NeoMTA Plus Research Articles

4-Year Follow-up of Full Pulpotomy in Symptomatic Mature Permanent Teeth with Carious Pulp Exposure Using a Stainproof Calcium Silicate–based Material

IntroductionThis study aimed to assess the pulpal and restorative outcome of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure over 4 years. MethodsUnder local anesthesia, full pulpotomy was performed using the aseptic technique and a stainproof calcium silicate–based material (NeoMTA Plus; Avalon Biomed Inc, Bradenton, FL). The pain level was scored preoperatively and at 1 week posttreatment. Clinical and radiographic evaluation was performed at 6 months, 1, 2, and 4 years. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze the data. Failed cases were classified as endodontic or restorative failure. ResultsFull pulpotomy was completed in 109 teeth in 90 patients with an age range of 14–60 years (mean = 25 years). The study sample available for follow-up was 100 teeth in 86 patients with a recall rate above 90%. Preoperative pulp diagnosis was reversible pulpitis in 39 teeth and irreversible pulpitis in 61 teeth. The cumulative survival rates of pulpotomy were generally high (ie, 98%, 97.4%, 93%, and 83.8% at 6 months and 1, 2, and 4 years, respectively). The overall mean survival time of pulpotomy was 3.89 years (95% confidence interval, 3.84–3.95). The mean survival time was significantly higher for patients aged ≤25 years. However, in the multivariate analysis, the only significant predictor of pulpotomy failure was severe preoperative pain. Over the 4 years, 23 cases failed; only 10 of 23 failures were classified as endodontic failure, and the success of pulpotomy can be assumed to be 90%. ConclusionsFull pulpotomy in cariously exposed pulp of mature permanent teeth sustained a high success rate over 4 years. The coronal seal is crucial for long-term survival.

Calcium silicate-based cements cause environmental stiffness and show diverse potential to induce osteogenesis in human osteoblastic cells

Calcium silicate-based cements differ markedly in their radiopacifiers and the presence of calcium sulfate, aluminates, carbonates and other components that can affect their biological properties. This study aimed to compare the biological properties of six calcium silicate cements in human osteoblastic cell culture (Saos-2 cells): Bio-C Repair (Bio-C), PBS HP (PBS-HP), Biodentine (Biodentine), MTA Repair HP (MTA-HP), NeoMTA Plus (NeoMTA-P), and ProRoot MTA (ProRoot). After exposure to these materials, the cells were analyzed by MTT, wound healing, cell migration, and alkaline phosphatase activity (ALP) assays, real-time PCR (qPCR) analysis of the osteogenesis markers (osteocalcin or bone gamma-carboxyglutamate protein, BGLAP; alkaline phosphatase, ALPL; bone sialoprotein or secreted phosphoprotein 1, BNSP), and alizarin red staining (ARS). Curiously, the migration rates were low 24–48 h after exposure to the materials, despite the cells showing ideal rates of viability. The advanced and intermediate cell differentiation markers BGLAP and BNSP were overexpressed in the Bio-C, MTA-HP, and ProRoot groups. Only the Biodentine group showed ALPL overexpression, a marker of initial differentiation. However, the enzymatic activity was high in all groups except Biodentine. The mineralization area was significantly large in the NeoMTA-P, ProRoot, PBS-HP, MTA-HP, and Bio-C groups. The results showed that cellular environmental stiffness, which impairs cell mobility and diverse patterns of osteogenesis marker expression, is a consequence of cement exposure. Environmental stiffness indicates chemical and physical stimuli in the microenvironment; for instance, the release of cement compounds contributes to calcium phosphate matrix formation with diverse stiffnesses, which could be essential or detrimental for the migration and differentiation of osteoblastic cells. Cells exposed to Bio-C, PBS-HP, ProRoot, NeoMTA-P, and MTA-HP seemed to enter the advanced or intermediate differentiation phases early, which is indicative of the diverse potential of cements to induce osteogenesis. Cements that quickly stimulate osteoblast differentiation may be ideal for reparative and regenerative purposes since they promptly lead to dentin or bone deposition.

