Tricalcium Silicate Cement Research Articles

Three-dimensional culture of dental pulp stem cells in direct contact to tricalcium silicate cements.

Calcium silicate cements are biocompatible dental materials applicable in contact with vital tissue. The novel tricalcium silicate cement Biodentine™ offers properties superior to commonly used mineral trioxide aggregate (MTA). Objective of this study was to evaluate its cytocompatibility and ability to induce differentiation and mineralization in three-dimensional cultures of dental pulp stem cells after direct contact with the material. Test materials included a new tricalcium silicate (Biodentine™, Septodont, Saint-Maur-des-Fossés, France), MTA (ProRoot® MTA, DENSPLY Tulsa Dental Specialities, Johnson City, TN, USA), glass ionomer (Ketac™ Molar Aplicap™, 3M ESPE, Seefeld, Germany), human dentin disks and polystyrene. Magnetic activated cell sorting for to the surface antigen STRO-1 was performed to gain a fraction enriched with mesenchymal stem cells. Samples were allowed to set and dental pulp stem cells in collagen carriers were placed on top. Scanning electron microscopy of tricalcium silicate cement surfaces with and without cells was conducted. Cell viability was measured for 14days by MTT assay. Alkaline phosphatase activity was evaluated (days 3, 7, and 14) and expression of mineralization-associated genes (COL1A1, ALP, DSPP, and RUNX2) was quantified by real-time quantitative PCR. Nonparametric statistical analysis for cell viability and alkaline phosphatase data was performed to compare different materials as well as time points (Mann-Whitney U test, α = 0.05). Cell viability was highest on tricalcium silicate cement, followed by MTA. Viability on glass ionomer cement and dentin disks was significantly lower. Alkaline phosphatase activity was lower in cells on new tricalcium silicate cement compared to MTA, whereas expression patterns of marker genes were alike. Increased cell viability and similar levels of mineralization-associated gene expression in three-dimensional cell cultures on the novel tricalcium silicate cement and mineral trioxide aggregate indicate that the material is cytocompatible and bioactive. The tested new tricalcium silicate cement confirms its suitability as an alternative to MTA in vital pulp therapy.

Bioactivity of a Calcium Silicate–based Endodontic Cement (BioRoot RCS): Interactions with Human Periodontal Ligament Cells In Vitro

IntroductionTricalcium silicate–based materials are recognized as bioactive materials through their capacity to induce hard tissue formation both in the dental pulp and bone. Sealing the apex implies that the root canal filling materials interact with the periapical tissues. This work was designed to study the interactions of newly developed tricalcium silicate cement (BioRoot RCS; Septodont, Saint Maur Des Fosses, France) with apical tissue compared with a standard zinc oxide–eugenol sealer (Pulp Canal Sealer [PCS]; SybronEndo, Orange, CA). MethodsCell viability was assessed by direct contact between human periodontal ligament (PDL) cells and BioRoot RCS or PCS. In addition, an in vitro tooth model was used to study the interactions between these materials and PDL cells. For this purpose, human extracted incisors were sectioned at the enamel-cementum junction; root canals were prepared, sterilized, and filled with lateral condensation with both materials. The root apices were dipped in the culture medium for 24 hours. These conditioned media were used to investigate their effects on human PDL cells. Cell proliferation was investigated with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and the secretion of angiogenic and osteogenic growth factors was quantified using an enzyme-linked immunosorbent assay. ResultsBioRoot RCS has less toxic effects on PDL cells than PCS and induced a higher secretion of angiogenic and osteogenic growth factors than PCS. ConclusionsTaken together, these preclinical results suggest that the calcium silicate cement (BioRoot RCS) has a higher bioactivity than the zinc oxide–eugenol sealer (PCS) on human PDL cells.

Morphological Study Of Border Area Of Pulp-Capping Materials And Er:YAG Laser Prepared Hard Dental Surface.

