Mineral Trioxide Aggregate Group Research Articles

A Study on Nanoleakage of Apical Retrograde Filling of Premixed Calcium Silicate-Based Cement Using a Lid Technique.

This study aimed to compare the nanoleakage of retrograde fillings with premixed calcium silicate-based putty and mineral trioxide aggregate (MTA), using two different techniques (traditional and Lid). Sixty-four extracted human teeth were decoronated, then root canals and ends were instrumented for retrograde filling and divided into four groups according to the retrograde filling technique: the traditional and the Lid technique. Each group (n = 15) was filled with Ceraseal + Well-Root putty, Well-Root putty, Ceraseal + ProRoot MTA, and ProRoot MTA. The nanoleakage was evaluated using the Nanoflow device (IB Systems) on days 1, 3, 7, 15 and 30. Data were collected twice per second at the nanoscale (nL/s) and calculated after archiving the stabilization of fluid flow. The Kruskal-Wallis and Mann-Whitney U-tests were used for statistical analysis. All groups showed enhanced sealing ability over time. Regardless of filling materials, the Well-Root putty, Ceraseal+Well-Root putty, and Ceraseal+ProRoot MTA groups indicated less nanoleakage than the ProRoot MTA group in the first week of evaluation (p < 0.05). Although all groups did not show significant differences after 2 weeks, the Ceraseal+ProRoot MTA group leaked less than ProRoot MTA on Days 3 and 7 (p < 0.05). The scanning electron microscopic examined good adaptation to the cavity wall, which was similar to nanoleakage results. Premixed calcium silicate-based putty retrograde filling material alone and using the "lid technique" were shown to be faster and less prone to nanoleakage when compared to MTA.

A Randomized Controlled Clinical Trial Comparing Clinical and Radiographic Success Rates of MTA and rhBMP2 in Pulpotomy of Primary Teeth.

Objectives: In an ideal pulpotomy, the radicular pulp remains vital, healthy, and fully encased within an odontoblastic layer. Mineral trioxide aggregate (MTA) and bone morphogenetic proteins (BMPs) have been suggested to facilitate this outcome. We aimed to compare the clinical and radiographic failure and success rates of MTA and rhBMP2 as pulpotomy medicaments. Materials and Methods: Sixty-eight teeth from 3-6-year-old children were randomly assigned to two groups using a split-mouth design. Cervical pulpotomy was performed using MTA in one group and rhBMP2 in the other. Subsequently, the teeth were restored with stainless-steel crowns. Clinical and radiographic assessments were performed at 3, 6, 9, and 12-month follow-up intervals to evaluate success and failure rates. Data were analyzed using Chi-square test and Kaplan-Meier survival analysis (P<0.05) Results: At six and nine months, one tooth in the BMP2 group and one tooth in the MTA group showed internal resorption, respectively. After 12 months, one tooth in the BMP2 group exhibited PDL widening. The radiographic success rate was 100% for the MTA- and 97.1% for the BMP2-group at six months, 96.7% for both groups at nine months, and 96.7% and 93.3%, respectively, at 12 months. No clinical failure criteria were observed in any of the teeth. Survival analysis revealed no significant difference between the two groups. Conclusion: The study reveals comparable outcomes between rhBMP2 and MTA, suggesting rhBMP2 as a viable alternative for pulpotomy in primary teeth. With minimal incidences of complications and no significant differences noted, rhBMP2 demonstrates potential for clinical use.

Histological Evaluation of Pulpal Response and Dentin Bridge Formation After Direct Pulp Capping Using Recombinant Amelogenin and Mineral Trioxide Aggregate (MTA).

The purpose of the study was to compare and histologically investigate pulpal response and dentin bridge formation after direct pulp capping using recombinant amelogenin and mineral trioxide aggregate (MTA). Recombinant amelogenin protein and MTA were used as pulp capping materials in 120 teeth from eight mongrel dogs. Dogs were sacrificed at two different evaluation times. Regenerative changes were evaluated histologically. At two weeks, in contrast to the MTA group, most of the amelogenin group showed moderately formed hard tissue formation and the pulp tissue was completely filling the entire pulp chamber. These results were statistically significant. At two months, all the samples of the amelogenin group showed complete dentin bridge formation and the pulp chamber was filled entirely with tissue-mimicking the authentic pulp in all the specimens of the amelogenin group. These results were statistically significant. In conclusion, direct pulp capping by recombinant amelogenin protein resulted in significantly better regeneration of the dentin-pulp complex than MTA.

