Mineral Trioxide Aggregate Research Articles

Mineral trioxide aggregate obturation quality with two obturation techniques in severe curved root canals – a micro-CT study

BackgroundThe existence of voids within the mineral trioxide aggregate (MTA) composition is one of the factors that can influence the treatment outcome. The primary objective of this study was to quantitatively assess and compare the MTA orthograde obturation quality in severe curved root canals using two different MTA compaction techniques: manual compaction with K-file, or Auger technique using micro-computed tomography (micro-CT) imaging.MethodsFor this study, 26 mandibular first molar teeth with severely curved mesiobuccal root canals were selected. These samples were randomly divided into two groups. All root canals were instrumented using ProTaper Gold rotary files up to the F3 file at the working length. In one group, OrthoMTA was compacted using a stainless steel K-file, while in the other group, the Auger technique was employed for compaction into the root canals. Once the MTA had completely set, the filled root canals were subjected to scanning using a high-resolution micro-CT scanner. The porosity volume was determined as a percentage in relation to the overal volume of the canal, and the collected data were subjected to analysis using SPSS software, with the significance level set at P < 0.05.ResultsThe two techniques had no significant difference in open, closed, and total mean porosity. In both groups, the mean of open porosity was significantly more than closed porosity.ConclusionsAccording to the results of the present study, neither of these two techniques is preferred to the other, and factors such as working time, etc., can be considered to choose the more appropriate clinical technique.

Implementing microfluidic flow device model in utilizing dural substitutes as pulp capping materials for vital pulp therapy

Vital pulp therapy (VPT) has gained prominence with the increasing trends towards conservative dental treatment with specific indications for preserving tooth vitality by selectively removing the inflamed tissue instead of the entire dental pulp. Although VPT has shown high success rates in long-term follow-up, adverse effects have been reported due to the calcification of tooth canals by mineral trioxide aggregates, which are commonly used in VPT. Canal calcification poses challenges for accessing instruments during retreatment procedures. To address this issue, this study evaluated the mechanical properties of dural substitute intended to alleviate intra-pulp pressure caused by inflammation, along with assessing the biological responses of human dental pulp stem cells (hDPSC) and human umbilical vein endothelial cells (HUVEC), both of which play crucial roles in dental pulp. The study examined the application of dural substitutes as pulp capping materials, replacing mineral trioxide aggregate (MTA). This assessment was conducted using a microfluidic flow device model that replicated the blood flow environment within the dental pulp. Computational fluid dynamics simulations were employed to ensure that the fluid flow velocity within the microfluidic flow device matched the actual blood flow velocity within the dental pulp. Furthermore, the dural substitutes (Biodesign; BD and Neuro-Patch; NP) exhibited resistance to penetration by 2-hydroxypropyl methacrylate (HEMA) released from the upper restorative materials and bonding agents. Finally, while MTA increased the expression of angiogenesis-related and hard tissue-related genes in HUVEC and hDPSCS, respectively, BD and NP did not alter gene expression and preserved the original characteristics of both cell types. Hence, dural substitutes have emerged as promising alternatives for VPT owing to their resistance to HEMA penetration and the maintenance of stemness. Moreover, the microfluidic flow device model closely replicated the cellular responses observed in live pulp chambers, thereby indicating its potential use as an in vivo testing platform.

Comparison of Surface Microhardness of Portland Cement Associated with Niobium Oxide and Zirconium Nanoparticles with the Mineral Aggregate Trioxide

To determine the surface microhardness of white portland cement associated with niobium nanoparticles, white portland cement associated with zirconium nanoparticles, and mineral trioxide aggregate. The present study is an experimental in-vitro study. The sample consisted of 03 study groups. These were divided into 09 subgroups of 04 hours, 14 days and 28 days. The instrument used to record the surface mechanical microhardness was the Vickers microdurometer. The Shapiro-Wilk statistical analysis was then performed to identify the normality of the data. The Anova test was applied to compare between the three groups and then the Tukey test for multiple comparisons with a 95% confidence level. White Portland cement associated with zirconium nanoparticles had the highest hardness value (p&lt;0.05), followed by white Portland cement associated with niobium nanoparticles and aggregate control cement of mineral trioxide. The lowest value of surface microhardness was obtained by the addition of mineral trioxide (p&lt;0.05). Surface microhardness values were significantly higher at 28 days than at 04 hours for all groups evaluated. White Portland cement with/without nanoparticulate additives generated higher surface microhardness than the control group added mineral trioxide in the evaluation periods.

Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth – a systematic review and network meta-analysis

Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT.

The effect of two different contemporary chelating agents on vital pulp therapy in mature permanent teeth with irreversible pulpitis using bioceramic material: randomized clinical trial.

Vital pulp therapy maintained functionality, vitality, and asymptomatic teeth. Compared to normal root canal treatment, pulpotomy was more helpful for irreversible pulpitis in adult permanent teeth. The research was aimed to assess effectiveness of vital pulp therapy using mineral trioxide aggregate with Apple Vinegar and Ethylene diamine tetra acetic acid (17%) for five minutes in adult carious exposed pulp of permanent teeth. Forty patients between 18 and 50 years old with a clinical diagnosis of symptomatic irreversible pulpitis but no periapical radiolucency were then divided randomly into two groups based on the irrigation method; ethylene diamine tetraacetic acid or apple vinegar. If pulpal bleeding could not be managed in less than six minutes, the assigned procedure was abandoned. After mineral trioxide aggregate application as a pulpotomy agent, glass ionomer and composite restoration were placed. Using a visual analogue scale, the pre and post-operative pain were recorded after 2,6,24,48, and 72h. Success was assessed using radiographic and clinical examination data at three, six, and twelve months. The success rate was discovered to be non-statistically significant in both groups after a year follow-up. Apple vinegar had a lower mean value than ethylene diamine tetra acetic acid at the preoperative baseline pain level, which was significant.Postoperatively, the ethylene diamine tetraacetic acid group reported the greatest mean value after two hours while Apple vinegar group reported the lowest mean values after 48h (P < 0.05). After 72h, pain level recorded insignificant difference. Apple vinegar yielded a marginally successful outcome but substantially improved pain alleviation. The trial was registered in Clinical trials.gov with this identifier NCT05970536 on 23/7/2023.

The effects of mineral trioxide aggregate and second-generation autologous growth factor on pulpotomy via TNF-α and NF-kβ/p65 pathways

This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene’s test, and the Shapiro-Wilk test on statistical software. A P value < 0.05 was considered significant. When compared with the control group, both MTAG and CGFG showed increased edematous and inflammatory areas. In MTAG, edematous and inflammatory areas decreased significantly from the 2nd week (2(2–2), 2(1–2)) to the 4th week (1(1–1), 1(0–1)), while in CGFG, edematous areas decreased (2(2–3), 1.5(1–2)), and inflammatory areas increased significantly (2(2–3), 3(2-2.5)). When compared with the control group, TNF-α and NF-kβ/p65 positivity were higher in both MTAG and CGFG. In MTAG, TNF-α [2(1.5-2)] and NF-kβ/p65 [1.5(1–2)] positivity decreased significantly from the 2nd week to the 4th week [TNF-α: 1(1–1), NF-kβ/p65: 1(1–2)], while no significant change was observed in CGFG. In conclusion, this study revealed a reduction in cells showing TNF-α and NF-kβ/p65 positivity in the MTA treatment group compared to the CGF group. Although MTA demonstrated more favorable results than CGF in mitigating pulpal inflammation within the scope of this study, further experimental and clinical investigations are warranted to obtain comprehensive data regarding CGF.

Comparative Analysis of Antimicrobial Properties and Physical Properties of Mineral Trioxide Aggregate Mixed With Distilled Water, Chlorhexidine, and Sodium Hypochlorite Solutions: An In Vitro Study.