Biomineralization potential and biological properties of a new tantalum oxide (Ta2O5)\u2013containing calcium silicate cement

ObjectiveThe present study evaluated the biological effects and biomineralization potential of a new tantalum oxide (Ta2O5)–containing material designed for vital pulp therapy or perforation repair (NeoMTA 2), compared to NeoMTA Plus and Bio-C Repair.Material and methodsHuman dental pulp stem cells (hDPSCs) were exposed to different eluates from NeoMTA Plus, NeoMTA 2, and Bio-C Repair. Ion release from each material was determined using inductively coupled plasma-optical emission spectrometry (ICP-MS). The biological experiments performed were MTT assays, apoptosis/necrosis assays, adhesion assays, migration assays, morphology evaluation, and reactive oxygen species (ROS) production analysis. Biomineralization was assessed by Alizarin red S staining. Finally, osteo/odontogenic gene expression was determined by real-time quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR). Data were analyzed using one-way ANOVA followed by Tukey’s multiple comparison test.ResultsNeoMTA 2 displayed a significantly higher calcium release compared to the other materials (p < 0.05). When hDPSCs were cultured in presence of the different material eluates, all groups exhibited similar hDPSC viability and migration rates when compared to untreated cells. Substantial cell attachment and spreading were observed in all materials’ surfaces, without significant differences. hDPSCs treated with NeoMTA 2 displayed an upregulation of ALP, Col1A1, RUNX2 (p < 0.001), ON, and DSPP genes (p < 0.05), and showed the highest mineralization potential compared to other groups (p < 0.001). Finally, the more concentrated eluates from these materials, specially NeoMTA Plus and NeoMTA 2, promoted higher ROS production in hDPSCs compared to Bio-C Repair and control cells (p < 0.001), although these ROS levels did not result in increased cell death.ConclusionsThe new tantalum oxide (Ta2O5)–containing material shows an adequate cytocompatibility and the ability to promote biomineralization without using chemical osteogenic inducers, showing great potential as a new material for vital pulp therapy.Clinical relevanceNeoMTA 2 seems to be a promising material for vital pulp therapy. Further studies considering its biocompatibility and biomineralization potential are necessary.

Marginal gaps and internal voids after root-end filling using three calcium silicate-based materials: A Micro-CT analysis.

This study evaluated the 3D quality of root-end filling, assessing the presence (volume and percentage) of marginal gaps and internal voids formed after retro-filling with three calcium silicate-based materials: MTA Angelus (Angelus Soluçoes Odontologicas, Londrina, PR, Brazil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, France) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Florida, US). Thirty human, extracted, single rooted teeth were used. Orthograde root canal treatment, root resection (3mm shorter than the apex) and retrograde cavity preparation with ultrasonic tips were performed. Teeth were divided into 3 groups (n =10 each) following a stratified randomization according to the initial volume of the root-end cavity. After retrofilling, samples were stored for 7 days. Then, two rounds of micro-CT scans were performed: soon after root-end preparation (with the cavity still empty) and 7 days after root-end filling. Marginal gaps, internal voids volume (mm3 and %), as well as, the overall defects (sum of gaps and voids) were evaluated. Statistics compared the three groups in relation to those defects. There was not statistical difference between groups regarding the marginal gaps (P≥ 0.05), the internal voids (P≥ 0.05), and the overall defects (P≥ 0.05). Median (mm3) and % of overall air-entrapment defects (gaps and/or voids) was: 0.004mm3 and 1.749% for MTA Angelus, 0.018mm3 and 6.660% for Biodentine, and 0.012mm3 and 4.079% for Neo MTA Plus. All materials had gaps and/or voids. No differences were found between MTA Angelus, Biodentine and Neo MTA Plus.

An In Vitro Stereomicroscopic Evaluation of Bioactivity between Neo MTA Plus, Pro Root MTA, BIODENTINE & Glass Ionomer Cement Using Dye Penetration Method.

