This in vitro study evaluated whether dentin bonding agent application or Nd: YAG laser irradiation can reduce tooth discoloration induced by different calcium silicate-based cements (CSCs) under blood-contaminated conditions simulating regenerative endodontic procedures. Ninety extracted human maxillary incisors were standardized and randomly assigned to nine groups (n = 10) according to pre-treatment strategy (no treatment, universal adhesive, or Nd: YAG laser) and CSC type (ProRoot MTA, Biodentine, or TheraCal PT). Following blood application and clot formation, Spongostan and the assigned CSC were placed in the coronal third of the canal. Specimens were restored with resin composite and stored at 37°C and 100% humidity. Color measurements were performed spectrophotometrically at baseline and after 7, 30, 90, and 180 days. Color changes were calculated using ΔE₀₀ and whiteness index difference (ΔWID) values. Data were analyzed using three-way repeated-measures ANOVA and Sidak post hoc tests (α = 0.05). All groups exhibited time-dependent discoloration. In ProRoot MTA groups, both dentin bonding agent and Nd: YAG laser pre-treatments significantly reduced discoloration compared with untreated controls (p < 0.05), with no significant difference between the two approaches (p > 0.05). Biodentine and TheraCal PT demonstrated significantly greater color stability than ProRoot MTA (p < 0.05). Within the limitations of this study, neither dentin bonding agent nor Nd: YAG laser pre-treatment completely prevented CSC-related discoloration. ProRoot MTA showed the greatest discoloration potential, even after preventive dentin pre-treatment, and therefore may not be the preferred material for anterior regenerative endodontic cases in which esthetics are critical. Biodentine and TheraCal PT demonstrated better color stability and may be more suitable alternatives for esthetically demanding regions, while dentin bonding or Nd: YAG laser pre-treatment appears to provide only limited, material-dependent benefit.

Aim: The aim of this study was to comparatively evaluate the shear bond strengths between different calcium silicate-based biomaterials and glass ionomer-based restorative materials. Materials and Methods: In this in vitro study, a total of 96 acrylic blocks were prepared, each containing a standardized cylindrical cavity measuring 4 mm in diameter and 2 mm in depth. Four different calcium silicate-based biomaterials (ProRoot MTA, Biodentine, TheraCal LC, and MTA BioRep) were placed into the cavities according to the manufacturers' instructions. Three different glass ionomer restorative materials (Fuji II LC, Equia Forte HT, and Riva Self Cure) were then applied onto the biomaterial surfaces using molds measuring 2 mm in diameter and 2 mm in height, resulting in 12 experimental groups (n = 8). After storage at 37 °C for 24 h, the shear bond strengths were measured using a universal testing machine. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p < 0.05). Results: The highest bond strength was observed in the TheraCal LC-Fuji II LC combination, whereas the lowest value was obtained in the MTA BioRep-Equia Forte HT group. Both the type of biomaterial and type of glass ionomer cement had a statistically significant effect on the bond strength (p < 0.05). Conclusions: The combination of calcium silicate-based biomaterial and glass ionomer-based restorative material influenced the early shear bond strength. These findings suggest that material selection may play an important role in early bonding behavior at the biomaterial-restorative material interface.

Calcium silicate-based cements (CSCs) play a pivotal role in endodontic applications due to their favorable properties. This study investigates how blood contamination, a common clinical challenge during endodontic procedures, affects the bonding performance and hydration of CSCs. Tooth specimens were filled with four CSC-containing products (ProRoot MTA: PM, Endocem MTA: EC, iRoot BP Plus: IB, and TheraCal LC: TC) and placed in either distilled water or blood for 7 days at 37 ℃. The push-out test and evaluations using an inverted microscope and scanning electron microscope (SEM) were performed to measure the bond strength and fracture mode. Energy-dispersive X-ray spectroscopy (EDS) was used to measure the elemental composition and the Ca/Si ratio. 29Si magic angle spinning nuclear magnetic resonance spectroscopy (29Si MAS NMR) analysis was conducted to investigate the structures of the calcium silicate, and the mean silicate length (MCL) was calculated. Blood contamination significantly reduced bond strength for PM and increased bond strength for IB; no significant changes were observed with EC or TC. Blood contamination increased the Ca/Si ratio of each specimen, which was associated with decreased hydration and MCL values. It also influenced cohesive, mixed, and adhesive fractures among different groups. Blood contamination impaired the mechanical reliability of most hydration-dependent CSCs due to disrupted silicate polymerization, with the exception of IB, which exhibited an anomalous increase in push-out bond strength. From a clinical standpoint, these findings highlight the importance of hemostasis before CSC placement and suggest that future CSC formulations should improve resistance to blood contamination to enhance patient care.

