Abstract
Objective The aim of this study was to histologically examine the tissue reaction of three different calcium silicate cements in the closure of perforations in rat incisor teeth. Material and Methods. An experimental lateral root perforation with pulp exposure was performed in 32 lower incisors of 16 male Wistar albino rats. They were randomly assigned into three test groups (each including eight teeth) that were filled either by Biodentine (BD) or MicroMega mineral trioxide aggregate (MM-MTA) or EndoSequence root repair material putty (ESRRM putty), besides eight unperforated incisors from the other four rats (control group). The inflammatory response and healing process were evaluated histologically and scored after one and four weeks. Differences among groups were tested by Kruskal–Wallis tests at P ≤ 0.05. Results In the first week, BD produced more inflammatory response in the pulpal (score 3) than other materials (score 2). Only ESRRM putty showed odontoblast-like cells in 50%, 25% dentine-like deposit, 25% evidence of bone deposition in the drilling site (score 2), and minimum periodontal ligament (PDL) necrosis and disorganization (25%, score 2). After one month, all groups had healthy pulpal tissue, but 25% of ESRRM putty retained score 1 inflammatory response, and 50% of the BD case had an incomplete palisading odontoblast layer (score 3). A thick and regular dentine bridge deposition was seen in the ESRRM putty group in comparison with MM-MTA and BD cases. The cortical plate healing in all ESRRM putty samples was complete (score 3), while an incomplete closure was seen in MM-MTA and BD groups (score 2). Both the MM-MTA and ESRRM putty groups had fully organized PDL (score 2), while in 50% of BD cases, a necrotizing area and disorganized PDL with inflammatory cells infiltration were still present. Statistically significant differences in the scores of any histologic parameters among the three tested materials were observed neither in the 1st nor in the 4th weeks of the experimental period. Conclusion Better tissue compatibility and repair of pulpal and periodontal tissue have been detected after lateral perforation in the root of rat incisors when treated with ESRRM putty than MM-MTA and BD. However, the difference was not significant.
Highlights
Root perforation is a communication between the root canal system and the surrounding tissues through the floor of the pulp chamber or root canal wall of the tooth [1]
Prognosis of root perforation depends on the site, size of the hole, the adjacent periodontal conditions, and sealing materials [4, 34, 35]. e choice of a proper sealing material to seal pathologic or accidental root perforations has a decisive role in the repair of these lesions [36]. is depends on the biocompatibility and bioactivity of the materials promoting the healing process, preserving the vitality of pulp as well as continuing formation of the dentine bridge [25, 37,38,39], stimulating the repair of the periodontal ligament [40] and regenerating the bone [41]
At the end of the experiment, there were no remarkable differences among the tested materials. e outcome of this study indicates that iatrogenic pulp defects treated with any of the three calcium silicate cements are principally free from serious degenerative tissue reaction after one month of the experiment. ese findings are in accordance with the previous investigation that separately found ESRRM putty to be as biocompatible as MTA [53,54,55], and higher inflammatory response was seen in BD compared with MTA that decreased with time [8, 56]
Summary
Root perforation is a communication between the root canal system and the surrounding tissues through the floor of the pulp chamber or root canal wall of the tooth [1]. Calcium silicate-based cements have been developed more than 20 years ago with Mineral Trioxide Aggregate as endodontic repair and root-end filling materials [10,11,12] Due to their biocompatible properties [13, 14], their clinical usage rapidly expanded towards direct and indirect pulp capping [15], taking into consideration some disadvantages associated with classic MTA formulations such as long setting time, difficulty in handling, poor mechanical properties, and tooth discoloration [10, 16]. This study aims to investigate and compare the repairing ability of MMMTA, ESRRM putty, and BD in the modulation of the inflammatory process of pulp, PDL, bone remodeling, odontoblastic differentiation, and dentine bridge formation after lateral perforations in rat incisors. None of the calcium silicate-based materials tested in this study has the ability to repair and/or regenerate pulp, PDL, dentine, and bone when applied on lateral perforations in rat incisors. Incomplete calcified bone formation extending to >1/2 of exposure site but not completely closing the exposure site
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