iRoot BP Plus Research Articles

Immature permanent incisors with complicated crown fractures treated with partial pulpotomy using white mineral trioxide aggregate and IRoot BP plus-a retrospective long-term study.

Calcium silicate cements have been widely used for pulpotomies in immature permanent teeth with complicated crown fractures due to their superior properties. However, few studies have evaluated the long-term outcomes of white mineral trioxide aggregate (WMTA) and iRoot BP Plus for partial pulpotomies. The aim of this study was to investigate the long-term clinical and radiographic outcomes of WMTA and iRoot BP Plus for partial pulpotomies in immature permanent incisors with complicated crown fractures. Children who had partial pulpotomies of immature permanent incisors with complicated crown fractures using WMTA or iRoot BP Plus as capping agents were enrolled. Eighty immature permanent incisors in 68 children (aged 8-13 years) were included. They were divided into two groups (WMTA and iRoot BP Plus) according to the capping agents. Clinical and radiographic information was collected during a 5-year follow-up period. Study data were analyzed using Chi-square tests or Fisher exact tests. The clinical and radiographic success rates in the WMTA (n=36) and iRoot BP Plus groups (n=44) were 94.4% versus 97.7% and 88.9% versus 97.7%, respectively (both p < .05). The average observation period was 74.5 ± 13.2months and 61.9 ± 1.6months in the WMTA and iRoot BP Plus groups, respectively (p < .01). Five cases presented with periapical radiolucencies. The WMTA group had four cases of pulp canal calcification (11.1%), while the iRoot BP Plus group had two cases (4.6%). There was crown discolouration in all cases in the WMTA group, but none in the iRoot BP Plus group. Both WMTA and iRoot BP Plus had favorable outcomes in promoting physiological development and maintaining the basic functions of immature permanent incisors with complicated crown fractures. As a partial pulpotomy material, iRoot BP Plus may be more suitable for the esthetic zone than WMTA.

Retraction Note: Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial.

Retraction Note: Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial.

Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study.

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

Experimental Pulp-Capping Agent Radiopaque Dicalcium Silicate Cement Facilitates Dentinogenesis

This study was designed to comparatively evaluate an experimental pulp-capping agent radiopaque dicalcium silicate cement (RDSC), white-colored mineral trioxide aggregate (WMTA), iRoot BP Plus and Biodentine both ex vivo and in vivo. Fourier Transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) were utilized to analyze the phase composition of pulp-capping agents. The surface morphology and element analysis were finished by Scanning electron microscopy (SEM) and Energy Dispersive X-Ray Spectroscopy (EDX). Color stability of the cements and pulp responses induced by different cements were examined by ex-vivo human tooth culture model and in-vivo miniature pig model. Micro-computed tomography was used for quantitative evaluation of the newly formed mineralized tissue. RDSC exhibited discoloration in both models, while WMTA exhibited more visible discoloration. The occurrence of discoloration for WMTA was significantly higher than that of RDSC (p &amp;lt; 0.05), iRoot BP Plus and Biodentine on the 7th day, also higher (p &amp;lt; 0.05) than that of iRoot BP Plus and Biodentine on the 70th day. Mineralized foci were noted in all 7-days groups except the control group both ex vivo and in vivo. Intact and complete reparative dentin bridge formation which possessed tubular structures was noted in all 70-days groups in vivo. RDSC appeared to induce the thickest dentin bridge formation among all these pulp-capping agents which showed statistically significant difference to that of Biodentine (p &amp;lt; 0.05). With decent biological properties, RDSC may have the potential to be a pulp-capping agent recommended in the non-aesthetic area alternative to WMTA, Biodentine and iRoot BP Plus.

