Calcium Silicate-based Cements Research Articles

3D-printing of architected calcium silicate binders with enhanced and in-situ carbonation

ABSTRACT This paper investigates the use of architected cellular and solid designs of materials via additive manufacturing and in-situ CO2 circulation to augment the carbonation and mechanical properties of a calcium silicate-based cement (CSC) binder. A wollastonite-based binder was formulated for extrusion-based 3D-printing. Solid and cellular lamellar architectures were designed to probe the role of layered interfaces and higher surface area on the degree of carbonation (DOC), respectively. Two carbonation exposure scenarios, with and without in-situ carbonation were employed. The DOC, microstructural phases, and flexural strength were characterised using TGA, modified over-flow image analysis technique, and three-point-bending, respectively. By exploiting 3D-printing and harnessing the higher surface area of cellular architecture, the material obtained a significantly higher DOC (by 8.9-folds) and flexural strength (by 5.7-folds) compared to reference cast. In-situ carbonation of cellular architected materials can additionally improve early-stage deformation, DOC (by 12.9-folds) and flexural strength (by 16.5-folds), compared to cast.

Comparison of push-out bond strength and apical microleakage of different calcium silicate-based cements after using EDTA, chitosan and phytic acid irrigations.

This research was aimed to evaluate push-out bond strength and apical-microleakage after application of three different calcium silicate-based cements with irrigation solutions on simulated immature teeth. 40 maxillary permanent canine teeth were used for push-out bond strength test, and 120 maxillary permanent incisors were used for microleakage evaluation. 120 root slices were divided into four main groups (EDTA, Chitosan, Phytic acid, and Saline) and immersed these solutiouns according to irrigation procedures. Each irrigation group was divided into 3 subgroups (Biodentine, MTA Repair HP, and NeoPUTTY). The prepared teeth were divided into four groups according to irrigation procedure for microleakage test. EDTA irrigation with Biodentine group showed highest push-out bond strength value and saline group with Neoputty showed the lowest push-out bond strength value. The highest microleakage value was seen in saline group with MTA Repair HP, while the lowest microleakage value was observed chitosan with Biodentine group. Chitosan and phytic acid solutions can be recommended as an alternative irrigation solution to 17% EDTA in single-session apexification treatment, since they are non-toxic, naturally occurring materials, effectively remove the smear layer, and have a positive effect on bond strength and apical leakage. RESEARCH HIGHLIGHTS: One of the factors affecting the long-term success of root canal treatment is a hermetic seal. Non-hermetic or inadequate filling triggers a chronic inflammatory reaction in periapical tissues, causing fluids to enter the spaces and negatively affecting the success of the treatment. Therefore, this study will help clinicians choose the right biomaterial and irrigation solution that will affect the success of root canal treatment.

Antibacterial, biocompatible, and mineralization-inducing properties of calcium silicate-based cements.

Different pulp capping materials have different origins and compositions, require different preparations, and may vary in their bioactive properties. The purpose of this study was to evaluate the antibacterial activity, biocompatibility, and mineralization-inducing potential of calcium silicate-based pulp capping materials. Six contemporary calcium silicate-based cements, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty, were evaluated. The antibacterial effects of these materials against Streptococcus mutans UA159 and Enterococcus faecalis ATCC 29212 were determined by the agar diffusion assay and the direct culture test. The biocompatibility and mineralization-inducing potential of these materials in preodontoblastic 17IIA11 cells were evaluated by the MTT assay and by Alizarin Red S staining, respectively. In agar diffusion test, only Biodentine showed distinct antibacterial effects against S. mutans. All the tested materials, however, showed antibacterial effects against S. mutans and E. faecalis in the direct culture test, with Biodentine showing the strongest growth inhibition against both S. mutans and E. faecalis. All the tested materials showed acceptable biocompatibility and mineralization-supporting potential in our experimental conditions. In summary, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty demonstrated acceptable invitro antimicrobial, biocompatible, and mineralization-supporting properties.