An animal study on the effectiveness of platelet-rich plasma as a direct pulp capping agent

Direct pulp capping (DPC) is a conservative approach for preserving tooth vitality without requiring more invasive procedures by enhancing pulp healing and mineralized tissue barrier formation. We investigated the effectiveness of Platelet Rich Plasma (PRP) vs. Mineral Trioxide Aggregate (MTA) as a DPC agent. Forty-two teeth from three mongrel dogs were divided into two equal groups. After three months, the animals were sacrificed to evaluate teeth radiographically using cone-beam computerized tomography, histopathologically, and real-time PCR for dentin sialophosphoprotein (DSPP), matrix extracellular phosphoglycoprotein (MEPE), and nestin (NES) mRNA expression. Radiographically, hard tissue formation was evident in both groups without significant differences (p = 0.440). Histopathologic findings confirmed the dentin bridge formation in both groups; however, such mineralized tissues were homogenous without cellular inclusions in the PRP group, while was osteodentin type in the MTA group. There was no significant difference in dentin bridge thickness between the PRP-capped and MTA-capped teeth (p = 0.732). The PRP group had significantly higher DSPP, MEPE, and NES mRNA gene expression than the MTA group (p < 0.05). In conclusion, PRP enables mineralized tissue formation following DPC similar to MTA, and could generate better cellular dentinogenic responses and restore dentin with homogenous architecture than MTA, making PRP a promising alternative DPC agent.

Clinical outcome of direct pulp capping by using mineral trioxide aggregate and calcium hydroxide in the mature permanent teeth during the carious tissue removal.

Objective: To compare the clinical outcome in between the mineral trioxide aggregate (MTA) and calcium hydroxide (CaOH) during the direct pulp capping in mature permanent teeth. Study Design: Comparative Cross Sectional. Setting: Department of Operative Dentistry and Endodontics, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad. Period: January 2022 to December 2022. Material &amp; Methods: We included all patients who had vital pulp, reversible pulpitis, mature teeth with closed apex, and were between the ages of 18 and 35, regardless of gender. Two groups of patients with equal numbers were formed. Those in groups A and B. Patients in Group A received MTA treatment, whereas those in Group B received CaOH treatment. Patients in both groups were encouraged to follow up to check on the discomfort and sensitivity of the tooth after 24 hours, a week, three months and six months. Data were gathered using a research proforma. Results: The mean age of the patients was 27.13+4.59 years in CaOH group and 27.43+4.40 years in MTA group. Pre- operatively the most of the patients had moderate to severe pain in both groups as 40.0% and 46.7% in CaOH group and 20.0% and 80.0% in MTA group respectively. Severity of the post-operative pain was less in MTA group while findings were statistically insignificant (p-0.143). On the pain assessment after 3 months, only 13.3% cases had mild pain in CaOH group, while no any case found with pain in MTA group (p-0.038). Post operative pain on 7th month was almost decreased complete in both groups. Test validity was positive in all of the cases till 6th months follow-up, which indicted that no nay cases had developed narcosis after treatment in both groups. Furthermore, in this study, there was no any cases found with radiological abnormalities during follow- up of 24 hours to 6 month post-operatively in both groups. Conclusion: After direct pulp capping in adult permanent teeth, both mineral trioxide aggregate and calcium hydroxide were demonstrated to be effective. However, MTA seems to be more effective than calcium hydroxide in preserving long-term pulp vitality.

Comparison of coronal sealing of flowable composite, resin-modified glass ionomer, and mineral trioxide aggregate in endodontically treated teeth: An in-vitro study

Background: Coronal seal is one of the essential factors that affects the success of endodontic treatment and reinforces the apical seal. The intra-orifice barrier is an efficient alternative approach to decrease coronal leakage in endodontically treated teeth and various materials have been used for this purpose. This study aimed to compare the coronal sealing of flowable composite, resin-modified glass ionomer (RMGI), and mineral trioxide aggregate (MTA) in endodontically treated teeth. Materials and Methods: In this in vitro study, 35 single-canal canine teeth were divided into five groups, including flowable composite, RMGI, MTA, positive control, and negative control groups. The teeth were filled with restorative materials according to the factory's instructions. Afterward, the samples were immersed in 2% methylene blue dye solution for 1 week at 37°C and 100% humidity condition. Finally, the teeth were sectioned longitudinally and dye penetration was measured using a stereomicroscope with ×10. Data were analyzed with Kolmogorov–Smirnov and Kruskal–Wallis tests (α = 0.05). Results: The positive control group showed the highest amount of dye penetration compared to other groups (12.34 ± 0.46). Dye penetration in the MTA group was significantly lower (4.25 ± 0.31) compared to the RMGI group (5.94 ± 0.24) (P = 0.02). Moreover, while the dye penetration in the MTA group was lower than in the flowable composite group (5.65 ± 0.26), the difference was not statistically significant (P = 0.12). Conclusion: MTA reduces the coronal leakage and provides an acceptable coronal seal in endodontically treated teeth, especially compared to RMGI, and therefore, using MTA as an intra-orifice barrier increases the endodontic treatment success rate.