Vital pulp therapy involves biologically based therapeutic activities aimed at restoring health and preserving the vitality of cariously or traumatically damaged pulp. Adaptation of pulp-capping materials to the prepared tooth surface may be the key to the success of biological tooth treatment. To investigate the area of adaptation of synthetic tricalcium silicate cement, calcium hydroxide cement and mineral trioxide-aggregate to the dentin surface, prepared with the help of Er:YAG dental laser. Four extracted human tooth cavities were prepared with the help of Er:YAG dental laser (LiteTouch, Syneron, Israel), establishing microcommunication with the pulp chamber less than 1 mm in diameter. As pulp-capping materials in the cavities we used tricalcium silicate cement (Biodentine, Septodont, France), calcium hydroxide cement (Dycal) and mineral-trioxide aggregate (ProRoot MTA), stirred and administered according to manufacturers' instructions. The first material fills the whole cavity and the other two are spread in a thin layer and sealed with glass ionomer cement. Thus prepared, the samples were left for three days at 37°C in humidified environment. The samples were prepared for scanning electron microscopy (SEM) by standard methodology. The border area surfaces of the materials and the dentin were scanned using electron microscopy. The morphological changes occurring to the Er:YAG laser prepared dentin and the structural characteristics of the studied pulp-capping materials are demonstrated using scanograms. The border areas where good contact of materials and dentinal tubules is established are thoroughly studied. Good adaptation is seen in three-calcium silicate cement, followed by mineral trioxide aggregate and calcium hydroxide cement. The dentin surface, prepared with Er:YAG laser demonstrates a very good adaptation of the three tested pulp-capping materials.

Radiopacifier Particle Size Impacts the Physical Properties of Tricalcium Silicate–based Cements

IntroductionThe aim of this study was to evaluate the impact of radiopaque additive, bismuth oxide, particle size on the physical properties, and radiopacity of tricalcium silicate–based cements. MethodsSix types of tricalcium silicate cement (CSC) including CSC without bismuth oxide, CSC + 10% (wt%) regular bismuth oxide (particle size 10 μm), CSC + 20% regular bismuth oxide (simulating white mineral trioxide aggregate [WMTA]) as a control, CSC + 10% nano bismuth oxide (particle size 50–80 nm), CSC + 20% nano-size bismuth oxide, and nano WMTA (a nano modification of WMTA comprising nanoparticles in the range of 40–100 nm) were prepared. Twenty-four samples from each group were divided into 4 groups and subjected to push-out, surface microhardness, radiopacity, and compressive strength tests. Data were analyzed by 1-way analysis of variance with the post hoc Tukey test. ResultsThe push-out and compressive strength of CSC without bismuth oxide and CSC with 10% and 20% nano bismuth oxide were significantly higher than CSC with 10% or 20% regular bismuth oxide (P < .05). The surface microhardness of CSC without bismuth oxide and CSC with 10% regular bismuth oxide had the lowest values (P < .05). The lowest radiopacity values were seen in CSC without bismuth oxide and CSC with 10% nano bismuth oxide (P < .05). Nano WMTA samples showed the highest values for all tested properties (P < .05) except for radiopacity. ConclusionsThe addition of 20% nano bismuth oxide enhanced the physical properties of CSC without any significant changes in radiopacity. Regular particle-size bismuth oxide reduced the physical properties of CSC material for tested parameters.

Interfacial characteristics of Biodentine and MTA with dentine in simulated body fluid

ObjectivesNewer tricalcium silicate cements (TSC) may offer biocompatibility with improved working properties. This study aimed to evaluate: (1) the occurrence of mineral deposition at the interface between dentine and two TSC (ProRoot® MTA and Biodentine®) in simulated body fluid, and (2) to investigate the nature of interfacial layer. MethodsSix root dentine segments of 1.5mm thickness were obtained from extracted human teeth and were instrumented with Gates-Glidden drills. The specimens were then randomly filled with either MTA or Biodentine. The specimens were placed in the simulated body fluid containing the same phosphate concentration as blood plasma. After 4 weeks, the specimens were examined with Scanning Electron Microscope (SEM) and Energy Disperse X-ray Spectroscopy (EDX) to measure the thickness of the interfacial layer and Ca/P ratio. Transmission Electron Microscope (TEM) and Selective Area Electron Diffraction (SAED) were conducted to examine the interface ultramicroscopically and to determine the nature of the crystalline structure within interfacial layer. ResultsThe thickness of interfacial layer was significantly higher in the MTA group (14.5μm vs 4.8μm) (p<0.001). However, there was no significant difference between MTA and Biodentine in Ca/P ratio of interfacial layer (4.1 vs 2.7) (p>0.05). From TEM examination, amorphous calcium phosphate (ACP) was observed in the interface along with the surface of dentine. ConclusionsAs an alternative to MTA, Biodentine displayed bioactivity by producing an interfacial layer on the root canal dentine even though its thickness was significantly lower than MTA. ACP was observed in the interfacial layer of both biomaterials. Clinical significanceBiodentine could be considered as an alternative to MTA due to comparable bioactivity which creates interfacial layer between root canal dentin and Biodentine.

