DiaRoot BioAggregate Research Articles

Periodontal Tissue Reaction Consecutive Implantation of Endodontic Materials and Subsequent Integration of Complex Oral Rehabilitation Treatments

Oral rehabilitation is a main branch of dentistry focused on diagnosing the patient’s problem and creating a treatment plan to restore aesthetics, recondition morphologically all components, and recover the functionality of the oral cavity. Biological compatibility of the materials used has a major importance, due to the direct contact with essential tissues, such as the soft and hard tissue of the periodontium and the potential influence on the outcome of the treatment. The present material aims to assess the inflammatory response after subcutaneous implantation of three materials frequently used in endodontics (Mineral Trioxide Aggregate—MTA, DiaRoot BioAggregate, and Sealapex). The evaluation of the reparative tissue reaction after 7, 30, and 60 days, respectively, subsequent to in vivo implantation, was carried out through electron microscopy imaging. Moreover, evaluation of the dynamics of the osteogenesis process was an indicator for the maintenance of internal homeostasis in the context of complex intraoral rehabilitation treatments that include fixed prosthodontics correlated with the particular periodontal-aesthetic aspects and completed by cranio-mandibular repositioning. Our study showed increased absolute values of alkaline phosphatase in all material-implanted cases (more pronounced in MTA and Bio Aggregate), highlighting that this enzyme could be an effective indicator of bone formation, which takes place after the material implantation, with the most significant elevated values at 30 days postoperatively.

In Vivo Evaluation of Biocompatibility of Three Biomaterials Used in Endodontics for Prosthetic Purposes in Complex Rehabilitation Treatment

The ideal biomaterial used in endodontics in the process of sealing the radicular canals should possess a group of qualities for a predictable outcome: biocompatibility, initiation of ontogenesis and cementogenesis, ease of handling, sufficient manipulation time, and convenient price. For a perfect sealing, the root canal treatment can be followed by prosthetic restoration. This study of biocompatibility aims to determine the quantification of the local reaction following the implantation of three biomaterials in the rabbit subcutaneous connective tissue. The used biomaterials with particular reparative properties are: MTA (Mineral Trioxide Aggregate, Dentsply, Tulsa Dental, Johnson City, TN, USA), Sealapex (Kerr, Switzerland), and DiaRoot BioAggregate (Innovative BioCaramix Inc, Vancouver, BC, Canada). The first two biomaterials (MTA, Sealapex) are already being used in endodontic treatments, and the latter was newly introduced during the concrete development of the study. This is an experimental study focused on qualitative and quantitative analysis based on histopathological examination and underlined by the positive result of the study undertaken of the applicability of oral rehabilitation treatments, increasing patients’ quality of life by a significant proportion of 95%, and generating optimal functionality of the stomatognathic system with prosthetic devices as well as accomplishing the objectives of homeostasis.

APICAL MICROLEAKAGE OF VARIOUS BIOMATERIALS IN SIMULATED IMMATURE APICES

Background:: In the treatment of open apex teeth, one-step apexification has been reported as an alternative method to the use of long-term calcium hydroxide. Methods:The present study evaluated and compared apical microleakage when ProRoot MTA (Dentsply) (Group I), DiaRoot BioAggregate (Diadent) (Group II) and Biodentine (Septodont) (Group III) were used in the endodontic treatment of the teeth with simulated immature apices. In order to simulate immature teeth, 57 bovine maxillary incisor roots were prepared and randomly divided into three groups (n = 15 per group). The remaining teeth were included in negative (n=6) and positive (n=6) control groups. The materials were prepared according to the manufacturers instructions and a radiograph was taken for each sample to confirm proper obturation of the samples. Apical microleakage was assessed using the dye penetration technique. Linear dye penetration was measured at 30X magnification and the data were analyzed using ANOVA.Results:Group I showed the lowest apical leakage with a mean dye penetration of 4.64 mm, whereas the leakage was highest in Group II with a mean dye penetration of 5.45 mm. The difference between the leakage in Group I and II was statistically significant (p<0.05), but the differences between other groups (Group I-III and Group II-III) were not (p > 0.05).Conclusions:The findings of the present study suggest that MTA has the best sealing ability when used for the obturation of immature apices. Keywords:BioAggregate, Biodentine, Endodontic treatment, Microleakage, MTA

Fracture resistance of roots with simulated internal resorption defects and obturated using different hybrid techniques

