Tricalcium Silicate-based Cement Research Articles

A randomized controlled clinical trial of the performance of three bioactive endodontic cements in primary molar teeth diagnosed with reversible pulpitis: 1-year follow-up study

ObjectivesThe objective of this clinical trial was to evaluate and compare the clinical and radiographic successes of three bioactive endodontic cements (BEC) including novel portland cement-based material releasing fluoride, resin-modified silicate glass cement, and pure tricalcium silicate-based cement—in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping. MethodsEighty-six (86) participants with previously untreated first and second primary molars were included in this study. The teeth were randomly allocated into three groups: pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride. Cavities were capped with the assigned cement after caries excavation using standard protocols. The teeth that underwent treatment were restored using glass ionomer cement and composite resin. Clinical and radiographic evaluations were performed at 1, 6, and 12 months. The data were analyzed using Pearson chi-square, Kruskal–Wallis H and Z test (P = 0.05). ResultsThe success rate was 88 % (n = 25) in the pure tricalcium silicate-based cement group, 88.5 % (n = 26) in the resin-modified silicate glass cement group, and 100 % (n = 25) in the novel portland cement-based material releasing fluoride group. The differences at the 1st, 6th, and 12th month follow-up visits were not statistically significant among the groups (P > 0.05). No difference was found between the integrity of the resin composite restorations overlying pure tricalcium silicate-based cement, resin-modified silicate glass cement, and novel portland cement-based material releasing fluoride according to the USPHS criteria. ConclusionsNovel portland cement-based material releasing fluoride can be considered an alternative for preserving the tooth, as it showed a high success rate in treating primary molars diagnosed with reversible pulpitis via indirect pulp capping. Clinical significanceNovel Portland cement-based material releasing fluoride could be beneficial in the treatment of primary molars diagnosed with reversible pulpitis via indirect pulp capping.

Evaluation of Biodentine Tricalcium Silicate-Based Cement after Chlorhexidine Irrigation

Evaluation of Biodentine Tricalcium Silicate-Based Cement after Chlorhexidine Irrigation

The Effect of Chitosan Incorporation on Physico-Mechanical and Biological Characteristics of a Calcium Silicate Filling Material.

A tricalcium silicate-based cement, Biodentine™, has displayed antibiofilm activity when mixed with chitosan powder. This study aimed to assess the effect of chitosan incorporation on the physico-mechanical and biological properties of Biodentine™. In this study, medium molecular weight chitosan powder was incorporated into Biodentine™ in varying proportions (2.5 wt%, 5 wt%, 10 wt%, and 20 wt%). The setting time was determined using a Vicat apparatus, solubility was assessed by calculating weight variation after water immersion, radiopacity was evaluated and expressed in millimeters of aluminum, the compressive strength was evaluated using an Instron testing machine, and the microhardness was measured with a Vickers microhardness tester. In addition, surface topography of specimens was analyzed using scanning electron microscopy, and the effect of chitosan on the viability of human embryonic kidney (HEK 293) cells was measured by a colorimetric MTT assay. Incorporation of 2.5 wt% and 5 wt% chitosan powder delivered an advantage by speeding up the setting time of Biodentine material. However, the incorporation of chitosan compromised all other material properties and the crystalline structure in a dose-dependent manner. The chitosan-modified material also showed significant decreases in the proliferation of the HEK 293 cells, signifying decreased biocompatibility. Chitosan incorporation into calcium silicate materials adversely affects the physical and biological properties of the material. Despite the increased antimicrobial activity of the modified material, the diminution in these properties is likely to reduce its clinical value.

Dislodgement resistance and structural changes of tricalcium silicate-based cements after exposure to different chelating agents.