Reinforcement of Teeth Having Reenacted Perforating Internal Resorption Cavities After Repair Using Different Calcium Silicate-based Cements and Backfilling Materials: An In vitro Study

ABSTRACT To evaluate the fracture resistance (FR) of the teeth having reenacted perforating internal resorption cavities repaired by distinctive calcium silicate-based cements (CSCs) specifically: Endocem MTA, Biodentine, NeoMTA Plus, and backfilling materials. Ninety-six freshly extracted human mandibular premolar teeth were selected. Twelve roots were used as the negative control group. Rotary files were used to complete the final irrigation and root canal preparation on the remaining teeth. Following that, burs were used to make standardized internal resorption chambers in the middle part of the roots. Twelve of these samples were used as positive control samples. The remaining 72 root canals were obturated in the apical 4 mm using a single-cone approach, and they were separated into 6 groups based on the CSCs used to fill voids and the materials used as backfilling. Group 1: Endocem MTA (resorption) + Endocem MTA (coronal), Group 2: Endocem MTA (resorption) + Gutta-percha/sealer (coronal), Group 3: Biodentine (resorption) + Biodentine (coronal), Group 4: Biodentine (resorption) + Gutta-percha/sealer (coronal), Group 5: NeoMTA Plus (resorption) + NeoMTA Plus (coronal), and Group 6: NeoMTA Plus (resorption) + Gutta-percha/sealer (coronal). Specimens were inserted in acrylic resin and then subjected to fracture testing. Fracture strength tests were performed using a Universal Testing Machine. The force was employed vertically with a consistent speed of 1 mm/minute. The results were analyzed with Variance and Bonferrini tests at P < 0.005. The mean force of fracture values were 447.00, 201.25, 318.75, 187.50, 596.58, 258.75, 347.50, and 298.75 N for Group 1, 2, 3, 4, 5, 6, 7, and 8, respectively. “There was a significant difference (P < 0.001) between the experimental groups and the control group”. Group 5 showed the highest FR as compared to other groups. Backfilling with CSCs appears to be a better material than a gutta-percha/sealer combination. Neo MTA plus furthermore appeared the highest fracture-resistant material, while Biodentine + Gutta percha/sealer showed the least FR.

Comparative evaluation of the antibacterial efficacy of two experimental calcium silicate-based intracanal medicaments: An in-vitro study.

Success of endodontic treatment relies on minimizing microbial load by chemo-mechanical preparation and intra-canal medication(ICM). Calcium hydroxide based ICMs have known disadvantages. Calcium silicate-based cements(CSC) exhibit antibacterial activity, thus promoting researchers to experiment with their formulations to use them as ICMs. Evaluation and comparison of the antimicrobial efficacy of two experimental CSC (MTA & Biodentine + 2%chlorhexidine) and Bio-C Temp against E.faecalis. Test materials were divided into four groups namely Group1-Bio-C Temp, Group2-UltraCAL XS, Group3-Biodentine+2%CHX and Group4-MTA+2%CHX. Direct contact test was done by placing a standardized suspension of E.faecalis on test materials and bacterial growth was assessed spectrophotometrically using ELISA at one, three and seven days. Data was analysed using one-way ANOVA, Tukey's multiple post hoc test and paired-t test. Results: Intragroup comparison revealed decreased mean optical density(OD) in groups 1, 2, and 4; no significant difference in group 3. Intergroup comparison showed statistical differences in mean OD values between groups (3 and 4); groups (1 and 2) at days one(p-0.018) and three(p-0.035), but no difference individually. Group 4 showed the highest antimicrobial efficacy on day seven. MTA+2%CHX & Biodentine+2%CHX showed better antimicrobial efficacy and hence could be used as potential ICMs.

Bioactivity of Calcium Silicate-Based Endodontic Materials: A Comparative in vitro Evaluation

ABSTRACT Background: Bioactivity refers to the ability of a material to interact with living organisms or biological systems in a way that elicits a specific response. In the context of materials science and medicine, bioactivity is particularly important because it can determine the suitability of material for various applications. Objective: To evaluate and compare different commercially available calcium silicate-based materials regarding: 1. Morphological and elemental analysis at the dentin/material interface. 2. Calcium and silicon release and uptake by adjacent root canal dentine by evaluating the calcium and silicon incorporation depth in adjacent root canal dentin. Materials and Methods: This study examined four calcium silicate-based cements: Biodentine, MTA Angelus, BioAggregate, and MTA Plus. One hundred extracted human teeth with intact apices and no cavities were selected. Root sections measuring 3 mm in length were created at the mid-root level using low-speed diamond discs. Bioactivity was evaluated at 1, 7, 30, and 90 days, respectively. Results: The principal composition of the interfacial dentine layer and incorporation of calcium and silicon into dentine was measured at 1, 7, 30, and 90 days. Statistical analysis was performed by multiple comparisons using post hoc Tukey HSD. Conclusion: All the materials have shown bioactivity, i.e. release of calcium, silicon, and their uptake in the adjacent dentin in the presence of phosphate-buffered saline.