Comparison of in vitro biocompatibility and antibacterial activity of two calcium silicate-based materials

This study is aimed at comparing and evaluating the biocompatibility and antibacterial activities of mineral trioxide aggregate (MTA) and iRoot BP Plus as novel retro-filling materials. Discs of both materials were prepared and incubated for 72 h to obtain material extracts in medium. Flow cytometry and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay were used to assess the rate of apoptosis and proliferation of human periodontal ligament stem cells (hPDLSCs) when exposed to eluates of both materials. The expression levels of alkaline phosphatase, collagen type I, osteocalcin, Runt-related transcription factor-2, and Osterix were tested for evaluating the osteogenic differentiation of hPDLSCs. The antibacterial activities of both materials were compared by the direct contact test. The hPDLSCs stimulated by MTA or iRoot BP Plus eluates showed significantly higher cell viability than that of the control group with no eluates. No significant differences were observed among the percentages of necrotic and apoptotic cells stimulated by MTA and iRoot BP Plus eluates and the control group. The expression of all osteogenic differentiation markers of hPDLSCs in both experimental groups were significantly higher than those of the control group, while the increment values in MTA group were significantly higher than those of the iRoot BP Plus group. The antibacterial activity against Enterococcus faecalis showed no significant difference between MTA and iRoot BP Plus. Therefore, both materials may be suitable for retro-filling applications.

A randomized clinical trial of two bioceramic materials in primary molar pulpotomies

Objective: To compare the success rates of iRoot BP Plus and mineral trioxide aggregate (MTA) used as pulp capping materials respectively in pulpotomies of human primary molars and to evaluate the clinical efficacy of iRoot BP Plus. Methods: Children who had at least one pair of carious primary molars and needed to receive pulpotomy under general anesthesia were selected in the present split-mouth trail from August to December, 2018. Each pair of the molars was randomly divided into iRoot BP Plus (experimental group) and MTA group (control group). Children were recalled after 3, 6 and 12 months of treatment both for clinical and radiographic evaluations. Relevant medical and radiographic records were collected. Success rates of two groups were compared and influence factors were analyzed. Results: Totally 20 children (10 boys and 10 girls), 28 pairs of split-mouth molars (56 molars, 28 in experimental group and 28 in control group) were included in the study. At the end of the study, 23 pairs of molars were received the 12-month follow-up. The success rates of 3, 6 and 12 months were 96% (25/26), 92% (22/24) and 87% (20/23) in the experimental group, and 100% (26/26), 96% (23/24), 96% (22/23) in the control group, respectively. There were no significant differences between each of the follow-ups in two groups (P>0.05). The success rate of iRoot BP Plus was significantly influenced by the time of hemostasis after amputating the coronal pulp (P<0.05). Conclusions: Pulpotomies of human primary molars with either iRoot BP Plus or MTA had favorable treatment outcomes. The iRoot BP Plus could be a promising biomaterial in pulpotomy.

Clinical efficacy observation of direct pulp capping using iRoot BP Plus therapy in mature permanent teeth with carious pulp exposure

Objective: To evaluate the clinical efficacy and influence factors of direct pulp capping using a bioactive ceramic in mature permanent teeth with carious pulp exposure, in order to explore the feasibility and indications of vital pulp therapy for such teeth. Methods: From January 2016 to September 2017, 57 patients (57 teeth) with carious pulp exposure in mature permanent teeth were selected from the Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology. All the teeth were preoperatively diagnosed as deep caries with normal pulp or reversible pulpitis. After rubber dam isolation, all the carious dentin was removed and the exposed pulp tissue was observed under microscope. Hemostasis should be achieved within 3 min by using 2.5% sodium hypochlorite cotton pellets with a gently press. A resin composite restoration was performed immediately or 2 weeks later after direct pulp capping by using a bioceramic material (iRoot BP Plus). The patients were re-examined 12 to 50 months after operation (average 30 months) and the outcomes were evaluated by symptoms, clinical examination and X-ray. Kaplan-Meier survival analysis was used to calculate the success rate and influence factors were analyzed by Log-Rank test. Results: Totally 50 patients [age (32±13) years old (13-68 years old), 12 males and 38 females] received the follow-up examination more than one year. The overall success rate was 90% (45/50) and the success rates at 1 year, 2 years, 3 years and more were 98%, 89% and 81%, respectively. Age, gender, symptom, tooth and cavity type, pulpal exposure size and coronal restoration material had no significant correlations with the treatment outcome (P>0.05). Conclusions: Direct pulp capping of mature permanent teeth with carious pulp exposure by using iRoot BP Plus might have high success rate. There's no significant correlations between the major clinical factors and the treatment outcome.