This study aimed to evaluate the dislodgement resistance and structural changes of different mineral trioxide aggregate cements (MTA) like Pro-Root MTA, Ortho MTA, and Retro MTA after exposure to sodium hypochlorite (NaOCl), NaOCl-Ethylenediaminetetraacetic acid (EDTA), 1-hydroxyethylidene-1, 1-bisphosphonate (Dual Rinse HEDP), and NaOCl-Maleic acid (MA). The root canal spaces of 150 dentine slices were obturated using tricalcium silicate cements and divided into 3 groups (n = 50): Group1: ProRoot MTA, Group2: Retro MTA, and Group3: Ortho MTA. The samples in each group were further subdivided into four experimental (n = 10) and one control groups (n = 10): 2.5% NaOCl-17% EDTA, Dual Rinse HEDP, 2.5% NaOCl-7% Maleic acid, 2.5% NaOCl, distilled water (control). The dislodgement resistance and structural changes of cements were measured. Use of DR HEDP resulted in higher dislodgement resistance compared to17% EDTA and 7% MA in the samples obturated with Ortho MTA and Pro-Root MTA (p<0.001). In Retro MTA group, samples treated with DR HEDP and 17% EDTA had higher dislodgment resistance compared to 7% MA (p<0.001). On microstructural and elemental analysis of all the three MTA cements, samples treated with 17% EDTA and 7% MA were more amorphous and granular when compared to DR HEDP, which was pettle shaped. Calcium level was decreased more in samples treated with 17% EDTA and 7% MA when compared to DR HEDP.

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

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

The Influence of the Matrix on the Apatite-Forming Ability of Calcium Containing Polydimethylsiloxane-Based Cements for Endodontics.

This study aimed to characterize the chemical properties and bioactivity of an endodontic sealer (GuttaFlow Bioseal) based on polydimethylsiloxane (PDMS) and containing a calcium bioglass as a doping agent. Commercial PDMS-based cement free from calcium bioglass (GuttaFlow 2 and RoekoSeal) were characterized for comparison as well as GuttaFlow 2 doped with dicalcium phosphate dihydrate, hydroxyapatite, or a tricalcium silicate-based cement. IR and Raman analyses were performed on fresh materials as well as after aging tests in Hank’s Balanced Salt Solution (28 d, 37 °C). Under these conditions, the strengthening of the 970 cm−1 Raman band and the appearance of the IR components at 1455–1414, 1015, 868, and 600–559 cm−1 revealed the deposition of B-type carbonated apatite. The Raman I970/I638 and IR A1010/A1258 ratios (markers of apatite-forming ability) showed that bioactivity decreased along with the series: GuttaFlow Bioseal > GuttaFlow 2 > RoekoSeal. The PDMS matrix played a relevant role in bioactivity; in GuttaFlow 2, the crosslinking degree was favorable for Ca2+ adsorption/complexation and the formation of a thin calcium phosphate layer. In the less crosslinked RoekoSeal, such processes did not occur. The doped cements showed bioactivity higher than GuttaFlow 2, suggesting that the particles of the mineralizing agents are spontaneously exposed on the cement surface, although the hydrophobicity of the PDMS matrix slowed down apatite deposition. Relevant properties in the endodontic practice (i.e., setting time, radiopacity, apatite-forming ability) were related to material composition and the crosslinking degree.

Effect of nonsteroidal anti-inflammatory drugs (NSAIDs) association on physicochemical and biological properties of tricalcium silicate-based cement.

The aim of this study was to investigate the physicochemical and biological properties of an experimental tricalcium silicate-based repair cement containing diclofenac sodium (CERD). For the physicochemical test, MTA, Biodentine and CERD were mixed and cement disc were prepared to evaluate the setting time and radiopacity. Root-end cavity were performed in acrylic teeth and filled with cements to analyze the solubility up to 7 days. Polyethylene tubes containing cements were prepared and calcium ions and pH were measured at 3h, 24h, 72h and 15 days. For the biological test, SAOS-2 were cultivated, exposed to cements extracts and cell proliferation were investigated by MTT assay at 6h, 24h and 48h. Polyethylene tubes containing cements were implanted into Wistar rats. After 7 and 30 days, the tubes were removed and processed for histological analyses. Parametric and nonparametric data were performed. No difference was identified in relation to setting time, radiopacity and solubility. Biodentine released more calcium ion than MTA and CERD; however, no difference between MTA and CERD were detected. Alkaline pH was observed for all cements and Biodentine exhibited highest pH. All cements promoted a raise on cell proliferation at 24h and 48h, except CERD at 48h. Biodentine stimulated cell metabolism in relation to MTA and CERD while CERD was more cytotoxic than MTA at 48h. Besides, no difference on both inflammatory response and mineralization ability for all cement were found. CERD demonstrated similar proprieties to others endodontic cements available.

