack of significant differences in the cytotoxicity between the sample and control groups. Discs made from composites containing nBG@Ag exhibited a significant reduction in the growth of Streptococcus mutans (p < 0.05), and the antibacterial activity increased with higher percentages of nBG@Ag. The shear bond strength of the adhesives decreased significantly (p < 0.001) after the addition of nanoparticles, but it remained above the recommended value. The addition of nBG@Ag showed improvement in the microhardness of the teeth, although the differences in microhardness between the study groups were not statistically significant. The formation of hydroxyapatite deposits on the tooth surface was confirmed through SEM and energy-dispersive X-ray spectroscopy (EDX). CONCLUSION: Adding nBG@Ag to orthodontic adhesives can be an effective approach to enhance antimicrobial activity and reduce enamel demineralization around the orthodontic brackets, without compromising biocompatibility and bond strength.

Evaluation and comparison of four types of bio-ceramic materials AGM MTA, Ortho MTA, pro root MTA and Cem cement in oral and dental health.

BACKGROUND AND OBJECTIVES: Mineral Trioxide Aggregate (MTA) is one of the main retrograde filling materials that is used today as a root end filling material and perforation repair material. This study was conducted with the aim of investigating the antibacterial and antifungal properties of four types of bio-ceramic materials, AGM MTA, Ortho MTA, Pro root MTA and Cem cement for oral and dental health. METHODS: In this study, the antibacterial activity of four types of bio-ceramic materials against two bacterial strains of Enterococcus faecalis (ATTC 29212), Escherichia coli (ATTC 35318) and antifungal activity against Candida albicans (ATTC 10231) were investigated using the well diffusion method. RESULTS: In the context of the relationship between the type of microorganism and the diameter of the growth inhibitory zone for each type of bio-ceramic material, there was no significant difference for Enterococcus faecalis, and a significant difference was observed for Escherichia coli and Candida albicans (p < 0.05). CONCLUSION: The results show that each of the bio-ceramic materials AGM, Pro root, Cem cement and Ortho have antibacterial and antifungal properties. AGM MTA bio-ceramic material on Candida albicans fungus and Ortho MTA bio-ceramic material had the most effect on Escherichia coli bacteria. Therefore, the mentioned bio-ceramic materials can play a significant role in oral and dental health by providing a suitable material for restoration.

The effect of the use of the deproteinization agent hypochlorous acid and two different pit and fissure sealant self-adhesive flowable composites upon its bonding with the enamel.

This study evaluates the effect of the deproteinization agents hypochlorous acid and sodium hypochlorite upon the bonding of the two different pit and fissure sealant, self-adhesive flowable composites with the enamel. Thirty-six third molars were randomly divided into six different groups. The groups were formed as follows: Group 1: 37% phosphoric acid + VertiseTM Flow; Group 2: 200 ppm hypochlorous acid + 37% phosphoric acid VertiseTM Flow; Group 3: 5.25% sodium hypochlorite + 37% phosphoric acid + VertiseTM Flow; Group 4: 37% phosphoric acid + Constic; Group 5: 200 ppm hypochlorous acid + 37% phosphoric acid + Constic; Group 6: 5.25% sodium hypochlorite + 37% phosphoric acid + Constic. In each group, samples were obtained that were rectangular prisms in shape (n = 12). Groups to which a deproteinization agent was applied (Groups 2, 3 and 5, 6) showed statistically higher microtensile bonding strength than Group 1, Group 4. There was no statistically significant difference in terms of microtensile bonding strength values between the Groups 3 and the Group 6. The study found that the groups to which deproteinization agents were applied had statistically higher microtensile bonding strength values compared with those groups to which acid and fissure sealants were applied. In this study, it was concluded that the use of fissure-sealing self-adhesive flowable composites after acid application to permanent tooth enamel provides an acceptable bond strength given the limitations of in vitro studies. In line with the results obtained, it was observed that in addition to the removal of the inorganic structure with the application of acid, the removal of the organic structure with the use of deproteinization agent increased the bond strength to the enamel.

Physicochemical, mechanical and biological properties of nano-calcium silicate-based cements: a systematic review.