Endodontics widely uses mineral trioxide aggregate (MTA) because of its excellent sealing ability, biocompatibility, and capacity to promote healing. However, the effectiveness of MTA can vary depending on the blending solution used. Endodontics commonly employ chlorhexidine (CHX) and sodium hypochlorite (NaOCl), but their impact on MTA's properties necessitates further investigation. We blended MTA with the specified solutions and prepared it for testing according to the manufacturer's instructions. The study was divided into four groups: group 1 involved MTA blended with distilled water, group 2 consisted of MTA blended with 0.12% CHX solution (PerioGard, Colgate-Palmolive, Osasco, Brazil), group 3 included MTA blended with 0.2% CHX solution (Corsodyl, GlaxoSmithKline Consumer Healthcare, England, UK), and group 4 comprised MTA blended with 5% NaOCl(Azure Research Lab Pvt. Ltd., New Delhi, India). The antimicrobial activity of each group was assessed using the agar diffusion method againstEnterococcus faecalis,Candida albicans, andStreptococcus mutans. We measured the compressive strength at 1, 3, 7, and 21 days using an Instron universal testing machine (Hounsfield Test Equipment, Redhill, UK). Statistical significance was evaluated through one-way ANOVA and Kruskal-Wallis tests, with p values <0.05 considered significant. Group 3 (MTA blended with 0.2% CHX) exhibited the highest antimicrobial efficacy, with significantly larger inhibition zones againstEnterococcus faecalis(25.25 ± 0.21 mm vs. 13.33 ± 0.12 mm, p = 0.011),Candida albicans(29.58 ± 0.24 mm vs. 16.97 ± 0.16 mm, p = 0.004), andS. mutans(26.37 ± 0.15 mm vs. 14.55 ± 0.25 mm, p = 0.027). Group 4 (MTA blended with 5% NaOCl) showed the highest compressive strength at one and threedays (p = 0.032 and p = 0.021, respectively), but by 21 days, group 2 demonstrated the greatest compressive strength (p = 0.044). MTA mixed with 0.2% CHX provides superior antimicrobial properties, making it suitable for enhanced microbial control in endodontic treatments. Conversely, MTA mixed with 0.12% CHX offers optimal long-term compressive strength. These findings guide selecting MTA formulations to maximize performance based on clinical needs.

Apoptotic effects of biodentine, calcium-enriched mixture (CEM) cement, ferric sulfate, and mineral trioxide aggregate (MTA) on human mesenchymal stem cells isolated from the human pulp of exfoliated deciduous teeth.

Preservation of primary teeth in children is highly important. Pulpotomy is a commonly performed treatment procedure for primary teeth with extensive caries. Thus, biocompatibility of pulpotomy agents is highly important. Biodentine, calcium enriched mixture (CEM) cement, ferric sulfate, and mineral trioxide aggregate (MTA) Angelus are commonly used for this purpose. Thus, this study aimed to assess the apoptotic effects of Biodentine, CEM cement, ferric sulfate, and MTA on stem cells isolated from the human pulp of exfoliated deciduous teeth. In this in-vitro, experimental study, stem cells isolated from the human pulp of exfoliated deciduous teeth were exposed to three different concentrations of Biodentine, CEM cement, ferric sulfate, and MTA for different time periods. The cytotoxicity of the materials was evaluated by flow cytometry using the annexin propidium iodide (PI) kit. Data were analyzed by ANOVA and Tukey's test at P<0.05 level of significance. All four tested materials induced significantly greater apoptosis compared with the control group. The difference in cell apoptosis caused by the first concentration of ferric sulfate and MTA was not significant at 24 hours. In other comparisons, the cytotoxicity of ferric sulfate was significantly lower than that of other materials. Biodentine showed higher cytotoxicity than MTA at first; but this difference faded over time. The cytotoxicity of CEM cement was comparable to that of MTA. The highest cell viability was noted at 24 hours in presence of the minimum concentration of ferric sulfate. The lowest cell viability was noted at 72 hours in presence of the maximum concentration of CEM cement. In comparison with other materials, ferric sulfate showed minimum cytotoxicity; the cytotoxicity of the three cements was comparable. It appears that the concentration of ferric sulfate and the composition of cements are responsible for different levels of cytotoxicity.

Potassium nitrate in polycarboxylate cement in direct pulp capping of carious, immature permanent molars: An 18-month randomised controlled trail

AimThe current study aimed to compare the clinical and radiographic success of potassium nitrate in polycarboxylate cement (KNO3/PCA) compared to mineral trioxide aggregate (MTA) in direct pulp capping (DPC) of carious, immature permanent molars over an 18-month follow-up. Materials and methodsA two-armed parallel randomised trial included one hundred children with 104 M have been included and assigned equally. The success rate was evaluated clinically and radiographically. Chi-square and Fisher's exact tests were used to compare the clinical and radiographic success rates. The percentage change in radiographic parameters was tested using an independent sample t-test. The effect of time on the mean values of radiographic parameters was tested using the general linear model (GLM). A significant level was set at 5%. ResultsThe overall success rates after 18 months of follow-up for KNO3/PCA and MTA were 90.4% and 92.3%, respectively (p > 0.05). Similarly, root maturation indicators showed no significant difference between the two groups over the follow-up (p > 0.05). ConclusionWith comparable clinical and radiographic results to MTA, KNO3/PCA is an effective treatment option in the DPC of carious, immature permanent teeth.

