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Background Bioceramic cements have been widely used in endodontic treatment. This study aimed to compare the microhardness, elastic modulus, internal microstructure and chemical compositions of Biodentine, WMTA, ERRM Putty, iRoot FS and IRM after exposure to PBS, butyric acid, and butyric acid followed by PBS. Methods Specimens of each material were prepared and randomly divided into 5 subgroups (n = 5): subgroup A: PBS (pH = 7.4) for 4 days, subgroup B: PBS (pH = 7.4) for 14 days, subgroup C: butyric acid (pH = 5.4) for 4 days, subgroup D: butyric acid (pH = 5.4) for 14 days, subgroup E: butyric acid for 4 days followed by 10 days in contact with PBS. The surface microhardness, elastic modulus, internal morphologic and chemical compositions of specimens were analyzed. Results The microhardness and elastic modulus values of all materials were significantly higher in the presence of PBS compared to exposure to butyric acid, with the same setting time ( P  < 0.01). After 4-day exposure to butyric acid followed by 10-day exposure to PBS, the microhardness values returned to the same level as 4-day exposure to PBS ( P  > 0.05). Biodentine showed significantly higher microhardness and elastic modulus values than other materials, while IRM displayed the lowest ( P  < 0.01). Conclusion Biodentine seems the most suitable bioceramic cements when applied to an infected area with acidic pH. Further storage at neutral pH, e.g. PBS reverses the adverse effects on bioceramic cements caused by a low pH environment.

Background To investigate the effects of adding ZrO₂, TiO₂, and two sizes of hydroxyapatite (HAP) nanoparticles on the physicochemical and bioactivity properties of calcium silicate-based cement (CSC). Methods MTA, PC, and nanoparticle-modified groups (5% and 10% n-ZrO₂, n-TiO₂, n-HAP1, n-HAP2) were evaluated for setting time, compressive strength (1, 7, 14 days), solubility (14 days), and bioactivity. Setting time and compressive strength followed ISO 9917–1:2007, solubility followed a modified ISO 6876:2012, and bioactivity was analyzed using SEM–EDS. Results All groups showed significantly reduced setting times (p < 0.001) compared to MTA and PC, with 10% n-HAP1 showing the greatest reduction. Compressive strength increased over time in all groups except 5% and 10% n-ZrO₂, which remained stable (p > 0.05). MTA had the highest strength at 14 days. MTA’s solubility was higher than PC’s (p < 0.001). All groups, except 10% n-TiO₂, 5% and 10% n-HAP1, showed increased solubility vs. MTA (p < 0.003); all exceeded PC (p < 0.001). SEM after 1 day showed spherical apatite structures, which thickened by days 7 and 14. EDS confirmed Ca/P ratios similar to controls. Conclusions All nanoparticles accelerated the setting time, and only ZrO₂ nanoparticles enhanced early strength. Despite increased solubility, all values remained within acceptable limits. All groups demonstrated bioactivity potential.

Objectives The push‐out bond strength (POBS) of calcium silicate‐based cements (CSCs) to the dentinal wall is considered one of the essential physical properties for clinical success. The presence of blood in the treatment area affects the POBS of these types of cement. This study aimed to evaluate the impact of blood contamination on the bond strength of CSCs and dentinal walls. Material and Methods This systematic review was performed by searching electronic databases (MEDLINE‐PubMed, Scopus, and EMBASE) to include relevant in vitro studies published between 1992 and April 2020. Two reviewers independently evaluated the selected studies and extracted data on the type of studied CSCs, evaluated area of the teeth, sample size, the dimension of a prepared area, slice thickness, storage duration, the setting of the universal testing machine (UTM), effects of blood contamination on POBS of CSCs and their failure modes. The bond strength of evaluated CSCs in studies was used for network meta‐analysis. Results Initial searches identified 292 articles, while only 13 articles met the inclusion criteria. Full texts of these articles were evaluated, and data extraction was performed. The effect of blood contamination on bond strength to the dentinal wall was assessed in various CSCs such as PMTA, Biodentine, and AMTA. The network meta‐analysis results showed that the bond strength of Biodentine was significantly higher than other types of cement in blood presence (p < .05). Conclusions Based on the current systematic review, despite controversies among the result of the different articles and the lack of data for some CSCs like bioaggregate, it could be concluded that the bond strength of Biodentine to the dentinal wall is better than other evaluated CSCs in the presence of blood.

