Calcium Silicate-based Materials Research Articles

Filling ability and bond strength of calcium silicate-based materials

Filling ability and bond strength of calcium silicate-based materials

Resistance to fracture of simulated immature teeth treated with intracanal medicaments and calcium silicate-based coronal barrier materials in endodontic regeneration

Resistance to fracture of simulated immature teeth treated with intracanal medicaments and calcium silicate-based coronal barrier materials in endodontic regeneration

Evaluation of Radiopacity of Calcium Silicate-Based and Resin-Based Materials Using Direct Digital Radiography Along With an Aluminium Step Wedge.

Background Radiopacity is a critical property for root canal sealers as it allows for the assessment of the material's placement and quality within the root canal system on radiographic images. The study aimed to evaluate the radiopacity of calcium silicate-based and resin-based materials using direct digital radiography, employing an aluminium step wedge according toAmerican National Standards Institute/International Organization for Standardization (ANSI/ISO) standard protocols for testing the radiopacity of root canal sealers. This study seeks to determine the effectiveness of these materials in meeting the required standards for clinical use. Methodology The materials tested were AH Plus, Apexit Plus, Biodentine and MTA Fillapex in circular disc form and radiographed alongsidethe aluminium step wedge using direct digital radiography to determine the radiopacity using grey-pixel values. All the materials, viz., AH Plus, Apexit Plus, Biodentine and MTA Fillapex were found satisfactorily radiopaque and met the minimum radiopacity standard, that is, minimum 3mm of aluminium recommended by ANSI/American Dental Association (ADA) Specification No. 57. Results AH Plus exhibited the highest radiopacity with values of 222.54 mm Al Eq (isodensity) and 220.88 mm Al Eq (densitometric), significantly surpassing Apexit Plus, Fillapexand Biodentine (p < 0.001). Apexit Plus and Fillapex showed no significant difference between them (p = 0.238), but both were significantly higher than Biodentine (p < 0.001). Biodentine had the lowest radiopacity among all the sealers tested. Conclusion All the tested materials met the ANSI/ADA minimum radiopacity standard, demonstrating their suitability for clinical use. The materials varied in their levels of radiopacity, demonstrating that they are adequately visible on radiographic images for effective assessment in root canal treatments.

Volumetric change of calcium silicate-based repair materials in a simulated inflammatory environment: A micro-computed tomography study

Context: An acidic hydrogen potential (pH) in an inflammatory condition in the periapical tissues may affect the properties of repair bioceramic cement. Aims: The aim of this study was to evaluate the effect of pH on the volumetric change of the ready-to-use bioceramic NeoPUTTY (NP) compared to the powder/liquid MTA Repair HP (MTAHP) after immersion in butyric acid (BA, pH 4.1) or phosphate-buffered saline (PBS, pH 7.35). Subjects and Methods: Dentin tubes filled with NP or MTAHP were scanned in micro-computed tomography (micro-CT) after 24 h. Then, the specimens were immersed in 1.5 mL of BA: NP/BA, MTAHP/BA or PBS: NP/PBS, MTAHP/PBS. After 7 days, new micro-CT scans were performed. The percentage of volumetric change (extremities and internal part) of the materials was assessed. Statistical Analysis Used: ANOVA/Tukey and Kruskal–Wallis tests were performed (α =0.05). Results: All materials showed a volumetric decrease after immersion in BA or PBS at the extremities in contact with the solutions. MTAHP/BA showed the highest volumetric loss. There was no difference in the volumetric change when the internal part of the materials was evaluated. Conclusions: An acid pH negatively affects the volumetric stability of MTAHP. Low values of volumetric change were demonstrated for NP in both immersion environments.

Evaluation of Surface Topography and Biomimetic Remineralization Capacity of Dendrimers in Comparison With Calcium Silicate Cement: An In Vitro Study.