Influence of composition on setting kinetics of new injectable and/or fast setting tricalcium silicate cements

ObjectivesNew commercial tricalcium silicate based cements were elaborated to improve handling properties and setting time. The goals of the present work were: (i) to determine the composition of the new injectable and/or fast setting calcium silicate based cements, and (ii) to investigate the impact of the differences in composition on their setting kinetics. MethodsThe materials considered were Angelus MTA™, Biodentine™, MM-MTA™, MTA-Caps™, and ProRoot MTA™ as control.Elemental composition of materials was studied by Inductively Coupled Plasma-Atomic Emission Spectroscopy and X-ray Energy Dispersive analysis, whereas phases in presence were analyzed by Micro-Raman spectroscopy and X-ray Diffraction analysis and cement surface by Scanning Electron Microscope. Setting kinetics was evaluated using rheometry. ResultsElemental analysis revealed, for all cements, the presence of three major components: calcium, silicon and oxygen. Chlorine was detected in MM-MTA, MTA-Caps and Biodentine. Different radio-opacifiers were identified: bismuth oxide in ProRoot MTA, Angelus MTA and MM-MTA, zirconium oxide in Biodentine and calcium tungstate (CaWO4) in MTA-Caps. All cements were composed of di- and tri-calcium silicate, except Biodentine for which only the latter was detected. Major differences in setting kinetics were observed: a modulus of 8×108Pa is reached after 12min for Biodentine, 150min for MM-MTA, 230min for Angelus MTA and 320min for ProRoot MTA. The maximum modulus reached by MTA-Caps was 7×108Pa after 150min. SignificanceEven if these cements possess some common compounds, major differences in their composition were observed between them, which directly influence their setting kinetics.

Tricalcium Silicate Cements with Resins and Alternative Radiopacifiers

ObjectiveThe objectives of this study were the investigation of the setting mechanisms and characterization of radiopacified tricalcium silicate–based materials mixed with different liquid vehicles. MethodsTricalcium silicate cement replaced with 20% of either zirconium oxide or barium zirconate radiopacifier was investigated. The cements were mixed with water, an epoxy resin, or a light-cured Bis-GMA–based resin. The setting mechanism and characterization of set materials after immersion in Hank's balanced salt solution (HBSS) for 28 days were investigated by scanning electron microscopy of polished specimens and x-ray diffraction analysis. The bioactivity and surface microstructure of cements immersed in HBSS or water were also assessed by similar techniques together with leaching in solution investigated by inductively coupled plasma emission spectroscopy. ResultsThe formation of calcium hydroxide as a by-product of cement reaction was affected by the type of radiopacifier and also by the resin vehicle used. Barium zirconate enhanced the formation of calcium hydroxide as indicated by both scanning electron microscopy and x-ray diffraction analysis. The use of resins as vehicles reduced the formation of calcium hydroxide, with the Bis-GMA–based resin being mostly affected. Calcium hydroxide was deposited on the material surface regardless of the type of vehicle used. Formation of beta calcium phosphate was observed on materials containing barium zirconate radiopacifier immersed in HBSS. Inductively coupled plasma emission spectroscopy analysis showed high levels of calcium leached from materials by using water and light-curable resin as mixing vehicles. Barium was leached in solution, with the highest amount from the water-based mixtures. Zirconium leaching was negligible in materials containing zirconium oxide as radiopacifier, but leaching of zirconium was measurable in materials by using barium zirconate with tricalcium silicate. ConclusionsThe resin type and composition of the radiopacifier affect the calcium releasing ability and bioactivity of tricalcium silicate cements. Barium was leached in solution with barium zirconate radiopacified variants. Light-cured Bis-GMA–based resins did not exhibit cement hydration; however, they encouraged leaching of calcium ions in solution and promoted surface deposition of calcium phosphate.