Background/purposeTeeth with internal resorption are susceptible to fracture because of the remaining thin dentinal walls. The aim of this study was to investigate the fracture resistance of roots with simulated internal resorption cavities and obturated with different hybrid techniques. Materials and methodsSeventy single root canals were instrumented. On the coronal half of the roots, standardized internal cavities with a length of 8 mm were created. The apical 6 mm of the 60 root canals were filled with AH Plus sealer and gutta-percha cones. Then, 80 roots were divided into four experimental groups and two control groups according to the internal cavity obturation: Group 1, AHPlus sealer + high-temperature thermoplasticized injectable gutta-percha; Group 2, DiaRoot Bioaggregate; Group 3, Biodentine; Group 4, MTA Fillapex; Group 5, instrumented, but not obturated roots; Group 6, intact roots. A compressive vertical loading at a speed of 1 mm/min was applied to the roots. The forces when the fracture occurred were statistically analyzed with one-way analysis of variance and post hoc Tukey test. ResultsBiodentine group showed statistically higher resistance to fracture than the other experimental groups (P < 0.05). ConclusionFilling the internal resorption cavities with thin dentinal walls using Biodentine may provide strength to the tooth structure more than the other calcium silicate-based materials.

Dislodgement resistance of calcium silicate-based materials from root canals with varying thickness of dentine.

To evaluate the dislodgement resistance of DiaRoot BioAggregate and Biodentine from canals in roots with varying amounts of remaining dentine thickness. A total of 90 maxillary incisor teeth with similar dimensions were used. The teeth were extracted for periodontal reasons from adult subjects aged between 52 and 61years. They were decoronated at the cemento-enamel junction. Simulated internal cavities with a depth of 3mm were performed by widening the canals on the coronal thirds of the roots, leaving varying amounts of remaining dentine thickness. The canals were enlarged progressively using round diamond burs until the desired dentine wall thickness was obtained. The samples were divided into three main groups (n=30 each) according to the dentine thickness as follows: group 1: dentine thickness of 0.75mm, group 2: dentine thickness of 1.50mm and group 3: dentine thickness of 2.25mm. Then, these main groups were further divided into two subgroups (n=15 each) according to the filling material (DiaRoot BioAggregate or Biodentine). Horizontal root slices of 1mm were obtained from each specimen. Vertical loading was applied to the filling materials at a cross-head speed of 1mmmin-1 using a universal testing machine. The force that led to dislodgement of the filling was recorded in Newtons. The resistance to dislodgement was calculated in megapascals (MPa) by dividing the load in Newtons by the area of the bonded interface. The data were statistically analysed with two-way anova with Tukey's honestly significant difference (HSD) test. Biodentine had significantly higher resistance to dislodgement than DiaRoot BioAggregate (P<0.001). The specimens with thinner remaining dentine had lower dislodgement resistance compared to those with dentine thicknesses of 1.50 and 2.25mm (P<0.001). The lowest mean value for dislodgement resistance was obtained from the DiaRoot BioAggregate group with 0.75mm dentine thickness (2.72±0.90MPa). The dislodgement resistance of Biodentine and DiaRoot BioAggregate from root dentine was influenced by remaining dentine thickness, which determines dentinal tubular density.

Effect of intracanal medicaments on the push-out bond strength of Biodentine in comparison with Bioaggregate apical plugs

To evaluate the effect of intracanal medicaments on the push-out bond strength of Biodentine in comparison with DiaRoot BioAggregate (BA) when used as apical plugs. Forty single-rooted teeth were prepared using Peeso reamers. The samples were divided into four groups. The intracanal medicaments were applied to the root canals as follows: Group1: a combination of metronidazole–ciprofloxacin–cefaclor, Group2: a combination of metronidazole–ciprofloxacin, Group3: calcium hydroxide, and Group4: no medication. After 21 days, the medicaments were removed. The apical part of each root was horizontally sectioned into 1-mm thick slices. The samples were divided into two subgroups, and the following materials were placed: Biodentine, DiaRoot-BioAggregate. After 48-h incubation, the push-out bond strength was measured. The data were analyzed by a two-way ANOVA. Biodentine showed a significantly higher mean push-out bond strength value than DiaRoot-BioAggregate (P = 0.00). The medications have an effect on the push-out bond strength of both materials (P = 0.002). Biodentine showed better adhesive performance as an apical plug than DiaRoot-BioAggregate.

X-ray diffraction analysis of MTA-Plus, MTA-Angelus and DiaRoot BioAggregate.

Objective:The purpose of this study was to investigate and compare the crystalline structures of recently released MTA Plus (MTA-P), MTA Angelus (MTA-A), DiaRoot BioAggregate (BA) by X-ray diffraction (XRD) analysis.Materials and Methods:Phase analysis was carried out on powder and set forms of tested materials. The powder specimens placed into sample holders that were packed with a glass slide and the set samples prepared according to the manufacturer's instructions were placed into molds. The samples after being set for three days at 37°C and 100% humidity in an incubator were mounted onto the XRD machine and phase identification was accomplished using a search-match software program.Results:XRD findings indicated that major constituents of MTA-P were bismuth oxide, portlandite, dicalcium silicate and tricalcium silicate. The crystal structure of MTA-A were similar to those of MTA-P except for the absence of portlandite. Additionally, MTA-A had tricalcium aluminate differing from MTA-P. BA mainly differed from MTA-P and MTA-A by the radiopacifier (tantalum oxide-TO) in its composition.Conclusions:The majority of constituents of the tested materials have shown similarity except for the presence of tricalcium aluminate in MTA-A and the inclusion of TO in BA. In addition, set MTA-P showed a strong peak of portlandite.