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

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

Choosing the Right Adhesive: A Review of Strategies for Composite Bonding to Glass Ionomers and Calcium Silicate-based Cements

Choosing the Right Adhesive: A Review of Strategies for Composite Bonding to Glass Ionomers and Calcium Silicate-based Cements

In vitro bacterial penetration and dissemination through dentinal tubules in roots filled with calcium silicate-based cements.

The aim of this study was to assess whether calcium silicate root fillings prevent bacterial penetration and to determine how bacteria penetrate roots. Extracted single-rooted, single-canal human teeth were decoronated, prepared and filled with ProRootMTA or Biodentine (n = 12 each). Positive and negative (n = 2 each) controls were not filled. A two-chamber model was used with Streptococcus gordonii. The lower compartment was evaluated for turbidity over 150 days. Roots were split and examined for bacteria via SEM. The chi-squared test was used for comparisons (α = 0.05). Experimental groups had bacteria in their coronal thirds. Tubules contained bacteria in 90.9% and 91.7% of areas examined in the Biodentine and ProRootMTA groups, respectively, with no significant difference (p = 0.914). Experimental and negative roots had no turbidity with no significant difference between Biodentine and ProRootMTA (p = 1.000). Positive controls had turbidity. Bacteria penetrate roots via dentine tubules of root-filled teeth. Biodentine was comparable to ProRoot MTA.

Shear bond strength of calcium silicate-based cements to glass ionomers

BackgroundA shear bond strength between the biomaterial and restorative material is crucial for minimizing bacterial microleakage and ensuring a favorable long-term prognosis for vital pulp therapy. This study aimed to conduct a comparative evaluation of the shear bond strength between calcium silicate-based biomaterials utilized in vital pulp treatment and various glass ionomer cement materials, both with and without the application of adhesive agents.MethodsA total of 270 acrylic blocks, each featuring cavities measuring 4 mm in diameter and 2 mm in depth, were prepared. Calcium silicate-containing biomaterials (ProRoot MTA, Medcem Pure Portland Cement, and Medcem MTA), following manufacturers’ instructions, were placed within the voids in the acrylic blocks and allowed to set for the recommended durations. The biomaterial samples were randomly categorized into three groups based on the restorative material to be applied: conventional glass ionomer cement, resin-modified glass ionomer cement, and bioactive restorative material. Using cylindrical molds with a diameter of 3.2 mm and a height of 3 mm, restorative materials were applied to the biomaterials in two different methods, contingent on whether adhesive was administered. After all samples were incubated in an oven at 37 °C for 24 h, shear bond strength values were measured utilizing a universal testing device. The obtained data were statistically evaluated using ANOVA and post-hoc Tukey tests.ResultsThe highest shear bond strength value was noted in the Medcem MTA + ACTIVA bioactive restorative material group with adhesive application, while the lowest shear bond strength value was observed in the ProRoot MTA White + Equia Forte HT Fil group without adhesive application (P < 0.05).ConclusionActiva Bioactive Restorative may be considered a suitable restorative material in combination with calcium silicate-based biomaterials for vital pulp treatment. The application of adhesives to calcium silicate-based biomaterials can effectively address the technical limitations.

Evaluation of the genotoxicity, cytotoxicity, and bioactivity of calcium silicate-based cements

BackgroundAs calcium silicate-based cements (CSCs) have found success in various vital pulp therapy applications, several new CSC products have emerged. This study aimed to assess the genotoxicity, cytotoxicity, and bioactivity of four CSCs by comparing the newly introduced materials Bio MTA+ and MTA Cem with previously studied materials, Biodentine and NeoMTA.MethodsGenotoxicity was evaluated using the micronucleus (MN) assay in human peripheral blood lymphocyte cells, measuring MN frequency and nuclear division index (NDI). Cytotoxicity was assessed in human dental pulp stem cells through the Water-Soluble Tetrazolium Salt-1 (WST-1) colorimetric assay. Bioactivity was determined by ELISA, measuring the levels of angiogenic and odontogenic markers (BMP-2, FGF-2, VEGF, and ALP). Statistical analyses included ANOVA, Dunnet and Sidak tests, and Wald chi-square test. (p < .05).ResultsThe MN frequency in the groups was significantly lower than that in the positive control group (tetraconazole) (p < .05). NDI values decreased with increasing concentration (p < .05). Bio MTA+ and NeoMTA showed decreased cell viability at all concentrations in 7-day cultures (p < .01). All materials increased BMP-2, FGF-2, and VEGF levels, with Biodentine and NeoMTA showing the highest levels of BMP-2 and FGF-2 on day 7. Biodentine displayed the highest VEGF levels on day 7. Biodentine and NeoMTA groups exhibited significantly higher ALP activity than the Bio MTA+ and MTA Cem groups by day 7.ConclusionBio MTA+ and MTA Cem demonstrated no genotoxic or cytotoxic effects. Moreover, this study revealed bioactive potentials of Bio MTA+ and MTA Cem by enhancing the expression of angiogenic and osteogenic growth factors.