Biodentine, a calcium silicate-based material, is known for its biocompatibility and ability to promote dentin regeneration. With their unique branching structure, polyamidoamine (PAMAM) dendrimers have shown promise in facilitating biomimetic remineralization processes. This study investigates the synergistic effects of combining PAMAM with Biodentine on root dentin remineralization, aiming to develop a novel bioactive compound that offers superior protective and regenerative properties. The following predictions were made: (1) In a cyclic artificial saliva/acid regimen, among the test groups, the combination of Biodentine and PAMAM would cause the most root dentin remineralization (2). Biodentine alone would increase Ca and P concentrations, neutralize acid, and promote root dentin remineralization (3). PAMAM, on the other hand, can remineralize the demineralized root dentin. Minimal mineral regeneration was accomplished in demineralized root dentin when treated with Biodentine or PAMAM alone. Root dentin remineralization was most pronounced when Biodentine and PAMAM were used together, and the hardness of demineralized root dentin was raised to an equivalent level to that of healthy root dentin. The study demonstrated the exceptional ability of PAMAM + Biodentine to promote root dentin remineralization. In an acid-challenging environment, PAMAM + Biodentine promoted full and efficient root dentin remineralization. Restorations made using innovative PAMAM + Biodentine technology show promise in remineralizing and protecting tooth structures.

Clinical influencing factors of vital pulp therapy on pulpitis permanent teeth with 2 calcium silicate-based materials: A randomized clinical trial.

Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by dental caries. However, there are still no clear guidelines for VPT because high-quality randomized clinical trials are scarce. This prospective cohort study evaluated the clinical efficacy of VPT with the light-curable calcium silicate-based material TheraCal LC (TH) and bioceramic material iRoot BP Plus (BP) in reversible and irreversible pulpitis permanent teeth with carious exposures. 115 teeth with reversible or irreversible pulpitis caused by deep care were randomly divided into 2 groups. TheraCal LC and iRoot BP Plus were used for the pulp capping. Direct pulp capping (DPC), partial pulpotomy (PP) and full pulpotomy (FP) were performed based on observation of the exposed pulp. Postoperative discomforts were enquired and recorded via follow-up phone calls. Clinical and radiographic evaluations were performed 3, 6, and 12 months postoperatively. The overall clinical success rate in the first year was 90.4% (47/52) in both groups. The TH group required less operating time, showed lower levels of pain, and had shorter pain duration post-operative (P < .001). According to the binary logistic regression model, preoperative pain duration was significantly correlated with the prognosis of VPT (P = .011). VPT with TheraCal LC and iRoot BP Plus in pulpitis permanent carious teeth both achieved good clinical outcomes, and TheraCal LC can be easily operated for clinical use. Preoperative pain duration of the affected tooth might have a significant correlation with the prognosis of VPT.

Titanium- and Strontium-Infused Calcium Silicates Toward Restorative and Regenerative Purposes.

Dental materials with dentine regenerative properties are preferred over conventional materials. Calcium silicate cements, such as Biodentine, are bioactive and offer excellent sealing ability, making them ideal for various dental treatments. This study aimed to fabricate bioactive calcium silicates infused with titanium (Ti) and strontium (Sr) to optimize their neo-angiogenic, antimicrobial, and regenerative propertieswhile maintaining mechanical stability. Ti- and Sr-infused calcium silicate cements were synthesized, and their mineral phases were characterized using X-ray diffraction. Morphological and elemental analyses were performed using field emission scanning electron microscopy (FESEM) and energy dispersive X-ray spectroscopy (EDS). Raman spectroscopy was used to confirm the formation of bioactive material. A hemocompatibility assessment was conducted to evaluate blood compatibility. The presence of Ca2, SiO4, and SrTiO3 mineral phases indicated the successful infusion of Ti and Sr into the calcium silicate cement. FESEM and EDS revealed interconnected small spheres and rods in the silicate network with the relevant elemental compositions. Raman spectra verified that Si-O-Si and Ti-O-Ti vibrations exist, validating the formation of a bioactive material. The hemocompatibility assessment demonstrated optimal blood compatibility. This study successfully fabricated an improved calcium silicate-based material with enhanced regenerative properties and excellent biocompatibility. This newly formed substrate holds promise for providing superior restorative solutions and aiding in conservative treatment modalities during dental procedures.

In Vitro Evaluation of Sealing Ability of Biodentine and TheraCal PT in Primary Molars.