The ideal root end filling material should form a tight seal in the root canal by adhering to the cavity walls. Several materials have been used for root end filling. The present study aims to find out and compare the bioactivity of Neo MTA Plus, Pro Root MTA White, BIODENTINE & glass ionomer cement as root end filling materials using 1% methylene blue as tracer. Materials and methods: 80 extracted human permanent maxillary anterior teeth were used in the study. They were divided into four groups. Specimens were sectioned transversely in the cervical area to separate the crown from the root. The root canal was obturated with gutta percha and zinc oxide eugenol sealers. Thereafter, each sample was resected apically by removing 3 mm of the apex and filled with different materials. Samples were kept in buffering solution at 37 °C until the recommended evaluation periods. The specimens were then suspended in 1% methylene blue for 24 h, prior to the analysis. The teeth were then sectioned, and dye penetration was examined, photographed, and evaluated under a stereomicroscope. Results: Vertical dye penetration showed significant differences across different groups. The minimum dye penetration was seen in Neo MTA plus followed by BIODENTINE, Pro Root MTA and maximum in GIC. There was no significant difference in dye penetration between Neo MTA plus and BIODENTINE both at fifteen days and one-month intervals. Conclusion: The present study suggests Neo MTA plus and BIODENTINE should be the preferred material for root end filling.

Biocompatibility of NeoMTA Plus\xae versus MTA Angelus as delayed furcation perforation repair materials in a dog model

BackgroundThe biocompatibility of NeoMTA Plus® (Avlon BioMed Inc., Bradenton, Fl) as a furcal perforation repair material is not fully understood. This study compares the biocompatibility of Mineral Trioxide Aggregate (MTA Angelus) and NeoMTA Plus® as delayed furcation perforation repair materials.MethodsPulpotomy and root canal obturation were performed in 72 premolars in six mongrel dogs and then a standardized furcal perforation was performed. The coronal access was left open for three weeks. After curetting, cleaning and drying of the perforations, these teeth were divided into three equal groups (N = 24 teeth/ 2 dogs each) according to the material used for perforation repair; group I: NeoMTA Plus®, group II: MTA Angelus and group III: no material (positive control). The coronal access cavities were sealed with a filling material. The inflammatory cell count and qualitative pathology (presence of calcific bridge, configuration of fibrous tissue formed, examination of tissue surrounding the furcation area, histology of intraradicular bone and the inflammatory nature of tissues) were carried out after one week (subgroup A, N = 8 teeth), one month (subgroup B, N = 8 teeth) and three months (subgroup C, N = 8 teeth). The inflammatory cell count was expressed as mean ± SD and statistically analyzed. P-value < 0.05 was considered significant.ResultsIn all subgroups, the control group exhibited the highest number of inflammatory cell count, followed by MTA Angelus group and the least inflammatory cell count was shown by NeoMTA Plus® group. There was a significant difference in the inflammatory cell count between the NeoMTA Plus® and MTA Angelus after one week (P < 0.05) while no significant differences were recorded between them after one month and three months (P > 0.05). In contrast to group II, there was no significant differences in inflammatory cell count between the subgroups in groups I and III (P > 0.05). NeoMTA Plus® exhibited better qualitative pathological features than MTA Angelus after one week and nearly similar features after one month and three months of repair.ConclusionNeoMTA Plus® has a better early biocompatibility than MTA Angelus after one week of delayed furcation perforation repair and a similar late biocompatibility after one month and three months.