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan.

Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved. To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months. A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group. After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30). There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Effects of mineral trioxide aggregate and methyl sulfonyl methane on pulp exposure via RUNX2 and RANKL pathways.

The aim of this study was to determine the therapeutic effects of mineral trioxide aggregate (MTA) and methyl sulfonyl methane (MSM) on pulp damage due to pulp exposure through the RUNX2 and RANKL pathways. Seventy-two male Sprague-Dawley rats aged 4-6months and weighing 250-300g were divided into healthy, control, MTA, and MSM groups. After experimental applications, all rats at 2, 4, and 8 weeks were killed anesthetically with xylazine hydrochloride (Rompun, Bayer) 30mg/kg and ketamine hydrochloride (Ketalar, Pfizer) 50mg/kg injections (i.p.). We observed that necrotic odontoblasts, edema, inflammation, and vascular congestion findings were reduced from week 2 to week 8 in the MSM treatment group after pulp capping compared to the control group and MTA group. Similarly, we found a decrease in RUNX2 and RANKL levels in the MSM application group compared to the control and MTA groups (p < 0.05). MSM material has shown therapeutic effects on pulp capping treatment-induced pulp injury via increased RUNX2 ve RANKL expression.

In vitro and in vivo evaluation of iRoot BP Plus as a coronal sealing material for regenerative endodontic procedures

ObjectivesTo investigate in vitro effects of a nanoparticle bioceramic material, iRoot BP Plus, on stem cells from apical papilla (SCAP) and in vivo capacity to induce pulp-dentin complex formation. Materials and methodsThe sealing ability of iRoot BP Plus was measured via scanning electron microscopy (SEM). SCAP were isolated and treated in vitro by iRoot BP Plus conditioned medium, with mineral trioxide aggregate (MTA) conditioned medium and regular medium used as controls, respectively. Cell proliferation was assessed by BrdU labeling and MTT assay and cell migration was evaluated with wound healing and transwell assays. Osteo/odontogenic potential was evaluated by Alizarin red S staining and qPCR. Pulp-dentin complex formation in vivo was assessed by a tooth slice subcutaneous implantation model.ResultsiRoot BP Plus was more tightly bonded with the dentin. There was no difference in SCAP proliferation between iRoot BP Plus and control groups (P > 0.05). iRoot BP Plus had a greater capacity to elevated cell migration (P < 0.05) and osteo/odontogenic marker expression and mineralization nodule formation of SCAP compared with MTA groups (P < 0.05). Furthermore, the new continuous dentine layer and pulp-like tissue was observed in the iRoot BP Plus group in vivo.ConclusionsiRoot BP Plus showed excellent sealing ability, promoted the migration and osteo/odontogenesis of SCAP and induced pulp-dentin complex formation without affecting the cell proliferation, which indicated iRoot BP Plus was a promising coronal sealing material in REPs.Clinical relevanceThe coronal sealing materials play crucial roles for the outcomes of REPs. This study showed that iRoot BP Plus has good coronal sealing and promote pulp-dentin complex formation compared with MTA, providing experimental evidences for the clinical application of iRoot BP Plus as a promising coronal seal material in REPs.