A major objective in the management of deep carious lesions involving proximal surfaces of primary molars is to control marginal leakage. This could occur due to dimensional changes or failure in the adaptation of pulp capping materials to the prepared cavity. Evaluation of microleakage is important for assessing the success of newer pulp capping materials. Biodentine exhibits good sealing ability but possesses longer setting times and handling difficulties, which might delay the placement of the final restoration. The sealing ability of newer dual-cure calcium silicate-based material in TheraCal PT in class II cavities of primary molars is not known. Hence, the current study aimed to evaluate and compare the microleakage of Biodentine and TheraCal PT in primary molars. Extracted, noncarious primary molars (n = 28) were collected, and standardized class II cavities were prepared and restored with Biodentine (group I) and TheraCal PT (group II). Following this type, IX glass ionomer cement (GIC) was placed and polished. Microleakage was assessed using the dye penetration method, and data obtained through stereomicroscopic analysis were statistically analyzed. The mean microleakage score observed in group I was 2.0 ± 1.3 MPa, and in group II was 1.0 ± 1.1 MPa. Comparable sealing ability was observed between both groups (p = 0.061). TheraCal PT could be used as a suitable alternative to Biodentine for use in vital pulp therapeutic procedures in children to reduce the treatment time and improve sealing ability. Anusha B, Shivashankarappa PG, Mohandoss S, et al. In Vitro Evaluation of Sealing Ability of Biodentine and TheraCal PT in Primary Molars. Int J Clin Pediatr Dent 2024;17(2):158-161.

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.

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.

Retreatment Strategies for Cases Containing Calcium Silicate-Based Root Canal Sealers: A Comprehensive Review.

This review explores the field of retreatment strategies for cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocompatibility, bioactivity, and sealing ability. Therefore, effective retreatment strategies are indispensable. This article aims to identify the challenges associated with the removal of calcium silicate-based sealers themselves and removal of gutta-percha with the sealers during retreatment, evaluate current techniques and materials, and provide future directions for research in this field. Regarding the strategies of removal of root canal sealers, calcium silicate-based sealers are still relatively new materials for clinicians compared with traditional sealers such as epoxy- or eugenol-based sealers. First, no clinically established solvents have been reported. Second, calcium silicate-based sealers are currently utilized by clinicians in either the cold sealer-based technique or the warm vertical condensation technique. Third, the setting process of calcium silicate-based sealers generates byproducts, primarily calcium hydroxide and secondarily hydroxyapatite, that could interact with dentine. Lastly, there is a lack of clinical studies evaluating the efficacy of retreatment protocols for teeth filled with calcium silicate-based sealers. Therefore, it is important to investigate the chemo-mechanical properties of calcium silicate-based sealers themselves and their reactions to solvents and/or mechanical instruments and identify the interfacial properties of calcium silicate-based sealers with respect to dentine and gutta-percha. In addition, researchers in the clinical field need to actively gather and report data on retreatments of teeth filled with calcium silicate-based sealers.

One-year radiographic and clinical performance of bioactive materials in primary molar pulpotomy: A randomized controlled trial

ObjectivesMineral Trioxide Aggregate (MTA) is considered the gold standard material for pulpotomy procedures. However, some drawbacks such as poor handling and long setting time are challenging when it is used as pulpotomy dressing in primary molars in children. Hence, the purpose of this study was to compare the radiographic and clinical performance of a premixed, fast setting bioceramic root repair material (BC RRM-F) with MTA in vital pulpotomy procedures of primary molars, with or without the added seal of a stainless steel crown (SSC). MethodsIn this double blinded, four-arm, parallel group randomized contolled trial (RCT), 64 primary molars were randomly allocated to one of the four treatment groups: MTA (PDTM MTA WHITE)+SSC, MTA+GI (bulk fill glass ionomer with glass hybrid technology GC EQUIA Forte® HT), BC RRM-F+GI and BC RRM-F+SCC. All molars were evaluated clinically and radiographically according to the modified Zurn and Seale criteria at 1, 3, 6, and 12 months follow up. Multivariate cox regression models and Kaplan-Meier curves were used for survival analysis. ResultsThere was no statistically significant difference between the success of both pulp capping materials used. Overall survival analysis showed that using GI instead of SCC as a final restorative material was significantly associated with increased risk of failure. ConclusionsTotalFill® BC RRM™ Fast Set Putty can be used as an alternative to MTA in primary molar pulpotomy. Regardless of the pulp capping material, one year survival of pulpotomized primary molars restored with SSC is higher compared to those restored with GC EQUIA Forte® HT. Clinical SignificanceClinicians’ preference and cost effectiveness may justify the use of either material in primary molar pulpotomy. Parents insisting on tooth-colored restorations for their children's pulpotomized teeth cannot be told that the expectation for success is the same as those restored with SSC, even if calcium silicate-based pulp capping materials are used.

