Calcium-enriched Mixture Cement Research Articles

Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial.

The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05). In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers.

This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months. A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05. Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05). Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.

Intentional Replantation to Seal Apical and Lateral Canals in A Failed Endodontically Treated Tooth: A Case Report

Intentional replantation (IR) is often viewed as a last-resort intervention for failed endodontically treated teeth. This case report presents the successful management of symptomatic apical and lateral lesions through IR, highlighting its potential as an effective solution for challenging endodontic cases. A 45-year-old female patient presented with persistent pain and recurrent labial swelling in the vicinity of her left anterior tooth. Cone-beam computed tomography revealed endodontic lesions at both the apical and mesial aspects of tooth #21, leading to a diagnosis of symptomatic apical periodontitis. The IR procedure involved meticulous preparation and sealing of both apical and lateral canals with calcium-enriched mixture cement. One-year post-treatment, the patient remained asymptomatic, with clinical and radiographic assessments demonstrating a favorable prognosis and evidence of bone healing. This case demonstrates the successful management of symptomatic apical and lateral lesions through IR, offering an effective solution for challenging endodontic cases.

Effect of Incorporating Titanium Dioxide Nanoparticles into White Portland Cement, White Mineral Trioxide Aggregate, and Calcium Enriched Mixture Cement on the Push-out Bond Strength to Furcal Area Dentin.

Bond strength of furcation repair materials is an essential factor in clinical success. Studies on the effect of adding titanium dioxide (TiO2) nanoparticles on the push-out bond strength of commonly used endodontic cements for furcation perforation repair is limited. This study aimed to evaluate the effect of adding TiO2 nanoparticles to white Portland cement (PC), white mineral trioxide aggregate (MTA), and calcium enriched mixture cement (CEM) on their push-out bond strengths. In this in vitro study, 120 endodontically treated molars were assigned to six groups (n=20) based on the material used to repair the perforation. In three groups, the cements (white PC, white MTA, and CEM) were placed in pure form, and in the three remaining groups, 1 weight % of TiO2 was added. The push-out bond strength was measured using a universal testing machine at a strain rate of 0.5 mm/min. Data were analyzed using one-way ANOVA and post hoc Games-Howell test (p< 0.05). One-way ANOVA showed significant differences in the mean bond strength values between the six groups (p= 0.002). The post hoc Games-Howell test showed that the bond strengths in MTA+TiO2 and PC+TiO2 groups were significantly higher than those in MTA and PC groups, respectively. However, there was no significant difference in the bond strength between CEM and CEM+ TiO2 groups. The incorporation of TiO2 into MTA and PC increased their push-out bond strength. However, it did not affect the push-out bond strength of CEM cement.

A successful case of maturogenesis by stepwise excavation using calcium-enriched mixture cement

This case report demonstrates the successful induction of apexogenesis in an extensively carious lower right first molar with immature roots through the use of stepwise excavation and calcium-enriched mixture (CEM) cement as an indirect pulp capping material. The patient, an 8-year-old boy, presented with pain and carious pulp exposure. The initial treatment involved removing soft dentin and applying CEM cement as an indirect pulp cap. The patient experienced pain relief after 24 h, and subsequent follow-up appointments showed complete healing and maturation of the tooth. The case highlights the potential of indirect pulp treatment with CEM cement and emphasizes the importance of regenerative biomaterials in promoting healing and dentin bridge formation. Further clinical work and research are recommended to explore the efficacy of this treatment approach.

THREE-YEAR OUTCOME OF DIODE LASER PULPOTOMY OF PRIMARY MOLARS USING THREE PULP CAPPING AGENTS: A SPLIT-MOUTH RANDOMIZED CLINICAL TRIAL

