SHED's Response to Various Pulpotomy Materials: Cytotoxicity and Gene Expression Analysis.

PURPOSE: To examine the cytotoxicity and genetic expression of SHEDs cultured in eluates of various calcium silicate based pulpotomy materials. STUDY DESIGN: MTT assay, flow cytometry, alizarin red staining and scratch assay was used to assess the cellular viability, apoptosis, calcium matrix deposits and cell migration respectively. The gene expression of ALP, OCN and BMP -2, were measured with rtPCR. One way ANNOVA and Bonferroni post test was used for statistical analysis. RESULTS: MTT assay analysis reported that all the test specimen had no cytotoxic effects. The highest number of live cells [ % ] was found in RetroMTA. The highest percentage of cell migration was observed in SHEDs cultured in EndoCem Zr. The mean absorbance for calcium matrix deposition was higher or similar in all test specimens, when compared to control groups. The expression of BMP -2 and OCN were significantly higher in cells exposed to RetroMTA and NeoMTA respectively after 24 hrs of incubation. After 72 hrs of incubation the mRNA expression of ALP was significantly higher in MTA. CONCLUSIONS: SHEDs cultured in eluates of various calcium silicate based cements exhibited cytocompatibility and maintained odontogenic like phenotype differentiation in SHEDs.

Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study.

The study aimed to assess the human pulpal response to direct pulp capping using Endosequence Root Repair Material (ERRM) and Endocem MTA against ProRoot MTA as control. Intentional direct pulp capping was done using the three materials in 30 caries-free human premolars. After 30 days, the teeth were extracted, fixed and decalcified. Sections were prepared for histologic examination using light microscopy. Thickness and quality of dentine bridge formed and level of inflammation were evaluated. Difference between dentine bridge thickness of the three groups was statistically significant. Mean thickness of dentine bridges formed in ProRoot MTA group was greater than other two groups, and difference was statistically significant. Difference in dentine bridge thickness between ERRM and Endocem MTA was statistically significant. No significant difference was observed between the 3 groups with respect to inflammation. Results indicate ProRoot MTA performed best with ERRM giving better results than Endocem MTA.

Microscopic and elemental characterization of hydrated dental pulp capping agents.

Context: Characteristics of dental pulp capping agents may influence its interaction with the pulpal cells and can impact the treatment outcome. Aims: This study aims to microscopically characterize various pulp capping agents following hydration. Settings and Design: Original research. Materials and Methods: Disk-shaped specimens of five calcium silicate-based materials, i.e., mineral trioxide aggregate (MTA) Angelus, Biodentine, TheraCal LC, ApaCal ART, and Endocem MTA were prepared. After final set, the materials were immersed in 10 mL of deionized water for 14 days at 37°C. The set materials were characterized by scanning electron microscopy (SEM), X-ray energy dispersive analysis (EDX), and X-ray diffraction (XRD) analysis along with pH analysis of the storage solution using pH meter. Results: On SEM analysis, all the materials showed crystalline deposition on the cement surface with Biodentine exhibiting the most dense and homogenous microstructure. Calcium-silicate-hydrate and calcium hydroxide (CH) were observed as dark-grey and light-grey matrix material, respectively. EDX analysis revealed a high concentration of calcium. The other major elements were oxygen and carbon. The surface calcium concentration in the tested specimens was as follows: Biodentine (42.59 wt.%) > MTA Angelus (38.51wt.%) > Endocem MTA (30.24wt.%) > TheraCal LC (27.51wt.%) > ApaCal ART (22.02wt.%). On XRD analysis, all the materials exhibited peaks for tricalcium silicate and CH, after 14 days of hydration. Conclusions: The higher surface calcium level in Biodentine and MTA Angelus may enhance reparative dentin formation. The surface calcium concentration of Endocem MTA and ApaCal ART was found to be lesser than that of MTA Angelus, but with the added advantage of fast-setting property. Hence, they are potential alternative materials for vital pulp therapy.

Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05). Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

Evaluation of indirect pulp capping using pozzolan-based cement (ENDOCEM-Zr®) and mineral trioxide aggregate - A randomized controlled trial.

BACKGROUND: Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials. AIM: The purpose of this randomized controlled trial was to compare the outcomes of mineral trioxide aggregate (MTA) (Angelus, Londrina, Brazil) and a pozzolan-based cement (ENDOCEM-Zr® [Maruchi, Wonju, Korea]) as an indirect pulp capping (IPC) material. MATERIALS AND METHODS: IPC was performed in forty patients who were randomly divided into ENDOCEM-Zr® and MTA groups. The outcome was assessed using clinical and radiographic tests at different time intervals. The prognostic factors on the outcome of IPC were also evaluated. RESULTS AND CONCLUSIONS: The success rate of ENDOCEM-Zr® and MTA groups was 94.7% and 89.4%, respectively. The results were not statistically significant. Binary logical regression showed that the age of the patient and the status of the pulp before treatment were deciding variables for the outcome of the study. Therefore, it was concluded from the study that the evaluated pozzolan-based cement could be used as an alternative to MTA because of its faster setting time and lower discoloration potential. In addition, pulp capping should be performed with caution in individuals above 40 years and in teeth with reversible pulpitis.