Radiographic Outcomes of Mineral Trioxide Aggregate (MTA) with and Without Platelet-Rich Fibrin (PRF) In Direct Pulp Capping: A Clinical Pilot Study

Aim: The purpose of the current investigation was to determine by radiographic means if a calcific dentinal bridge had formed following direct pulp capping (DPC) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), or a combination of platelet-rich fibrin (PRF) and MTA. Materials and Methods: In the beginning, 45 systemically healthy patients who needed DPC and had pulpal exposure were enrolled in the trial. They were then randomly assigned to one of three groups: CH (control, n = 15), MTA ( n = 15), or PRF + MTA ( n = 15). To determine the radiographic density of the dentin immediately underneath the location of pulpal exposure, pre-operative intraoral digital radiographs of the afflicted teeth were acquired. Through sequential imaging, the radiographic evaluation of dentinal bridge formation was performed. All images were studied carefully, keeping the reference point constant. Results: Out of the 45 patients, finally 10 per group were analysed. According to an analysis of variance, difference in mean density values among the various groups was found to be significant [( p = .001). On bi-group comparison (using post-Tukey HSD), difference between CH and PRF + MTA was significant ( p = .001), between MTA and PRF + MTA was significant ( p = .022), and between CH and MTA not significant ( p = .347)]. The PRF + MTA group showed the highest increase in mean density values. Conclusion: The results of the present study suggest that PRF and MTA when used in combination have better radiographic outcomes compared to MTA alone when used as DPC agents.

Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial

BackgroundPostoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis.MethodsA total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18–65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests.ResultsThe mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05).ConclusionMTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain.Trial registrationThe trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).

The Effect Of Root Canal Irrigants On The Push –out Bond Strength Of Biodentine

Aims: The aim of This study was to evaluate the effect of some endodontic irrigants on the push-out bond strength Biodentine in comparison with Mineral trioxide aggregate (MTA) and Glass ionomer cement (GIC).Materials and Methods: Mid root dentine of single rooted teeth was horizontally sectioned into 1-mm-thick slices. The canal space of each dentine slice was enlarged with a diamond bur to 1.4 mm in diameter. The samples were divided into 3 groups (n=21)for each, and the following materials were placed, respectively: Biodentine( Septodont, Saint Maur des Foss'es, France),MTA(Dentsply, TulsaDental, Tulsa, OK),and GIC(Medifil, PROMEDICA, Germany).The samples were wrapped in wet gauze for 30 minutes to ensure setting of the materials and then divided into 3 subgroups (n=7)for each, to be immersed into QMix ((Dentsply Tulsa Dental, Tulsa, OK, USA), Bio Pure MTAD (Dentsply Tulsa Dental),and saline solutions for 30 minutes. No irrigant was placed over any test material in the other three subgroups. After incubation for 48 hours, the dislodgement resistance of the samples was measured (with and with exposure to the irrigant solutions) using a universal testing machine. Then the samples were examined under stereomicroscope to determine the nature of the bond failures. Results: The lowest push-out bond strength was observed in the MTA group. Biodentine displayed a significantly higher resistance to displacement than the MTA group. Exposure to QMix, MTAD, and saline solutions did not affect the resistance to displacement of the Biodentine and GIC groups, whereas MTA lost strength after exposure to the irrigant solutions ,but the difference was not significant. Conclusions: The PBS of Biodentine and GIC was not affected by the irrigant solutions. Contact with the irrigant solutions did not have a significant effect on the failure modes of the tested materials

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

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

Effect of Fluorohydroxyapatite on Biological and Physical Properties of MTA Angelus.

This study aimed to assess the effect of addition of fluorohydroxyapatite (FHI) on biological and physical properties of mineral trioxide aggregate (MTA) Angelus. In this in vitro, experimental study, nano-FHI powder was first synthesized, and the morphology and chemical structure of particles were evaluated by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). Three groups were evaluated in this study: MTA Angelus, MTA modified with 10% FHA, and MTA modified with 15% FHA. After mixing, the materials were applied to ring molds (10 mm diameter, 1 mm height), and the setting time of the three groups was evaluated according to ISO6876 and ASTMC266-03 with a Gillmore needle. The pH was measured using a pH meter at 24 and 48 hours and 7 days after mixing. The cytotoxicity of the materials was assessed in freshly mixed form and after 1 and 7 days using the methyl thiazolyl tetrazolium (MTT) assay according to ISO10993-5. Data were analyzed by one-way and repeated measures ANOVA and Tukey's test (alpha = 0.05). The addition of FHA to MTA significantly decreased the initial setting time (P < 0.05) and had no significant effect on cell viability (compared with pure MTA Angelus) at 1 and 7 days. However, modified MTA groups in freshly mixed form showed significantly lower cell viability (P < 0.05). The pH remained alkaline at all time points. Addition of 15% FHA to MTA Angelus decreased its setting time with no adverse effect on cell viability (except for fresh form) or pH.