ObjectivesPulpotomy is the most commonly performed treatment for asymptomatic primary molars with exposed dental pulp. This study aimed to assess the clinical /radiographic success of diode laser pulpotomy with mineral trioxide aggregate (MTA), calcium hydroxide (CH), and calcium-enriched mixture (CEM) cement as pulp capping agents. MethodsThis split-mouth randomized clinical trial was conducted initially on 34 children aged 3-8 years but 4 patients left the study before the first follow-up visit and the study was accomplished and analyzed with 30 cases. The patients had at least 3 first/second molars with deep caries that in radiographic evaluation revealed that they required pulpotomy. Following pulpotomy, the pulp stump was irradiated with diode laser (noncontact mode, 632 nm, 30 mW power) as photobiomodulation mode. Pulp tissue was then capped with MTA, CH, or CEM cement (n = 30 in each group). Reinforced zinc oxide eugenol was applied over the capping agent, and the teeth were restored with stainless steel crowns. Teeth were clinically/radiographically assessed at 6, 12, 18, and 36 months, after treatment. Data were analyzed by Cochran and McNemar tests. ResultsAll 30 patients showed up for clinical/radiographic follow-ups for up to 36 months. Regarding clinical outcomes, the 6-, 12-, 18-, and 36-month success rates of all experimental groups were nearly similar with no significant difference (p > .05). Regarding radiographic outcomes, the 6-month success rates were similar among the groups (p > .05); however, the 12-, 18-, and 36-month outcomes of CEM and MTA groups were similar but significantly superior to that of CH group (p < .05). ConclusionDiode laser irradiation and subsequent capping of pulp tissue with MTA or CEM cement can be employed for pulpotomy of primary molars.

Effects of White Chicken Eggshell Powder on Compressive Strength, Water Solubility, and Setting Time of Calcium-Enriched Mixture.

The present study aimed to evaluate the effects of adding chicken eggshell powder (CESP) to calcium-enriched mixture (CEM) cement on its compressive strength (CS), solubility, and setting time. In this study, CESP was added at weight percentages of 3% and 5% to the powder component of the CEM cement. To measure the CS, a total of 36 samples (height, 6 mm; diameter, 4 mm) were tested in a universal testing machine. The setting time was assessed for 18 disk-shaped samples (diameter, 10 mm; height, 1 mm). Additionally, solubility test was performed on 18 samples (diameter, 8 mm; height, 1 mm) after 24 hours, 72 hours, seven days, and 14 days under dehydration conditions by calculating the weight changes; the results were then subjected to a normality test. Next, for the comparison of different test groups, parametric ANOVA test and post-hoc Tukey's multiple comparison test were performed at a significance level of 0.05. The addition of 5% CESP to the CEM cement significantly reduced its setting time and water solubility (P=0.02 and P=0.01, respectively). Moreover, it significantly increased the CS over a 21-day period (P<0.001). Additionally, the addition of 3% CESP also resulted in a significant increase in CS (P<0.001). While 3% CESP reduced setting time and water solubility, the difference was not statistically significant. The findings suggest that the addition of 5% CESP to CEM cement has the potential to improve its sealing ability, durability, and ability to withstand chewing forces in endodontic treatments. These results highlight the relevance of CESP as an additive for cement modifications and indicate its potential clinical implications.

Antimicrobial and cytotoxic properties of calcium-enriched mixture cement, Iranian propolis, and propolis with herbal extracts in primary dental pulp stem cells.

In this study, natural substances were introduced as primary dental pulp caps for use in pulp therapy, and the antimicrobial and cytotoxic properties of these substances were investigated. In this in vitro study, the antimicrobial properties of calcium-enriched mixture (CEM) cement, propolis, and propolis individually combined with the extracts of several medicinal plants were investigated against Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Then, the cytotoxicity of each substance or mixture against pulp stem cells extracted from 30 primary healthy teeth was evaluated at 4 concentrations. Data were gathered via observation, and optical density values were obtained using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) test and recorded. SPSS software version 23 was used to analyze the data. Data were evaluated using 2-way analysis of variance and the Tukey test. Regarding antimicrobial properties, thyme alone and thyme + propolis had the lowest minimum inhibitory concentrations (MICs) against the growth of S. aureus, E. coli, and P. aeruginosa bacteria. For E. faecalis, thyme + propolis had the lowest MIC, followed by thyme alone. At 24 and 72 hours, thyme + propolis, CEM cement, and propolis had the greatest bioviability in the primary dental pulp stem cells, and lavender + propolis had the lowest bioviability. Of the studied materials, thyme + propolis showed the best results in the measures of practical performance as a dental pulp cap.

Effects of CEM cement and emdogain on proliferation and differentiation of human stem cells from the apical papilla: a comparative in vitro study.