Calcium silicate-based cements are widely used for vital pulp therapy (VPT); however, newer formulations such as premixed putty and light‑curable resin‑modified MTAs may differ in handling, bioactivity, and biocompatibility. This study compared the cytotoxicity and key physicochemical properties of Cal‑Bio LC MTA, ProRoot MTA and NeoPutty MTA. Three calcium silicate-based cements were evaluated in vitro (n = 5 per test). Setting time, flow, and radiopacity were assessed according to ISO 6876:2012; radiopacity was calculated as mm Al using an aluminum step wedge. Solubility (mass loss, %) was assessed at 1, 7 and 30 days (ISO 6876), while water sorption, solubility (µg/mm³), and porosity were assessed at 30 days (ISO 4049:2019). pH changes of set specimens were measured after 24h, 7 d and 30 d. Compressive strength (4 × 6mm cylinders) and Vickers microhardness were measured. FT-IR (ATR, 4000-400cm⁻¹) was used to characterize functional groups. Cytotoxicity was assessed on human dermal fibroblasts using an extract‑based MTT assay and IC₅₀ values were calculated. Data were statistically analysed using Kruskal-Wallis H test (α = 0.05). Cal‑Bio LC MTA exhibited the shortest setting time, the highest flowability, compressive strength, and microhardness values (p < .05). While ProRoot MTA and NeoPutty MTA displayed higher radiopacity values (p < .05) radiopacity of all materials exceeded 3mm Al. All materials met the ISO 6876 solubility limit (< 3%). ProRoot MTA exhibited the highest alkalinity over time and the highest cytocompatibility (IC₅₀ >147.224), followed by NeoPutty (IC₅₀ 91.59) and Cal‑Bio LC (IC₅₀ 78.79). Material formulation and setting mechanism strongly influenced biological and physicochemical properties. Cal‑Bio LC MTA provided superior early handling and mechanical properties, whereas ProRoot MTA showed higher alkalinity and better cytocompatibility.

This study aimed to evaluate the influence of incorporating bioactive glass into glass-ionomer cement (GIc) as a pulp-capping material using a human tooth-pulp culture model. Experimental groups included GIc mixed with three bioglasses (45S5, 45S5.5Zn, 45S5.5Sr), β-tricalcium phosphate (TCP), ProRoot MTA, or Biodentine powder. Capping with unmodified GIc and Biodentine served as controls. Pulpal healing was assessed via histology following a 28-day culture period. Fisher's exact tests determined differences in mineral foci formation and pulp-tissue organization (p<0.05). Initiation of pulp mineralization was observed only when pulps were capped with GIc45S5 or Biodentine. While bioactive glass-modified GIcs demonstrated biocompatibility and promoted early pulpal healing (cell-rich eosinophilic zones), their mineralization potential remained lower than that of the calcium-silicate cement, Biodentine. These findings suggest that GIc45S5 offers a potential preclinical alternative for pulp-capping, though its bioactivity requires further optimization.

This study aimed to compare the biological performance of a hydraulic calcium silicate cement (EndocemMTA Premixed) containing dimethyl sulphoxide (DMSO), developed to improve handling properties, in comparison with ProRoot mineral trioxide aggregate and Biodentine. Human dental pulp cells were used for in vitro evaluation of cytocompatibility, cell migration and cell-material interactions. Odontogenic differentiation was assessed using a 3D culture model designed to simulate the clinical environment. Pulp capping was performed in vivo on rat maxillary molars, and reparative dentin formation and pulpal inflammatory responses were evaluated using micro-computed tomography (µCT) and histological analyses. In vitro, all investigated materials exhibited comparable cytocompatibility, cell migratory behaviour and odontogenic marker expression, with no significant differences among study groups. The µCT analysis demonstrated significantly greater reparative dentin formation in all experimental groups compared with the control, with Biodentine producing a higher dentin volume than EndocemMTA Premixed. Histological evaluation revealed no significant differences among the experimental groups with respect to pulpal inflammation or dentin bridge continuity. These findings suggest that the incorporation of DMSO into premixed formulations would not adversely affect cytocompatibility or pulp healing. Moreover, the 3D model used in this study might serve as a clinically relevant platform for evaluating pulp-material interactions.