Evaluation of antibacterial effects of pulp capping agents with direct contact test method.

Objectives:Calcium hydroxide has been used in dentistry as a major capping material having the capacity to introduce the formation of a mineralized dentin bridge, but it has no direct inducing effect to the pulp cells. The purpose of this study was to evaluate the antibacterial properties of three different pulp capping agents using a direct contact test (DCT).Materials and Methods:The antibacterial properties of three pulp capping agents were evaluated a DCT. For the DCT, wells (n = 12) of 96-microtiter plates were coated with the tested cements (Dycal, Dentsply, USA; DiaRoot BioAggregate, Diadent, Holland; Calcimol LC, Voco, Germany) and Kalzinol (zinc oxide/eugenol cement, Dentsply, USA) was used as control material. A Lactobacillus casei suspension was placed on the surface of each specimen for 1 h at 37°C. Bacterial growth was monitored for 16 h with a temperature-controlled microplate spectrophotometer. The kinetics of the outgrowth in each well were recorded continuously at 650 nm every 30 min. The data were analyzed by one-way ANOVA, and Tamhane's T2 multiple comparison test. The level of significance was determined as P < 0.05.Results:All pulp capping agents showed an increase in the logarithmic growth rate of L. casei when compared with the control group (P < 0.05). Therefore, all pulp capping agents did not show antibacterial activity.Conclusions:The tested pulp capping agents haven't got antibacterial properties. Therefore, they should be used carefully when pulp is exposed or only very thin dentin remained over the pulp to avoid bacterial contamination.

Evaluation of the sealing ability of pulp capping agents against leakage on direct pulp capping with a computerized fluid filtration meter

Objective: The aim of this study was to assess the sealing abilities of two calcium hydroxide (Ca[OH] 2) pastes and two mineral trioxide aggregates (MTA) against leakage on direct pulp capping with a computerized fluid filtration (CFF) method. Materials and Methods: The 60 recently extracted sound human molar teeth were sectioned at the level of the highest pulp horn to obtain dentin discs of 0.5 ± 0.2 mm. The dentin discs were numbered and permeability measurements were done before and after the operation for the same sample. For simulating direct pulp capping, dentin discs were perforated with a standard diamond bur and restorated with four different capping materials: Dycal, Calcimol light-curing (LC), ProRoot MTA and DiaRoot BioAggregate. Fluid movement measurements were tested with a CFF method and a mean value was calculated for each specimen. Results: Calcimol LC and Dycal showed significantly higher fluid conductance values compared to other pulp capping materials (P 0.05). Conclusion: Within the limitations of this study, it can be concluded that using the MTA materials as a pulp-capping agent would be more efficient than Ca (OH) 2 materials with regard to pulpal microleakage.

Subcutaneous connective tissue reactions to iRoot SP, mineral trioxide aggregate (MTA) Fillapex, DiaRoot BioAggregate and MTA.

To evaluate connective tissue reactions to iRoot SP (Innovative Bioceramics, Vancouver, BC, Canada), mineral trioxide aggregate (MTA) Fillapex (FLPX) (Angelus Soluções Odontológicas, Londrina, Brazil), DiaRoot Bioaggregate (DiaDent Group International, Burnaby, BC, Canada) and white MTA (Angelus, Londrina, Brazil) in Wistar rats. A total of 128 dentine tubes filled with the materials and 32 empty tubes (control) were implanted into 32 rats. After 7, 15, 30 and 90 days (n = 8 per period), the animals were euthanized, and the tissues were processed for histological evaluation using haematoxylin-eosin (H&E) and Von Kossa (VK) staining. Observations were made for cellular inflammatory components and the presence of multinucleated giant cells (MNGC), macrophages and tissue necrosis. Data were analysed by Fisher's exact and Kruskal–Wallis tests (P < 0.05). In all experimental periods, MTA FLPX and iRoot SP scored higher than the other groups for the variable macrophages (P < 0.05). After 30- and 90-day experimental periods, MTA FLPX scored higher than the other groups for the variable MNGC (P < 0.05). After 90 days, the only group that exhibited samples with severe inflammatory response was MTA FLPX. VK positivity was observed in areas of necrosis in all groups, except in the control group. The materials were considered biologically acceptable except MTA FLPX, which remained toxic to subcutaneous tissue even after 90 days.

