Examination of surface porosity of current pulp capping materials by micro-computed tomography (micro-CT) method.

When dental pulp is exposed, it must be covered with a biocompatible material to form reparative dentine. The material used, besides being biocompatible, should have an ideal surface structure for the attachment, proliferation and differentiation of dental pulp stem cells. This study aimed to evaluate the porosity of the microstructures of four pulp capping materials using micro-computed tomography (micro-CT). Biodentine, Bioaggregate, TheraCal and Dycal materials were prepared according to the manufacturer's instructions using 2 × 9 mm Teflon molds. A total of 60 samples, 15 in each group, were scanned using micro-CT. Open and closed pores and the total porosity of the microstructures of the materials were assessed. The findings obtained from the study were analyzed via the Kruskal-Wallis test followed by the Mann-Whitney U test. The porosity of Bioaggregate was significantly higher than that of Biodentine, Dycal and TheraCal in all porosity values. While Biodentine did not show a statistically significant difference in open and total porosity values from either TheraCal or Dycal, closed porosity values of Dycal were significantly higher than those of Biodentine and TheraCal. Because of the affinity of cells to porous surfaces, the pulp capping materials' microstructure may affect the pulp capping treatment's success. From this perspective, the use of Bioaggregate in direct pulp capping may increase the success of treatment.

Inflammatory and differentiation cellular response to calcium silicate cements: An in vitro study.

AIM: Inflammatory-regenerative cell interaction is believed to mediate hard tissue formation. This study aimed to investigate the interaction between human inflammatory monocytes with human regenerative fibroblasts after exposure to different calcium silicate materials. METHODOLOGY: Human monocytes were cultured on three materials, polystyrene (PS), mineral trioxide aggregates (MTA) and biodentine (BD), in the presence or absence of lipopolysaccharide (LPS). Half of the monocyte-conditioned media (MoCM) of each group was used to analyse inflammatory cytokine secretion, namely TNF-α, IL-1ß, IL-1RA and IL-6. The remaining MoCM was used to culture recipient fibroblasts, measuring the cell number (proliferation) and levels of alkaline phosphatase (differentiation) and lactic acid dehydrogenase (cytotoxicity). RESULTS: In absence of LPS, MTA was associated with higher secretion of TNF-α and lower secretion of IL-1ß, while BD triggered higher secretions of both cytokines when both materials were compared to control (PS). When LPS was added, higher levels of all analysed cytokines were observed in the PS and BD groups, whereas for the MTA group, only TNF-α and IL-6 were increased. Fibroblasts responded differently to the MoCM from the different groups, revealing significant increases in proliferation and differentiation capacities, particularly when cultured in CM from monocytes exposed to MTA. The morphological evaluation revealed different patterns of fibroblast shape and spread in the different MoCM groups. CONCLUSION: Calcium silicate materials modulate the monocyte inflammatory response, which subsequently induce differential effects on the recipient fibroblasts. MTA appears to promote the secretion of prodifferentiation signals from the monocytes, which are received by fibroblasts, promoting their proliferation and differentiation. The model represents a promising tool to evaluate the interaction of different cells in response to different materials.

Inflammatory response and odontogenic differentiation of inflamed dental pulp treated with different pulp capping materials: An in vivo study.

AIM: Previous studies have evaluated the pulpal responses to calcium silicate cements (CSCs) on normal dental pulp, but investigations on the effects of CSCs on inflamed pulp are limited. This study aimed to test the inflammatory response and odontogenic differentiation of inflamed rat dental pulp after direct pulp capping with CSCs. METHODOLOGY: Wistar rat molars pulps were exposed for 48 h to induce inflammation and then capped with ProRoot MTA (Dentsply), Biodentine (Septodont), RetroMTA (Bio MTA) and Dycal (Dentsply Caulk). The degree of pulpal inflammation and hard tissue formation was evaluated by histological analysis. Immunofluorescence staining for interleukin (IL)-6, osteocalcin (OCN) and runt-related transcription factor 2 (RUNX2) was also performed. RESULTS: After 4 weeks, complete recovery from inflammation was evident in 22%, 37.5%, 10% and none of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. Heavy hard tissue deposition as a continuous hard tissue bridge was observed in 77.8%, 75%, 70% and 60% of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. IL-6, OCN and RUNX2 were detected in all materials, mainly adjacent to areas of inflammation and reparative dentine formation. At one, two and 4 weeks, significant differences were not observed between the inflammation and hard tissue formation scores of the four material groups (p > .05). CONCLUSIONS: In this study, pulpal inflammation was still present in most specimens at 4 weeks after pulp capping and a significant number of samples showed incomplete and discontinuous dentine bridge formation. The results of this study suggest that initial inflammatory conditions of the pulp may risk the prognosis of teeth treated with CSCs.

Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions in permanent posterior teeth: a randomized controlled clinical trial up to 2 years.

OBJECTIVES: The aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment. MATERIALS AND METHODS: Between November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher-Freeman-Halton exact tests, Kaplan-Meier survival analysis, and the log-rank tests were performed for comparisons between groups. RESULTS: No statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up. CONCLUSIONS: SRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2 years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome. CLINICAL RELEVANCE: SRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth. TRIAL REGISTRATION: Clinical trial registration number NCT04052685 (08/09/2019).

Microstructure and color stability of calcium silicate-based dental materials exposed to blood or platelet-rich fibrin.

OBJECTIVES: To investigate the effects of blood and platelet-rich fibrin (PRF), commonly used scaffolds in regenerative endodontic treatment (RET), on the hydration, microstructure, and color stability of three hydraulic calcium silicate cements (HCSCs), OrthoMTA, RetroMTA, and TotalFill-BC-RRM. MATERIALS AND METHODS: The HCSCs were prepared and placed into polyethylene molds and transferred to Eppendorf tubes containing PRF, blood, or PBS and then incubated for 1 week or 1 month. The microstructure and hydration of the cements were studied by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD). The chromatic alteration of materials was also measured using a spectrophotometer. The data for color stability were analyzed using 2-way analysis of variance and Tukey post hoc tests. RESULTS: There was no significant difference between the color stability of cements exposed to PBS (p > 0.05). The chromatic alteration of cements exposed to blood was significantly greater than those exposed to PRF and PBS (p < 0.001). In the presence of blood and PRF, the color change of OrthoMTA was significantly greater than that of RetroMTA and TotalFill (p < 0.05), with no significant difference between RetroMTA and TotalFill (p > 0.05). XRD analysis of all cements revealed a calcium hydroxide peak after 1-week and 1-month exposure to the media; however, OrthoMTA and TotalFill exposed to blood and PRF for 1 month showed weaker calcium hydroxide peaks. SEM images revealed cements exposed to PBS had a different surface microstructure compared to those exposed to blood and PRF. Furthermore, the surface microstructure of HCSCs was influenced by the type of cement radiopacifier (bismuth oxide or zirconium oxide). EDS analysis of the elemental composition in all groups displayed peaks of Ca, O, C, Si, P, and Al. CONCLUSIONS: Color stability, hydration behavior, and microstructure of HCSCs were affected by exposure to PRF and blood and the type of cement radiopacifier. CLINICAL RELEVANCE: As some important physicochemical properties of HCSCs could be influenced by the environmental conditions and the type of radiopacifier, alternatives to blood clot and HCSCs containing substitutes for bismuth oxide might be more suitable in RETs.

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.

Radiopacity evaluation of calcium silicate cements.

BACKGROUND: The aim of this study was to compare the radiopacity of calcium silicate cements using a digital imaging method. METHODS: Four calcium silicate cements, NeoMTA 2, OrthoMTA, ProRoot MTA, and Biodentine, were used in this study. Disk-shaped samples were prepared from each material and placed on a plexiglass plate. An aluminum step-wedge was placed alongside the samples on a digital sensor and exposed to 70 kVp and 8 mA from 30 cm away for 0.32 s. The greyness values ​​of the tested materials were measured digitally with the system software and compared with those of the step-wedge to determine the equivalent aluminum thickness. RESULTS: The radiopacity values, expressed in equivalent millimetres of aluminum, of the studied materials ProRoot MTA, OrthoMTA, NeoMTA 2, and Biodentine were 4.32 ± 0.17 mm Al, 3.92 ± 0.09 mm Al, 3.83 ± 0.07 mm Al, and 2.29 ± 0.21 mm Al, respectively. Statistically significant differences were found between the mean radiographic density values of the tested materials (p < 0.05). CONCLUSION: ProRoot MTA was the most radiopaque root canal filling material among the tested materials. All materials, except Biodentine, were found to be compliant with the minimum radiopacity requirements of ISO 6876 and ADA 57 standards.