Hydraulic calcium silicate cements are widely employed in endodontics due to their excellent biocompatibility, bioactivity, sealing ability, and remineralisation potential. However, currently used products such as mineral trioxide aggregate (MTA) exhibit several limitations, including discolouration, cost, and poor handling properties. Therefore, this study aimed to develop and characterise a bovine-derived hydroxyapatite (BHA) and montmorillonite (MMT) nanoclay hybrid composite (BHA-MMT), incorporating zirconium oxide as a radiopacifier and calcium silicate phases as setting agents. BHA was produced from waste bovine bones using a defatting and deproteination method. MMT clay was exfoliated into nanoclay using shear force with a planetary ball mill. The composite powders were prepared by combining BHA (20% and 25% wt), zirconium oxide (30% wt), setting agents with exfoliated MMT (15% and 20% wt) to produce three composite materials with different BHA and MMT ratios, namely B20, B25, and M20. The resulting powders were mixed with deionised water to form hydraulic cements. The composite materials were tested for chemical, mechanical, and physical properties compared with the commercially available ProRoot MTA. The biocompatibility, bioactivity, and remineralisation potential of the materials were also examined using established invitro assays. The pH of the material increased above 11 after 24 h and remained constant up to 21 days. The compressive strengths of B20, B25, and M20 were 23.63, 21.2, and 23.8 MPa, respectively, after 21 days. The mean setting time of the composites ranged from 13 to 14 min, and the concentrations of heavy metals were within the permissible limits specified by ISO standards. The experimental composite materials demonstrated radiopacity values within the range, consistent with ISO recommendations. Among the variants, B20 and B25 demonstrated good cell viability, while M20, containing a higher proportion of MMT, showed enhanced apatite formation and remineralization, indicating improved bioactivity. The developed BHA-MMT composites demonstrated promising physicochemical, biological, and remineralisation properties consistent with ISO standard requirements. Overall, the product represents a bioactive composite material system; further investigations, including invivo studies, are necessary to confirm its clinical applicability in vital pulp treatment (direct/indirect pulp capping, pulpotomy) and root-end filling procedures.

This study aimed to compare the physicochemical properties of EndoSequence Root Repair Material (ERRM) Fast and CeraPutty with ProRoot MTA and Biodentine, focusing on setting time, radiopacity, microhardness, and pH. Setting time was measured using a Gilmore-type indenter applied every 5 min until no indentation was observed (n = 15 per group). Radiopacity was assessed via aluminium step wedge, microhardness using Vickers hardness, and pH changes with a digital pH meter. Nonparametric statistical analyses were conducted with a significance level of 95%. Biodentine exhibited the shortest setting time and highest microhardness, while ERRM Fast showed the highest radiopacity. High alkaline pH values were measured for all materials. Within the limitations of this study, the new pre-mixed calcium silicate materials exhibited physicochemical properties comparable to traditionally mixed materials, indicating their potential suitability for endodontic treatments. However, careful selection based on clinical requirements, including handling, setting time, and mechanical properties, is essential.

This study compared the physicochemical and biological properties of Bio-C Repair (BR), a new putty-type calcium silicate-based material, with ProRoot MTA (P) and Super-Bond (SB). Discs of the three materials were prepared. Human periodontal ligament cells were seeded onto the discs, and metabolic activity was assessed by MTT assay on days 7 and 28; cells without discs served as the negative control (NC). Moreover, the pH and calcium ion concentration of the eluate, the mass change, and the water sorption were investigated. On day 7, BR showed significantly lower cell activity than P and NC. However, by day 28, BR activity increased significantly, with no significant difference relative to other groups, whereas P activity was significantly suppressed relative to SB and NC. Physiochemically, BR maintained a significantly higher alkalinity (pH ~11.0) and greater calcium ion release than P throughout the 28 days. Furthermore, BR exhibited significant mass gain (15.7%) and the highest water sorption (15.4%), whereas P showed mass loss (-1.1%). Although the high pH of BR initially suppressed cell activity, it demonstrated favorable cytocompatibility by day 28. BR showed a significantly improved long-term cellular response compared to P, suggesting it is a promising alternative as a root-end filling material.