Evaluation of Surface Microstructure and Compressive Strength of Mineral Trioxide Aggregate and Biodentine in the Existence and Absence of Oral Tissue Fluids.

Calcium silicate cement like mineral trioxide aggregate (MTA) and Biodentine are known for their biocompatibility and are effectively used as retrograde filling materials. During their placement, the materials interact with oral tissue fluids like saliva and blood, so the aim of the present study was to assess the effect of distilled water, saline, and blood on the surface microstructure and compressive strength of MTA and Biodentine. In this experimental study, a total of 84 custom-made cylindrical molds were randomly allocated into two main cement groups (n = 42) MTA and Biodentine. Each group was further subdivided into three subgroups (n = 14) as per the testing conditions, that is, samples exposed to distilled water, saline, and fresh blood. Around 10 samples from each subgroup were tested for compressive strength using a universal testing machine (UTM), and the remaining four samples were used to examine the surface characteristics of MTA and Biodentine using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) and Tukey's post hoc tests were employed to calculate the mean compressive strength and standard deviation values. There was a significant difference in the compressive strength between MTA and Biodentine, especially in the presence of blood. During the SEM analysis, it was found that samples contaminated with blood or saline were devoid of acicular crystals in both groups. MTA group showed a more porous matrix with few hexagonal crystals than Biodentine. Biodentine may be advantageous as a root-end filling or root repair material in the presence of blood. Bhullar KK, Gupta V, Sapra M, et al. Evaluation of Surface Microstructure and Compressive Strength of Mineral Trioxide Aggregate and Biodentine in the Existence and Absence of Oral Tissue Fluids. Int J Clin Pediatr Dent 2024;17(S-1):S1-S5.

To Evaluate and Compare Platelet-rich Fibrin and Mineral Trioxide Aggregate as Direct Pulp Capping Agents in Primary Molars: A Randomized Prospective Clinical Study.

This study aimed to evaluate and compare the clinical and radiographic success of platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) as direct pulp capping (DPC) agents in primary molars. In this study, 50 primary first and second molars from healthy children aged 5-9 years requiring pulp therapy were randomly allocated into two groups. In the PRF group, after coronal pulp removal and hemostasis, the remaining pulp tissue was covered with PRF preparation. In the MTA group, after coronal pulp removal and hemostasis, MTA was placed, followed by a zinc oxide eugenol (ZOE) base and glass ionomer cement (GIC) in both groups. Clinical and radiographic evaluations were undertaken at 1-, 3-, 6-, 9-, and 12-month intervals. By the end of the 12th month, the overall success rate was 82.6% in the PRF group, whereas it was 61.9% in the MTA group. Platelet-rich fibrin can be used successfully as an appropriate alternative material in DPC of primary teeth when compared with MTA. Tiwari T, Tyagi P, Tiwari S, et al. To Evaluate and Compare Platelet-rich Fibrin and Mineral Trioxide Aggregate as Direct Pulp Capping Agents in Primary Molars: A Randomized Prospective Clinical Study. Int J Clin Pediatr Dent 2024;17(S-1):S25-S29.

Optimizing restorative procedure and material selection for pulpotomized primary molars: Mechanical characterization by 3D finite element analysis

PurposeThis study aimed to assess the stress distribution in pulpotomized primary molars with different types of restorative materials using 3D-finite element analysis (FEA), and provide valuable insights into the selection and application of restorative materials, with the ultimate goal of reducing the risk of pulpotomy failure and protecting residual dental tissue. MethodsFour 3D models of pulpotomized primary molars with different restorative materials according to the material and its elastic modulus were analysed: resin composite, stainless steel crowns (SSCs), prefabricated zirconia crowns and endocrowns. The food layer was also designed before vertical and bucco-lingual forces were applied to simulate physiological masticatory conditions. The results were obtained by colorimetric graphs of the von Mises stresses (VMS) in the restoration and tooth remnant. The maximum shear stress on the bonding interfaces and pressure stress on the Mineral trioxide aggregate (MTA)-pulp interfaces were recorded. ResultsThe results of the 3D-FEA showed that all restorative materials generated stresses and strains on the tooth structure after pulpotomy. In the resin composite group, the marginal enamel exhibited the highest stress peaks. In the zirconia crown and SSC groups, there was a concentration of stress at the dentin-restoration margin. The shear stress concentrations were mainly at the adhesive margins, with lower levels around endocrowns compared to other groups. MTA in the resin composite group experienced more VMS than in the other group. The resin composite group also generated relatively higher pressure stress values at the MTA-pulp interface compared to the other groups. SignificanceIn the model of primary teeth following pulpotomy, the three types of restorations covering the occlusal surface can effectively reduce the stress on pulp capping materials under occlusal loads, thereby potentially decreasing the risk of pulpotomy failure. In addition, the group of endocrowns demonstrated reduced stress at the bonding interface and in the stress concentration zone near the dentist-restoration edge, making them more effective at protecting residual dental tissue.