Effects of direct pulp capping with recombinant human erythropoietin and/or mineral trioxide aggregate on inflamed rat dental pulp.

This study aimed to evaluate the dental pulp responses to recombinant human erythropoietin (rhEPO) and/or mineral trioxide aggregate (MTA) in pulp capping of inflamed dental pulp in vivo. In accordance with ARRIVE guidelines, pulp inflammation was induced by exposing the maxillary first molars (n = 64) of Wistar rats (n = 32) to the oral environment for two days. The exposed pulps were randomly assigned four groups based on the pulp capping material: rhEPO, MTA, MTA + rhEPO, or an inert membrane. An additional eight rats formed the healthy control group. After four weeks, the animals were euthanized, and histological, qRT-PCR, and spectrophotometric techniques were employed to analyze the left maxillary segments, right first maxillary molars, and blood samples, respectively. Statistical significance was set at p < 0.05 and < 0.001. Pulp capping with rhEPO, MTA, or MTA + rhEPO resulted in lower inflammation and higher mineralization scores compared to untreated control. MTA + rhEPO group exhibited significantly decreased expression of tumor necrosis factor-alpha, and interleukin 1-beta, while MTA group showed substantially reduced expression of interferon-gamma. Both rhEPO and MTA + rhEPO groups presented elevated dentin matrix protein 1 levels compared to untreated control. Furthermore, pulp capping with rhEPO and/or MTA led to increased transforming growth factor-beta 1 expression and reductions of pro-inflammatory/immunoregulatory cytokine ratios and prooxidative markers. Pulp capping with rhEPO also resulted in increase of systemic antioxidative stress markers. Capping with rhEPO or MTA + rhEPO resulted in a favorable effect that was similar or even superior to that of MTA.

Molecular mechanism of a novel root-end filling material containing zirconium oxide on the osteogenic/odontogenic differentiation of human osteosarcoma MG-63 cells.

Although the novel root-end filling material containing zirconium oxide (NRFM-Zr) which is hydroxyapatite-based may promote osteoblast differentiation, the molecular mechanism remains unclear. The aim of this study is to investigate it underlying the osteogenic/odontogenic differentiation of human osteosarcoma MG-63 cells induced by NRFM-Zr, compared with calcium silicate-based mineral trioxide aggregate (MTA), and glass ionomer cement (GIC). Firstly, three different types of root filling materials were co-cultured with MG-63 cells, and their cell toxicity, alkaline phosphatase (ALP) activity, and calcium ion concentration were evaluated. Next, gene expression profiling microarray was employed to analyze the impact of the materials on the gene expression profile of MG-63 cells. The results of cell viability revealed that NRFM-Zr group had no significant difference compared to the negative control group. After 5 and 7days of cultivation, both the NRFM-Zr and MTA groups exhibited significantly higher ALP activity compared to the negative control (p < 0.05). Moreover, the NRFM-Zr group had the highest calcium ion concentration, while the GIC group was the lowest (p < 0.05). Gene expression profiling microarray analysis identified 2915 (NRFM-Zr), 2254 (MTA) and 392 (GIC) differentially expressed genes, respectively. GO functional and KEGG pathway analysis revealed that differentially expressed genes of NRFM-Zr, MTA and GIC participated in 8, 6 and 0 differentiation-related pathways, respectively. Comparing the molecular mechanisms of osteogenic/odontogenic differentiation induced by hydroxyapatite-based NRFM-Zr and calcium silicate-based MTA, it was found that they shared similarities in their molecular mechanisms of promoting osteogenic differentiation. NRFM-Zr primarily promotes differentiation and inhibits cell apoptosis, thereby enhancing osteogenic/odontogenic differentiation of MG-63 cells. Furthermore, the inducing efficacy of NRFM-Zr was found to be superior to MTA.

Evaluation of the biological effect of mineral trioxide aggregate in inflamed pulp-in vivo analysis.