The Effect of Irrigation with Citric Acid on Biodentine Tricalcium Silicate-Based Cement: SEM-EDS In Vitro Study.

There are various factors that may interfere with the activity of biomaterials during endodontic therapy. One of them is the canal system irrigation procedure with different rinsing solutions performed after the placement of bioactive cements. The authors investigate the influence of citric acid, a chelating agent, on the surface and the chemical composition of Biodentine tricalcium silicate-based cement using a multimethod approach. Twenty samples were divided into two groups based on the material setting time. They were subjected to citric acid irrigation with or without ultrasonic activation for 5 and 20 min. The chemical analysis was made with energy dispersive spectroscopy (EDS). The visual assessment of Biodentine surface was carried out in scanning electron microscope (SEM). The volume of material loss during the procedure was measured with Keyence optic microscope and dedicated digital software. Statistical analysis was performed. The results of the study show that the irrigation with citric acid influenced the surface appearance of the material and changed its chemical composition in both investigated groups. The ultrasonic activation (US) of the liquid has also aggravated its impact. Further research is needed to assess if that fact may change the sealing properties of the material influencing the long-term clinical outcome.

REVIEW ON BIODENTINE - A BIODENTINE DENTINE SUBSTITUTE

Biodentine is a tricalcium silicate-based cement designed for permanent dentin replacement material and has drawn attention in recent years. Biodentine has been adviced to be used in various clinical applications such as pulp caping, apexification,root perforations, retrograde fillings and dentine replacement. There has been considerable research performed on this material since its launching however, there is scarce number of review articles that collates information and data obtained from these studies. Therefore, this review article was prepared for providing a general picture regarding the characteristics of the material. Biodentine is a good biocompatible and bioactive material. It helps in the protection of underlying pulp by inducing tertiary dentin formation. Unlike other dentin substitutes, Biodentine application does not require any conditioning of the dentin surface. The restoration sealing of Biodentine is micromechanical retention by penetrating into the dentin tubules forming tag-like structures. After its setting, Biodentine can be reshaped like natural dentin. Published clinical trials, histology of human teeth and clinical cases show that Biodentine has a wide spectrum of clinical applications as a permanent bulk dentin substitute in pediatric dentistry and restorative dentistry as a possible replacement material.

Influence of photobiomodulation and tricalcium silicate-based cement on viability and dentinogenic activity of cultured human dental pulp stem cells

Objective: To assess the effect of application of Biodentine (BD), Photobiomodulation (PBM) using 810 nm diodelaser and both on the proliferation and odontogenic differentiation of human dental pulp stem cells (HDPSCs).Material and Methods: HDPSCs were collected, isolated, and characterized and then divided into six groups:groups 1, control; groups 2, biodentine (BD); group 3, irradiation at 1 J/cm2 of 810-nm diode laser; group 4,irradiation at 1 J/cm2 and culture with BD; group 5, irradiation at 2 J/cm2, and group 6, irradiation at 2 J/cm2and culture with BD. Viability assay was measured through MTT assay and Alkaline phosphatase (ALP) enzymeactivity and mRNA levels of RUNX2, collagen 1 (Col-1) and BMP2 were also assessed. Results: Photobiomodulationat 1 and 2 J/cm2 combined with biodentine significantly promoted HDPSCs proliferation (in MTT assay results)and odontogenic differentiation (through the gene expression of RUNX2, Col-1 and BMP2 levels (p &lt; 0.05).Conclusion: Photobiomodulation at 2 J/cm2 combined with biodentine enhanced proliferation and odontogenicdifferentiation of cultured HDPSCs and thus could further be beneficial for dentin regeneration.KEYWORDSHuman dental pulp stem cells (HDPSCs); PBM; BMP2; RUNX2; COL1.

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study

The use of Biodentine as a pulp capping material / O uso de Biodentine como um material de capeamento pulpar

Biodentine is a material with different clinical applications, one of which is directed and indicated for cases of direct and indirect pulp capping. It is a tricalcium silicate-based cement, considered an artificial dentin substitute. The material's formulation, being based on modified calcium silicate, has several structural and biological qualities when used as a substitute material for deep dentin. It is commercially presented as an ampoule containing liquid and a capsule containing powder in correct proportions. Once mixed, they become an alkaline cement that can be applied to deep dentin or directly to the pulp tissue. Biodentine has antifungal and antibacterial action, provides a peripheral seal that hinders the infiltration of microorganisms, in addition to being biocompatible with dental structures.

