Search Results (48)

When performing an apicoectomy avoiding the microleakage is desired. That is why materials used for this procedure should be resistant to washout. Washout refers to the tendency of freshly prepared materials to disintegrate upon contact with fluids. Background/Objectives: The aim of this paper is to provide a literature review on the washout resistance of bioactive root-end filling materials. Methods: This systematic review was conducted following the PRISMA 2020 guidelines. International databases (PubMed, Google Scholar, ScienceDirect, and Wiley Online Library) were searched, and articles published in the last 20 years were selected for analysis. The following keywords were used “antiwashout”, “washout resistance”, “washout in dentistry”, “root-end filling materials”, “calcium silicate-based cements”, “bioceramic materials”. A total of 6 in vitro studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was low in all six studies. Results: Most tested bioceramic materials are Endocem, Capasio, and Ceramicrete-D. Generex-A, MTA-Plus, MTA-AW, Bioaggregate, and MTA HP usually demonstrate very good washout resistance. ProRoot and MTA Angelus performed differently depending on the test; however, generally they showed good washout resistance. The Biodentine material showed significant washout, and requires further research. There is still a lack of a unified method for washout evaluation in dentistry, which makes it difficult to compare different studies. Conclusions: The study the confirmed excellent washout resistance of EndoCem, Capasio, Ceramicrete-D, Generex-A, Bioaggregate, MTA-Plus, and MTA HP. ProRoot, MTA-Angelus, and MTA Angelus White exhibited lower washout resistance. Biodentine shows poor washout resistance, and requires further research. A unified method for assessing washout would be beneficial for comparing different studies. Full article

Background and Objectives: This study aimed to investigate the effect of zinc phosphate (ZnP) cement, glass ionomer cement (GIC), and nano-integrated bio-ceramic (NIB) cement on mineralization when placed in contact with bone tissue-forming cells. Materials and Methods: ZnP cement, GIC, and NIB cement were divided into direct and indirect groups. A total of 72 cement pellets (24 pellets of each test sample) of 3 × 1 mm (width × height) were prepared using polytetrafluoroethylene molds. A total of 3 sample groups were demarcated using 96- cell well culture plates. In the control group, 24 wells were filled with mineralized osteoblasts and 1 µL of gingival crevicular fluid (GCF). In test group 1, to show a direct effect, 36 samples were plated with mineralized osteoblasts and 1 µL GCF for 24 h; the cells were directly exposed to cement pellets. A total of 36 samples were immersed in GCF for 24 h; later the supernatant was transferred to the mineralized osteoblasts to demonstrate an indirect effect in test group 2. To assess the mineralization, osteoblasts were stained with alizarin red and later observed under an inverted phase-contrast microscope. Data were analyzed using the statistical package for social sciences. An independent t-test compared the direct and indirect effects of the ZnP cement, GIC, NIB cement, and control groups on the mineralization of osteoblasts derived from hDPCs. Results: A statistically significant difference was observed between the ZnP cement, GIC, and NIB cement groups (p < 0.05). ZnP cement exhibited a moderate, NIB cement the least harmful effect, and GIC showed the most harmful effect on the mineralization of osteoblast cells. Conclusions: The biocompatibility of dental luting cements is an important aspect that clinicians should consider during their selection. Nano-integrated bio-ceramic cement showed the least negative effect on the mineralization of osteoblast cells which is beneficial for the cementation of cement-retained implant prostheses. However, further studies are needed to evaluate osteoblast and osteoclast activity in vivo. Full article

Bioceramic endodontic cements, known for their antibacterial properties, calcium ion release, and alkaline pH, may come into contact with various irrigants after furcal perforation repair. This study aimed to evaluate the effect of different irrigating solutions and setting times on the shear bond strength (SBS) of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) to a self-adhering flowable composite. Sixty Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) blocks were prepared and divided into two groups based on the setting time: 72 h and 7 days. These were further subdivided into five subgroups based on the irrigation solution applied: distilled water, sodium hypochlorite, ethylenediaminetetraacetic acid, chlorhexidine, and phosphoric acid. They were then restored with Dyad Flow^TM (Kerr^TM, Orange, CA, USA). SBS and failure modes were assessed at 24 h and 6 months. A two-way analysis of variance (ANOVA) test was performed to analyze the effect of the different irrigating solutions and setting times on the SBS of Biodentine^® (Septodont, Saint-Maur-des-Fosses Cedex, France) and Dyad Flow^TM (Kerr^TM, Orange, CA, USA). The level of significance was set at a ≤0.05. At 24 h, SBS was significantly influenced by both the irrigant solution (p = 0.029) and setting time (p = 0.018); at 6 months, SBS was influenced only by the irrigating solutions (p < 0.001). The predominant mode of bond failure was adhesive across all groups. In conclusion, while the setting time did not affect the bond strength, certain irrigating solutions reduced it. Thus, careful consideration of surface treatments applied to Biodentine^® is crucial for successful endodontic and restorative outcomes. Full article