Effects of Superfine Tricalcium Silicate Powder on the Physicochemical and Mechanical Properties of Its Premixed Cement as a Root Canal Filling Material.

Calcium silicate-based cement is a promising material for filling root canals. However, it has several drawbacks to its clinical application, including difficult operation and low curing strength. In this study, we successfully prepared an ultrafine tricalcium silicate powder and investigated the effects of this ultrafine powder on the performance of the premixed tricalcium silicate cement, including the curing process, setting time, hydration products, microstructure, injectivity, fluidity, and compressive strength. The results demonstrate that the addition of ultrafine tricalcium silicate powder alters the hydration product content and product morphology of the premixed cement. By increasing the content of the ultrafine powder, the injectable property of the cement can be increased to more than 95%, the fluidity can be increased from 18 mm to 35 mm, and the curing time can be shortened from 13 h to 11 h. Notably, the addition of the ultrafine powder greatly enhances the compressive strength of the hardened cement, which increases from 20.6 MPa to 51.0 MPa. These results indicate that altering the particle size distribution of the powder is an effective method for enhancing the physicochemical and mechanical properties of tricalcium silicate cement as a root canal filling material.

A novel and facile synthesis of calcium silicate nanoparticles as a base for root canal cement/sealer under constant potential: Compared to chemical synthesis

Among inorganic biomaterials, which recently have received great attention in regenerative medicine, calcium silicate-based cements are bioactive materials that are prepared based on a composition of calcium and silicate. This manuscript explores the synthesis of pure calcium silicate (CaSiO3) nanoparticles using two different methods: sol-gel synthesis and electrochemical synthesis. The goal is to compare the structural characteristics of the synthesized products. In the sol-gel method, CaSiO3 is prepared using tetraethyl orthosilicate (TEOS) and calcium nitrate tetrahydrate, while in the electrochemical method; CaSiO3 is synthesized under constant potential using the same materials. The resulting nanoparticles were characterized using various analytical techniques such as scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction analysis (XRD). Additionally, thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) were performed. The XRD analysis revealed crystal sizes of 21 nm and 39.94 nm for electrochemical and chemical synthesis, respectively, indicating the formation of wollastonite-type CaSiO3 in the electrochemical method. SEM analysis showed average particle sizes of 62.44 nm and 119 nm for electrochemical and chemical synthesis, respectively. The results demonstrate that the proposed electrochemical method offers a simple, rapid, inexpensive, and high-purity approach for the synthesis of CaSiO3, which can serve as an alternative to chemical methods. The findings of this study contribute to the development of biomaterials for dental and medical applications.

Evaluation of the Marginal Adaptation of Two Hydraulic Calcium Silicate Cements Used in Apical Plugs: An In Vitro Study

Background: The emergence of new hydraulic calcium silicate cements has revolutionized endodontics, addressing the limitations of mineral trioxide aggregate (MTA). The aim of this study is to assess and compare the marginal adaptation of two calcium silicate-based cements (White ProRoot MTA® and TotalFill® BC RRM Fast Set PuttyTM), when creating apical plugs for teeth with open apices. Methods: twenty-four single-rooted teeth were divided into two groups—GMTA (plug with MTA®) and GTBC (plug with TotalFill® BC RRM Fast Set PuttyTM)—and were sectioned at 1 mm and 2 mm from the apex. The transverse sections were analyzed with scanning electron microscopy and the marginal adaptation of the cements was measured with ImageJ® 1.3 software. Statistical analysis (IBM® SPSS® statistics software version 27) was performed and statistical significance was set at 0.05 (p &lt; 0.05). Results: There was a significant difference in the apical region, favoring White ProRoot MTA®, with a lower percentage of marginal adaptation failure (1.32 ± 4.47), presenting a statistically significant difference in the apical region (p = 0.029) but not in the cervical region of the apical plugs (p = 0.774). Conclusions: White ProRoot MTA® showed superior marginal adaptation in the apical section compared to TotalFill® BC RRM Fast Set PuttyTM.