The Bond Strength of Universal Adhesives with Different Acidities to Calcium Silicate-Based Materials

Objective: To compare the micro-shear bond strengths of 3 different universal adhesives to 2 different calcium silicate-based materials. Methods: A hole was prepared in the center of the top surfaces of 60 cylindrical acrylic blocks, and the blocks were randomly divided into 2 groups (n=30) according to biomaterial filling; NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) and ProRoot MTA (Dentsply Tulsa, Tulsa, OK, USA). Biomaterials were prepared according to the manufacturers’ instructions. The sample surfaces were flattened after the initial setting, and the samples were incubated for 24h at 37°C. After placing the biomaterials in the prepared holes, the specimens were randomly divided into 3 subgroups (n=10) according to adhesive; G-Premio Bond (GC Corp., Tokyo, Japan), All-Bond Universal (Bisco, Inc., Schaumburg, IL, USA) and Single Bond Universal (3M ESPE, St Paul, MN, USA). Adhesives were applied to the specimens and polymerized. A micro-hybrid composite resin (Filtek Z250, 3M ESPE, MN, USA) was then placed on the specimen surfaces and polymerized. Micro-shear bond strengths were tested using a universal testing device (LRX, Lloyd Instruments, Farnham, UK). A Shapiro-Wilk test confirmed normal distribution, and 2-way ANOVA was used for statistical analysis. Result: No significant differences were found in the shear bond strengths of any of the tested adhesives to either of the calcium silicate-based materials (p&amp;gt;0.05). Conclusion: The results indicate that the acidity of a universal adhesive does not affect the bond strength of composite resin to calcium silicate-based materials.

Biocompatibility and bioactive potential of the NeoMTA Plus endodontic bioceramic-based sealer.

ObjectivesThis study evaluated the biocompatibility and bioactive potential of NeoMTA Plus mixed as a root canal sealer in comparison with MTA Fillapex.Materials and MethodsPolyethylene tubes filled with NeoMTA Plus (n = 20), MTA Fillapex (n = 20), or nothing (control group, CG; n = 20) were inserted into the connective tissue in the dorsal subcutaneous layer of rats. After 7, 15, 30 and 60 days, the specimens were processed for paraffin embedding. The capsule thickness, collagen content, and number of inflammatory cells (ICs) and interleukin-6 (IL-6) immunolabeled cells were measured. von Kossa-positive structures were evaluated and unstained sections were analyzed under polarized light. Two-way analysis of variance was performed, followed by the post hoc Tukey test (p ≤ 0.05).ResultsAt 7 days, the capsules around NeoMTA Plus and MTA Fillapex had more ICs and IL-6-immunostained cells than the CG. However, at 60 days, there was no significant difference in the IC number between NeoMTA Plus and the CG (p = 0.1137) or the MTA Fillapex group (p = 0.4062), although a greater number of IL-6-immunostained cells was observed in the MTA Fillapex group (p = 0.0353). From 7 to 60 days, the capsule thickness of the NeoMTA Plus and MTA Fillapex specimens significantly decreased, concomitantly with an increase in the collagen content. The capsules around root canal sealers showed positivity to the von Kossa stain and birefringent structures.ConclusionsThe NeoMTA Plus root canal sealer is biocompatible and exhibits bioactive potential.

Cytotoxicity and Bioactivity of Calcium Silicate-based Cements in a Culture of Stem Cells from the Apical Papilla.

The present in vitro study evaluated the cytotoxicity and bioactivity of commonly-used calcium silicate-based cements in a culture of stem cells from the apical papilla (SCAPs). NeoMTA Plus (Avalon Biomed), BiodentineTM (Septodont) and MTA HP Repair (Angelus) cements were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) and sulphorhodamine-B (SRB) viability assays. Cells were seeded (1*104 cells mL-1) in 96-well plates and exposed to 1:4 diluted extract in 24 h and 72 h. For the analysis of bioactivity, alkaline phosphatase (ALP) enzyme activity and Alizarin Red S (AZR) were assessed after 24 h of cell culture in 12-well plates (1*104 cells mL-1), where cells were exposed to 1:4 diluted extract on days 1 and 7. Minimum Essential Eagle's Medium alpha modification was used as control. ANOVA and Tukey's post hoc test were used to compare the different cements at each experimental time point. No significant differences were found between the cements and the control specimens on MTT at 24 h and 72 h (P>0.05); however, the calcium silicate-based cement materials showed higher cell viability compared to the control group (P<0.05). In the 24-h SRB, NeoMTA Plus showed lower cell viability than BiodentineTM and MTA HP Repair (P<0.05), with all groups similar to the control group (P>0.05). Compared to 24-h results, only NeoMTA Plus presented increased cell viability at 72 h (P<0.05). ALP activity was similar across the materials at 1 day (P>0.05). ALP activity was higher for BiodentineTM when compared to NeoMTA Plus (P<0.05), nevertheless, it was similar to MTA HP Repair and control groups (P>0.05) at 7 days. At 1- and 7-day periods of AZR assay, BiodentineTM presented higher levels of mineralized nodule formation (P<0.05). All evaluated calcium silicate-based cements demonstrated cell viability and bioactivity, suggesting that these (bio)materials may be indicated for use in regenerative dentine-pulp complex procedures.