Objectives: This study aimed to evaluate the cytotoxicity, proliferation, and differentiation potential of e-MTA compared to conventional MTA on human apical papilla-derived stem cells. Methods: Two dilutions of e-MTA and ProRoot MTA were tested using MTT assay, Alamar Blue assay, and Alizarin Red S staining at 24, 48, and 72 hours. Statistical analysis was performed using the Wilcoxon signed-rank test. Results: Cell viability and differentiation potential showed no significant difference between groups. However, e-MTA demonstrated significantly reduced proliferation compared to control MTA. Conclusions: e-MTA demonstrated comparable biocompatibility to conventional MTA, though reduced proliferation warrants further investigation.

To develop an innovative hydraulic bioceramic (HB) formulation by incorporating zinc-functionalized mesoporous bioactive glass (MBG-Zn) into a commercial calcium silicate-based cement (ProRoot MTA White), aiming to enhance bioactivity, accelerate setting kinetics, and improve clinical performance. A modified cement (MTA-MBG-Zn) was processed by blending MTA with 15 wt% MBG-7.5Zn. The physicochemical properties, including crystalline phases, microstructure and textural characteristics, were analyzed. Functional performance was evaluated through setting time measurements, in vitro bioactivity in simulated body fluid (SBF), and biocompatibility using human dental pulp stem cells (hDPSCs). MTA-MBG-Zn exhibited increased surface area and porosity, resulting in faster bioactive response and reduced final setting time compared to unmodified MTA. Enhanced hydroxyapatite formation and elevated silicon ion release were observed, alongside reduced release of potentially toxic bismuth and aluminum ions. Both materials demonstrated excellent biocompatibility, with MTA-MBG-Zn showing slightly higher cell viability and alkaline phosphatase activity. The integration of MBG-Zn into calcium silicate-based cement significantly improves its physicochemical and biological performance. These findings support the potential of MTA-MBG-Zn as an advanced material for regenerative endodontics, offering enhanced biomineralization, sealing ability, and a more favorable ion release profile.

Repairing strip perforations is challenging due to limited access and visibility. Mineral trioxide aggregate (MTA) is the standard material for perforation repair but is difficult to handle, whereas calcium silicate-based sealers (CSBSs) offer good adaptation, biocompatibility, and easier application during obturation. However, their ability to repair perforations during canal obturation, has not been validated in blood-contaminated conditions. This in vitro study compared the push-out bond strength and failure modes of iRoot SP (IR), BioRoot RCS (BR), and ProRoot MTA in strip-perforated canals under blood and saline contamination. Thirty mandibular molars with two separate mesial root canals were selected. Mesial root canals were prepared using reciprocating files, and strip perforation was created on the distal surface of the mesial roots. The roots were randomly assigned to blood or saline contamination. Each group was then randomly obturated with (1) Gutta-percha + IR, (2) Gutta-percha + BR, or (3) ProRoot MTA (10 canals/subgroup). Each root was sectioned into a slice at the perforation site for push-out testing. Bond-strength data were analyzed with one-way ANOVA and independent T-test (p < 0.05). Failure modes were assessed under a stereomicroscope. MTA exhibited significantly higher bond strength than both sealers under all conditions (p < 0.05). Blood contamination significantly increased the bond strength of IR (p = 0.016) but had no effect on BR (p = 0.878) or MTA (p = 0.33). MTA showed adhesive failures, while IR and BR exhibited mixed and adhesive failures under blood contamination. ProRoot MTA showed the highest bond strength and distinct failure modes. Blood contamination increased IR's bond strength but did not affect BR or ProRoot MTA. Under in vitro conditions, CSBSs may offer a feasible option for repairing strip perforations during obturation, but further studies are needed to confirm clinical applicability.