Immunomodulatory effects of tricalcium silicate-based cements on osteogenesis

Although the effects of tricalcium silicate-based cements (TSCs) on osteogenesis have been extensively investigated, their immunomodulatory role on bone regeneration remains elusive. The present study investigated how TSCs modulate bone regeneration by inducing macrophage polarization. The ex vivo part of the study evaluated the effects of two TSCs on mouse bone marrow-derived macrophages (mBMDMs), and on the osteogenic potential of mouse bone marrow mesenchymal stromal cells (mBMMSCs) that had been co-cultured with TSC-exposed mBMDMs. The in vivo part of the study utilized a rat mandibular defect model to investigate the osteogenic effects of the TSCs on healing of bone defects. Immunofluorescence and immunohistochemistry were used to identify polarization of the macrophages adjacent to bone defects and their cytokine secretion in vivo. The TSCs induced mBMDMs to polarize into the M2 phenotype ex vivo. Osteogenic differentiation of mBMMSCs was enhanced when these cells were co-cultured with mBMDMs that had been exposed to either TSC at non-cytotoxic concentrations. In vivo observations of more profuse new bone formation, presence of defect-adjacent macrophages with M2 phenotype and expression of osteogenesis-related cytokines are indicative of the immunomodulatory role played by TSCs on bone regeneration. This is achieved via induction of macrophage polarization into the M2 phenotype.

Evaluation of Pulp Repair after BiodentineTM Full Pulpotomy in a Rat Molar Model of Pulpitis.

Dental pulp is a dynamic tissue able to heal after injury under moderate inflammatory conditions. Our study aimed to evaluate pulp repair under inflammatory conditions in rats. For this purpose, we developed a rat model of controlled pulpitis followed by pulpotomy with a tricalcium silicate-based cement. Fifty-four cavities were prepared on the occlusal face of the maxillary upper first molar of 27 eight-week-old male rats. E. coli lipopolysaccharides at 10 mg/mL or phosphate-buffered saline PBS was injected after pulp injury. Non-inflamed molars were used as controls. Levels of inflammation-related molecules were measured 6 and 24 h after induction by enzyme-linked immunosorbent assay of coronal pulp samples. Pulp capping and coronal obturation after pulpotomy were performed with tricalcium silicate-based cement. Four and fifteen days after pulpotomy, histological and immunohistochemical analysis was performed to assess pulp inflammation and repair processes. Our results showed significantly higher levels of innate inflammatory proteins (IL-1β, IL-6, TNF-α and CXCL-1) compared with those in controls. Moderate residual inflammation near the capping material was demonstrated by histology and immunohistochemistry, with the presence of few CD68-positive cells. We showed that, in this model of controlled pulpitis, pulpotomy with BiodentineTM allowed the synthesis at the injury site of a mineralized bridge formed from mineralized tissue secreted by cells displaying odontoblastic characteristics. Analysis of these data suggests overall that, with the limitations inherent to findings in animal models, pulpotomy with a silicate-based cement is a good treatment for controlling inflammation and enhancing repair in cases of controlled pulpitis.

BiodentineTM Full Pulpotomy in Mature Permanent Teeth with Irreversible Pulpitis and Apical Periodontitis

Vital pulp therapy, including direct pulp capping and partial and full pulpotomy, is primarily indicated for immature or mature permanent teeth with reversible pulpitis. Mature permanent teeth with irreversible pulpitis are frequently treated with root canal therapy. This report presents two cases of full pulpotomy using BiodentineTM in mature permanent teeth with irreversible pulpitis and acute apical periodontitis. The periapical radiograph illustrated a deep carious lesion extended to the pulp with apical radiolucency lesion or widened periodontal ligament space. Full pulpotomy with a tricalcium silicate-based cement was chosen as the definitive treatment. After decayed tissue excavation under a rubber dam, the exposed pulp tissue was amputated to the level of the canal orifice with a new sterile bur. BiodentineTM was applied as the pulp capping agent after hemostasis was obtained and for temporary restoration. The clinical signs disappeared quickly after the treatment. After one month, the coronal part of the temporary restoration was removed, and a composite resin was placed over the capping agent as a final restoration. At two-year follow-ups, the teeth were asymptomatic. Radiographs showed healing of the periapical lesion and periodontal ligament. BiodentineTM full pulpotomy of mature permanent teeth with irreversible pulpitis and apical periodontitis can be an alternative option to root canal therapy.