Concentrated growth factor combined with iRoot BP Plus promotes inflamed pulp repair: an in vitro and in vivo study.

BACKGROUND: Platelet concentrates combined with calcium silicate cements may promote reparative dentin formation. However, few studies have reported their effect on dental pulp inflammation. This study aimed to evaluate the effects of concentrated growth factor (CGF) combined with iRoot BP Plus on inflammatory human dental pulp stem cells (hDPSCs) in vitro and inflamed pulp in rats in vivo. METHODS: The proliferation of LPS-stimulated hDPSCs treated with 50% CGF with/without 25% iRoot BP Plus was evaluated using Cell Counting Kit-8 on days 1, 4 and 7. The expression of genes associated with inflammation on day 1 and differentiation on day 14 was analysed by real-time polymerase chain reaction. The exposed pulp of rat maxillary molars was injected with 10 mg/mL LPS and directly capped with CGF membrane with/without iRoot BP Plus extract for 1, 7 and 28 days. The teeth were subjected to histologic analyses and immunohistochemistry. RESULTS: The proliferation rates of the inflammatory hDPSCs after the combination treatment were significantly higher than those after the other treatments on days 4 and 7 (P < 0.05). IL-1ß, IL-6, and TNF-α levels were increased in inflammatory hDPSCs but decreased after treatment with CGF combined with iRoot BP Plus extract, whereas IL-4 and IL-10 showed the opposite expression patterns. Expression of the odontogenesis-related genes OCN, Runx2, and ALP was dramatically enhanced by combined treatment with CGF and iRoot BP Plus extract. In rat pulp, the average inflammation scores of the CGF and CGF-iRoot BP Plus groups significantly decreased in comparison with those of the LPS group (P < 0.05), and the CGF-iRoot BP Plus group had more reparative dentin than the CGF and BP groups. Immunohistochemical staining showed fewer M1 macrophages on day 1 and more M2 macrophages on day 7 in the CGF-iRoot BP Plus group than in the other groups. CONCLUSIONS: The combination of CGF and iRoot BP Plus showed a synergistic effect on anti-inflammatory potential and promoted greater pulp healing than CGF or iRoot BP Plus alone.

Efficacy of Chitosan Scaffolded Calcium Silicate-based Cements for Treating Internal Resorption Defects with Perforation: In Vitro Study.

AIM: The present study aimed to evaluate the efficacy of chitosan scaffold combined with calcium silicate cements in the management of internal resorption with perforation. MATERIALS AND METHODS: Internal resorption cavities were simulated in 20 human permanent maxillary incisors that were then divided into two groups: group I - biodentine and group II - chitosan scaffold combined with biodentine. The samples were evaluated for the mineralization activity at the end of the 7th day and 14th day using scanning electron microscopy-energy dispersive X-ray (SEM-EDX) analysis. The data were recorded, tabulated, and then statistically analyzed. RESULTS: From the SEM-EDX analysis, the mean score of calcium and phosphorus ion uptake by the material was obtained. Statistical analysis by nonparametric Mann-Whitney test showed that there was statistically significant difference in calcium ion uptake at the end of the 7th day (p = 0.016) and at the end of 14th day (p = 0.043) between the group biodentine and group chitosan scaffold combined with biodentine (p < 0.05). CONCLUSION: In this present study, the use of chitosan scaffolds combined with biodentine showed a statistically significant difference in the mineralization activity when compared with pure biodentine. These scaffolded biomaterials exhibited greater potential for mineralization in vitro which can be efficiently used for the management of teeth with internal resorption with perforation. Further clinical trials are required for the understanding of their behavior in real-world scenarios. CLINICAL SIGNIFICANCE: Calcium silicate cements have often exhibited defective hard tissue barrier formation and hence there is a pressing need to search for newer biomaterials that can overcome these shortcomings. Scaffolded biomaterials provide a controlled microcellular environment for bioactivity, and they were found to be efficient in the remineralization of tooth structure. The present study findings indicate that these chitosan scaffolds can be efficiently used in combination with calcium silicate cements for the management of internal resorption with perforation to enhance the treatment outcome.