A Comparative Study of Surface Hardness between Two Bioceramic Materials in an Experimental Apexification Model under Wet and Dry Conditions

Background:The placement of a wet cotton pellet against Mineral Trioxide Aggregate (MTA) is often recommended to ensure the completion of its setting reaction.Objective:This study aimed to evaluate the setting behaviour of MTA Angelus and NeoMTA by comparing their hardness after placing them in dry and moist conditions.Methodology:A simulated open apex was created on 40 polyvinyl tubes. The apical 4 mm of the tubes was filled with the two materials, NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) and MTA Angelus (Angelus, Londrina, PR, Brazil) (n=20 per group). Both groups were subdivided into two subgroups based on the dry and wet conditions (n=10 per group). A wet cotton pellet was placed above the two materials in the wet group, and the coronal segment was sealed using Type II Glass ionomer cement (GC corporation Tokyo, Japan). Gutta-percha was placed against the test materials in the dry group with the coronal segment sealed with amalgam. Samples were placed in an oasis soaked in phosphate-buffered saline for seven days in 100% humidity and at 37°C. Microhardness was measured independently at 4 and 2 mm from the apex. Hardness was compared between materials and conditions, applying analysis of variance (a = .05).Results:The presence of dry or wet conditions had no significant effect on material hardness. MTA Angelus showed significantly higher hardness values compared with NeoMTA Plus.Conclusion:The moisture of the periapical environment can compensate for the absence of a wet cotton pellet and is adequate for the setting of the materials.

Cytotoxicity of NeoMTA Plus, ProRoot MTA and Biodentine on human dental pulp stem cells

Background/purposeDental pulp stem cells (DPSCs) play a crucial role in the tissue healing process through odontoblast like cell differentiation. The aim of this study was to evaluate the biocompatibility and compare the potential invitro cytotoxic effects of NeoMTA Plus, ProRootMTA and Biodentine on human dental pulp stem cells (hDPSCs). Materials and methodsTo assess the effects of NeoMTA Plus, ProRoot MTA and Biodentine extracts at 1st, 3rd and 7th d on hDPCs, cell populations was determined by flow cytometry using an Annexin V detection kit. The data were analyzed statistically using the Kruskal–Wallis test. A p < 0.05 was considered as statistically significant. ResultsAll groups showed cell viability similar to that of the control group on 1st, 3rd and 7th d. Although Biodentine exhibited higher cell viability rates than the other material groups, no statistically significant differences were noted between the sampled days (p > 0.05). ConclusionAll materials extracts are not cytotoxic and do not induce apoptosis in the hDPSCs. These results suggest that all the tested materials can lead to positive outcomes when used as reparative biomaterials.

Antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans: An in vitro study

ObjectiveTo evaluate the antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans. Material and methodsA total of 171 sterile dentin blocks, measuring 4 mm × 4 mm × 1 mm, were incubated in media containing E. faecalis (3.1 × 108 cells/mL) and/or C. albicans (1 × 107 cells/mL) for 2 d. These blocks were randomly divided into three groups: the control (no treatment with biomaterials), MTA (treated with an MTA sample with width and thickness same as those of the dentin block after the material was set), and NeoMTA Plus (treated with NeoMTA Plus in a fashion similar to the treatment of the MTA group) groups. The biomaterials remained in contact with the biofilms for 24 h. Quantitative analyses of the number of colony-forming units (CFUs) and metabolic activity (XTT), were performed. Furthermore, qualitative analysis of biofilm structure was performed by scanning electron microscopy. Data were statistically analyzed considering a significance level of 5%. ResultsXTT and the number of CFUs were similar among the groups (p > 0.05). The type of biofilm (mono- or dual-species) or the biomaterial used (MTA or NeoMTA Plus) did not affect the results. Biofilm structure exhibited a robust architecture composed of yeast and bacterial cell multilayers and was homogeneous among the groups. ConclusionNeoMTA Plus was not effective against mono- and dual-species biofilms of E. faecalis and C. albicans. Further research investigating biofilm removal methods including those involving the use of biomaterials with antiseptics and other supporting therapies is warranted.

Filling Ability and Flow of Root Canal Sealers: A Micro-Computed Tomographic Study.

This study evaluated by micro-computed tomography (μCT) the filling ability in curved root canals, besides the flow of AH Plus (AHP) and Neo MTA Plus (NMTAP) sealers using different methodologies. Mandibular molars mesial roots with two root canals and degree of curvature between 20° and 40° were selected. The specimens were prepared with the ProDesign R system up to size 35.05 and were filled with the sealers by a continuous wave of condensation technique, Thermo Pack II (n=12). The teeth were scanned using μCT after root canal preparation and obturation. The volumetric percentage of filling material and voids were calculated. Flow was evaluated based on ISO 6876/2012 (n=10). Flow and filling were also evaluated in μCT using a glass plate with a central cavity and four grooves from the central cavity (n=6). Flow was linearly calculated into the grooves. The central cavity filling (CCF) and lateral cavity filling (LCF) were calculated in mm³. Data were submitted to non-paired t test with a significance threshold at 5%. The percentage of filling and voids between the root canals filled with AHP or NMTAP was similar (p>0.05). NMTAP presented the lowest flow in conventional test (p<0.05). Using μCT, sealers had similar CCF, LCF and linear flow (p>0.05). In conclusion, NMTAP and AHP had similar filling ability in curved mesial root canals of mandibular molars without presence of isthmus. Although AHP presented better flow than NMTAP using ISO methodology, there was no difference between these materials regarding volumetric filling when evaluated by μCT.

Micro-CT analysis of the marginal adaptation and porosity associated with ultrasonic activation of coronally placed tricalcium silicate-based cements.

This study aimed to evaluate the effect of ultrasonic activation on coronal marginal adaptation and microporosity of tricalcium silicate-based materials. Sixty freshly extracted human maxillary lateral incisor teeth were instrumented with ProTaper Next X2 files followed by Peeso-Reamer burs, sizes 1 to 5. The specimens were randomly divided into six groups (n=10): Group 1, Biodentine+hand condensation; Group 2, Biodentine+ultrasonic activation; Group 3, NeoMTA Plus+hand condensation; Group 4, NeoMTA Plus+ultrasonic activation; Group 5, ProRoot WMTA+hand condensation; and Group 6, ProRoot WMTA+ultrasonic activation. All tested materials were mixed mechanically and placed 2mm underneath the cement-enamel junction by hand condensation or indirect ultrasonic activation. Volumetric analysis of the voids between the dentine wall and coronal barrier material and the porosity within the material was evaluated with micro-CT. There was no significant difference in marginal adaptation among the six groups (P>0.05). Ultrasonic activation favoured a reduced microporosity in Biodentine Group (P<0.001).

The Effectiveness of Laser-Activated Irrigation on the Apical Microleakage Qualities of MTA Repair HP and NeoMTA Plus in Simulated Immature Teeth: A Comparative Study.