Magnesium silicate ceramics are promising materials for bone tissue regeneration and can be prepared through 3D printing of magnesium oxide/silica (MgO/SiO₂) cement pastes followed by calcination. Despite the growing interest in these formulations, additive manufacturing technology has only recently been explored for these cements, and the effects of admixtures and additives on such printing inks remain largely unexplored. In this study, we prepared various MgO/SiO₂ cement formulations with differing amounts of sodium orthophosphate, a setting retarder, and cellulose ethers, used as rheo-modifiers. The samples’ setting properties were investigated, and printing parameters were properly adjusted. The most promising formulations were then 3D printed and calcined to obtain forsterite bioceramics, which were further characterized using confocal Raman microscopy, scanning electron microscopy, atomic force microscopy, gas porosimetry, and compressive strength tests. Our results revealed that the cellulose derivatives influence the printability of the MgO/SiO₂ formulations without affecting the hardening time, which can be adjusted by the addition of sodium phosphate. The use of fine-tuned formulations allowed for the preparation of 3D-printed forsterite bioceramics, potentially suitable for biological applications as cancellous bone scaffolds. Full article

The ion doping of mesoporous silica nanoparticles (MSNs) has played an important role in revolutionizing several materials applied in medicine and dentistry by enhancing their antibacterial and regenerative properties. Mineral trioxide aggregate (MTA) is a dental material widely used in vital pulp therapies with high success rates. The aim of this study was to investigate the effect of the modification of MTA with cerium (Ce)- or calcium (Ca)-doped MSNs on the biological behavior of human gingival fibroblasts (hGFs). MSNs were synthesized via sol–gel, doped with Ce and Ca ions, and mixed with MTA at three ratios each. Powder specimens were characterized using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Biocompatibility was evaluated using a 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay following hGFs’ incubation in serial dilutions of material eluates. Antioxidant status was evaluated using Cayman’s antioxidant assay after incubating hGFs with material disc specimens, and cell attachment following dehydration fixation was observed through SEM. Material characterization confirmed the presence of mesoporous structures. Biological behavior and antioxidant capacity were enhanced in all cases with a statistically significant increase in CeMTA 50.50. The application of modified MTA with cerium-doped MSNs offers a promising strategy for vital pulp therapies. Full article

The present in vitro study focuses on the filling ability of three different bioceramic cements with or without the addition of a bioceramic sealer in an open apex model on the marginal apical adaptation, tubule infiltrations, and void distributions as well as the interface between the cement and the sealer materials. To this end, sixty mandibular premolars were used. MTA-Biorep (BR), Biodentine (BD), and Well-Root Putty (WR) were used to obturate the open apex model with or without the addition of a bioceramic sealer, namely TotalFill^® BC sealer™ (TF). A digital optical microscope and scanning electron microscope (SEM) were used to investigate the cement–dentin interface, marginal apical adaptation, and the material infiltration into the dentinal tubules. Micro-computed X-ray tomography and digital optical microscopy were used to investigate the cement–sealer interface. The results were analyzed by using the Kruskal–Wallis test. No significant difference was found between the groups for the marginal apical adaptation quality (p > 0.05). Good adaptation of the dentin–cement interface was found for all tested groups and the sealer was placed between the cement material and dentinal walls. All the groups demonstrated some infiltrations into the dentinal tubules at the coronal part except for the BR group. A good internal interface was found between the cement and the sealer with the presence of voids at the external interface. A larger number of voids were found in the case of the BD-TF group compared to each of the other two groups (p < 0.05). Within the limitations of the present in vitro study, all the groups demonstrated good marginal apical adaptation. The use of a sealer in an open apex does not guarantee good filling and, in addition, creates voids at the external interfaces with the dental walls when the premixed sealer is used with powder–liquid cement systems. The use of a premixed bioceramic cement could offer fewer complications than when a powder–liquid cement system is used. Full article