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.

Determining the setting of root canal sealers using an in vivo animal experimental model.

OBJECTIVES: To present and explore the potential of an animal-based experimental model developed to determine the set of root canal sealers in vivo. The setting of AH Plus, BioC Sealer, TotalFill BC Sealer, and Sealapex was determined using either ISO 6876 or the novel in vivo method proposed in this study. MATERIAL AND METHODS: The in vitro setting time of the sealers tested was determined in accordance with ISO 6876:2012. In determining the in vivo set, 24 adult Wistar rats were followed up for two evaluation periods: 1 and 4 weeks. Their upper-right incisor was extracted, and its pulp tissue was removed. The root canal was then filled from retrograde with one of the 4 sealers, and the tooth was re-implanted and fixed with a layer of a flowable composite resin. After 1 or 4 weeks of the surgical procedures, the animals were euthanized, and their incisors were extracted. Two-mm-thick slices of the middle third of the tooth root were obtained and assessed with a Gillmore device, to determine whether or not the sealer had set. RESULTS: The following in vitro results were obtained by using ISO 6876 methodology: AH Plus set after a mean time of 423 ± 20 min and 476 ± 35 min, in metal and plaster molds, respectively. BioC Sealer set after 7 days (in dental plaster molds), whereas TotalFill BC Sealer and Sealapex did not set even after 25 days in both tested conditions (metal or dental plaster molds). Using the novel in vivo methodology, AH Plus, BioC Sealer, and TotalFill BC Sealer set after both 7 and 30 days. In contrast, Sealapex did not set at either time point. CONCLUSIONS: AH Plus and BioC Sealer set under both in vitro and in vivo test conditions. TotalFill BC Sealer did not set under in vitro conditions but did after 1 week under in vivo conditions. Sealapex did not set under either in vitro or in vivo conditions. CLINICAL RELEVANCE: The influence of the testing conditions on the setting results is a clear indication that new in vivo experimental models should be useful in future studies on Bioceramics root canal sealers.

The Effect of Calcium-Silicate Cements on Reparative Dentinogenesis Following Direct Pulp Capping on Animal Models.

Dental pulp vitality is a desideratum for preserving the health and functionality of the tooth. In certain clinical situations that lead to pulp exposure, bioactive agents are used in direct pulp-capping procedures to stimulate the dentin-pulp complex and activate reparative dentinogenesis. Hydraulic calcium-silicate cements, derived from Portland cement, can induce the formation of a new dentin bridge at the interface between the biomaterial and the dental pulp. Odontoblasts are molecularly activated, and, if necessary, undifferentiated stem cells in the dental pulp can differentiate into odontoblasts. An extensive review of literature was conducted on MedLine/PubMed database to evaluate the histological outcomes of direct pulp capping with hydraulic calcium-silicate cements performed on animal models. Overall, irrespective of their physico-chemical properties and the molecular mechanisms involved in pulp healing, the effects of cements on tertiary dentin formation and pulp vitality preservation were positive. Histological examinations showed different degrees of dental pulp inflammatory response and complete/incomplete dentin bridge formation during the pulp healing process at different follow-up periods. Calcium silicate materials have the ability to induce reparative dentinogenesis when applied over exposed pulps, with different behaviors, as related to the animal model used, pulpal inflammatory responses, and quality of dentin bridges.

Effect of exposure to etidronic acid on the bond strength of calcium silicate-based cements after 1 and 21 days: an in vitro study.