This study compared the effects of calcium-enriched mixture (CEM) cement, Emdogain (EMD), and their combination (CEM/Emdogain) on the differentiation and proliferation of stem cells from the apical papilla (SCAPs). In this in vitro, experimental study, SCAPs were isolated from two sound immature impacted third molars and cultured. After ensuring their stemness by detecting cell surface markers they were exposed to CEM cement, Emdogain, and CEM cement coated with Emdogain for 24 and 72h. The control cells did not undergo any intervention. Cell viability [by methyl thiazolyl tetrazolium (MTT) assay], expression of odontogenic differentiation genes [by quantitative reverse-transcription polymerase chain reaction (qRT-PCR)], and alkaline phosphatase (ALP) activity (by ALP staining kit) were evaluated. Data were analyzed by one-way ANOVA, t-test, and Mann-Whitney test (α = 0.05). Cell viability in the CEM cement and CEM/Emdogain groups decreased compared with the control group at 72h (P < 0.05). Expression of dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP1), bone sialoprotein (BSP) genes, and ALP activity significantly increased in all three experimental groups compared with the control group at both 24 and 72h. This increase was substantially more significant in CEM/Emdogain group (P > 0.05). The number of mineralized nodules significantly increased in all groups at 72h, with a higher rate in the CEM/Emdogain group. All biomaterials increased the differentiation of SCAPs, expression of odontogenic differentiation genes, and ALP activity, but CEM/Emdogain was considerably more effective for this purpose.

Comparison of Coronal Discoloration Induced by White MTA and CEM Cement

Coronal discoloration of endodontically treated teeth is a challenge in clinical dentistry. This study aimed to compare coronal discoloration induced by White Mineral Trioxide Aggregate and Calcium-enriched mixture cement. Fifty single-rooted, unrestored premolar teeth extracted for orthodontic reasons were selected. After access cavity preparation, all the root canals were instrumented with MTWO rotary files up to #40.6%. The specimens were randomly assigned to two experimental groups, White Mineral Trioxide Aggregate and Calcium-enriched mixture cement groups (n = 20), and two control groups (n = 5). In the White Mineral Trioxide Aggregate and Calcium-enriched mixture cement groups, the material was condensed via the access cavity 3 mm below the cementoenamel junction to a thickness of 3 mm. Tooth color was assessed using computer analysis of digital images. Tooth color measurements were recorded at eight time intervals: before material placement (but after tooth preparation), at 24 h, 48 h, one week, two weeks, four weeks, eight weeks, and sixteen weeks after material placement. Data were analyzed using t-test, ANOVA, repeated measure ANOVA, and Tukey HSD tests. The significance level was set at 5% for all the tests. Cervical discoloration of teeth in both experimental groups significantly increased over time (p &lt; 0.05). However, samples in the White Mineral Trioxide Aggregate group showed more discoloration in cervical regions than Calcium-enriched mixture cement specimens after two, four, eight, and sixteen weeks (p &lt; 0.05). Applying both White Mineral Trioxide Aggregate and Calcium-enriched mixture cement induced coronal discoloration; however, White Mineral Trioxide Aggregate samples exhibited greater cervical discoloration than Calcium-enriched mixture cement specimens after two, four, eight, and sixteen weeks.

Push-out bond strength of two calcium silicate-based cements used for repair of artificial furcal perforation following different power outputs of Nd:YAG laser.

Proper bond strength of endodontic materials is an essential factor in the final success of root canal treatments, including perforation repairs. This study was designed to evaluate the effect of two power outputs of Nd:YAG laser (1064nm) on push-out bond strength (PBS) of ProRoot mineral trioxide aggregate (MTA) and calcium-enriched mixture cement (CEM Cement) in the repair of artificial furcal perforations. This ex vivo study enrolled 66 extracted human molars. After preparing the access cavity, perforations were created on the floor of the pulp chamber with a diameter of 1.4mm. The teeth were randomly distributed into the following six groups according to the repair material (MTA and CEM) and power output of laser irradiation (1W and 1.5W); A: MTA (case), B: CEM (case), C: Nd:YAG (1W)/MTA, D: Nd:YAG (1W)/CEM, E: Nd:YAG (1.5W)/MTA, and F: Nd:YAG (1.5W)/CEM. Then, a universal testing machine was utilized to assess the PBS. Data analysis was performed using ANOVA and T tests. Significant level was considered at P < 0.05. The highest mean ± SD of PBS was noted in Group Nd:YAG (1W)/MTA (58.92 ± 36.13), followed by Nd:YAG (1.5W)/MTA > Nd:YAG (1.5W)/CEM > Nd:YAG (1W)/CEM > MTA > and CEM. A significant difference was noted between laser and non-laser applications (P < 0.05). However, the increase of power output from 1 to 1.5W had no significant influence on PBS (P > 0.05). The PBS of MTA groups was always significantly greater than that of CEM groups (P < 0.05). Although Nd:YAG laser irradiation positively influenced on PBS values in both material studied, increasing power output was not effective.