The health of dental pulp tissue is critical to maintaining normal tooth function from the eruption of permanent teeth to the formation of the apex. The study evaluated the inflamed pulp response to the mineral trioxide aggregate (MTA) after direct pulp capping with the mechanical pulp exposure in rats' incisor. Forty-eight mandibular central incisors of twenty-four Sprague-Dawley rats which were prepared with the cavities of one mm diameter, and the pulp exposures were randomly assigned into two groups: MTA group and calcium hydroxide (Ca(OH)2) group. The direct pulp capping was performed after three days and samples histological observations conduction within eight weeks. In both MTA and Ca(OH)2 groups, dentin -like structures were observed in the pulp tissues of some teeth. The number of teeth with reparative tissue in MTA group was statistically significantly higher than that in Ca(OH)2 group (p = 0.041). Inflammatory cell infiltration was found in the crown pulp tissues in two groups, and no statistical difference was observed between the two groups (p = 0.243). Pulp necrosis occurred in both groups, and there was no statistical difference between the two groups (p = 0.622). The results in this paper suggest that MTA promotes direct pulp capping and hence has certain potential clinical applications value in the treatments for the preservation of inflamed pulp.

Histological evaluation of dental pulp response to Biodentine, enamel matrix derivative (Emdogain), and mineral trioxide aggregate as direct pulp-capping agents – A randomized clinical trial

ABSTRACT Aim: We aimed to study the response of pulp tissue to Biodentine, enamel matrix derivative (Emdogain), and mineral trioxide aggregate (MTA) as direct pulp-capping (DPC) agents. Materials and Methods: This study was performed on 78 maxillary/mandibular permanent teeth indicated for surgical extraction (periodontal/orthodontic). Exposure of 1.2 mm in diameter was made. Hemostasis was achieved. The tooth was randomly allocated to one of the three groups. In Group 1, pulp capping was done with Biodentine. In Group 2, Emdogain was used. In Group 3 (control), pulp capping was carried out with MTA. Final restoration was done with glass-ionomer cement. Teeth were extracted atraumatically after 6 weeks. Histologic examination was done and samples were evaluated. Differences in inflammatory response in the three groups were statistically evaluated using Chi-square test. Results: Grade 1 inflammatory response was observed in 57.7% of cases treated with Biodentine, 36% with Emdogain, and 65.4% with MTA. The difference was however not statistically significant (P = 0.427). Majority of cases in the MTA group (57.7%) showed presence of calcific bridge directly adjacent to the medicament interface as compared to Biodentine (46.1%) and Emdogain (0%), and the difference between the groups was statistically significant (P &lt; 0.05). The difference in formation of calcific bridge with MTA and Biodentine was not statistically significant (0.694). Conclusions: Within the limitations of this histological study, it can be concluded that MTA and Biodentine are well tolerated as DPC agents by pulp tissue as compared to Emdogain.

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

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

Effect of incorporation of nano-graphene oxide on physicochemical, mechanical, and biological properties of tricalcium silicate cement

ObjectiveEvaluation of setting time, compressive strength, pH, calcium ion release, and antibacterial activity of mineral trioxide aggregate (MTA) after modification with three different concentrations of nano-graphene oxide (GO) powder compared to unmodified Biodentine as a commercial control. MethodsGO powder, unhydrated and hydrated cements were characterized using Environmental Scanning Electron Microscope (ESEM) with Energy Dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), Raman Spectroscopy, and Fourier Transform Infrared spectroscopy (FTIR). GO was also analyzed using Scanning Transmission Electron Microscope (STEM) to determine average lateral dimensions. Specimens were prepared and grouped according to the concentration of GO added to Rootdent MTA (control, 1, 3, and 5 wt%) and the material used (MTA and unmodified Biodentine) into five groups. Setting time was evaluated using Gillmore penetrometer (n = 5). Compressive strength was evaluated using universal testing machine (n = 7). pH and calcium ion release were assessed using pH meter and Induced Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) at 1, 7, 14, and 28 days (n = 7). Antibacterial activity was evaluated against Streptococcus mutans using direct contact test (n = 7). One-way and repeated measures ANOVA followed by Tukey's post hoc test were used for data analysis with significance level set at p ≤ 0.05. ResultsAddition of GO to MTA reduced both initial and final setting time. GO modified MTA groups and unmodified Biodentine showed significantly increased calcium ion release at 14 and 28 days. All cements showed alkaline pH of the storage media at all tested time intervals. 1 wt% GO recorded the highest compressive strength values in MTA modified groups. The increased concentration of GO from 1 to 5 wt% successively increased antibacterial activity of MTA, with Biodentine showing the lowest significant value. ConclusionAddition of 1 wt% GO can significantly improve the tested properties of tricalcium silicate-based cements without compromising their compressive strength. Clinical significanceGO is a promising modification for tricalcium silicate cements to improve setting time, compressive strength, and antibacterial activity to provide a variety of materials for different clinical situations. This in turn can reduce the risk of reinfection and allow placement of the final restoration in a single visit.