The outcome of endodontic microsurgery depends on the integrity of the apical seal and the adaptation of root-end filling materials under functional stresses. The study aims to compare the void volumes and distribution of ProRoot MTA, ERRM, and ERRM combined with Bioceramic sealer under simulated functional loading using micro-computed tomography (micro-CT). Forty-four single-rooted mandibular premolars were prepared with 3 mm apical cavities and divided into four groups (n = 11 each): Cavit (Control), ProRoot MTA, ERRM Putty, and ERRM + BC Sealer. Samples were scanned by micro-CT to quantify internal, marginal, and total voids. Each specimen was then subjected to cyclic vertical loading of 20 N for 1,000,000 cycles in a chewing simulator, followed by post-scanning. Pre- and post-loading void volumes and distribution were analyzed and compared statistically (α = 0.05). Functional loading significantly increased void volumes in all groups (p < 0.05). Control and MTA showed the highest total and marginal voids (p < 0.05), while ERRM and ERRM + BC maintained significantly lower overall and marginal voids. No difference was detected between ERRM and ERRM + BC (p > 0.05). ERRM and ERRM + BC Sealer showed relatively lower marginal-to-internal voids ratios compared to MTA. Material dislodgement occurred only in Cavit and MTA. ERRM and ERRM + BC sealer groups exhibited favorable marginal adaptation and significantly lower overall void volumes after low-load functional loading compared to MTA and the control. The findings indicate preserved sealing performance and suggest resistance to void formation under simulated occlusal stresses.

Ex vivo human tooth culture models preserve the native dentine-pulp complex and offer a translational platform to study pulp-capping biomaterials. This systematic review aimed to synthesize the evidence on histological pulp tissue responses to calcium silicate-based cement (CSCs) used for direct pulp capping in human tooth culture models. The review followed PRISMA 2020 guidance. Eligible studies were ex vivo whole human tooth culture models with direct pulp exposure treated with commercial or experimental CSCs and reporting histological outcomes. Risk of bias was assessed using the QUIN tool. Thirteen studies were included. Most used immature human third molars (from 15- to 19-year-old patients) and culture periods up to 28 days, with a minority extending observation to 45-90 days. Across hydraulic CSCs, Biodentine was the most frequently evaluated material, followed by ProRoot MTA and several experimental hydraulic and resin-modified formulations. Overall, hydraulic CSCs were consistently associated with biocompatible pulp responses and a pro-mineralization pattern characterized by periexposure mineralized foci/osteodentin-like tissue; where assessed, immunohistochemistry supported odontoblast-like differentiation. In contrast, the resin-modified CSC TheraCal LC and other experimental resin-modified CSCs showed more heterogeneous findings, with reports of absent, delayed, or less prominent mineralization compared with reference hydraulic CSCs. In intact human tooth culture models, hydraulic CSCs show reproducible biocompatibility and early mineralization features consistent with reparative dentinogenesis, whereas resin-modified CSCs demonstrate more variable histological performance.

This study aimed to compare the radiopacity of pulp capping materials with that of dental hard tissues. In this study, the radiopacity of traditional and contemporary pulp capping materials was examined and compared with that of dental hard tissues and an aluminum step wedge. Eight pulp capping materials were used in the study. Ten disk-shaped specimens, each 1 mm thick and 5 mm in diameter, were prepared from each material. Ten specimens from each material were placed on a photostimulable phosphor (PSP) plate system together with a tooth slice and the aluminum stepwedge. The images were analyzed with a software program (Adobe Photoshop) to measure mean gray values (MGVs). A one-way analysis of variance (ANOVA) was used to determine whether there were significant differences among the groups. Tukey's test was applied for pairwise comparisons (p < 0.05). All materials used in the study showed greater radiopacity than dentin. BiOfactor, Dycal, MTA Angelus, ProRoot MTA were more radiopaque than enamel, while the other materials showed lower radiopacity than enamel. The radiopacity values of the materials were found as follows: Dentin < MTA CEM LC < Calcimol LC < Biodentin < TheraCal LC < Enamel < Dycal < BiOfactor < MTA Angelus < ProRoot MTA. The materials examined were found to be more radiopaque than dentin. This may allow a more objective evaluation in radiographic examinations. However, in radiographic images in which enamel is superimposed, materials that do not exhibit greater radiopacity than enamel may complicate radiographic assessment.

Tricalcium Silicate Endodontic Cements: A Bibliometric Analysis of the 100 Most Cited Articles.