Push-out bond strength of three calcium silicate cements to root canal dentine after two different irrigation regimes

The aim of this study was to compare the push-out bond strength of three calcium silicate cements to dentine after two different irrigation regimes. One hundred eighty 2-mm-thick root sections were prepared. The sections were divided into three main groups (n = 60). In group A, the sections were immersed in 1 % NaOCl for 3 min. In group B, the sections were immersed in 17 % EDTA for 3 min followed by 1 % NaOCl for the same period of time. In group C (control group), no irrigation was applied to the sections. The samples from each group were divided into four subgroups (n = 15). In subgroups A1, B1 and C1, DiaRoot BioAggregate; in subgroups A2, B2 and C2, MTA-Angelus and in subgroups A3, B3 and C3, MM-MTA were mixed with hand-mixing. In subgroups A4, B4 and C4, MM-MTA was mixed with auto-mixing. The mixed cements were then placed into cavities with a carrier. The samples were submitted to the push-out test and were loaded. All the data were analysed with one-way analysis of variance and the Tukey HSD multiple comparisons (p < 0.05). There were no statistically significant differences between the irrigation regimes regardless of the used materials. The resistance to displacement in subgroup B4 was significantly greater than that presented by subgroups A3, B3 and C3 (p < 0.05) while not different than all other groups. Irrigation regimes had not affected the push-out bond strength of the calcium silicate cements. Also, strength of auto-mixed MM-MTA was similar to the other cements. The novel calcium silicate cements would be a potentially useful material in endodontic procedures with favourable properties.

Biocompatibility of BioAggregate and mineral trioxide aggregate on the liver and kidney

To investigate and compare the systemic toxic effect of DiaRoot BioAggregate and grey ProRoot Mineral trioxide aggregate (MTA) on the liver and kidney after 7 and 30days. Forty-two white albino rats were divided into two main groups. Group (1), considered the control group (n=18), was further divided into two subgroups. The negative control subgroup (n=6) received no treatment. The empty tube subgroup (n=12) received empty sterile Teflon tubes. In Group (2), considered the experimental group (n=24), the rats were divided equally into two subgroups. One subgroup received MTA, whilst the other received BioAggregate. The materials in the Teflon tubes were implanted subcutaneously in the dorsal side of the rats. Blood samples were taken to investigate the change of kidney and liver functions on day 7 and day 30. The liver and kidney organs were subjected to histopathological examination and calculation of the number of inflammatory cells. Data analysis was performed using one-way anova with post hoc multiple comparisons with the Tukey's test. Student's t-test was used to compare the changes in liver and kidney functions amongst the groups. On day 7, a significantly more severe inflammatory reaction was observed in both experimental subgroups compared with the control (P<0.05); the severity decreased after 30days. The kidney functions were not affected after 7days but had subsequently increased after 30days (P<0.001). Liver functions increased after 7days and had decreased in the BioAggregate subgroup after 30days, whilst in the MTA subgroup, a continuous increase in the level of liver function was observed. Mineral trioxide aggregate had adverse effects on the liver and kidney that were significantly more severe than BioAggregate but with no permanent damage.

The cytotoxic evaluation of mineral trioxide aggregate and bioaggregate in the subcutaneous connective tissue of rats

Objectives: The purpose of this study was to evaluate and compare the cytotoxic effects of ProRoot MTA and DiaRoot BA, a bioceramic nanoparticulate cement, on subcutaneous rat tissue. Study Design: Fifty Sprouge Dawley rats were used in this study. Polyethylene tubes filled with ProRoot MTA and DiaRoot BioAggregate, along with a control group of empty, were implanted into dorsal connective tissue of rats for 7, 15, 30, 60, and 90 days. After estimated time intervals the rats were sacrificed. The specimens were fixed, stained with hematoxylin and eosin, and then evaluated under a light microscope for inflammatory reactions and mineralization. Results: All groups evoked a severe to moderate chronic inflammatory reaction at 7 and 15 days, which decreased with time. Both the MTA and BioAggregate groups showed similar inflammatory reactions, except at 90 days when MTA showed statistically significant greater inflammation (p>0.05). The MTA group showed foreign body reaction at all times. Compared to BioAggregate, MTA showed significantly more foreign body reaction at 60 and 90 days (p<0.0001). After 30 days foreign body reaction of BioAggregate decreased significantly. Both MTA and BioAggregate groups showed similar necrosis at 7 and 15 days (p=0.094 and p=0.186 respectively). No necrosis was observed after 15 days. Similarly there was no fibrosis after 30 days for both MTA and BioAggregate groups (p>0.05). Conclusions: Since DiaRoot BioAggregate showed significantly better results than MTA, we can conclude that it is more biocompatible. However, further studies are required to confirm this result. Key words:Biocompatibility, mineral trioxide aggregate, bioAggregate.