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties. Full article

This study focuses on developing hydroxyapatite synthesized from a CaCO₃-rich byproduct of sugar beet processing called Carbocal^® using a hydrothermal reactor. The purpose of this biomaterial is to enhance the osteoinductivity of implantable surfaces and serve as a bone filler, providing a sustainable and economically more affordable alternative. This research involved compositional analysis and micro- and macrostructural physicochemical characterization, complemented with bioactivity and live/dead assays. The biphasic nature of the Carbocal^®-derived sample was significant within the context of the bioactivity concept previously proposed in the literature. The bioactivity of the biomaterial was demonstrated through a viability test, where the cell growth was nearly equivalent to that of the positive control. For comparison purposes, the same tests were conducted with two additional samples: hydroxyapatite obtained from CaCO₃ and commercial hydroxyapatite. The resulting product of this process is biocompatible and possesses properties similar to natural hydroxyapatite. Consequently, this biomaterial shows potential as a scaffold in tissue engineering and as an adhesive filler to promote bone regeneration within the context of the circular bioeconomy in the geographical area proposed. Full article

The aim of this study was to evaluate and quantify, in vitro, the extent of coronal discoloration induced by bioceramic materials over time. In total, 44 human monoradicular teeth were divided into four groups (n = 11), according to the applied material: Negative control (NC); White MTA ProRoot^® (WMTAP); Biodentine^™ (BD); and TotalFill^® BC RRM^™ Putty (TF). Teeth were immersed in saline solution and incubated at 37 °C; the following periods of time were defined: before incubation: [t0]—without bioceramic material, t1—immediately after the bioceramic material placement; after incubation: t24h—24 h, t7d—7 days, and 30d—30 days. Descriptive and inferential statistical analysis were performed. Cochran’s Q test was used to evaluate coronal discoloration across the different groups, while the Kruskal–Wallis test was employed to determine differences in discoloration among the groups at each time interval. Additionally, the Friedman test was applied to analyze the variations in discoloration within each group over time. A significance level of 5% was set. All experimental groups revealed coronal discoloration over time: NC (p = 0.001), WMTAP (p < 0.001), BD (p = 0.001), and TF (p = 0.006). No significant differences were observed between groups for each time interval (p > 0.05). The WMTAP group varied the most considering the intervals [t0—t1] and [t24h—t7d] (p = 0.037) compared to the remaining experimental groups. Full article

Hydraulic calcium silicate-based cements (HCSCs) have become a superior bioceramic alternative to epoxy-based root canal sealers in endodontics. A new generation of purified HCSCs formulations has emerged to address the several drawbacks of original Portland-based mineral trioxide aggregate (MTA). This study was designed to assess the physio-chemical properties of a ProRoot MTA and compare it with newly formulated RS+, a synthetic HCSC, by advanced characterisation techniques that allow for in situ analyses. Visco-elastic behaviour was monitored with rheometry, while phase transformation kinetics were followed by X-ray diffraction (XRD), attenuated total reflectance Fourier transform infrared (ATR-FTIR), and Raman spectroscopies. Scanning electron microscopy with energy-dispersive spectroscopy, SEM-EDS, and laser-diffraction analyses was performed to evaluate the compositional and morphological characteristics of both cements. While the kinetics of surface hydration of both powders, when mixed with water, were comparable, an order of magnitude finer particle size distribution of RS+ coupled with the modified biocompatible formulation proved pivotal in its ability to exert predictable viscous flow during working time, and it was more than two times faster in viscoelastic-to-elastic transition, reflecting improved handling and setting behaviour. Finally, RS+ could be completely transformed into hydration products, i.e., calcium silicate hydrate and calcium hydroxide, within 48 h, while hydration products were not yet detected by XRD in ProRoot MTA and were obviously bound to particulate surface in a thin film. Because of the favourable rheological and faster setting kinetics, synthetic, finer-grained HCSCs, such as RS+, represent a viable option as an alternative to conventional MTA-based HCSCs for endodontic treatments. Full article