Comparison of pulpal vitalization and root canal therapy in symptomatic immature permanent molars.

Endodontic treatment of immature permanent teeth has various problems. Today, the primary goal in the treatment of such teeth is to preserve the life of the pulp so that roots can develop entirely and naturally. If vital pulp therapy can treat these teeth, the treatment will be simpler and less expensive. Therefore, this study compared vital pulp therapy (including calcium-enriched mixture (CEM) cement and MTA methods) and root canal therapy (RCT) in symptomatic immature permanent molars. Also, the expression of TLR-2 and TLR-4 was evaluated in the gingival tissue of patients for further evaluation. In this clinical trial study, 615 patients randomly received three treatments: pulpotomy with CEM (205 cases), pulpotomy with MTA (207 cases), and root canal therapy (203 cases). The presence of periapical lesion was evaluated radiographically at three-time points: start, six months, and 12 months after treatment. The expression of TLR-2 and TLR-4 was also evaluated in the gingival tissue of patients by the Real-time PCR technique. The one-year follow-up of the periapical index shows that the presence of periapical lesion at six-month follow-up in the three groups of MTA, CEM, and RCT equals 14 cases (8%), 7 cases (4%), and 40 cases (22%). The one-year follow-up equals 12 cases (7%), 9 cases (5%), and 33 cases (18%), respectively. The TLR-2 and TLR-4 gene expression results showed no statistical difference between the three groups (CEM, MTA, and RCT). Still, one year after treatment, there was a statistically different between vital pulp therapy (CEM and MTA) and root canal therapy (P<0.05). Also, the results showed no statistical difference between CEM and MTA treatment in terms of TLR-2 and TLR-4 gene expression before and one year after treatment. In general, the results showed that pulpotomy treatment using two biomaterials, CEM and MTA, is more successful than RCT treatment.

Microhardness of Calcium-enriched Mixture Cement and Covering Glass Ionomers after Different Time Periods of Application.

Various studies have recommended using calcium-enriched mixture (CEM) cement in different endodontic treatments, including vital pulp therapy. However, possible reciprocal effects of the covering glass ionomer cement (GIC) on their mechanical properties have not been yet investigated in detail. The current research aimed to experimentally evaluate the surface microhardness of CEM cement and the covering GICs after different application/testing times. Using stainless steel moulds (8×4×4 mm), CEM cement samples were prepared (n=120) and randomly divided into 12 experimental groups (n=10). CEM cement with thickness of 4 mm was inserted into the moulds, and the remaining spaces were filled with self-cured or light-cured resin-modified GICs at three-time intervals; immediate, in 15 min and after 24 h. Then, the samples were incubated for one and seven days. Using a Vickers microhardness tester, the microhardness of CEM and GICs was measured. The data were analyzed using two-way ANOVA and Tukey's test, and the significance level was set at 5% (P<0.05). The reciprocal effects of the type/time of application of GICs on the surface microhardness of CEM cement or GICs were statistically significant (P<0.001). The surface microhardness of CEM cement and both covering GICs significantly increased over time and in seven-day samples was significantly higher than in one-day samples (P<0.05). Low surface microhardness of CEM/GICs in short-term (24 h) seems transient; and appears to be compensated over a longer period (i.e. 7-day). Therefore, using GICs adjacent to CEM cement in single-visit restorative treatments may be advocated.

Effect of laser-assisted retrograde cavity preparation on push-out-bond-strength of mineral trioxide aggregate and calcium-enriched-mixture-cement