Hydration of Biodentine, Theracal LC, and a Prototype Tricalcium Silicate–based Dentin Replacement Material after Pulp Capping in Entire Tooth Cultures

IntroductionThe calcium-releasing ability of pulp-capping materials induces pulp tissue regeneration. Tricalcium silicate–based materials produce calcium hydroxide as a by-product of hydration. Assessment of hydration and calcium ion leaching is usually performed on samples that have been aged in physiological solution for a predetermined period of time. The hydration and activity of the materials in vivo may not be similar to those displayed in vitro because of insufficient fluid available in contact with dentin. The aim of this research was the assessment of hydration of Biodentine, Theracal LC, and a prototype radiopacified tricalcium silicate–based material after pulp capping and to compare it with direct hydration in an aqueous solution. MethodsThe extent of hydration of Biodentine, Theracal LC, and a prototype radiopacified tricalcium silicate–based material with a similar composition to Biodentine but not incorporating the additives was assessed by scanning electron microscopy and energy dispersive spectroscopy of polished specimens after being allowed to hydrate in Hank's balanced salt solution for 14 days. The extent of hydration was compared with material hydration when used as direct pulp capping materials by using a tooth culture model. Material activity was also assessed by x-ray diffraction analysis to investigate the deposition of calcium hydroxide by the materials, and calcium ion leaching in Hank's balanced salt solution was assessed by ion chromatography. ResultsBiodentine and the prototype tricalcium silicate cement hydrated and reaction by-products were deposited in the cement matrix both after pulp capping and when incubated in an aqueous solution. Calcium hydroxide was formed, and calcium ions were leached in solution. Theracal LC hydration was incomplete because of the limited moisture diffusion within the material. Thus, no calcium hydroxide was produced, and a lower calcium ion leaching was recorded. ConclusionsTheracal LC had a heterogeneous structure with large unhydrated particles because not enough moisture was present to allow hydration to proceed. Biodentine composition was shown to be optimized, and the environmental conditions did not affect material microstructure. Biodentine exhibited formation of calcium hydroxide and calcium ion leaching, which are beneficial to the dental pulp.

Effects of tricalcium silicate cements on osteogenic differentiation of human bone marrow-derived mesenchymal stem cells in vitro

Tricalcium silicate cements have been successfully employed in the biomedical field as bioactive bone and dentin substitutes, with widely acclaimed osteoactive properties. This research analyzed the effects of different tricalcium silicate cement formulations on the temporal osteoactivity profile of human bone marrow-derived mesenchymal stem cells (hMW-MSCs). These cells were exposed to four commercially available tricalcium silicate cement formulations in osteogenic differentiation medium. After 1, 3, 7 and 10days, quantitative real-time polymerase chain reaction and Western blotting were performed to detect expression of the target osteogenic markers ALP, RUNX2, OSX, OPN, MSX2 and OCN. After 3, 7, 14 and 21days, alkaline phosphatase assay was performed to detect changes in intracellular enzyme level. An Alizarin Red S assay was performed after 28days to detect extracellular matrix mineralization. In the presence of tricalcium silicate cements, target osteogenic markers were downregulated at the mRNA and protein levels at all time points. Intracellular alkaline phosphatase enzyme levels and extracellular mineralization of the experimental groups were not significantly different from the untreated control. Quantitative polymerase chain reaction results showed increases in downregulation of RUNX2, OSX, MSX2 and OCN with increasing time of exposure to the tricalcium silicate cements, while ALP showed peak downregulation at day 7. For Western blotting, OSX, OPN, MSX2 and OCN showed increased downregulation with increased exposure time to the tested cements. Alkaline phosphatase enzyme levels generally declined after day 7. Based on these results, it is concluded that tricalcium silicate cements do not induce osteogenic differentiation of hBM-MSCs in vitro.

Effect of Biodentine™ on the proliferation, migration and adhesion of human dental pulp stem cells

ObjectivesTo investigate the proliferative, migratory and adhesion effect of Biodentine™, a new tricalcium silicate cement formulation, on the human dental pulp stem cells (hDPSCs). MethodsThe cell cultures of hDPSCs obtained from impacted third molars were treated with Biodentine™ extract at four different concentrations: Biodentine™ 0.02mg/ml (BD 0.02), Biodentine™ 0.2mg/ml (BD 0.2), Biodentine™ 2mg/ml (BD 2) and Biodentine™ 20mg/ml (BD 20). Human dental pulp stem cells proliferation was evaluated by MTT (3-(4,5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H-tetrazolium bromide) and BrdU (5-bromo-2′-deoxyuridine) viability analysis at different times. Migration was investigated by microphotographs of wound healing and transwell migration assays. Adhesion assay was performed as well in presence of BD 0.2, BD 2 and blank control, while qRT-PCR (quantitative real-time reverse-transcriptase polymerase chain) was used for further analysis of the mRNA expression of chemokine and adhesion molecules in hDPSCs. ResultsBiodentine™ significantly increased proliferation of stem cells at BD 0.2 and BD 2 concentrations while decreased significantly at higher concentration of BD 20. BD 0.2 concentration had a statistically significant increased migration and adhesion abilities. In addition, qRT-PCR results showed that BD 0.2 could have effect on the mRNA expression of chemokines and adhesion molecules in human dental pulp stem cells. ConclusionsThe data imply that Biodentine™ is a bioactive and biocompatible material capable of enhancing hDPSCs proliferation, migration and adhesion abilities. Clinical significanceBiodentine™ when placed in direct contact with the pulp during pulp exposure can positively influence healing by enhancing the proliferation, migration and adhesion of human dental pulp stem cells.