Assessing the efficacy of Laser pulpotomy versus conventional pulpotomy in primary teeth: A systematic review and meta-analysis of clinical trials.

This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment. An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05. Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy. Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

Antimicrobial activity of calcium hydroxide, calcium oxide, and mineral trioxide aggregate paste against α-Hemolytic Streptococcus

Background: The bacteria mostly found in the root canals are aerobic and facultative anaerobic bacteria, such as α-Hemolytic Streptococcus. Calcium hydroxide has alkaline characteristics with pH of 12.5, and antimicrobial properties. Calcium oxide is hydrophilic and has a smaller molecular weight than calcium hydroxide. Mineral trioxide aggregate (MTA) has alkaline properties, good biocompatibility, stimulates healing and inhibits bacterial growth. Purpose: The purpose of this study was to examine the differences of antimicrobial activity between calcium hydroxide, calcium oxide, and mineral trioxide aggregate (MTA), also to find which of these materials has the highest antimicrobial activity. Methods: The design of this study was a post-test only control group design. The study subjects were divided into 4 groups. K (-) was control group without any treatment, P1 was treated with calcium hydroxide, P2 was treated with calcium oxide, and P3 was treated with MTA. Each group consisted of 7 samples. The α-Hemolytic Streptococcus were spread on Mueller Hinton agar. Antimicrobial test was using diffusion method and diameter of inhibition zones were measured with caliper. Results: Average inhibitory zone of each sample was P1 (30.9643 mm ± 0,7431), P2 (35,2357 mm ± 0,7099), P3 (28,6 mm ± 1,5532). Tukey HSD test showed significances results between samples P1 and P2 (p=0,001), P1 and P3 (p=0,002), P2 and P3 (p=0,001). Conclusion: The highest antimicrobial activity against α-Hemolytic Streptococcus was calcium oxide followed by calcium hydroxide and MTA.

The sealing ability of different endodontic biomaterials as an intra-orifice barrier: evaluation with high-performance liquid chromatography.

This study evaluated the sealing ability of different biomaterials as intra-orifice barriers in the internal bleaching of discolored teeth with the walking bleaching technique. The release of hydroxyl ions from the bleaching materials can cause cervical root resorption, making it necessary to use intra-orifice barrier materials to prevent this issue. In the current study, the high-performance liquid chromatography (HPLC) method was used to measure the released hydroxyl ions. The study included 90 single-rooted and single-canal premolars, which were divided into four groups based on the intra-orifice barrier materials used (mineral trioxide aggregate [MTA], calcium-enriched mixture [CEM], Biodentine, and MTA+PG) and the type of bleaching material (sodium perborate + water or sodium perborate + hydrogen peroxide 30%). Two control groups were also considered in this study: a positive control group, where sodium perborate and hydrogen peroxide were placed inside the pulp chamber without any intra-orifice barriers; and a negative control group, where no bleaching agent or surgical obstruction was used, and the root surface was covered with wax up to the cemento-enamel junction (CEJ) level. The results showed that there was a significant difference in the concentration of hydroxyl ions released among the studied groups. The amount of hydroxyl ion released was highest in the positive control group and lowest in the CEM group. Among the intra-orifice barrier materials used, CEM cement was found to be the most appropriate material for use in the step-by-step internal bleaching method. The study highlights the importance of using appropriate intra-orifice barrier materials to prevent root cervical resorption in internal bleaching procedures.

Effect of Acetylsalicylic Acid on Biological Properties of Novel Cement Based on Calcium Phosphate Doped with Ions of Strontium, Copper, and Zinc.