BACKGROUND: After reparation of root perforations with calcium silicate-based cements (CSBC), the surface of the material is expected to be exposed to root canal irrigants (RCI) while resuming the root canal treatment. METHODS: The aim of this study was to compare the effect of exposure to a mixture of sodium hypochlorite (NaOCl) and etidronic acid (HEBP) or other irrigants on the Push Out Bond Strength (POBS) of CSBC after two different setting times. 240 root slices 1 mm thick were obtained from single-rooted human teeth. A 1.4 mm diameter perforation was performed on each slice and filled with Biodentine (BD) or ProRoot MTA (PMTA). After 1 or 21 days they were exposed to 17% ethylenediaminetetraacetic acid, 5.25% NaOCl, a mixture of 5.25% NaOCl and 9% HEBP (NaOCl + HEBP) or saline (n = 15) and submitted to a push-out test. POBS results were analysed with ANOVA and Tukey tests. RESULTS: BD showed higher POBS than PMTA after 1 day (p < .05). After 21 days no differences were found between materials. After 1 day exposure to NaOCl + HEBP resulted in higher POBS, compared to the other irrigants (p < .05). CONCLUSION: POBS results are influenced by the cement, the setting time and the exposure to irrigants.

Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes.

Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial-2-year results.

OBJECTIVES: Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations. MATERIALS AND METHODS: Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24. RESULTS: At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations. CONCLUSIONS: Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria. CLINICAL SIGNIFICANCE: Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years. TRIAL REGISTRATION: NCT02201641.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy.

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.

In vitro evaluation of different dental materials used for the treatment of extensive cervical root defects using human periodontal cells.

INTRODUCTION: Repair materials for extensive cervical root defects may come in direct contact with periodontal tissues. This in vitro study compared the effects of four calcium silicate cements (CSC), one resin-modified glass ionomer cement, and one glass carbomer cement on primary human gingival fibroblasts (HGF), alveolar osteoblasts (HAO), and a human osteoblast cell line (hFOB 1.19). METHODS: HGF, HAO, and hFOB were seeded on discoid test specimens. Relative numbers of viable cells were quantitatively assessed after 1 and 24 h for cytotoxicity/adhesion assays and after 4, 24, 48, and 72 h for proliferation assays. Data were statistically analyzed using non-parametric tests (α = 0.05). RESULTS: Relative to the control (100 %), CSC allowed for mean numbers of 71-81 % viable HGF and 80-82 % viable HAO. Then, 64 % of HGF and 56 % of HAO were assessed on GC Fuji II LC. Mean numbers of viable cells were 59-64 % HGF and 67-68 % HAO for GCP Glass Fill specimens. Cells exposed to CSC over 24 h remained viable and even increased in number. Both cell types adhered almost equally well to CSC and GC Fuji II LC. GCP Glass Fill continued to decrease cell viability and adhesion. CSC-based materials and GC Fuji II LC allowed for HGF and hFOB proliferation; however, none of the tested materials specifically stimulated cell proliferation. CONCLUSIONS: CSC characterized by low cytotoxicity. GC Fuji II LC shows moderate cytotoxic effects. ProRoot MTA, Harvard MTA, Biodentine, EndoSequence putty, and GC Fuji II LC allow HGF and HAO to adhere and HGF and hFOB to proliferate. GCP Glass Fill decreases cell viability, adhesion, and proliferation. CLINICAL RELEVANCE: CSC remain the paramount biologic choice for the repair of extensive cervical root defects. GC Fuji II LC might be considered in addition to CSC when the defect comprises supracrestal areas and the restoration requires superior aesthetic and mechanical characteristics.

The effect of human blood on the setting and surface micro-hardness of calcium silicate cements.