Cytocompatibility and Bioactive Properties of Hydraulic Calcium Silicate-Based Cements (HCSCs) on Stem Cells from Human Exfoliated Deciduous Teeth (SHEDs): A Systematic Review of In Vitro Studies.

The implementation of hydraulic calcium silicate-based endodontic cements (HCSCs) in biologically based endodontic procedures for the primary dentition has been recently investigated, focusing on the biological response of stem cells from human exfoliated deciduous teeth (SHEDs) towards them. The present systematic review aimed to present a qualitative synthesis of the available literature consisting of in vitro assays, which assessed the cytocompatibility and bioactive properties of HCSCs in direct contact with SHEDs. Following the PRISMA statement, an electronic database search was carried out in Medline, Scopus, Embase, Web of Science, and SciELO on March 31st and updated on November 16th, 2020. In vitro studies evaluating the biological response of SHEDs to the treatment with HCSCs were eligible. Within the term biological response, assays assessing the cytocompatibility (i.e., cell viability, migration, proliferation), cell plasticity or differentiation (i.e., osteo/odontogenic marker expression), and bioactivity or biomineralization (i.e., mineralized nodule formation) were included. A total of seven studies were included after the selection process. The study sample comprised an extensive range of cell viability, migration, proliferation, adhesion, and bioactivity assays regarding the biological response of SHEDs towards five different commercially available HCSCs (MTA, ProRoot MTA, Biodentine, iRoot BP Plus, and Theracal LC). Biodentine, MTA, and iRoot BP Plus showed significant positive results in cytocompatibility and bioactivity assays when cultured with SHEDs. The results from in vitro assays assessing the cytocompatibility and bioactivity of the HCSCs MTA, Biodentine, and iRoot BP Plus towards SHEDs support their use in vital pulp treatment for the primary dentition.

Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial.

The purpose of this randomized controlled trial was to compare the 24-month success rates of indirect pulp treatment (IPT) and iRoot BP Plus pulpotomy of primary molars with extremely deep caries. Generally healthy children aged 3-7 years requiring general anesthesia for treating primary molars with extremely deep caries or reversible pulpitis were recruited. Patients with systemic disease, mental health problems, or manifestations of irreversible pulpitis were excluded. In total, 175 molars were randomized and blinded for either IPT (n = 87) or iRoot BP Plus pulpotomy (n = 88). All teeth were restored with stainless steel crowns and evaluated after 6, 12, 18, and 24 months by two blinded calibrated investigators. Kaplan-Meier survival curves were used to compare the survival rates between the groups. The correlations between success rate and patient characteristics were explored with the Cox proportional hazards model. A total of 168 primary molars in 67 patients (average age: 3.83 years) were evaluated. The cumulative survival probability at 24 months was not significantly different between the IPT (93.8%) and pulpotomy (97.7%) groups (P = 0.238). IPT treatment success was significantly associated with age (odds ratio = 2.347; 95% CI: 1.068-5.156; P = 0.034) and preoperative sensitivity (odds ratio = 9.742; 95% CI: 1.079-87.970; P = 0.043). The 24-month success rates of IPT and iRoot BP Plus pulpotomy performed in primary molars with extremely deep caries were not significantly different. Increasing age and preoperative sensitivity were found to be associated with the cumulative survival probability in IPT-treated primary molars with extremely deep caries. Primary teeth with extremely deep carious lesions without signs of irreversible pulpitis can be treated successfully by either indirect pulp capping or iRoot BP Plus pulpotomy. ChiCTR2000032462.