Objective: This study aimed to determine the push-out-bond-strength(PBS) of mineral trioxide aggregate(BIOMTA+) and calcium-enriched-mixture-cement (CEM) in retrograde cavities prepared using Er: YAG laserand stainless-steel bur. Material and Methods: The root canals of 60 extracted single-rooted human teeth wereprepared, filled and their apical portion of 3-mm were resected using a diamond bur and randomly dividedinto four groups according to technique of retrograde preparation and filling material as follows(n=15):Group1: bur/ BIOMTA+ ,Group2: bur/ CEM, Group3: Er:YAG laser/ BIOMTA+, Group4: Er:YAG laser/ CEM.PBS test were performed to specimens and failure modes were evaluated. The data were statistically analyzedwith ANOVA, Post-Hoc Tukey and t tests (p&lt; 0.05). Results: CEM was exhibited higher than bond strengthcompared to BIOMTA+ in retrograde cavity prepared using laser (p= 0.021) and BIOMTA+ in retrograde cavityprepared using bur was exhibited higher than bond strength compared to in retrograde cavities prepared usinglaser (p= 0.024). Failure modes were dominantly cohesive in all groups tested and one representative specimeneach failure mode was examined in SEM and the general characteristics of the failure modes were confirmed.Conclusion: With in the limitations of the present study, when used CEM, Er: YAG laser-assisted retrogradecavity preparation positively affected the bond strength values compared to BIO MTA+. Considering its optimaladhesion, the calcium-enriched-mixture-cement (CEM) might be a good option as a filling material in retrogradecavities in clinical use.KEYWORDSCalcium-Enriched-Mixture-Cement (CEM); Er: YAG laser; Mineral trioxide aggregate; Retrograde cavity preparation.

A comparative evaluation of four regenerative materials for pulpotomy in primary molars: An in vivo study

Preservation of pulpal vitality is of paramount importance as the vital functioning pulp is capable of initiating a unique reparative capacity. The present study aimed to evaluate and compare four regenerative materials for pulpotomy in primary molars.This in vivo study included a total of 120 primary molars from 30 healthy children aged 3-9 years for regenerative pulpotomy procedure. The teeth were then divided by the lottery method (chits with names of materials on it) into four groups so that each child received all four of the regenerative materials; Group 1: Biodentine (BD)™, Group II: Mineral Trioxide Aggregate Plus (MTA Plus™), Group III: Retro MTA (Retro MTA®), and Group IV: Calcium Enriched Mixture (CEM) cement. All the primary molars (1st/2nd molars) were evaluated clinically and radiographically at 6, 12, 18, and 24 months. Data were subjected to the statistical analysis using the Chi-square test. The level of significance was considered as P < 0.05.Clinical evaluation showed 100% success with BD™ and CEM cement; whereas 96.2% success was seen with MTA Plus™ and Retro MTA®. On radiographic evaluation, MTA Plus™ and CEM cement showed 96.2% success, whereas BD™ and Retro MTA® showed 92.59% success rate.All four regenerative materials showed high success in the pulpotomy of primary molars.

Scanning electron microscopic evaluation of the effect of different root-end resection methods in the crack formation in root canals filled with mineral trioxide aggregate or calcium-enriched mixture cement

There is some concern that root resection may alter the surface features and crack formation of the previously set orthograde material. The aim of this in vitro study was to evaluate the crack formation in orthograde mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) plugs after root resection.This in vitro study was conducted on 170 extracted human maxillary anterior teeth. The teeth were randomly divided three experimental (n = 50) and control (n = 20) groups. In Group 1, after root canal treatment, half of the roots were cut with a bur, and the other half with an ultrasonic cutter. In Groups 2 and 3, after the 4-mm CEM and MTA plugs were placed and set, the root ends of half of the samples were cut with a bur and the other half by an ultrasonic cutter. The prevalence of cracks in the dentin and orthograde apical plugs of MTA and CEM was then assessed by scanning electron microscopy. Data were analyzed using the McNemar's, Chi-square, and Fisher's exact tests at P ≤ 0.05 level of significance.In general, the prevalence of crack in dentin in Groups 2 and 3 was significantly higher than in the plug (P < 0.05). There was no significant difference in the prevalence of dentin crack in the studied groups (P > 0.05). The prevalence of crack in dentin was lower when the bur was used to cut off the end of the root, although the difference was not significant. The prevalence of crack in the plug was similar in CEM and MTA.Based on the results of this study, the prevalence of crack in dentin is always significantly higher than its prevalence in the plug, and the prevalence of crack in the plug was similar in CEM and MTA; then, when there is an orthograde access to the root canal and surgery is likely in future, MTA and CEM can be placed in an orthograde technique and it just resects the root during surgery.

Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial.