This systematic review evaluated the effects of nano-sized cement particles on the properties of calcium silicate-based cements (CSCs). Using defined keywords, a literature search was conducted to identify studies that investigated properties of nano-calcium silicate-based cements (NCSCs). A total of 17 studies fulfilled the inclusion criteria. Results indicated that NCSC formulations have favourable physical (setting time, pH and solubility), mechanical (push out bond strength, compressive strength and indentation hardness) and biological (bone regeneration and foreign body reaction) properties compared with commonly used CSCs. However, the characterization and verification for the nano-particle size of NCSCs were deficient in some studies. Furthermore, the nanosizing was not limited to the cement particles and a number of additives were present. In conclusion, the evidence available for the properties of CSC particles in the nano-range is deficient-such properties could be a result of additives which may have enhanced the properties of the material.

Antibacterial effect, cytotoxicity, and bond strength of a modified dental adhesive containing silver nanoparticles.

This study aimed to evaluate the antibacterial effect, cytotoxicity, and microtensile bond strength of an adhesive system containing silver nanoparticles (NAg). NAg was synthesized and incorporated (500 and 1000 ppm) into Scotchbond Multi-Purpose (SBMP) primer and bond. A microtensile bond test (µTBS) was performed after 24 h and 1 year. The adhesive interface was characterized using a confocal Raman microscope. The antibacterial activity was assessed using agar diffusion and biofilm inhibition assays (S. mutans). MTT assay was used to assess the cytotoxicity of NAg-conditioned culture media on human dental pulp stem cells (hDPSCs). The results were statistically analyzed using analysis of variance and Tukey's tests (α = .01). Incorporating 500 and 1000 ppm of NAg in the SBMP did not affect the µTBS after 24 h (p > 0.05). However, in the 1 year evaluation, 500 ppm presented the highest µTBS values (p < 0.05). The addition of NAg at 500 and 1000 ppm in the primer and bond led to larger inhibition halos and colony-forming units than the control (p < 0.05). For the unpolymerized and polymerized groups, the combination of primer and bond presented the highest cytotoxic effects on hDPSCs (p < 0.05). In conclusion, incorporating 500 or 1000 ppm of NAg into an etch-and-rinse adhesive system led to an antibacterial effect without altering the cytotoxicity. SBMP at 500 ppm presented a higher µTBS at 1 year.

Application of Silver Nanoparticles to Improve the Antibacterial Activity of Orthodontic Adhesives: An In Vitro Study.

There is a significant change in the bacterial plaque populations in the oral cavity during and after orthodontic treatment. Numerous studies have demonstrated that 2−96% of patients could increase the risk of white spot lesions. Streptococcus mutans and Lactobacilli ssp. are responsible for these white spot lesions. In this work, silver nanoparticles (AgNPs) with a diameter of 11 nm and dispersed in water were impregnated onto three different commercial orthodontic adhesives at 535 µg/mL. The shear bond strength (SBS) was assessed on 180 human premolars and metallic brackets. The premolars were divided into six groups (three groups for the commercial adhesives and three groups for the adhesives with AgNPs). All the groups were tested for their bactericidal properties, and their MIC, MBC, and agar template diffusion assays were measured. After adding AgNPs, the SBS was not significantly modified for any adhesive (p > 0.05), and the forces measured during the SBS did not exceed the threshold of 6 to 8 MPa for clinical acceptability in all groups. An increase in the bactericidal properties against both S. mutans and L. acidophilus was measured when the adhesives were supplemented with AgNPs. It was concluded that AgNPs can be supplement commercial orthodontic adhesives without modifying their mechanical properties with improved bactericidal activity.

Evaluation of the chemical, physical, and biological properties of a newly developed bioceramic cement derived from cockle shells: an in vitro study.