The effect of partial pulpotomy with iRoot BP Plus in traumatized immature permanent teeth: A randomized prospective controlled trial

A new bioceramic material iRoot BP Plus has been introduced and reported to have good biocompatibility, sealing ability and antibacterial activity. It has also been reported to be successfully used for procedures such as pulpotomy, pulp floor perforation repair and so on. However, there are only a few reports on the use of iRoot BP Plus in the management of traumatised teeth with an exposed pulp. The aim of this study was to investigate the clinical and radiographic outcomes of partial pulpotomy with iRoot BP Plus in immature permanent teeth with complicated crown fracture or complicated crown-root fracture. The study was prospectively designed and 110 immature permanent teeth with complicated crown fracture or complicated crown-root fracture were randomly allocated into two groups (n = 55). All teeth were clinically and radiographically assessed at 1, 3, 6, 12, 18 and 24 months after partial pulpotomy with iRoot BP Plus (experimental group, n=50) or calcium hydroxide (control group,n=49) as the pulp capping agent. Eleven cases were lost during follow-up, and 99 teeth were finally analysed. There were no intergroup differences in the survival rate, survival time, root length and dentin wall thickness. The calcific bridge was significantly thinner in the iRoot BP Plus group than in the calcium hydroxide group (0.97±0.13mm vs. 1.36±0.12mm; F=5.128, P=0.029). iRoot BP Plus may be an effective capping material for partial pulpotomy.

Effect of iRoot BP Plus Pulpotomy for Immediate Repair in Children with Young Permanent Teeth Crown Fracture

Objective: To explore the clinical effect of iRoot BP Plus pulpotomy for immediate repair in children with young permanent teeth crown fracture. Methods: From September 2017 to October 2018, 80 children (80 affected teeth) with young permanent teeth crown fracture who treated in the hospital were selected as the research objects. Random number table method was used to divide them into observation and control groups with each group of forty patients (40 affected teeth). The children in the control group were treated with calcium hydroxide resin, while the observation group were treated with iRoot BP Plus for immediate repair. The surgical success rate was compared between the two groups, and the pulp vitality before and after treatment were compared. Results: At 3 months and 6 months after surgery, the success rate of children in the observation group was higher than that in the control group, and the difference was statistically significant (P&lt;0.05). The percentage of children with negative pulp activity in the observation group was higher than that in the control group, and the difference was statistically significant (P&lt;0.05). Conclusion: Immediate repair with iRoot BP Plus pulpotomy in children with young permanent teeth crown fracture has significant clinical effect.

Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study

IntroductionCalcium hydroxide has been used as a traditional pulpotomy agent for a long time but has some disadvantages. iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) is a newly developed, ready-to-use calcium silicate–based bioactive ceramic with excellent bioactivity and sealing ability. However, whether iRoot BP Plus shows superiority over calcium hydroxide as a pulpotomy material on permanent incisors with complicated crown fractures remains unknown. MethodsThis research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material (105 treated with iRoot BP Plus and 100 with calcium hydroxide). Clinical and radiographic information was collected during the 12- to 24-month follow-up period. The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups. ResultsThe success rates for recall in the average follow-up period of 17.5 ± 4.4 months (12–24 months) after pulpotomy treatment were significantly different between the 2 groups, with 99% for the iRoot BP Plus group and 93% for the calcium hydroxide group. Reparative dentin bridges were observed in 92.4% of the iRoot BP Plus group and 90% of the calcium hydroxide group, but the difference was not significant. Pulp canal obliteration was observed in 2 teeth (2%) in each group. ConclusionsThe success rates obtained in our study indicate that iRoot BP Plus as a pulpotomy agent can be a suitable alternative to calcium hydroxide to manage complicated crown fractures.