ObjectiveThe concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.Materials and methodsA total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis.ResultsAt 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).ConclusionIn the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.Clinical relevanceSimple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

Non-surgical endodontic treatment of long-standing traumatized immature tooth with periapical lesion: a case report

The treatment of necrotic permanent teeth with immature apices is a daunting challenge. Apexification has been traditionally used to treat immature permanent teeth with lost pulp vitality. This technique promotes the formation of an apical barrier to close the open apex so that filling materials can be confined to the root canal. The authors present a case report of the successful treatment of a traumatized tooth with an open apex that was weakened due to a long-standing infection and thin dentin walls. In this case, we first used a triple antibiotic to disinfect the canal and then placed a calcium-enriched mixture (CEM) cement plug. Follow-up evaluations were performed 15 months after treatment. The CEM-cement appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps.

Effect of MTA versus CEM apical plugs on fracture resistance of endodontically treated simulated immature teeth restored with cast metal posts: an in-vitro study

BackgroundEndodontically treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture. An apical plug is usually used as root end filling in order to seal the wide apical foramen. The current study was performed to evaluate the effect of different apical plug materials (MTA and Calcium enriched mixture cement) at varied thicknesses on fracture resistance of teeth restored with cast metal posts.MethodsA total of 40 extracted intact single-rooted human mandibular premolars (removed for orthodontic reasons) were used in the study. The coronal part of each tooth was removed and root canal preparation was performed. A size 4 Gates Glidden drill was used to enlarge the canal and was passed through the apical foramen in order to simulate an immature apex. Samples were randomly divided into 5 groups (n = 8) according to apical plug (control group: No plug, group MTA5: 5 mm MTA plug, group CEM5: 5 mm CEM plug, group MTA3: 3 mm MTA plug, group CEM3: 3 mm CEM plug). Post-space preparations were performed and cast metal post-and-cores were fabricated and cemented. Fracture resistance was assessed using a universal testing machine. Fracture thresholds were recorded and data were analyzed using One-way ANOVA and Dunnett’s T3 tests with significance level at P value < 0.05.ResultsThe analysis showed a significant difference of fracture resistance between groups (P value < 0.05). The mean fracture resistance of samples in control group was significantly lower than MTA5 (P value = 0.003). There was no significant difference between other groups (P value > 0.05).ConclusionsWithin the limits of this study, the evidence indicated that placement of a 5 mm MTA apical plug increased the fracture resistance in simulated immature teeth which are restored with cast metal posts, compared to control group (gutta-percha and sealer). While the results were not as promising for a 3 mm MTA apical plug or either 3 or 5 mm CEM apical plug.

The Effects of Various Restorative Techniques on the Fracture Resistance of Pulpotomized Permanent Premolars.

Aim This study aimed to evaluate the effects of various restorative techniques on the fracture resistance of pulpotomized premolars with mesioocclusodistal (MOD) cavities treated with mineral trioxide aggregate (MTA) or calcium enriched mixture (CEM) cement. Materials and Methods One hundred and eight sound extracted maxillary premolars were randomly assigned to nine experimental groups (n = 12). The teeth in group 1 did not receive any preparation. Class II MOD cavities were prepared in the other experimental groups. In groups 2, 4, 6, and 8, tooth-colored MTA was used for pulpotomy. In groups 3, 5, 7, and 9, CEM cement was used for pulpotomy. Groups 2 and 3 were left unrestored. Groups 4 and 5 were restored with amalgam. Groups 6 and 7 were restored with a conventional composite resin, and groups 8 and 9 were restored with bulk-fill giomers. Fracture resistance was measured, the fracture pattern of each specimen was assessed, and the results were statistically analyzed. Results The fracture resistance of group 1 was significantly higher than those of the other groups (p < 0.05). The fracture resistance of group 2 (MTA + amalgam) was statistically lower than those of all experimental groups (p values < 0.05) except groups 3, 4, and 5 (p values > 0.05). No statistically significant differences were found between the groups restored with amalgam, conventional composite resin, and bulk-fill giomer (groups 4, 5, 6, 7, 8, and 9) (p values < 0.05). The highest rate of mode 1 fracture (restorable fracture) was observed in group 1 followed by groups 8 and 9. Conclusion No significant differences were found among the fracture resistances of the restored teeth using various restorative techniques. Bulk-fill giomers followed by conventional composite resin were better able to prevent unfavorable fractures compared to amalgam. Therefore, they seem to be more reliable for the restoration of pulpotomized teeth with MOD cavities.