BACKGROUND: Tricalcium silicate is the main component of commercial bioceramic cements that are widely used in endodontic treatment. Calcium carbonate, which is manufactured from limestone, is one of the substrates of tricalcium silicate. To avoid the environmental impact of mining, calcium carbonate can be obtained from biological sources, such as shelled mollusks, one of which is cockle shell. The aim of this study was to evaluate and compare the chemical, physical, and biological properties of a newly developed bioceramic cement derived from cockle shell (BioCement) with those of a commercial tricalcium silicate cement (Biodentine). METHODS: BioCement was prepared from cockle shells and rice husk ash and its chemical composition was determined by X-ray diffraction and X-ray fluorescence spectroscopy. The physical properties were evaluated following the International Organization for Standardization (ISO) 9917-1;2007 and 6876;2012. The pH was tested after 3 h to 8 weeks. The biological properties were assessed using extraction medium from BioCement and Biodentine on human dental pulp cells (hDPCs) in vitro. The 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5[(phenylamino)carbonyl]-2 H-tetrazolium hydroxide assay was used to evaluate cell cytotoxicity following ISO 10993-5;2009. Cell migration was examined using a wound healing assay. Alizarin red staining was performed to detect osteogenic differentiation. The data were tested for a normal distribution. Once confirmed, the physical properties and pH data were analyzed using the independent t-test, and the biological property data were analyzed using one way ANOVA and Tukey's multiple comparisons test at a 5% significance level. RESULTS: The main components of BioCement and Biodentine were calcium and silicon. BioCement's and Biodentine's setting time and compressive strength were not different. The radiopacity of BioCement and Biodentine was 5.00 and 3.92 mmAl, respectively (p < 0.05). BioCement's solubility was significantly higher than Biodentine. Both materials exhibited alkalinity (pH ranged from 9 to 12) and demonstrated > 90% cell viability with cell proliferation. The highest mineralization was found in the BioCement group at 7 days (p < 0.05). CONCLUSIONS: BioCement exhibited acceptable chemical and physical properties and was biocompatible to human dental pulp cells. BioCement promotes pulp cell migration and osteogenic differentiation.

The Effect of Ethanol Associated with Universal Adhesive on Resin Composite Adhesion to Different Dentin Depths: A Long-Term In Vitro Study.

To evaluate the ethanol wet-bonding protocol with a universal adhesive in etch-andrinse and self-etch modes on microleakage and microtensile bond strength (µTBS) of resin composite to different dentin depth. Molars were distributed into groups according to protocol and dentin depth: universal adhesive (C - control), ethanol + universal adhesive (E), and phosphoric acid etch + ethanol + universal adhesive (PA+E). All protocols were applied to dentin at superficial, middle and deep depths. The specimens (n = 10) were submitted to microleakage and µTBS tests. Half of specimens were submitted to thermocycling (10,000 cycles; 5∘C/55∘C). Data were submitted to Spearman correlation (µTBS x microleakage) and three-way ANOVA (protocol, aging and depth), followed by Bonferroni post hoc test (α=0.05). PA+E group showed highest µTBS and lowest microleakage mean values in 24h. All groups presented similar µTBS mean values after thermocycling. The deep dentin showed less stable µTBS results. PA+E group presented highest microleakage mean values after thermocycling. Spearman's correlation showed a strong correlation between microleakage and µTBS. The PA+E group improved immediate adhesion and E group promoted a more stable µTBS in the long-term adhesion of universal adhesive. The aging for all protocols jeopardized the stability of the hybrid layer. The ethanol wet bonding technique associated with universal adhesive has enhanced the immediate result of the resin composite adhesion.

[Adhesive bonding on the endodontically treated tooth]. / Adhesieve hechting aan het endodontisch behandelde gebitselement.

Endodontic irrigants negatively influence the physical properties of dentine. The effect of sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA) on the bond strength to dentine was investigated in a systematic review. Inclusion criteria were the following: a microtensile or microshear test, the irrigants sodium hypochlorite and/or EDTA, an irrigation time of ≥ 5 minutes of sodium hypochlorite, an irrigation protocol for endodontic treatment, human dentine, the presence of a control group and no post space preparation. Of the 188 eligible articles, 13 were suitable for inclusion. There was strong evidence that rinsing with sodium hypochlorite and also additional rinsing minutes with ethylenediaminetetraacetic acid leads to minimum bond strength to dentin for a two-step self-etching adhesive. For a two-step etch-and-rinse adhesive, the bond strength is approximately significant after rinsing with sodium hypochlorite (rinsing time: 10-60 minutes).

L-arginine-containing mesoporous silica nanoparticles embedded in dental adhesive (Arg@MSN@DAdh) for targeting cariogenic bacteria.

Dental caries is the major biofilm-mediated oral disease in the world. The main treatment to restore caries lesions consists of the use of adhesive resin composites due to their good properties. However, the progressive degradation of the adhesive in the medium term makes possible the proliferation of cariogenic bacteria allowing secondary caries to emerge. In this study, a dental adhesive incorporating a drug delivery system based on L-arginine-containing mesoporous silica nanoparticles (MSNs) was used to release this essential amino acid as a source of basicity to neutralize the harmful acidic conditions that mediate the development of dental secondary caries. The in vitro and bacterial culture experiments proved that L-arginine was released in a sustained way from MSNs and diffused out from the dental adhesive, effectively contributing to the reduction of the bacterial strains Streptococcus mutans and Lactobacillus casei. Furthermore, the mechanical and bonding properties of the dental adhesive did not change significantly after the incorporation of L-arginine-containing MSNs. These results are yielding glimmers of promise for the cost-effective prevention of secondary caries.