Antimicrobial activity and pH measurement of calcium silicate cements versus new bioactive resin composite restorative material

BackgroundThe purpose of this in vitro study is to compare the antimicrobial effect and pH of two calcium silicate cements Mineral trioxide aggregate high plasticity (Angelus PR, Brazil) and iRoot BP Plus (BioCeramix Inc., Vancouver, BC, Canada) and new bioactive restorative resin composite restorative material (ACTIVA, MA, Pulpdent, USA) against aerobic bacteria, strictly anaerobic bacteria and a yeast by using an agar diffusion test.MethodsThe materials were tested immediately after manipulation and were applied to the agar plates. Sodium hypochlorite (NaOCl) 5.25% was used as a positive control group. The dry filter paper acted as a negative control group for this study. The size of the inhibition zone for each material was measured after 12, 24 and 48 h. At the time of pH measurement; materials were prepared, crushed then dispersed in distilled water.ResultsThe one-way Anova test revealed that iRoot BP Plus significantly showed superior antimicrobial efficacy compared to MTA-HP against the following species; Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, Enterococcus faecium, Peptostreptococcus anaerobius and Candida albicans (P < 0.05). All of the tested materials did not show any antimicrobial effect against Porphyromonas gingivalis and Actinomyces israelii. The new bioactive resin composite material (ACTIVA) showed the least antimicrobial activity against the previously mentioned microorganisms except E. faecalis. NaOCl significantly showed the highest antimicrobial activity among the test group (P < 0.05). iRoot BP Plus was more alkaline (pH 12.1 ± 0.14/ 11.9 ± 0.25) in comparison to MTA-HP (pH 11.6 ± 0.16/ 11.2 ± 0.10) while ACTIVA was slightly acidic (pH 5.4 ± 0.09/ 6.5 ± 0.08).ConclusionsAccording to the findings of this study, it was concluded that calcium silicate- based cements showed a potential antimicrobial activity mainly due to its high alkalinity. The new bioactive resin composite restorative material exhibits less antimicrobial activity due to its resinous ingredients and slightly acidic nature. Antimicrobial effect of calcium silicate cements against strictly anaerobic bacterial species is still questionable.

IRoot BP Plus promotes osteo/odontogenic differentiation of bone marrow mesenchymal stem cells via MAPK pathways and autophagy

BackgroundiRoot BP Plus is a novel bioceramic endodontic material. Recently, it has been considered as an alternative to MTA which is the most popular scaffold cover during regenerative endodontic therapy. This study aimed to evaluate the effects of iRoot BP Plus on the osteo/odontogenic capacity of bone marrow mesenchymal stem cells (BMMSCs), including the underlying mechanisms.MethodsBMMSCs were collected by a whole marrow method and treated with iRoot BP Plus-conditioned medium (BP-CM). The proliferation ability was evaluated by cell counting kit 8 and flow cytometry. Complete medium was used as a blank control, and 2 mg/ml MTA-conditioned medium was served as a positive control. Alkaline phosphatase (ALP) activity assay, ALP staining, western blot, real-time RT-PCR, Alizarin Red S staining, and immunofluorescence staining were performed to explore the osteo/odontogenic potential and the involvement of MAPK pathways. Besides, autophagy was investigated by western blot, immunofluorescence staining, and transmission electron microscopy.Results

Evaluation of bioceramic putty repairment in primary molars pulpotomy

To evaluate the clinical characteristics and effectiveness of bioceramic putty repairment (iroot BP Plus) used as pulp capping agents on pulpotomy in primary molars. Forty primary molars were treated by pulpotomy with bioceramic putty repairmen as the pulp capping agents at the Third Clinical Division of Peking University School and Hospital of Stomatology, from September 2016 to September 2017. The children who were followed up over one year were selected as the subjects of this study. The teeth were checked clinically and radiographically during fixed intervals, and classified into one of five outcomes: N, H, P0, PX, PY. N, absence of clinical symptoms, and absence of apical radiolucency; H, absence of clinical symptoms, and nonpathologic radiographic change present; P0, absence of clinical symptoms, and pathologic change present, no need for treatment; PX, present or absence of clinical symptoms, pathologic change present treatment or extract immediately; PY, premature loss of deciduous tooth. Molars classified into N and H were regarded as successful, classified into P0, PX and PY were regarded as failed. Followed up for 12-24 months (the average follow up time was 16months), thirty four children were finally included, aged from 3.1 years to 8.5 yaers (the average age was 4.3 years), forty primary molars were included. Thirty four primary molars were included into N group, with absence of clinical symptoms, absence of apical radiolucency. Two molars were included into H group with physiological root absorption. One molar was included into P0group with absence of clinical symptoms butinternal absorption of the root. Three molars were included into PX group, with gingival fistula and apical radiolucency. None was included into PY group. Thirty six teeth got successful treatment, four molars failed. One year success rate of pulpotomy of primary molars using bioceramic putty repairment was 95%. Current evidence suggests that bioceramic putty repairment as a pulpotomy medicament showed satisfied clinical and radiographic result in pulpotomy of primary molars. Bioceramic putty repairment is an acceptable material when used in pulpotomy of primary molars.