Biodentine Induces Human Dental Pulp Stem Cell Differentiation through Mitogen-activated Protein Kinase and Calcium-/Calmodulin-dependent Protein Kinase II Pathways

IntroductionBiodentine (Septodont, Saint-Maur-des-Fossès, France), a new tricalcium silicate cement formulation, has been introduced as a bioactive dentine substitute to be used in direct contact with pulp tissue. The aim of this study was to investigate the response of human dental pulp stem cells (hDPSCs) to the material and whether mitogen-activated protein kinase (MAPK), nuclear factor-kappa B (NF-κB), and calcium-/calmodulin-dependent protein kinase II (CaMKII) signal pathways played a regulatory role in Biodentine-induced odontoblast differentiation. MethodshDPCs obtained from impacted third molars were incubated with Biodentine. Odontoblastic differentiation was evaluated by alkaline phosphatase activity, alizarin red staining, and quantitative real-time reverse-transcriptase polymerase chain reaction for the analysis of messenger RNA expression of the following differentiation gene markers: osteocalcin (OCN), dentin sialophosprotein (DSPP), dentin matrix protein 1 (DMP1), and bone sialoprotein (BSP). Cell cultures in the presence of Biodentine were exposed to specific inhibitors of MAPK (U0126, SB203580, and SP600125), NF-κB (pyrrolidine dithiocarbamate), and CaMKII (KN-93) pathways to evaluate the regulatory effect on the expression of these markers and mineralization assay. ResultsBiodentine significantly increased alkaline phosphatase activity and mineralized nodule formation and the expression of OCN, DSPP, DMP1, and BSP. The MAPK inhibitor for extracellular signal-regulated kinase 1/2 (U0126) and Jun N-terminal kinase (SP600125) significantly decreased the Biodentine-induced mineralized differentiation of hDPSCs and OCN, DSPP, DMP1, and BSP messenger RNA expression, whereas p38 MAPK inhibitors (SB203580) had no effect. The CaMKII inhibitor KN-93 significantly attenuated and the NF-κB inhibitor pyrrolidine dithiocarbamate further enhanced the up-regulation of Biodentine-induced gene expression and mineralization. ConclusionsBiodentine is a bioactive and biocompatible material capable of inducing odontoblast differentiation of hDPSCs. Our results indicate that this induction is regulated via MAPK and CaMKII pathways.

Porosity and root dentine to material interface assessment of calcium silicate-based root-end filling materials

The aim of this study was to evaluate the porosity and assess the root dentine to material interface of four root-end filling materials based on tricalcium silicate cement using two microscopy techniques. The porosity of Bioaggregate, Biodentine, a prototype radiopacified tricalcium silicate cement (TCS-20-Zr) and intermediate restorative material (IRM) was evaluated after immersion for 28 days in Hank's balanced salt solution (HBSS) using mercury intrusion porosimetry. The root dentine to material interface of the cements when used as root-end filling materials in extracted human teeth was assessed after 28 days of dry storage and immersion in HBSS using a confocal microscope together with fluorescent tracers and also a field emission gun scanning electron microscope. Biodentine and IRM exhibited the lowest level or degree of porosity. The confocal microscopy used in conjunction to fluorescent tracers demonstrated that dry storage resulted in gaps at the root dentine to material interface and also cracks in the material with Biodentine being the most affected. Zinc was shown to be present in root dentine adjacent to the IRM restorations. Dry storage of Biodentine resulted in changes in the material microstructure and cracks at the root dentine to Biodentine interface. Furthermore, the gaps resulting from material shrinkage allowed the passage of the fluorescent microspheres thus indicating that these gaps are significant and can potentially allow the passage of micro-organisms.