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

INTRODUCTION: Few studies have reported direct pulp capping in inflamed pulp conditions. The purpose of this study was to investigate the in vitro and in vivo responses of dental pulp during direct pulp capping using various pulp capping materials in inflamed conditions. METHODS: Human dental pulp cells were treated with lipopolysaccharide (LPS) and cultured with Dycal (Dentsply Caulk, Milford, DE), ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), and Endocem MTA (Maruchi, Wonju, South Korea). The expressions of interleukin (IL)-1ß, IL-6, dentin matrix protein 1, and dentin sialophosphoprotein were analyzed through real-time polymerase chain reaction. The maxillary molars of Sprague-Dawley rats were exposed for 2 days. The exposed pulps were capped with Dycal, ProRoot MTA, and Endocem MTA and sealed with resin-modified glass ionomer followed by histologic and immunohistochemical analyses. RESULTS: The expression of IL-1ß and IL-6 was increased with LPS and decreased by Dycal, ProRoot MTA, and Endocem MTA. Dentin matrix protein 1 and dentin sialophosphoprotein levels were decreased with LPS and increased after treatment with pulp capping materials.In the in vivo study, inflammation associated with Dycal was higher than that associated with ProRoot MTA and Endocem MTA at week 1, without any significant difference between the 2. At 4 weeks, inflammation was decreased, and mineralization was increased compared with week 1 in all 3 of the materials. At week 1, IL-6 immunoreactivity was strongly expressed. Dycal exhibited stronger immunoreactivity than ProRoot MTA and Endocem MTA. However, the immunoreactivity was decreased in all groups at week 4. CONCLUSIONS: Successful direct pulp capping requires more effective pulp capping materials for the treatment of inflamed pulps.

A randomized controlled study of the use of ProRoot mineral trioxide aggregate and Endocem as direct pulp capping materials.

INTRODUCTION: The purpose of the present study was to evaluate and compare the short-term clinical outcomes of direct pulp capping using ProRoot MTA (Dentsply, Tulsa, OK) or Endocem (Maruchi, Wonju, Korea) as capping materials in a prospective randomized controlled study. MATERIALS AND METHODS: This study was conducted with subjects who were recruited from the pool of patients from the Department of Conservative Dentistry at the Dental College of Yonsei University, Seoul, Korea, between January and May 2013. Of the 48 teeth confirmed to be eligible for direct pulp capping, a total of 46 teeth were randomly assigned to either the ProRoot MTA or the Endocem group (23 teeth per group). Direct pulp capping was performed using these 2 materials, and clinical and radiographic evaluations were performed at 1, 2, 4, and 12 weeks after the treatments. Teeth with no response to pulp vitality test and those exhibiting clinical or radiographic signs and/or symptoms of irreversible pulpitis or pulp necrosis were considered to be failures. RESULTS: Thirty-two patients (43 teeth) were examined at the 3-month follow-up (patient recall rate = 91.4%); 22 of these teeth were in the ProRoot MTA group, and 21 were in the Endocem group. The overall success rate was 93%, and the success rates in the ProRoot MTA and Endocem groups were 95.5% (21/22 teeth) and 90.5% (19/21 teeth), respectively. Statistical analyses of these success rates did not reveal any significant difference between the groups (P = .522). CONCLUSIONS: In this randomized controlled study, no significant difference in the short-term clinical outcomes of direct pulp capping using ProRoot MTA or Endocem as the capping material was found. Furthermore, the favorable short-term outcome success rate of 93% indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth.

A Randomized Controlled Study of the Use of ProRoot Mineral Trioxide Aggregate and Endocem as Direct Pulp Capping Materials: 3-month versus 1-year Outcomes.

INTRODUCTION: The purpose of this study was to assess the long-term clinical outcomes of direct pulp capping (DPC) with ProRoot MTA (Dentsply, Tulsa, OK) and Endocem (Maruchi, Wonju, Korea) as pulp capping materials. To this end, the 1-year cumulative successes of both materials were evaluated and compared with those of the 3-month outcomes in a prospective, randomized controlled trial. METHODS: Patients were recruited from the Department of Conservative Dentistry of the Yonsei University Dental Hospital, Seoul, South Korea, from January to May 2013. Of the 48 teeth that met the inclusion criteria, 46 teeth were randomly allocated to either ProRoot MTA or Endocem groups (n = 23). Direct pulp capping was performed, and clinical and radiographic examinations were conducted over 1 year after the treatment. Survival analyses were conducted to compare the cumulative successes between ProRoot MTA and Endocem and to evaluate other clinical variables. RESULTS: Forty-one teeth were recalled 1 year after the treatments (recall rate = 89.13%). There were no significant differences between the cumulative successes of ProRoot MTA and Endocem in either log-rank or Cox proportional hazard regression analyses (P > .05). Among the other clinical variables, cavity type (class I, II, III vs class V) was determined to be significant in both the log-rank test (P = .001) and Cox regression analysis (P = .006). CONCLUSIONS: Both ProRoot MTA and Endocem exhibited similar cumulative successes as direct pulp capping materials up to 1 year. The teeth restored with class V cavities exhibited significantly lower cumulative success rates after direct pulp capping compared with the teeth restored with other types of cavities.