OBJECTIVES: The purpose of the present study was to evaluate the effects of human blood on the setting and microhardness of calcium silicate cements. MATERIALS AND METHODS: Three types of silicate-based cements were used: ProRoot MTA (PMTA), OrthoMTA (OMTA), and RetroMTA (RMTA). Mixed cement was placed into polyethylene molds with lengths of 2 and 4 mm. After storage for 4 days under three different storage conditions, i.e., saline, saline after 5 min of human blood, and human blood, the polyethylene molds were removed. With the specimens set, the surface microhardness was measured using a Vickers microhardness tester, crystalline structure was analyzed with X-ray diffraction (XRD), and the surface characteristics were examined with scanning electron microscopy (SEM). RESULTS: All specimens of 4 mm in length were set with all materials, and the blood groups exhibited lower microhardnesses than did the saline groups (p < 0.05). Among the 2-mm specimens that were stored in blood, the numbers of specimens that set were significantly different across the materials (p < 0.001). Regarding the microhardnesses of the RMTA and OMTA groups, there were no significant differences between storage conditions. For the PMTA group, only one specimen that was set in the blood group exhibited reduced microhardness. XRD showed changes of crystalline structure in the PMTA and OMTA blood group, whereas RMTA did not. SEM analysis revealed more rounded and homogeneous structures and demonstrated a clear lack of acicular or needle-like crystals in the PMTA and OMTA blood groups, while RMTA did not reveal substantial differences between the saline- and blood-stored groups. CONCLUSION: Blood contamination detrimentally affected the surface microhardnesses of all materials; furthermore, among the 2-mm specimens, blood contamination interfered with normal setting. Therefore, RMTA might be a more suitable choice when blood contamination is unavoidable due to limited depth. Clinical relevance RetroMTA might be a more suitable choice in situations in which blood contamination is unavoidable.

Calcium silicate/calcium phosphate biphasic cements for vital pulp therapy: chemical-physical properties and human pulp cells response.

OBJECTIVES: The aim was to test the properties of experimental calcium silicate/calcium phosphate biphasic cements with hydraulic properties designed for vital pulp therapy as direct pulp cap and pulpotomy. METHODS: CaSi-αTCP and CaSi-DCDP were tested for ion-releasing ability, solubility, water sorption, porosity, ability to nucleate calcium phosphates, and odontoblastic differentiation­alkaline phosphatase (ALP) and osteocalcin (OCN) upregulation­of primary human dental pulp cells (HDPCs). RESULTS: The materials showed high Ca and OH release, high open pore volume and apparent porosity, and a pronounced ability to nucleate calcium phosphates on their surface. HDPCs treated with CaSi-αTCP showed a strong upregulation of ALP and OCN genes, namely a tenfold increase for OCN and a threefold increase for ALP compared to the control cells. Conversely, CaSi-DCDP induced a pronounced OCN gene upregulation but had no effect on ALP gene regulation. CONCLUSIONS: Both cements showed high biointeractivity (release of Ca and OH ions) correlated with their marked ability to nucleate calcium phosphates. CaSi-αTCP cement proved to be a potent inducer of ALP and OCN genes as characteristic markers of mineralization processes normally poorly expressed by HDPCs. CLINICAL RELEVANCE: Calcium silicate/calcium phosphate cements appear to be attractive new materials for vital pulp therapy as they may provide odontogenic/dentinogenic chemical signals for pulp regeneration and healing, and dentin formation in regenerative endodontics.

Histological evaluation of tissue reaction and new bone formation of different calcium silicate-based cements in rats.

BACKGROUND: The purpose of this study was to evaluate the local reactions and new bone formation of rat subcutaneous and bone tissue to different calcium silicate cements. METHODS: In this study, 80 rats were divided into five groups as control, BIOfactor MTA (BIO), NeoMTA Plus (NEO), MTA Repair Hp (REP), Biodentine (DENT) and then into two subgroups according to sacrification times (7, 30 days; n = 8). Polyethylene tubes filled with appropriate materials (test groups); empty tubes (control group) were implanted into the dorsum of each rat subcutaneously. For intraosseous implantation, materials were placed in the cavities created in tibia of rats. Subcutaneous tissue and tibia samples were stained with haematoxylin-eosin and subjected to histopathological analysis. A score (0-3) was used to grade inflammatory reaction and new bone formation. Data were analysed by Kruskal-Wallis and Mann-Whitney U tests (P < 0.05). RESULTS: Inflammatory reaction observed in subcutaneous and intraosseous tissues for 7 days decreased significantly in all groups over time (P < 0.05). It was determined that there was significant increase in new bone formation in REP, BIO, DENT groups over time (P < 0.05). CONCLUSION: Four contemporary bioceramic materials induced local inflammation and tissues changes shortly after subcutaneous implantation, which were reduced over time. In intraosseous implantation, all materials induced new bone formation over time. REGISTRATION NUMBER: ADJ-03-23-0134. © 2023 Australian Dental Association.