In Vitro Osteogenic/Dentinogenic Potential of an Experimental Calcium Aluminosilicate Cement

IntroductionCalcium aluminosilicate cements are fast-setting, acid-resistant, bioactive cements that may be used as root-repair materials. This study examined the osteogenic/dentinogenic potential of an experimental calcium aluminosilicate cement (Quick-Set) by using a murine odontoblast-like cell model. MethodsQuick-Set and white ProRoot MTA (WMTA) were mixed with the proprietary gel or deionized water, allowed to set completely in 100% relative humidity, and aged in complete growth medium for 2 weeks until rendered non-cytotoxic. Similarly aged Teflon disks were used as negative control. The MDPC-23 cell line was used for evaluating changes in mRNA expressions of genes associated with osteogenic/dentinogenic differentiation and mineralization (quantitative reverse transcription polymerase chain reaction), alkaline phosphatase enzyme production, and extracellular matrix mineralization (alizarin red S staining). ResultsAfter MDPC-23 cells were incubated with the materials in osteogenic differentiation medium for 1 week, both cements showed up-regulation in ALP and DSPP expression. Fold increases in these 2 genes were not significantly different between Quick-Set and WMTA. Both cements showed no statistically significant up-regulation/down-regulation in RUNX2, OCN, BSP, and DMP1 gene expression compared with Teflon. Alkaline phosphatase activity of cells cultured on Quick-Set and WMTA were not significantly different at 1 week or 2 weeks but were significantly higher (P < .05) than Teflon in both weeks. Both cements showed significantly higher calcium deposition compared with Teflon after 3 weeks of incubation in mineralizing medium (P < .001). Differences between Quick-Set and WMTA were not statistically significant. ConclusionsThe experimental calcium aluminosilicate cement exhibits similar osteogenic/dentinogenic properties to WMTA and may be a potential substitute for commercially available tricalcium silicate cements.

Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, Biodentine and MTA Angelus

ObjectiveNovel root-end filling materials are composed of tricalcium silicate (TCS) and radiopacifier as opposed to the traditional mineral trioxide aggregate (MTA) which is made up of clinker derived from Portland cement and bismuth oxide. The aim of this research was to characterize and investigate the hydration of a tricalcium silicate-based proprietary brand cement (Biodentine™) and a laboratory manufactured cement made with a mixture of tricalcium silicate and zirconium oxide (TCS-20-Z) and compare their properties to MTA Angelus™. MethodsThe materials investigated included a cement containing 80% of TCS and 20% zirconium oxide (TCS-20-Z), Biodentine™ and MTA Angelus™. The specific surface area and the particle size distribution of the un-hydrated cements and zirconium oxide were investigated using a gas adsorption method and scanning electron microscopy. Un-hydrated cements and set materials were tested for mineralogy and microstructure, assessment of bioactivity and hydration. Scanning electron microscopy, X-ray energy dispersive analysis, X-ray fluorescence spectroscopy, X-ray diffraction, Rietveld refined X-ray diffraction and calorimetry were employed. The radiopacity of the materials was investigated using ISO 6876 methods. ResultsThe un-hydrated cements were composed of tricalcium silicate and a radiopacifier phase; zirconium oxide for both Biodentine™ and TCS-20-Z whereas bismuth oxide for MTA Angelus™. In addition Biodentine™ contained calcium carbonate particles and MTA Angelus™ exhibited the presence of dicalcium silicate, tricalcium aluminate, calcium, aluminum and silicon oxides. TCS and MTA Angelus™ exhibited similar specific surface area while Biodentine™ had a greater specific surface area. The cements hydrated and produced some hydrates located either as reaction rim around the tricalcium silicate grain or in between the grains at the expense of volume containing the water initially present in the mixture. The rate of reaction of tricalcium calcium silicate was higher for Biodentine™ than for TCS-20-Z owing to its optimized particle size distribution, the presence of CaCO3 and the use of CaCl2. Tricalcium calcium silicate in MTA hydrated even more slowly than TCS-20-Z as evident from the size of reaction rim representative of calcium silicate hydrate (C-S-H) around tricalcium silicate grains and the calorimetry measurements. On the other hand, calcium oxide contained in MTA Angelus™ hydrated very fast inducing an intense exothermic reaction. Calcium hydroxide was produced as a by-product of reaction in all hydrated cements but in greater quantities in MTA due to the hydration of calcium oxide. This lead to less dense microstructure than the one observed for both Biodentine™ and TCS-20-Z. All the materials were bioactive and allowed the deposition of hydroxyapatite on the cement surface in the presence of simulated body fluid and the radiopacity was greater than 3mm aluminum thickness. SignificanceAll the cement pastes tested were composed mainly of tricalcium silicate and a radiopacifier. The laboratory manufactured cement contained no other additives. Biodentine™ included calcium carbonate which together with the additives in the mixing liquid resulted in a material with enhanced chemical properties relative to TCS-20-Z prototype cement. On the other hand MTA Angelus™ displayed the presence of calcium, aluminum and silicon oxides in the un-hydrated powder. These phases are normally associated with the raw materials indicating that the clinker of MTA Angelus™ is incompletely sintered leading to a potential important variability in its mineralogy depending on the sintering conditions. As a consequence, the amount of tricalcium silicate is less than in the two other cements leading to a slower reaction rate and more porous microstructure.