Cellular response of human apical papilla cells to calcium hydroxide and tricalcium silicate-based cements

BackgroundThis study aimed to evaluate the biological response of human apical papilla cells to different calcium hydroxide formulations and three tricalcium silicate-based materials.MethodsPrimary cells were obtained from explants of young immature premolars. 20,000 cells adhered for 24 h over discs of Biodentine™, ProRoot®MTA, BioRoot®RCS and calcium hydroxide mixed either with sodium chloride 0.9%w/v or polyethylene glycol and UltraCal® were used to evaluate cell adhesion by scanning electron microscopy and cell viability by MTT assay.ResultsCells adhered to ProRoot®MTA showed an increase of F-actin like protrusions, suggesting bioactivity. Cells adhered to UltraCal® show protrusion such as filopodia. On the contrary, cells adhered to BioRoot®RCS showed no signs of any cellular protrusion. Regarding viability between the materials, we found a higher percentage of viability in cells cultured over discs of Biodentine™ and ProRoot®MTA.ConclusionProRoot®MTA and Biodentine™ exhibit a better cellular response of human apical papilla cells in vitro conditions compared to BioRoot® and calcium hydroxide diluted in sodium chloride.

Behaviour of nanocrystalline tricalcium silicate-based cements at early stages of hydration

Tricalcium silicate-based cements (TCS-BC) have reached great relevance in modern dentistry, where they are used in root-end filling or perforation repair treatments, and also for restoring deep and/or voluminous coronary carious lesions, among other applications. In some TCS-BC such as BiodentineTM, the physical and chemical properties, e.g. high compressive strength, have led to consider this cement as a dentine substitute. One of the drawbacks of BiodentineTM is its very high washout; which refers to the tendency of disintegrate at initial stage of hydration upon early contact with blood or other fluids, just at the moment after it is still as a freshly prepared paste. The present research was focused to compare properties related to workability and hardening at early stages of hydration of experimentally synthetized nano-sized tricalcium silicate (nTCS) and BiodentineTM (BIOD). Both pastes were tested for hardening at 0, 1, 2 and 3 h of hydration, using a penetration test adapted from standards D3441-79 and D1558-84. The hydrated products were evaluated by X-ray diffraction (XRD), thermogravimetry (TG) and 29Si NMR spectroscopy; pH measurements were taken along 28 days of hydration. The set cement pastes were evaluated for sealing ability and microleakage. Following literature reports, the CSH phase as a hydration product, was identified and modeled in both cements as defective clinotobermorite Ca11Si9O28(OH)2·8.5H2O. The CSH phases obtained differ from each other by its microstructural arrangement and packing densities, which depend on the w/c ratio of nTCS and BIOD pastes, which were 0.5 and 0.36 respectively. The hardening of BIOD is significantly influenced by its w/c ratio with a hydration fluid that presumably contains about 0.05% of polycarboxylate-based superplasticizer, which was identified by Raman spectroscopy. The washout and hardening properties were pictured by and scheme for flocculation, w/c ratio, and packing density of the CSH particles characterizing the cement pastes.

The calcium dynamics of human dental pulp stem cells stimulated with tricalcium silicate-based cements determine their differentiation and mineralization outcome