This study aimed to compare the biological properties of newly synthesized cements based on calcium phosphate with a commercially used cement, mineral trioxide aggregate (MTA). Strontium (Sr)-, Copper (Cu)-, and Zinc (Zn)-doped hydroxyapatite (miHAp) powder was obtained through hydrothermal synthesis and characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), and energy dispersive X-ray spectrometry (EDX). Calcium phosphate cement (CPC) was produced by mixing miHAp powder with a 20 wt.% citric acid solution, followed by the assessment of its compressive strength, setting time, and in vitro bioactivity. Acetylsalicylic acid (ASA) was added to the CPC, resulting in CPCA. Biological tests were conducted on CPC, CPCA, and MTA. The biocompatibility of the cement extracts was evaluated in vitro using human dental pulp stem cells (hDPSCs) and in vivo using a zebrafish model. Antibiofilm and antimicrobial effect (quantified by CFUs/mL) were assessed against Streptococcus mutans and Lactobacillus rhamnosus. None of the tested materials showed toxicity, while CPCA even increased hDPSCs proliferation. CPCA showed a better safety profile than MTA and CPC, and no toxic or immunomodulatory effects on the zebrafish model. CPCA exhibited similar antibiofilm effects against S. mutans and L. rhamnosus to MTA.

Resin-based dental pulp capping restoration enclosing silica and portlandite nanoparticles from natural resources

Natural-based materials represent green choices for biomedical applications. In this study, resin pulp capping restoration enclosing strengthening silica and bioactive portlandite nanofillers were prepared from industrial wastes. Silica nanoparticles were isolated from rice husk by heat treatment, followed by dissolution/precipitation treatment. Portlandite nanoparticles were prepared by calcination of carbonated lime waste followed by ultrasonic treatment. Both were characterized using x-ray diffraction, energy dispersive x-ray, and transmission electron microscopy. For preparing pulp capping restoration, silica (after silanization) and/or portlandite nanoparticles were mixed with 40/60 weight ratio of bisphenol A-glycidyl methacrylate and triethylene glycol dimethacrylate. Groups A, B, and C enclosing 50 wt.% silica, 25 wt.% silica + 25 wt.% portlandite, and 50 wt.% portlandite, respectively, were prepared. All groups underwent microhardness, compressive strength, calcium release, pH, and apatite forming ability inspection in comparison to mineral trioxide aggregate (MTA) positive control. In comparison to MTA, all experimental groups showed significantly higher compressive strength, group B showed comparable microhardness, and group C showed significantly higher calcium release. Groups B and C showed prominent hydroxyapatite formation. Thus, the preparation of economic, silica-fortified, bioactive pulp capping material from under-utilized agricultural residues (rice husk) and zero-value industrial waste (carbonated lime from sugar industry) could be achieved.

Enhancing the Physical, Antimicrobial, and Osteo/Odontogenic Properties of a Sol-Gel-Derived Tricalcium Silicate by Graphene Oxide for Vital Pulp Therapies.

This study developed a sol-gel tricalcium silicate/graphene oxide (TCS-GO) composite and examined its physicochemical properties, antimicrobial activity, and osteo/odontogenic effect on dental pulp stem cells. Tricalcium silicate was synthesized and combined with graphene oxide at three different concentrations, namely 0.02%, 0.04%, and 0.08% w/w, while tricalcium silicate and mineral trioxide aggregate served as controls. The setting time, compressive strength, pH, and calcium ion release of the composites were evaluated, as well as antimicrobial properties against Streptococcus mutans and Lactobacillus acidophilus. Additionally, the viability of dental pulp stem cells; apatite forming ability; and the gene expression of Alkaline phosphatase, Dentin sialophosphoprotein, and Runt-related transcription factor 2 were assessed. TCS-GO (0.08%) showed a significantly shorter setting time and higher compressive strength when compared to MTA (p < 0.05). Additionally, tricalcium silicate and TCS-GO groups showed a higher release of Ca ions than MTA, with no significant difference in pH values among the different groups. TCS-GO (0.08%) also demonstrated a significantly stronger antimicrobial effect against Lactobacillus acidophilus compared to MTA (p < 0.05). ALP expression was higher in TCS-GO (0.08%) than MTA on days 3 and 7, while DSPP expression was higher in TCS-GO (0.08%) than MTA on day 3 but reversed on day 7. There was no significant difference in RUNX2 expression between TCS-GO (0.08%) and MTA on days 3 and 7. The TCS-GO (0.08%) composite demonstrated superior physicochemical characteristics and antimicrobial properties compared to MTA. Moreover, the early upregulation of ALP and DSPP markers in TCS-GO (0.08%) indicates that it has the potential to promote and enhance the osteo/odontogenic differentiation of DPSCs.

Regenerative endodontic treatment and traumatic dental injuries.

Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study.

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.