Characterization of set Intermediate Restorative Material, Biodentine, Bioaggregate and a prototype calcium silicate cement for use as root‐end filling materials

To investigate the composition of materials and leachate of a hydrated prototype cement composed of tricalcium silicate and radiopacifier and compare this to other tricalcium silicate-based cements (Biodentine and Bioaggregate) to assess whether the additives in the proprietary brand cements affect the hydration of the materials, using Intermediate Restorative Material (IRM), a standard root-end filling material as a control. The materials investigated included a prototype-radiopacified tricalcium silicate cement, Biodentine, Bioaggregate and Intermediate Restorative Material (IRM). The pH and calcium ion concentration of the leachate were investigated. The hydrated cements were characterized using scanning electron microscopy (SEM) and X-ray energy dispersive analysis (EDX), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR). All the cements tested were alkaline. The tricalcium silicate-based cements leached calcium in solution. Scanning electron microscopy of the prototype-radiopacified tricalcium silicate cement, Biodentine and Bioaggregate displayed hydrating cement grains, surrounded by a matrix composed of calcium silicate hydrate and calcium hydroxide. The presence of calcium hydroxide was evident from the XRD plots. FT-IR indicated the occurrence of a poorly crystalline calcium silicate hydrate. Biodentine displayed the presence of calcium carbonate. Bioaggregate incorporated a phosphate-containing phase. IRM consisted of zinc oxide interspersed in an organic matrix. The hydration of prototype-radiopacified tricalcium silicate cement, Biodentine and Bioaggregate resulted in the formation of calcium silicate hydrate and calcium hydroxide, which was leached in solution. The hydrated materials were composed of a cementitous phase that was rich in calcium and silicon and a radiopacifying material. Biodentine included calcium carbonate, and Bioaggregate included silica and calcium phosphate in the powders. IRM was composed of zinc oxide interspersed in a matrix of organic material.

Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report

The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials

ObjectiveTricalcium silicate-based cements have been displayed as suitable root-end filling materials. The physical properties of prototype radiopacified tricalcium silicate cement, Bioaggregate and Biodentine were investigated. Intermediate restorative material was used as a control. MethodsThe physical properties of a prototype zirconium oxide replaced tricalcium silicate cement and two proprietary cements composed of tricalcium silicate namely Bioaggregate and Biodentine were investigated. Intermediate restorative material (IRM) was used as a control. Radiopacity assessment was undertaken and expressed in thickness of aluminum. In addition the anti-washout resistance was investigated using a novel basket-drop method and the fluid uptake, sorption and solubility were investigated using a gravimetric method. The setting time was assessed using an indentation technique and compressive strength and micro-hardness of the test materials were investigated. All the testing was performed with the test materials immersed in Hank's balanced salt solution. ResultsAll the materials tested had a radiopacity value higher than 3mm thickness of aluminum. IRM exhibited the highest radiopacity. Biodentine demonstrated a high washout, low fluid uptake and sorption values, low setting time and superior mechanical properties. The fluid uptake and setting time was the highest for Bioaggregate. SignificanceThe addition of admixtures to tricalcium silicate-based cements affects the physical properties of the materials.