There are limited data regarding the potential effect of erbium, chromium: yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser-activated irrigation (LAI) on the microleakage qualities of calcium silicate-based cements. The objective of the present study was to assess the effect of LAI on the microleakage qualities of MTA Repair HP (MTA-HP) and NeoMTA Plus (Neo) used in root-end filling and to compare the antimicrobial effectiveness of MTA- HP. Two experimental sets were conducted: antimicrobial activity (agar diffusion test/at 24, 48 h) and microleakage (glucose leakage model/at 1st, 10th, 20th days). Antimicrobial activities of MTA-HP, Neo, Biodentine, ProRoot and MTA Angelus were evaluated, and inhibition zones were observed not only against a range of Gram-positive and Gram-negative bacteria but also against yeast at 48h. For microleakage evaluation, fifty teeth were prepared to simulate the clinical situation where the root-tips (apex) are open, and randomly divided into two experimental groups (n = 20/group) according to the cement type (MTA-HP and Neo), and two control (n = 5/group) groups. Each experimental group was further divided into two subgroups (n = 10/group) with respect to LAI: MTA-HP, L-HP, Neo, L-Neo. A statistical difference was only detected between Neo and L-HP groups on day 1. Subsequently, MTA-HP exhibited superior microleakage quality compared to Neo in the short-term. Er,Cr:YSGG laser-activated irrigation could be used as a reliable technique without creating adverse effects on the sealing abilities of MTA Repair HP and NeoMTA Plus.

Influence of Powder-to-Gel Ratio on Physicochemical Properties of a Calcium Silicate Sealer

Differences in liquid-to-powder ratio can affect the properties of calcium silicate-based materials. This study assessed the influence of powder-to-gel ratio on physicochemical properties of NeoMTA Plus. Setting time (minutes), flow (mm and mm²), pH (at different periods), radiopacity (mm Al) and solubility (% mass loss) were evaluated using the consistencies for root repair material (NMTAP-RP; 3 scoops of powder to 2 drops of gel) and root canal sealer (NMTAP-SE; 3 scoops of powder to 3 drops of gel), in comparison to Biodentine cement (BIO) and TotalFill BC sealer (TFBC). Statistical analysis was performed using one-way ANOVA and Tukey tests (α=0.05). BIO had the shortest setting time, followed by NMTAP-RP and NMTAP-SE. TFBC showed the highest setting time and radiopacity. BIO, NMTAP-RP, and NMTAP-SE had similar radiopacity. All materials promoted an alkaline pH. NMTAP-RP/SE presented lower solubility than BIO and TFBC. Regarding the flow, TFBC had the highest values, followed by NMTAP-SE, and NMTAP-RP. BIO had the lowest flow. In conclusion, NMTAP in both powder-to-gel ratios showed high pH and low solubility. The increase in the powder ratio decreased the setting time and flow. These findings are important regarding the proper consistency and work time to clinical application.

Flow, Filling Ability and Apical Extrusion of New Calcium Silicate-Based Sealers: A Micro-Computed Tomographic Study

Aim: To evaluate flow, filling ability, and apical extrusion of three calcium silicate-based sealers, Neo MTA Plus (Avalon, USA), Bio-C Sealer (Angelus, Brazil) and Sealer Plus BC (MK Life, Brazil), in comparation with the gold standard based on epoxy resin, AH Plus (Dentsply, Germany). Methodology: The flow was evaluated based on ISO 6876/2012 standard (mm) and in area (mm2 ). For assessment of filling ability and apical extrusion of the sealers, curved artificial canals were prepared up to size 25.06, and filled with the sealers by the single cone technique. The samples were scanned in microcomputed tomography (SkyScan 1272. Bruker, Belgium) after preparation and after filling of the root canals. The percentage of voids throughout the entire extension of the root canals and in the apical third, besides the volume of apical extrusion of each sealer were calculated. Data were statistically analyzed using ANOVA/Tukey tests (α = 0.05). Results: Bio-C Sealer showed the highest flow and NeoMTA Plus had the lowest value (p &lt; 0.05). Bio-C Sealer had lower percentage of total voids than NeoMTA Plus (p &lt; 0.05). AH Plus had greater percentage of voids in the apical third than Bio-C Sealer and Sealer Plus BC (p &lt; 0.05). Bio-C Sealer showed higher volume of extrusion (p &lt; 0.05) than AH Plus and NeoMTA Plus. Conclusion: Bio-C Sealer and Sealer Plus BC had greater flow and proper filling ability in the apical third. However, these sealers presented high volume of apical extrusion. NeoMTA Plus provided less sealer extrusion, low flow, and more presence of voids.