Delayed vs. immediate placement of restorative materials over Biodentine and RetroMTA: a micro-shear bond strength study

BackgroundThe aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS.MethodsA total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05).ResultsThere is a statistically significant difference (p < 0.05) between the µSBS values obtained by applying resin composite on RetroMTA after different setting times (24 h > 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p < 0.05) than the µSBS values at 12 min and 24 h. For both calcium silicate cements, at the end of all time periods, the µSBS obtained when resin composite was applied at the end was higher than the other materials (p < 0.05).ConclusionsFor Biodentine-resin composite bonding, the manufacturer’s recommendation of 12 min can be considered an appropriate time, whereas for RetroMTA-resin composite bonding, the µSBS increased as the waiting time increased. Regardless of the waiting time, it is recommended to prefer direct composite resin restoration over Biodentine and RetroMTA.

Comparative Evaluation of Shear Bond Strength of Tricalcium Silicate-based Materials to Composite Resin with Two Different Adhesive Systems: An In Vitro Study.

Establishing a strong bond between the pulp capping agent and the restorative material is crucial to the success of the procedure. Without this bond, there is a risk of bacterial infiltration into the pulp, leading to treatment failure. In the past, calcium hydroxide was commonly used for such treatments, but it faced challenges, including poor adhesion to dentin, dissolution over time, and the development of multiple tunnel defects. Mineral trioxide aggregate (MTA), introduced to dentistry in 1993, offered an alternative but came with drawbacks like challenging handling and extended setting times. However, in recent times, several new calcium silicate-based materials have emerged to address MTA's limitations. Two notable examples are Biodentine and MTA Plus. Biodentine, for instance, exhibits excellent sealing ability, while MTA Plus distinguishes itself with a finer particle size compared to traditional MTA. These innovative materials offer promising solutions to enhance the efficacy of pulp capping procedures. Therefore, in this research, we conducted a comparative analysis of the shear bond strength (SBS) between composite resin and three materials-MTA, MTA Plus, and Biodentine. We examined the effects of applying two distinct adhesive systems in order to evaluate their influence on the bond strength. A total of 60 acrylic blocks were evenly distributed into three groups, each containing 20 blocks-group I received Biodentine, group II was assigned MTA, and group III received MTA Plus. The respective test materials were compacted into the holes within the blocks. Following this, the samples were incubated for a period of 72 hours. Subsequently, the samples were divided into two subgroups, each consisting of 10 blocks-the self-etch and the total-etch subgroup. The SBS values were then carefully measured for analysis. The SBS of the Biodentine group demonstrated a significantly higher value when compared to the other groups. It's worth noting that when the self-etch adhesive system was employed, the SBS of all the groups experienced a significant reduction. Biodentine cement proves to be an effective choice for pulp capping procedures, regardless of the specific adhesive system employed. Notably, the total-etch adhesive system consistently yields higher bond strength when compared to the self-etch adhesive system. Kumar V, Showkat I, Manuja N, et al. Comparative Evaluation of Shear Bond Strength of Tricalcium Silicate-based Materials to Composite Resin with Two Different Adhesive Systems: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-3):S272-S277.

Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement

Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement

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.

Comparison of Shear Bond Strength in Novel Calcium Silicate-Based Materials to Composite Resin

The purpose of this study was to evaluate whether the newly introduced calcium silicate-based materials with fast-setting properties could be appropriately used as basement materials in indirect pulp treatment (IPT). This was performed by quantifying the durability of adhesion between the material and composite resin, measured by the shear bond strength (SBS). Five calcium silicate-based materials, TheraCal LC&lt;sup&gt;®&lt;/sup&gt; (TLC), TheraCal PT&lt;sup&gt;®&lt;/sup&gt; (TPT), TheraBase&lt;sup&gt;®&lt;/sup&gt; (TB), Well-Root™ PT (WPT), and Endocem&lt;sup&gt;®&lt;/sup&gt; MTA (EMTA), as well as two glass ionomer-based materials, Fuji II and Fuji II LC, were included. Specimens containing these materials were manufactured and bonded to composite resin with a universal adhesive applied in self-etch mode. The SBS values and failure modes were recorded, and the mean SBSs of the materials were compared. Both TPT and TB exhibited SBS values that were similar to TLC, while both WPT and EMTA appeared to have statistically lower SBS values. Mixed failure was commonly observed in TLC and TPT, while all WPT and EMTA samples showed cohesive failure. In comparison with TLC and TPT, more samples with cohesive failure were observed in TB, implying that this material forms a stronger bond with composite resin. Together with the ability of TB to chemically bind to dentin due to its 10-methacryloyloxydecyl dihydrogen phosphate component, TB seems to be a promising material for IPT within the limitations of this in vitro study.