Influence of different intraradicular chemical pretreatments on the bond strength of adhesive interface between dentine and fiber post cements: A systematic review and network meta-analysis.

Systematic review and network meta-analyses were performed to answer the question: Do intraradicular chemical pretreatments affect the bond strength of the adhesive interface between dentine and fiber post cements? A literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane Library in October 2018 (updated September 2021). In vitro studies that compared the bond strength assessed by push-out tests following at least two dentine chemical treatments prior to fiber post cementation were included. Risk of bias was evaluated. A random-effects Bayesian-mixed treatment comparison model was used to compare push-out bond strength of different chemical pretreatments. SUCRA (surface area under the cumulative ranking) analysis was performed to rank the pretreatments. After removing duplicates and screening titles and abstracts, 61 studies remained. SUCRA analysis showed that the best bond strength values for self-etch, etch-and-rinse, and self-adhesive cements were ethyl acetate (SUCRA: 99.8%), low concentration NaOCl (SUCRA: 83.4%), and grape seed extract (SUCRA: 97.6%), respectively. According to the SUCRA rankings, ethanol was in a good position for all adhesive strategies (SUCRA: 78.6%). The use of chemical pretreatments in intraradicular dentine of endodontically treated teeth depends on the adhesive and cementation strategy. The pretreatment generally associated with the highest bond strength was ethanol.

Comparative cytocompatibility of the new calcium silicate-based cement NeoPutty versus NeoMTA Plus and MTA on human dental pulp cells: an in vitro study.

OBJECTIVES: The aim of the present in vitro study is to determine the cytocompatibility of the recently introduced NeoPutty in contact with human dental pulp cells compared with its precursor NeoMTA Plus and the classic gold standard MTA Angelus. MATERIALS AND METHODS: Sample disks were obtained for each of the tested materials (5 mm diameter; 2 mm thickness; n = 30), along with 1:1, 1:2, and 1:4 material eluents. HDPCs were extracted and cultured with the tested materials (test groups) or in unconditioned medium (control group), and the following biocompatibility assays were performed: MTT assay, scratch wound assay, cell cytoskeleton staining assays, and cell attachment assessment via SEM. Additionally, material ion release and surface element composition were evaluated via ICP-MS and SEM-EDX, respectively. Each experimental condition was carried out three times and assessed in three independent experiments. Statistical significance was established at p < 0.05. RESULTS: 1:2 dilutions of all the tested materials exhibited a comparable cell viability to that of the control group at 48 and 72 h of culture (p < 0.05). The same was observed for 1:4 dilutions of the tested materials at 24, 48, and 72 h of culture (p > 0.05). All the tested materials exhibited adequate cytocompatibility in the remaining biocompatibility assays. MTA exhibited a significantly higher calcium ion release compared to NeoPutty and NeoMTA Plus (p < 0.05). CONCLUSION: The results from the present work elucidate the adequate cytocompatibility of NeoPutty, NeoMTA Plus, and MTA Angelus towards human dental pulp cells. CLINICAL RELEVANCE: Within the limitations of the present in vitro study, our results may act as preliminary evidence for its use in vital pulp therapy as a pulp capper. However, results need to be interpreted with caution until further clinical supporting evidence is reported.

Physicochemical and biological properties of experimental dental adhesives doped with a guanidine-based polymer: an in vitro study.