Color changes of teeth after treatment with various mineral trioxide aggregate-based materials: an ex vivo study.

INTRODUCTION: Mineral trioxide aggregate (MTA) materials have been used for many years as a pulp therapy material. The most widely used product, ProRoot MTA (Dentsply, Tulsa, OK), has a major drawback in that it causes tooth discoloration. Alternatives have recently been developed such as ENDOCEM Zr (MARUCHI, Wonju, Korea) and RetroMTA (BioMTA, Seoul, Korea). The purpose of this study was to compare the discoloration of these various MTA-based materials. METHODS: Discoloration of discs prepared from 4 different MTA-based materials (ProRoot MTA, MTA Angelus [Angelus, Londrina, PR, Brazil], ENDOCEM Zr, and RetroMTA) were observed at 15 and 30 minutes after exposure to light at an intensity of 1000 mA/cm(2). In a tooth model, 12 premolars were used per each group to retrofill the pulp chamber with MTA-based materials. The degree of discoloration was measured over a 16-week period using a digital spectrophotometer. RESULTS: Distinct color changes were observed for discs made from ProRoot MTA and MTA Angelus, but no clear change was observed for those made from either ENDOCEM Zr or RetroMTA. In the tooth model, more distinct, time-dependent color changes were observed for teeth filled with ProRoot MTA and MTA Angelus than for those filled with ENDOCEM Zr and RetroMTA. CONCLUSIONS: Less discoloration was observed with ENDOCEM Zr and RetroMTA (which contain zirconium oxide) than with ProRoot MTA and MTA Angelus (which contain bismuth oxide) in both of the test models used.

Cytotoxicity of newly developed pozzolan cement and other root-end filling materials on human periodontal ligament cell.

OBJECTIVES: The purpose of this study was to evaluate in vitro cytotoxicity of the pozzolan cement and other root-end filling materials using human periodontal ligament cell. MATERIALS AND METHODS: Endocem (Maruchi), white ProRoot MTA (Dentsply), white Angelus MTA (Angelus), and Super EBA (Bosworth Co.) were tested after set completely in an incubator at 37℃ for 7 days, Endocem was tested in two ways: 1) immediately after mixing (fresh specimens) and 2) after setting completely like other experimental materials. The methods for assessment included light microscopic examination, cell counting and WST-1 assay on human periodontal ligament cell. RESULTS: In the results of microscopic examination and cell counting, Super EBA showed significantly lower viable cell than any other groups (p < 0.05). As the results of WST-1 assay, compared with untreated control group, there was no significant cell viability of the Endocem group. However, the fresh mixed Endocem group had significantly less cell viability. The cells exposed to ProRoot MTA and Angelus MTA showed the highest viability, whereas the cells exposed to Super EBA displayed the lowest viability (p < 0.05). CONCLUSIONS: The cytotoxicity of the pozzolan cement (Endocem) was comparable with ProRoot MTA and Angelus MTA. Considering the difficult manipulation and long setting time of ProRoot MTA and Angelus MTA, Endocem can be used as the alternative of retrofilling material.

Comparison of the biological properties of ProRoot MTA, OrthoMTA, and Endocem MTA cements.

INTRODUCTION: OrthoMTA (BioMTA, Seoul, Korea) and Endocem MTA (Maruchi, Wonju-si, Korea) were recently developed to overcome the disadvantages of ProRoot MTA (Dentsply, Tulsa, OK). This study aimed to compare the biological properties of OrthoMTA and Endocem MTA with those of ProRoot MTA using the preosteoblastlike cell line MC3T3-E1. METHODS: The setting times of calcium silicate-based cements (CSCs) and their effects on the pH of distilled water during storage were determined according to ISO standards. MC3T3-E1 cells were cultured with ProRoot MTA, OrthoMTA, and Endocem MTA. The viability of the cells was assessed using the Cell Counting Kit-8 assay (Dojindo Laboratory, Kumamoto, Japan) on the supernatants of CSCs, and the cells' osteopontin production was determined by an enzyme-linked immunosorbent assay on a culture with the materials on days 3 and 7 of incubation. RESULTS: Endocem MTA exhibited a significantly shorter setting time (15.3 ± 0.5 minutes) than did ProRoot MTA and OrthoMTA (318.0 ± 56.0 and 324.3 ± 2.1 minutes, P < .05). Additionally, all CSCs caused their storage water to become highly alkaline after 7 days. OrthoMTA was significantly more cytotoxic than ProRoot and Endocem MTA (P < .05). ProRoot MTA induced significantly more OPN production than OrthoMTA and Endocem MTA on both days 3 and 7 (P < .05). CONCLUSIONS: ProRoot MTA appeared to be superior to OrthoMTA and Endocem MTA in terms of biological properties although Endocem MTA exhibited the shortest setting time and presented lower cytotoxicity with osteoblastlike cells.