Root canal retreatment of root canals filled with "Neo MTA 2" and epoxy resin, using continuous and asymmetric reciprocal rotation systems: In vitro study.

The study aimed to compare the amount of extrusion, the time taken to achieve apical patency and duration for removing filling material during the retreatment of teeth filled with NeoMTA 2® (Avalon Biomed, Houston, TX, USA), a calcium silicate hydraulic cement and AHPlus™ (Denstsply, Konstanz, Germany), a resin-based cement, using continuous rotation and asymmetric reciprocating rotation instruments. 60 monoradicular human teeth were selected and instrumented with Race #35.06 (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The teeth were randomly assigned to two groups based on the cement used for filling (n = 30 each) AHPlus™ and NeoMTA 2®. Both groups were obturated with gutta-percha, using the lateral condensation technique. During non-surgical retreatments, each group was further divided into two subgroups: D-Race (FKG) and Reciproc (VDW, Munich, Germany) (n = 15 each). The total time to achieve apical patency and complete the retreatment were recorded. Extruded debris were collected and weighted. Student t-tests were employed for mean comparisons to assess significant differences between variables. No statistically significant differences were found in terms of type of cement and apical extrusion. Regarding the rotation system, using the Reciproc system resulted in longer time to achieve patency and retreatment times compared to D-Race system, with statistically significant differences (P< 0.05). All systems used in retreatment led to apical extrusion. Apical patency was achieved in all cases. Key words:D-Race, Reciproc, calcium silicate-based cement, root canal retreatment.

Dentin Bond Strength of Calcium Silicate-Based Materials: A Systematic Review of In Vitro Studies

Background: Dentin adhesion is a basic aspect to consider in a root canal sealer. Calcium silicate-based cements are materials that have excellent biocompatibility and bioactivity. Bioactivity is closely related to dentin bond strength. One of the tests that is most used to evaluate the adhesive property of a sealing cement is the “push-out bond strength” test, which consists of applying tensile forces to the root to measure the resistance of the bonding of a material to root dentin. Aim: The aim of this systematic review is to perform a qualitative synthesis of available evidence on the adhesion of calcium silicate-based sealers to dentin. Methods: An advanced search of the literature was performed in five databases, limited to in vitro studies on human teeth published in the last 5 years. Results: 42 studies were eligible for the review, and data were collected according to the number of teeth studied, the canal preparation, the irrigant used, the mechanical test used, the root thirds and the type of sealer studied. A qualitative synthesis of the evidence is presented. Conclusions: TotalFill BC sealer and EndoSequence Root Repair Material appear as the calcium silicate-based materials with the highest bond strength to dentin. In addition, using 17% EDTA as a final irrigant increases the bond strength of calcium silicate-based sealers.

Examining Carbonation of Calcium Silicate-Based Cements in Real Time Using Neutron Radiography

Examining Carbonation of Calcium Silicate-Based Cements in Real Time Using Neutron Radiography

Evaluation of pH Variation and the Release of Calcium Ions in three Endodontic Sealing Cements: BioRoot RCS, MTA Fillapex, and Acroseal