Comparison between iRoot BP Plus (EndoSequence Root Repair Material) and Mineral Trioxide Aggregate as Pulp-capping Agents: A Systematic Review.

Introduction:iRoot BP Plus, also known as EndoSequence root repair material (EERM) is a premixed bioceramic thick/putty. According to its instruction manual, iRoot BP Plus is composed of tricalcium silicate, zirconium oxide, tantalum pentoxide, dicalcium silicate, calcium sulfate, calcium phosphate monobasic, and filler agents. This systematic review was carried out to evaluate and present the iRoot BP Plus material as a pulp-capping agent.Materials and Methods:A systematic search for articles with the scope of the selection criteria undergoing for data extraction was conducted through electronic databases. Studies on evaluation of the cytotoxicity, bioactivity, and dentinal bridge formation of iRoot BP, iRoot BP Plus, ERRM putty, or ERRM paste (ERRM) on variant human cells were selected for in vitro models, and dentinal bridge formation on human and animals teeth for in vivo models were selected.Results:A total of 22 articles were discussed in the review, 14 in vitro studies, five in vivo studies, and three articles with both studies. Methyl thiazol tetrazolium was the most used method for evaluating cytotoxicity. As for dentinal bridge formation, histological assessment and micro-Computed tomography were used. Human dental pulp cells (hDPCs) were the most investigated for in vitro models and rats for in vivo models. Except for one study, all studies involved in this review were primarily examining the material and comparing it to different types of mineral trioxide aggregate.Conclusion:iRoot BP, iRoot BP Plus, and ERRM are biocompatible materials that enhance hDPCs and other variant human cells proliferation, migration, attachment adhesion, mineralization, and dentinal bridge formation.

Comparison of cytotoxic effects of calcium silicate-based materials on human pulp fibroblasts Mehmet.

Background. This study aimed to compare the in vitro cytotoxicity of Theracal LC, BiodentineTM, iRoot BP Plus, and MTA Angelus on human pulp fibroblasts (HPF). Methods. Fifteen discs from each calcium silicate-based material were prepared in sterile Teflon molds. After setting, the fabricated discs were eluated with a culture medium for 24 h. HPF cells were plated onto 24-well plates at 5×103 cells/well, and the cells were exposed to the material eluates. The cell viability was evaluated with MTT assay at three different times (24, 48, and 72 h). Data were statistically analyzed. The apoptotic/necrotic status of HPF cells exposed to material eluates was determined by flow cytometry. Results. The differences between the effects of Theracal LC, BiodentineTM, MTA Angelus, and iRoot BP Plus on HPF cells were found to be statistically significant (P<0.05). Theracal LC was found to be more cytotoxic considering other vital pulp capping materials at 24- (28.3%), 48- (44.9%), and 72-hour (49.2%) intervals. On the other hand, BiodentineTM showed the least cytotoxic effects (97.1%, 130.0%, and 103.7%, respectively) According to flow cytometry results, Theracal LC material increased apoptosis/necrosis ratios compared to the other materials. Conclusion. Based on the results of the present study, BiodentineTM, MTA Angelus, and iRoot BP Plus can be classified as biocompatible materials in vital endodontic treatments. However, the Theracal LC materials should be used carefully due to their cytotoxic effects.