Background: Recently several calcium silicate flowable sealers have been introduced as endodontic materials for the root canal. This clinical study tested the use of a new premixed calcium silicate bioceramic sealer in association with the Thermafil warm carrier-based technique (TF). Epoxy-resin-based sealer with the warm carrier-based technique was the control group. Methodology: Healthy consecutive patients (n = 85) requiring 94 root canal treatments were enrolled in this study and assigned to one filling group (Ceraseal-TF n = 47, AH Plus-TF n = 47) in accordance with operator training and best clinical practice. Periapical X-rays were taken preoperatively, after root canal filling and after 6, 12 and 24 months. Two evaluators blindly assessed the periapical index (PAI) and sealer extrusion in the groups (k = 0.90). Healing rate and survival rate were also evaluated. Chi-square tests was used to analyze significant differences between the groups. Multilevel analysis was performed to evaluate the factors associated with healing status. Results: A total of 89 root canal treatments in 82 patients were analyzed at the end-line (24 months). The total drop-out was 3.6% (3 patients; 5 teeth). A total of 91.1% of healed teeth (PAI 1-2) was observed in Ceraseal-TF, with 88.6% in AH Plus-TF. No significant difference was observed on healing outcome and survival among the two filling groups (p > 0.05). Apical extrusion of the sealers occurred in 17 cases (19.0%). Of these, 6 occurred in Ceraseal-TF (13.3%) and 11 in AH Plus-TF (25.0%). Three Ceraseal extrusions were radiographically undetectable after 24 months. All the AH Plus extrusions did not change during the evaluation time. Conclusions: The combined use of the carrier-based technique and premixed CaSi-based bioceramic sealer showed clinical results comparable with carrier-based technique and epoxy-resin-based sealer. The radiographical disappearance of apically extruded Ceraseal is a possible event in the first 24 months. Full article

Carbonate apatite (CO₃Ap) is a bioceramic material with excellent properties for bone and dentin regeneration. To enhance its mechanical strength and bioactivity, silica calcium phosphate composites (Si-CaP) and calcium hydroxide (Ca(OH)₂) were added to CO₃Ap cement. The aim of this study was to investigate the effect of Si-CaP and Ca(OH)₂ on the mechanical properties in terms of the compressive strength and biological characteristics of CO₃Ap cement, specifically the formation of an apatite layer and the exchange of Ca, P, and Si elements. Five groups were prepared by mixing CO₃Ap powder consisting of dicalcium phosphate anhydrous and vaterite powder added by varying ratios of Si-CaP and Ca(OH)₂ and 0.2 mol/L Na₂HPO₄ as a liquid. All groups underwent compressive strength testing, and the group with the highest strength was evaluated for bioactivity by soaking it in simulated body fluid (SBF) for one, seven, 14, and 21 days. The group that added 3% Si-CaP and 7% Ca(OH)₂ had the highest compressive strength among the groups. SEM analysis revealed the formation of needle-like apatite crystals from the first day of SBF soaking, and EDS analysis indicated an increase in Ca, P, and Si elements. XRD and FTIR analyses confirmed the presence of apatite. This combination of additives improved the compressive strength and showed the good bioactivity performance of CO₃Ap cement, making it a potential biomaterial for bone and dental engineering applications. Full article

Biocompatible ceramics are extremely important in bioengineering, and very useful in many biomedical or orthopedic applications because of their positive interactions with human tissues. There have been enormous efforts to develop bioceramic particles that cost-effectively meet high standards of quality. Among the numerous bioceramics, calcium phosphates are the most suitable since the main inorganic compound in human bones is hydroxyapatite, a specific phase of the calcium phosphates (CaPs). The CaPs can be applied as bone substitutes, types of cement, drug carriers, implants, or coatings. In addition, bioresorbable bioceramics have great potential in tissue engineering in their use as a scaffold that can advance the healing process of bones during the normal tissue repair process. On the other hand, the main disadvantages of bioceramics are their brittleness and poor mechanical properties. The newest advancement in CaPs doping with active biomolecules such as Mg, Zn, Sr, and others. Another set of similarly important materials in bioengineering are biopolymers. These include natural polymers such as collagen, cellulose acetate, gelatin, chitosan, and synthetic polymers, for example, polyvinyl pyrrolidone (PVP), polyvinyl alcohol (PVA), and polycaprolactone (PCL). Various types of polymer have unique properties that make them useful in different fields. The combination of CaP particles with different biopolymers gives rise to new opportunities for application, since their properties can be changed and adjusted to the given requirements. This review offers an insight into the most up-to-date advancements in the preparation and evaluation of different calcium phosphate–biopolymer composites, highlighting their application possibilities, which largely depend on the chemical and physical characteristics of CaPs and the applied polymer materials. Overall, these composites can be considered advanced materials in many important biomedical fields, with potential to improve the quality of healthcare and to assist in providing better outcomes as scaffolds in bone healing or in the integration of implants in orthopedic surgeries. Full article