Abstract Aim: To create a comparative analysis of the biological and mechanical performance of three different root canal filling materials in microscopic apical surgery. Methods: A total of 96 patients who underwent failed root canal therapy at our hospital between January 2020 and November 2021 were included in this study. The 96 extracted single-rooted mandibular premolars from these patients were selected. Their 96 single-rooted mandibular premolars were randomly divided into six groups (based on G*Power effect size calculations, 16 teeth per group), performing in vitro simulated microsurgical apicoectomy by using three different root canal filling materials [proRoot mineral trioxide aggregate (PMTA), zinc oxide-eugenol (ZoE), and bioceramic putty plus root repair material (BP-RRM)]. Both forward and reverse placement techniques were employed during the surgical procedure. Postoperatively, two 1-mm-thick sections were excised from the apical region of each tooth. Marginal adaptation, surface hardness, and push-out bond strength (POBS) were evaluated using a Vickers hardness tester and a universal testing machine, respectively. Results: In the same material, the maximum gap width placed in the forward direction was significantly greater than the maximum gap width placed in the reverse direction (PMTA: forward 3.06 ± 0.82 μm vs. reverse 1.06 ± 0.92 μm, ZoE: forward 3.05 ± 0.90 μm vs. reverse 1.10 ± 0.51 μm, BP-RRM: forward 3.07 ± 0.68 μm vs. reverse 0.98 ± 0.36 μm, P &lt; 0.05). POBS placed in the forward direction was significantly greater than POBS placed in the reverse direction (PMTA: forward 19.80 ± 5.18 MPa vs. reverse 14.80 ± 6.85 MPa, ZoE: forward 25.58 ± 9.80 MPa vs. reverse 18.60 ± 5.80 MPa, BP-RRM: forward 18.62 ± 7.69 MPa vs. reverse 13.10 ± 4.48 MPa, P &lt; 0.05). Within the same placement method, the surface hardness of ZoE was significantly lower than that of PMTA and BP-RRM ( P &lt; 0.05), while the POBS value was significantly higher than that of PMTA and BP-RRM ( P &lt; 0.05). Conclusion: In postoperative filling following microsurgical apicoectomy, the reverse placement technique offers superior marginal adaptation, while the forward placement technique provides better anti-shedding property. The surface hardness of PMTA and BP-RRM is superior to that of ZoE, but their anti-shedding property is inferior to that of ZoE.

This study aimed to evaluate the fracture resistance of teeth with simulated internal root resorption cavities filled with calcium silicate‐based cements (CSCs). Seventy‐two extracted central incisor teeth had their crowns removed to standardize the root length to 14 mm. The teeth were randomized into six groups (n = 12 each), including a positive control (with no simulated resorption cavities) and negative control (with no filling) group. To simulate internal root resorption cavities, cavities were made along the 6 mm section using a number 10 round bur on groups. In four groups, artificially created resorption areas were filled with ProRoot MTA, Biodentine, NeoMTA 2, and BioMTA+. The specimens were subjected to fracture resistance testing using a universal testing machine (UTC). Compressive 135° angle loading was applied to the roots at a rate of 1 mm/min. The fracture resistance was recorded in Newtons and statistically analyzed using a one‐way analysis of variance (Welch’s test) and Tamhane’s T2 test. The fracture resistance was significantly higher in the Biodentine group than in the negative control group. Therefore, the use of Biodentine in internal root resorption cavities may, to some extent, contribute to preserving or supporting the tooth structure.

This scoping review identified laboratory methods used to evaluate the sealing ability of mineral trioxide aggregate (MTA) and compared representative calcium silicate-based cements. A systematic search of articles from 2015 to 2024 was conducted following PRISMA-ScR guidelines. Studies were included if they assessed the sealing ability of commercially available calcium silicate cements under commonly applied laboratory protocols. Thirty-one studies met the criteria. Various in vitro methods were used, but no single standard emerged. Among the materials reviewed, ProRoot MTA showed superior sealing ability, followed by Biodentine and MTA Angelus, though results varied depending on the method. The findings highlight the need for consistent protocols. Combining techniques such as bacterial leakage and dye penetration using confocal microscopy is suggested to improve reproducibility and support evidence-based material selection in endodontics.

The Effect of Set Conditions on Volumetric Changes of Different Hydraulic Cements: An In Vitro Root-End Model.