The microstructure and surface morphology of radiopaque tricalcium silicate cement exposed to different curing conditions

ObjectiveTricalcium silicate is the major constituent phase in mineral trioxide aggregate (MTA). It is thus postulated that pure tricalcium silicate can replace the Portland cement component of MTA. The aim of this research was to evaluate the microstructure and surface characteristics of radiopaque tricalcium silicate cement exposed to different curing conditions namely at 100% humidity or immersed in either water or a simulated body fluid at 37°C. MethodsThe materials under study included tricalcium silicate and Portland cements with and without the addition of bismuth oxide radiopacifier. Material characterization was performed on hydrated cements using a combination of scanning electron microscopy (SEM) with X-ray energy dispersive (EDX) analyses and X-ray diffraction (XRD) analyses. Surface morphology was further investigated using optical profilometry. Testing was performed on cements cured at 100% humidity or immersed in either water or Hank's balanced salt solution (HBSS) for 1 and 28 days at 37°C. In addition leachate analysis was performed by X-ray fluorescence of the storage solution. The pH of the storage solution was assessed. ResultsAll the cements produced calcium silicate hydrate and calcium hydroxide on hydration. Tricalcium silicate showed a higher reaction rate than Portland cement and addition of bismuth oxide seemed to also increase the rate of reaction with more calcium silicate hydrate and calcium hydroxide being produced as demonstrated by SEM and XRD analysis and also by surface deposits viewed by the optical profilometer. Cement immersion in HBSS resulted in the deposition of calcium phosphate during the early stages following immersion and extensive calcification after 28 days. The pH of all storage solutions was alkaline. The immersion in distilled water resulted in a higher pH of the solution than when the cements were immersed in HBSS. Leachate analysis demonstrated high calcium levels in all cements tested with higher levels in tricalcium silicate and bismuth replaced cements. SignificanceTricalcium silicate cement is more bioactive than Portland cement as demonstrated by various characterization techniques. The bioactivity was monitored by measuring the production of calcium hydroxide and the formation of calcium phosphate when in contact with simulated body fluids.

Characterization and analyses of acid‐extractable and leached trace elements in dental cements

Determination of the elemental constitution and investigation of the total and leachable arsenic, chromium and lead in Portland cement, pure tricalcium silicate, Biodentine, Bioaggregate and mineral trioxide aggregate (MTA) Angelus. The chemical composition of Portland cement, MTA Angelus, tricalcium silicate cement, Biodentine and Bioaggregate was determined using X-ray fluorescence (XRF). Measurements of arsenic, lead and chromium were taken with inductively coupled plasma-mass spectrometry (ICP-MS), following acid digestion on the hydrated material and on leachates of cements soaked in Hank's balanced salt solution (HBSS). All the cements investigated had a similar oxide composition with the main oxide being calcium and silicon oxide. Both the Portland cement and MTA Angelus had an additional aluminium oxide. The dental cements included a radiopacifying material. All the materials tested had higher acid-extractable arsenic content than the level set by ISO 9917-1 (2007) and an acceptable level of lead. Regardless these high levels of trace elements present in the materials, the leaching in HBSS was minimal for all the dental material tested in contrast to the high levels displayed by Portland cement. Dental materials based on tricalcium silicate cement and MTA Angelus release minimal quantities of trace elements when in contact with simulated body fluids. The results of acid extraction could be affected by nonspecific matrix effects by the cement.

The effect of curing conditions on the physical properties of tricalcium silicate cement for use as a dental biomaterial

To investigate the physical properties of tricalcium silicate (TCS) with and without the addition of a radiopacifier and compare them with that of Portland cement (PC) and radiopaque PC in an mineral trioxide aggregate-like system. Tricalcium silicate, PC and radiopacified variants containing 20% bismuth oxide were tested for radiopacity, compressive strength, setting time and dimensional stability. All the testing was performed at 37 °C and under different environmental conditions namely at 100% humidity or immersed in either water or Hank's balanced salt solution (HBSS). Testing was performed after both 1 and 28 days. The cements exhibited radiopacity values equivalent to <3 mm. Addition of 20% bismuth oxide resulted in adequate radiopacity. The strength of TCS was independent of the curing conditions. The cements without radiopacifier had improved strength characteristics when immersed in HBSS, whilst the radiopacified cements exhibited higher strengths when soaked in water. Tricalcium silicate demonstrated the shortest setting time. Addition of bismuth oxide increased the setting time of the cements while HBSS inhibited the setting of bismuth oxide-replaced cements. The PC-based materials exhibited a net contraction higher than that recorded for TCS-based cements in all curing conditions. The dimensional change exhibited by the specimens was generally greater in the first few hours of setting, but then stabilized with time. Tricalcium silicate cement required the addition of a radiopacifying agent to make it suitable for use as a dental material. Tricalcium silicate exhibited adequate physical properties and thus was shown to be a suitable replacement for the PC component in MTA. Bismuth oxide drastically increased the setting time of the test cements in phosphate-containing solutions. Alternative radiopacifiers that do not retard the setting time need to be investigated.