Calcium (Ca2+) signalling plays an indispensable role in dental pulp and dentin regeneration, but the Ca2+ responses of human dental pulp stem cells (hDPSCs) stimulated with tricalcium silicate-based (TCS-based) dental biomaterials remains largely unexplored. The objective of the present study was to identify and correlate extracellular Ca2+ concentration, intracellular Ca2+ dynamics, pH, cytotoxicity, gene expression and mineralization ability of human dental pulp stem cells (hDPSCs) stimulated with two different TCS-based biomaterials: Biodentine and ProRoot white MTA. The hDPSCs were exposed to the biomaterials, brought in contact with the overlaying medium, with subsequent measurements of extracellular Ca2+ and pH, and intracellular Ca2+ changes. Messenger RNA expression (BGLAP, TGF-β, MMP1 and BMP2), cytotoxicity (MTT and TUNEL) and mineralization potential (Alizarin red and Von Kossa staining) were then evaluated. Biodentine released significantly more Ca2+ in the α-MEM medium than ProRoot WMTA but this had no cytotoxic impact on hDPSCs. The larger Biodentine-linked Ca2+ release resulted in altered intracellular Ca2+ dynamics, which attained a higher maximum amplitude, faster rise time and increased area under the curve of the Ca2+ changes compared to ProRoot WMTA. Experiments with intracellular Ca2+ chelation, demonstrated that the biomaterial-triggered Ca2+ dynamics affected stem cell-related gene expression, cellular differentiation and mineralization potential. In conclusion, biomaterial-specific Ca2+ dynamics in hDPSCs determine differentiation and mineralization outcomes, with increased Ca2+ dynamics enhancing mineralization.

Retrograde filling material in periapical surgery: a systematic review.

Background Periapical surgery focuses on the treatment of teeth with persistent periapical lesions when orthograde root canal treatment fails. Although MTA® is the gold standard material for retrograde filling, Biodentine® - a tricalcium silicate-based cement - has been proposed in order to resolve several of its limitations. A systematic review has been carried out to compare the physicochemical properties of Biodentine® versus MTA® as root-end filling material in periapical surgery. Material and Methods An electronic search was conducted by two independent examiners during March 2020 in the Cochrane, PubMed-MEDLINE and Scopus databases. In addition, a manual search was made in specialized journals. Comparative human or in vitro studies that evaluated bond strength, the presence of marginal gap and sealing ability were included. No restriction on publication date was applied. Animal studies, clinical cases, cases series and expert opinions were excluded. Results After analyzing 147 initially selected studies, 13 publications were included. Regarding bond strength, the studies seemed to evidence better performance of Biodentine® in both acidic and blood contaminated environments. In relation to the presence of marginal gap and sealing ability, the studies yielded contradictory results. According to some authors, the sealing ability of Biodentine® is greater than that of MTA® during the first 24 hours, though both materials prove equal after one week. Other authors recorded no significant differences. Conclusions Considering the limitations and heterogeneity of the studies included, there is not sufficient evidence to confirm the clinical superiority of Biodentine® as a root-end filling material in periapical surgery. Key words:Biodentine, MTA, retrograde filling, periapical surgery.

Root-end microsurgery using a premixed tricalcium silicate putty as root-end filling material: a prospective study.

The purpose of this study was to assess the clinical and radiographic outcome of root-end microsurgery using a premixed fast-set calcium silicate putty as root-end filling material in human teeth. This study included 50 teeth in 35 patients, whose ages ranged from 16 to 69 years. After clinical and radiographic examination, informed consent was obtained and one resident performed all surgical procedures using an endodontic microsurgical approach. A tricalcium silicate-based putty (TotalFil FS putty, FKG Dentair, La Chaux-de-Fonds, Switzerland) was used as a root-end filling material. Patients were recalled and treated teeth were examined clinically and radiographically at 3 months, 6 months, and 1 year postoperatively. The outcome was determined based on clinical and radiographic results. Radiographic healing was classified into 4 categories: complete, incomplete, uncertain, and unsatisfactory. Analysis of predictors was performed using the Pearson chi-square or Fisher's exact test. At the time of surgery, 3 teeth were diagnosed with cracks and were excluded from the study. The recall rates were 85% at 3 months, 100% at 6 months, and 95% at 1 year. One tooth failed at 3 months, 3 failed at 1 year, with a success rate of 93%. None of the predictors investigated had a significant influence on the outcome of microsurgery. Premixed fast-set tricalcium silicate putty is a suitable root-end filling material for use in endodontic microsurgery. Tricalcium silicate-based cements have shown promising biological properties as a root-end-filling material. Premixed and fast-set formulations achieved high success rates in clinical studies. Clinicaltrials.gov registration number NCT03733938.