Objectives The aim of this study was to evaluate the shear bond strength inherent to immediate and delayed definitive composite resin restorations, over three different biomaterials. Methods Fifty-four aluminum blocks were randomly assigned to six experimental groups ( n = 9) according to the biomaterial (Biodentine, TotalFill BC Putty, or PCM) and restoration timing (immediate or 7 days delayed). Regarding the restorative procedures, a two-step self-etch bonding system (Clearfil SE Bond) was applied and subsequently restored using a flowable composite resin (SDR). After shear bond strength testing, fracture pattern analysis was performed. The significance level was set at α = 0.05. Results Within the immediate groups, Biodentine showed the highest mean shear bond strength value, with no statistically significant differences ( P > 0.05) being detected when compared with both TotalFill ( P = 0.072) and PCM ( P = 0.232) groups. Regarding the delayed restoration groups, Biodentine and TotalFill presented the highest mean shear bond strength value, with statistical differences when compared with PCM ( P = 0.002 and P = 0.043, respectively). No statistically significant differences ( P > 0.05) were verified between both immediate and delayed groups for each tested biomaterial. Also, a statistically significant association was found between the fracture type and the biomaterial ( P < 0.001). Conclusions and clinical relevance Our findings suggest that all tested biomaterials present suitable alternatives which allow to perform restorative procedures immediately after pulp capping biomaterial placement (3 or 12 min, depending on the bioactive cement), therefore requiring one single appointment to complete the procedure. Biodentine and TotalFill BC Putty have shown superior shear bond strength results when compared with PCM, within a delayed timeframe (7 days).

The goal of this study was to evaluate the pH and the release of calcium from four calcium-silicate-based cements. Methods: Four materials were tested (ProClinic MTA; Angelus MTA; ProRoot MTA; Biodentine). The palatal canal root of acrylic upper molars was filled with each cement. Afterwards, they were set in phosphate-buffered saline. Measurements were taken by atomic adsorption spectroscopy (AAS) at 3, 24, 72, 168, 336, 672, and 1008 h. The pH was measured at the same timepoints. Kruskal–Wallis tests were carried out in each period, as the Kolmogorov–Smirnov and Shapiro–Wilk tests showed no parametric results. Results: Significant differences (p < 0.05) in calcium release were found at the 3-, 24-, and 72-hour evaluations. All of the analyzed groups presented a release of calcium ions up to 168 h, and the general tendency was to increase up to 672 h, with a maximum release of 25.45 mg/g in the ProRoot group. We could only observe significant differences (p < 0.05) in pH value over 168 h between the Biodentine (7.93) and Angelus MTA (7.31) groups. Conclusions: There were significant differences (p < 0.05) in calcium release. Nevertheless, no significant differences (p > 0.05) in the pH values were found at the studied timepoints, except for the values at 168 h.

Vital pulp therapy aims to preserve the vitality of dental pulp exposed due to caries, trauma, or restorative procedures. The aim of the present review was to evaluate the clinical, radiographic, and histological outcomes of different calcium silicate-based cements used in vital pulp therapy for both primary and permanent teeth. The review included 40 randomized controlled trials from a search across PubMed, LILACS, and the Cochrane Collaboration, as well as manual searches and author inquiries according to specific inclusion and exclusion criteria. A critical assessment of studies was conducted, and after data extraction the results were submitted to a quantitative statistical analysis using meta-analysis. The studies, involving 1701 patients and 3168 teeth, compared a total of 18 different calcium silicate-based cements in both dentitions. The qualitative synthesis showed no significant differences in short-term outcomes (up to 6 months) between different calcium silicate-based cements in primary teeth. ProRoot MTA and Biodentine showed similar clinical and radiographic success rates at 6 and 12 months. In permanent teeth, although the global results appeared to be well balanced, ProRoot MTA generally seemed to perform better than other calcium silicate-based cements except for Biodentine, which had comparable or superior results at 6 months. Meta-analyses for selected comparisons showed no significant differences in clinical and radiographic outcomes between ProRoot MTA and Biodentine over follow-up periods. The present review highlights the need for standardized definitions of success and follow-up periods in future studies to better guide clinical decisions. Despite the introduction of new calcium silicate-based cements aiming to address limitations of the original MTA. ProRoot MTA and Biodentine remain the most used and reliable materials for vital pulp therapy, although the results did not deviate that much from the other calcium silicate-based cements. Further long-term studies are required to establish the optimal CSC for each clinical scenario in both dentitions.