Novel evaluation method of dentin repair by direct pulp capping using high-resolution micro-computed tomography.

We evaluated a novel micro-computed tomography (micro-CT) assessment for quality and quantity of dentin repair, which is difficult to visualize by histological analysis, after direct pulp capping under standardized cavity preparation. Standardized cavities were prepared on Wistar rats and direct pulp capping was performed using two commercial bioceramics, ProRoot MTA, and iRoot BP Plus. After 2 or 4weeks, quality and quantity of tertiary dentin formation were evaluated using high-resolution micro-CT analyses including dentin mineral density, dentin mineral contents, compactness and integrity of tertiary dentin, and dentin volume with/without void space. Reproducibility of micro-CT analyses was confirmed by histological evaluation of the same specimen. The exposed pulp area sizes were similar between iRoot BP Plus and ProRoot MTA. Micro-CT analysis of 2-week samples showing compactness of tertiary dentin was significantly higher in iRoot BP Plus than ProRoot MTA (p < 0.05). Tertiary dentin volume without void space, dentin mineral contents, and density were not significantly different between the groups. In 4-week samples, a significant increase was observed in dentin mineral density, compactness, and dentin volume with/without void space induced by iRoot BP Plus (p < 0.05). Micro-CT analysis of tertiary dentin integrity demonstrated that some ProRoot MTA specimens had small defects and lacked continuity (6/512 images). No defects were observed with iRoot BP Plus. Micro-CT analysis was confirmed as an accurate, objective, and inclusive approach for evaluating quality and quantity of dentin repair. These multifaceted approaches to evaluate pulp capping materials may accelerate review processes, ultimately improving vital pulp therapy.

Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root-end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study

IntroductionThis prospective randomized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material (BP-RRM; Innovative BioCeramix Inc, Vancouver, BC, Canada) or mineral trioxide aggregate (MTA) as the retrograde filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery. MethodsBy using strict inclusion and exclusion criteria, 240 teeth were successfully enrolled and randomly and equally allocated to either the MTA or BP-RRM treatment group. A standardized surgical procedure was performed by a single operator. The patients were followed up at 1 week, 3 months, 6 months, and 12 months; follow-up included clinical and radiographic examination. Clinical and radiographic evaluations acquired at the 12-month follow-up were taken as the primary outcome. For the identification of prognostic factors, the dichotomous outcome (success vs failure) was taken as the dependent variable. ResultsA total of 158 teeth were analyzed at the 12-month follow-up, including 87 teeth in the MTA group and 71 teeth in the BP-RRM group. The success rate in the MTA and BP-RRM groups was 93.1% (81/87 teeth) and 94.4% (67/71 teeth), respectively (P > .05). Three significant outcome predictors were identified: quality of root filling (P < .05), tooth type (P < .05), and size of the lesion (P < .05) ConclusionsThese results suggest that BP-RRM is comparable with MTA in clinical outcome when used as root-end filling materials in endodontic microsurgery.

Comparison of the Sealing Ability of Biodentine, iRoot BP Plus and Mineral Trioxide Aggregate

Objective: The aim of this study was to compare the properties of two new root repair materials, Biodentine and iRoot BP Plus against ProRoot MTA when used as root-end fillings. Methods: The root canals of 45 extracted maxillary anterior teeth were prepared with ProTaper instruments. After apical resection and ultrasonic root-end cavity preparation, the teeth were divided into three groups. The cavities in the first group of 15 were filled with Biodentine, the second with iRoot BP Plus and the third with ProRoot MTA. A computerized fluid filtration method assessed the seal at 2, 10 and 28 days. Results: Significant differences were found between Groups 1-2, Groups 1-3 and between Groups 2-3 at all-time intervals (P 0.05). Conclusion: The two new root repair materials showed good performance and both offered improved handling properties compared to MTA. KEYWORDS endodontics; calcium silicate-based cement; bioceramic root repair material;