Introduction: For several years, calcium silicates have proven to be very useful in numerous endodontic or restorative clinical situations. Derived from Portland cement and later from Mineral Trioxide Aggregate (MTA), a new generation of calcium silicate-based cement is marketed. To meet the requirements of endodontic sealing cements, several modifications according to the original formulation of calcium silicate and several additives have been implemented to create materials with excellent physical properties and endowed with the biological properties of MTA. Aim: The objective of the present in vitro study was to evaluate the variation in pH and the release of calcium ions in three endodontic cements over a period of time ranging from 3 hours to 28 days. The evaluation involved the following cements: BioRooT RCS (a pure calcium silicate-based endodontic cement), MTA Fillapex (a Mineral Trioxide Aggregate-based endodontic cement), and Acroseal (a calcium hydroxide-based endodontic cement). Materials and Methods: In this in vitro study, three root canal sealant cements were compared. A total of fifty-eight samples were prepared, and they were divided into three groups: Group 1 included 18 samples of BioRoot RCS, group 2 involved 18 samples of MTA Fillapex, and Group 3 included 18 samples of Acroseal. The samples were prepared and inserted into the molds. Then, the molds were immersed in glass test tubes containing 10 ml of double-distilled deionized water. A control tube, containing no material, was also prepared for each group. After each experimental period, the samples were taken from the tubes using sterile tweezers and weighed after 3 hours, 24 hours, 48 hours, 7 days, 14 days, and 28 days, respectively. The liquid in which the samples were previously immersed was used for measuring pH and the release of Ca ++ ions. Measurements of pH were carried out with a pH meter, previously calibrated using a buffer solution (pH 7). Measurement of the release of calcium ions was carried out using the technique of complexation of calcium ions with ethylene-diamine-tetra-acetic-acid, better known by the acronym EDTA. Statistical analysis was performed using data processing software, SPSS Statistics v.21.0. In this analytical study, two statistical tests were used for data analysis: A two-factor ANOVA test and a linear regression test for comparison of quantitative variables. Results: The results of the present study showed that compared to other materials, BioRoot RCS had the greatest calcium ion release, an ion release that is prolonged over time and which remains markedly high. The analytical study showed that BioRoot RCS had higher pH and calcium ion release values than the other two materials. These values are statistically significant (p&lt;0.05) with a strong correlation between the release of calcium ions and the variation in pH. Conclusion: BioRoot RCS, a cement based on pure calcium silicate, showed an alkalinizing activity and an ion release power clearly superior to those of sealers based on MTA and calcium hydroxide. This is largely correlated with the chemical composition and the physicochemical behavior of the material.

Shear bond strength of calcium silicate-based cements to composite resin using a universal adhesive in different application modes: an in vitro study.

To assess the shear bond strength (SBS) of four calcium silicate-based cements (CSCs) to composite resin using a universal adhesive in self-etch (SE) and etch-and-rinse (ER) modes and to evaluate surface microstructure and chemical composition of CSCs after acid-etching. In total, 30 specimens of each cement, Biodentine (BD), mineral trioxide aggregate (MTA) Angelus (MTA-A), ProRoot MTA (MTA-P) and MTA Repair HP (MTA-HP), were prepared and assigned into 2 groups (n = 15) according to universal adhesive (Clearfil Universal Bond Quick) applied in SE and ER mode. After composite resin (Clearfil Majesty Esthetic) was applied, the SBS was measured. Scanning electron microscope-energy dispersive spectroscopy (SEM-EDS) analysis was used to evaluate the changes in surface structure and elemental composition. MTA-P demonstrated significantly higher SBS than all CSCs, except for MTA-HP in the SE mode. The ER mode exhibited significantly higher SBS compared to the SE mode for MTA-P and MTA-A. Acid-etching caused morphological differences and affected elemental distribution. MTA-P may be a more suitable pulp capping material due to its superior SBS compared to BD and MTA-A. The application of a universal adhesive in ER mode may be suggested to increase the SBS of MTA-P and MTA-A to composite resin.

Outcomes of coronal pulpotomy on permanent first molars in children: a retrospective cohort study.

To investigate the survival probability of permanent first molars (PFMs) after coronal pulpotomy (CP) using two outcome definitions: success-focused and functional survival-focused, and to identify factors influencing tooth survival. A retrospective cohort study reviewing records of children undergoing CP with calcium silicate-based cements (CSCs) on PFMs. Each CP-treated PFM was classified as success, uncertain, failure, or censored. Survival probability was analyzed using Kaplan-Meier estimators. Success-focused definition considered failures and uncertain outcomes as events, while functional survival-focused definition considered only failures as events. Prognostic factors were analyzed using Cox regression analysis. Seventy-seven CP-treated PFMs with a follow-up period of 6-111months. Using the success-focused definition (two failures and 12 uncertain outcomes as events), survival probabilities were 93.1% (95% CI 84.3-97.1%) at 12months, 78.7% (95% CI 65.6-87.3%) at 36months, and 74.9% (95% CI 59.5-89.0%) at 60-111months. However, with the functional survival-focused definition, survival probabilities were 100% at 12months and 96.6% (95% CI 86.9-99.1%) at 24-111months. In multivariable analysis, proximal lesions increased failure risk compared to occlusal lesions (HR 17.17, 95% CI 2.18-135.31, p < 0.01), and resin composite restorations had higher failure risk than stainless steel crowns (HR 13.97, 95% CI 1.49-130.69, p < 0.05). CP using CSCs shows long-term survival potential as an alternative treatment for cariously exposed PFMs in children. Proximal lesions and resin composite restoration could contribute to the lower survival, indicating the need for careful consideration of restoration options and lesion location during treatment planning.