The aim of the study was to analyze the chemical–physical properties and bioactivity (apatite-forming ability) of three recently introduced premixed bioceramic root canal sealers containing varied amounts of different calcium silicates (CaSi): a dicalcium and tricalcium silicate (1–10% and 20–30%)-containing sealer with zirconium dioxide and tricalcium aluminate (CERASEAL); a tricalcium silicate (5–15%)-containing sealer with zirconium dioxide, dimethyl sulfoxide and lithium carbonate (AH PLUS BIOCERAMIC) and a dicalcium and tricalcium silicate (10% and 25%)-containing sealer with calcium aluminate, tricalcium aluminate and tantalite (NEOSEALER FLO). An epoxy resin-based sealer (AH PLUS) was used as control. The initial and final setting times, radiopacity, flowability, film thickness, open pore volume, water absorption, solubility, calcium release and alkalizing activity were tested. The nucleation of calcium phosphates and/or apatite after 28 days aging in Hanks balanced salt solution (HBSS) was evaluated by ESEM-EDX, vibrational IR and micro-Raman spectroscopy. The analyses showed for NeoSealer Flo and AH Plus the longest final setting times (1344 ± 60 and 1300 ± 60 min, respectively), while shorter times for AH Plus Bioceramic and Ceraseal (660 ± 60 and 720 ± 60 min, respectively). Radiopacity, flowability and film thickness complied with ISO 6876/12 for all tested materials. A significantly higher open pore volume was observed for NeoSealer Flo, AH Plus Bioceramic and Ceraseal when compared to AH Plus (p < 0.05), significantly higher values were observed for NeoSealer Flo and AH Plus Bioceramic (p < 0.05). Ceraseal and AH Plus revealed the lowest solubility. All CaSi-containing sealers released calcium and alkalized the soaking water. After 28 days immersion in HBSS, ESEM-EDX analyses revealed the formation of a mineral layer that covered the surface of all bioceramic sealers, with a lower detection of radiopacifiers (Zirconium for Ceraseal and AH Plus Bioceramic, Tantalum for NeoSealer Flo) and an increase in calcium, phosphorous and carbon. The calcium phosphate (CaP) layer was more evident on NeoSealer Flo and AH Plus Bioceramic. IR and micro-Raman revealed the formation of calcium carbonate on the surface of all set materials. A thin layer of a CaP phase was detected only on AH Plus Bioceramic and NeoSealer Flo. Ceraseal did not show CaP deposit despite its highest calcium release among all the tested CaSi-containing sealers. In conclusion, CaSi-containing sealers met the required chemical and physical standards and released biologically relevant ions. Slight/limited apatite nucleation was observed in relation to the high carbonation processes. Full article

The purpose of the present study was to evaluate the physicochemical properties and antibacterial activity of three calcium silicate cements. Mineral trioxide aggregate (MTA Biorep “BR”), Biodentine (BD) and Well-Root PT (WR) materials were investigated using scanning electron microscopy (SEM) at 24, 72 and 168 h of immersion in phosphate buffered saline (PBS). The antibacterial activity against Enterococcus faecalis (E. faecalis), the solubility, roughness, pH changes and water contact angle were also analyzed. All results were statistically analyzed using a one-way analysis of variance test. Statistically significant lower pH was detected for BD than WR and BR (p < 0.05). No statistical difference was found among the three materials for the efficacy of kill against E. faecalis (p > 0.05). Good antibacterial activity was observed (kill 50% of bacteria) after 24 h of contact. The wettability and the roughness of BR were higher than for the other cements (p < 0.05). BD was more soluble than WR and BR (p < 0.05). In conclusion, the use of bioceramic cements as retrograde materials may play an important role in controlling bacterial growth and in the development of calcium phosphate surface layer to support healing. Moreover, the premixed cement was easier to use than powder–liquid cement. Full article