The Effect of Calcium Silicate-Based Materials on Tooth Discoloration and Evaluation of Color Change After Bleaching Treatment: A Spectrophotometric Study.

To evaluate tooth discoloration after the use of calcium silicate-based materials and to examine the effect of internal bleaching on tooth discoloration. The specimens were randomly divided into two experimental groups (n = 45) and a control group (n = 6). Cavities were filled with ProRoot MTA (Dentsply) in Group 1 and Biodentine (Septodont) in Group 2. Color measurements were taken with a spectrophotometer before and after the application of materials at 1 week and then at 13, and 6 months. After 6 months, Groups 1 and 2 were divided into three subgroups according to internal bleaching techniques. All color change ratios and lightness differences were calculated using the CIE L*a*b* system. Data were analyzed using repeated ANOVA and the Kruskal-Wallis test (P = .05). There were statistically significant differences between Groups 1 and 2 at all time intervals (P < .05). Group 1 showed more discoloration than Group 2 (P < .05). There were no significant differences between the bleaching agents (P > .05). Additionally, specimens in both groups became lighter than their initial color (P < .05). Teeth treated with ProRoot MTA exhibited darkening at 1 week that increased over time, whereas those treated with Biodentine maintained the lightness for 6 months.

Global survey of endodontic practice and adoption of newer technologies.

To investigate current endodontic practices, adoption of technologies and continuing education attendance within specialist endodontic practice globally and to identify geographic trends. A web-based survey of endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA on routine treatment preferences, armamentarium and education attendance was conducted. Chi-squared, independent sample t-tests, Cochran's Q test and McNemar's test were performed. The survey was completed by 543 endodontists or endodontic post-graduate students. Almost all respondents used the dental operating microscope (DOM, 91.3%), engine-driven nickel-titanium instruments (NiTi, 97.6%), electronic apex locators (EAL, 93.0%), cone-beam computed tomography (CBCT, 91.2%) and calcium silicate-based materials (CSBMs, 93.7%). Dental dam was always used by 99.1%. Over half used irrigation adjuncts (81.8%), warm vertical compaction (74.6%) and heat-treated NiTi (60.2%). Geographic comparison between AP (Asia-Pacific, n = 78), AM (Americas, n = 402) and EM (Europe and Middle East, n = 63) was performed. AM and EM preferred single-visit treatment more (p < .001) and used higher sodium hypochlorite concentrations than AP. AM had more access to CBCT in the workplace (86.6%) than AP (65.4%, p < .001) and used CBCT for routine preoperative assessment (39.6%) more than EM (7.3%, p < .001). Almost all of EM used irrigation adjuncts (95.2%), more than AM (78.1%, p = .001). AP used steroid/antibiotic medicaments most (p < .001) and had the highest attendance at continuing education programmes. Several endodontic-specific armamentaria have reached almost complete adoption within global specialist endodontic practice, whilst the continued uptake of newer technologies should be followed over time. Some practising philosophies varied significantly across different geographic regions.

Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells

ObjectivesTo investigate the effect of three different calcium silicate-based materials (CSBM) on the biological behavior of human periodontal ligament stem cells (hPDLSCs).MethodsEluates of Biodentine, NeoPutty and TheraCal PT prepared at 1:1, 1:2, and 1:4 ratios were extracted under sterile conditions. The cytotoxicity of the extracts to the hPDLSCs was assessed using the MTT assay. Scratch wound healing assay was utilized for assessing cell migration. Scanning electron microscopy was used to detect cell attachment and morphology. Calcium ion release was measured using inductively coupled plasma-optical emission spectrometry; the pH-value was evaluated with a pH-meter. ANOVA with post hoc Tukey test was used for statistical analysis.ResultsCell viability was significantly higher for Biodentine and NeoPutty at day 1 with all dilutions (p < 0.05), while at day 3 and day 7 with dilutions 1:2 and 1:4; all materials showed similar behavior (p > 0.05). Biodentine had the highest percentage of cell migration into the scratched area at day 1 for all dilutions (p < 0.05). Stem cells were attached favorably on Biodentine and NeoPutty with evident spreading, and intercellular communications; however, this was not shown for TheraCal PT. Biodentine showed the highest pH values and calcium ion release (p < 0.05).ConclusionsThe resin-free CSBM showed better performance and favorable biological effects on hPDLSCs and were therefore considered promising for usage as endodontic repair materials.Clinical significance: Proper selection of materials with favorable impact on the host stem cells is crucial to ensure outcome in different clinical scenarios.