OBJECTIVES: The objective of this study is to formulate experimental dental adhesives with different polyhexamethylene guanidine hydrochloride concentrations (PHMGH) and evaluate their physical, chemical, and biological properties. MATERIALS AND METHODS: The experimental adhesives were formulated with 0 (control, GCTRL), 0.5 (G0.5%), 1 (G1%), or 2 (G2%) wt.% into the adhesive. The adhesives were analyzed for degree of conversion (DC%), softening in solvent (ΔKHN%), ultimate tensile strength (UTS), microtensile bond strength (µTBS) immediately and after 1 year of aging, antibacterial activity, and cytotoxicity. RESULTS: There were no differences among groups for DC%, ΔKHN%, and UTS (p > 0.05%). There were no differences between each PHMGH-doped adhesive compared to GCTRL in the immediate µ-TBS (p > 0.05). Adhesives with at least 1 wt.% of PHMGH presented better stability of µ-TBS. PHMGH-doped adhesives showed improved longitudinal µ-TBS compared to GCTRL (p < 0.05). Lower Streptococcus mutans biofilm formation was observed for PHMGH-doped adhesives (p < 0.05). There was lower viability of planktonic S. mutans in the media in contact with the samples when at least 1 wt.% of PHGMGH was incorporated (p < 0.05). The formulated adhesives showed no cytotoxicity against pulp cells (p > 0.05). CONCLUSIONS: The adhesive with 2 wt.% of PHMGH showed the highest antibacterial activity, without affecting the physicochemical properties and cytotoxicity, besides conferring stability for the dental adhesion. CLINICAL RELEVANCE: PHMGH, a positively charged polymer, conveyed antibacterial activity to dental adhesives. Furthermore, it did not negatively affect the essential physicochemical and biocompatibility properties of the adhesives. More importantly, the incorporation of PHMGH provided stability for the µ-TBS compared to the control group without this additive.

Evaluation of the ability of adhesives with antibacterial and remineralization functions to prevent secondary caries in vivo.

OBJECTIVE: The bonding interface of dental filling therapy is the weak point in resisting secondary caries. Adhesives containing nanoparticles of amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM) have been demonstrated in vitro to prevent bacteria from producing acid and to promote tooth remineralization. The present study aimed to evaluate the efficacy of adhesive with NACP and DMAHDM to prevent secondary caries in vivo. MATERIALS AND METHODS: Artificial cavities were created on the first molar on both sides of the maxillary in a rat model. One side was treated with adhesive containing NACP + DMAHDM, while on the other side, a commercial adhesive served as control. After 24 days of cariogenic feeding, the degree of secondary caries was evaluated by micro-CT and a modified Keyes scoring method. Quantitative real-time PCR (qPCR) and colony-forming unit (CFU) counts were used to evaluate the antibacterial efficacy of the materials. Biocompatibility was also investigated. RESULTS: In the rat model, the adhesive with NACP + DMAHDM showed excellent biocompatibility and effectively decreased the amount of bacteria. The experimental group demonstrated excellent remineralization effectiveness, with a lower modified Keyes score and mineral loss of 34.16 ± 2.13 vol% µm, compared with 77.44 ± 7.22 vol% µm in the control group, according to micro-CT (P < 0.05), showing excellent capacity to inhibit secondary caries. CONCLUSIONS: The NACP-DMAHDM-containing adhesive exhibited good performance in preventing secondary caries in vivo. CLINICAL RELEVANCE: Adhesives containing NACP and DMAHDM have great potential for use in clinical dentistry to prevent secondary caries by inhibiting bacterial growth and promoting remineralization.

Effect of ultrasonic activation of the adhesive system on dentin tubule penetration and the pushout bond strength of fiber posts.

STATEMENT OF PROBLEM: Whether ultrasonic activation of the adhesive system improves dentin tubule penetration and the bond strength of fiber posts to root dentin is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of ultrasonic activation of 2 adhesive systems (etch-and-rinse and self-etch) and 1 glass ionomer cement on the dentin tubule penetration and pushout bond strength of fiber posts to root dentin. MATERIAL AND METHODS: Sixty maxillary central incisors were endodontically treated and divided into 6 groups (n=10) as per the post cementation strategy: etch-and-rinse, etch-and-rinse and ultrasonic, self-etch, self-etch and ultrasonic, glass ionomer cement, and glass ionomer cement and ultrasonic. The primers, the adhesives, and the glass ionomer cement were activated for 20 seconds each, and the fiber posts were cemented with a resin cement. Dentin tubule penetration was evaluated by confocal laser scanning microscopy and the pushout bond strength measured at 3 post locations: cervical, middle, and apical. The failure patterns were also described after pushout testing. RESULTS: Self-etch and ultrasonic showed higher dentin tubule penetration than the other cementation strategies (P<.05) and improved the bond strength values (P<.05), which were higher than etch-and-rinse and ultrasonic and glass ionomer cement and ultrasonic (P<.05). Adhesive failures at the cement and dentin interface were predominant in the etch-and-rinse, self-etch, and self-etch and ultrasonic groups. CONCLUSIONS: Ultrasonic activation improved the dentin tubule penetration of a self-etch adhesive system. The bond strength of fiber posts cemented with a self-etch adhesive system and a resin cement was improved after ultrasonic activation.