Bioactivity evaluation of calcium silicate‐based endodontic materials used for apexification

This study aims to compare the bioactivity of Biodentine, ProRoot MTA and NeoMTA Plus with regard to their element uptake (Ca, Si and Ca/P) by root canal dentine in a simulated apex (n=30 each) and evaluate the correlation between the dentine fracture resistance (n=30 each) and interfacial layer thickness. Specimens immersed in a corrected simulated body solution (c-SBF) for 1, 30 and 90days were used. In all test materials, the Ca and Si concentrations in the root dentine were found to be significantly higher, whereas the Ca/P and Si concentrations increased over time (P<0.05). The dentine fracture resistance showed a difference at only day 30. The dentine fracture resistance of Biodentine and ProRoot MTA was positively correlated with the Si and Ca/P values, and the mean interfacial layer thickness of all specimens. A high biomineralisation capacity of ProRoot MTA and Biodentine, and their positive effects on the dentine fracture resistance during the first 30days suggest that they may present more advantages than NeoMTA Plus in apexification treatment.

The biological effect of the endodontic bioactive cements fast set NeoMTA plus and ProRoot-MTA on osteogenic differentiation of mesenchymal stem cells: A systematic review

Background and Objective: Mineral trioxide aggregates (MTA) is the standard material used in endodontic treatment and different dental specialties as pulp capping, repair for root perforation, retrograde filling restoration, apexification and/or revascularization. The aim of this systematic review is to assess the osteogenic activity of NeoMTA Plus in compared with ProRoot-MTA using mesenchymal stem cells. Material and Methods: Two automated databases (Google Scholar and PubMed using English-language literature) were used for this systematic review. The electronic search was done in December 2018 and updated in April 2019. Results: Our inquiry uncovered nine studies that met the exclusion and inclusion criteria. These studies investigated the osteogenic activity of NeoMTA Plus in compared with ProRoot-MTA using mesenchymal stem cells. Most of investigations in this review showed the ProRoot-MTA had a greater osteoinductivity and induced the gene expression by different MSCs exposed to it. Conclusion: Both NeoMTA Plus and ProRoot-MTA had osteogenic activity when used as endodontic repair material. Keywords: Bioactivity, NeoMTA, ProRootMTA, Mesenchymal stem cells, Osteogenic differentiation.

Pulpal repair after direct pulp capping with new bioceramic materials: A comparative histological study

AimTo histopathologically evaluate the pulpal healing after direct pulp capping with TotalFill and compared it with Neo MTA Plus in human tooth cultures. MethodsForty sound human premolars freshly extracted for orthodontic reasons were randomly assigned to two experimental groups; group I: TotalFill and group II: Neo MTA Plus. Standardized Class V cavities were prepared on the buccal surface of each tooth where the pulp exposure was performed with a dental explorer. The pulp-exposed teeth were immediately capped with one of the tested materials. The prepared cavities were then finally restored with glass-ionomer cement. Teeth were cultured for three weeks and three months. Then, the cultured teeth were demineralized, sectioned and stained for histopathological evaluation. Data collected and statistically analyzed by using Fisher's exact test. The significance level was set at P ≤ 0.05. ResultsHistopathological analysis showed complete dentin bridge formation and an absence of inflammatory pulp response. Statistical analysis showed no significant differences between the TotalFill and Neo MTA Plus groups during the observation periods. However, a significantly higher thickness of the dentin bridge was found in the group of teeth treated with TotalFill at three months. ConclusionsTotalFill produced similar favorable pulp healing and repair, and were comparable to Neo MTA Plus. Furthermore, TotalFill can form a thicker dentin bridge compared with Neo MTA Plus.