The purpose of the present study was to assess the proper time to perform a restoration (immediately or delayed) after placement of two calcium silicate-based cements (CSCs) and to test the performance of two different restorative protocols regarding shear bond strength (SBS). Seventy-five acrylic blocks were randomly divided into five groups (n = 15). Specimens were filled with either ProRoot MTA (Dentsply Tulsa Dental) or Biodentine (Septodont). The restoration was performed at an immediate (12 min) or delayed (seven days) timeframe, using a resin-based flowable composite (SDR) (bonded to the CSC using a universal bonding system) or glass ionomer cement (GIC) as restorative materials. SBS was measured using a universal testing machine. Fractured surfaces were evaluated, and the pattern was registered. Statistical analysis was performed using the Dunn–Sidak post hoc test (P < 0.05). Biodentine/immediate SDR showed the highest mean SBS value (4.44 MPa), with statistically significant differences when compared to mineral trioxide aggregate (MTA)/GIC (1.14 MPa) and MTA/immediate SDR (1.33 MPa). MTA/GIC and MTA/immediate SDR did not present significant differences regarding SBS. No statistical differences were verified concerning mean SBS between both CSCs within the 7 day groups. MTA/delayed SDR (3.86 MPa) presented statistical differences compared to MTA/immediate SDR, whereas no differences were observed regarding Biodentine performance (Biodentine/immediate SDR and Biodentine/delayed SDR (3.09 MPa)). Bonding procedures directly on top of MTA might be preferably performed at a delayed timeframe, whereas Biodentine might allow for immediate restoration.

Introduction: Calcium silicate-based cements (CSC), are self-setting hydraulic biomaterials widely used for reparative procedures in dentistry and endodontics. These materials possess physical properties, such as ion release, porosity, solubility, and radiopacity. Their biological properties are connected to their alkalizing activity and calcium release capacity. Materials and Methods: Six calcium silicate-based materials were selected for this study: TheraCal LC (Bisco Inc., Schaumburg, IL, USA), MTA Plus (PrevestDenpro, Jammu, India Avalon Biomed Inc., Bradenton, FL, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), RetroMTA (BioMTA, Seoul, Korea), MTA Flow (Ultradent Products, Inc., South Jordan, UT, USA), and OrthoMTA (BioMTA, Seoul, Korea). The pH was analyzed immediately after immersion (baseline) and after 1 h, 3 h, 1 day, 2 days, 3 days, 1 week, 2 weeks, 3 weeks, and 1 year with a pH meter, previously calibrated with solutions of known pH. All testing materials had alkaline pH. Results: Analysis of the tested materials showed statistically significant differences in terms of pH changes as a function of the time showed a gradual rise in the pH of all materials. Conclusions: All tested materials exhibited continuous hydroxyl ion release resulting in a rise in pH until the end of time of experience.

Calcium silicate based cement is a group of biomaterials, based on Portland cement. Its physicochemical properties such as solubility are of the utmost importance. It should have low solubility in tissue fluid since the dissolution of materials may lead to treatment failure. is to evaluate the solubility of five calcium silicate cements after being placed in distilled water for a period of 28 days. The purpose of this study was to compare solubility of a four new calcium silicate-based cements, such as: gray MTA Angelus; white MTA Angelus; BioAggregate and Biodentine with conventional mineral trioxide aggregate White ProRoot. Solubility is evaluated using standardized samples of materials, which are weighed before and after 28-day immersion in distilled water. The lowest solubility is found at White ProRoot and the significantly highest solubility – at Biodentine.

The aim of the present ex vivo study was to assess and compare coronal discoloration induced by four endodontic biomaterials used in regenerative endodontic procedures (REPs). Root resection was executed horizontally, 2 mm apical to the cementoenamel junction, in all fifty-four teeth. After accessing the pulp chamber, specimens were randomly divided in groups and filled with either saline solution or blood, followed by calcium silicate-based cements (CSCs) placement: ProRoot mineral trioxide aggregate (MTA) (Dentsply Sirona), Biodentine (Septodont), TotalFill BC (FKG), or pulp capping material (PCM) (Coltène). Color change (ΔE) was assessed using the L* a* b* system at five different timepoints (before and immediately after biomaterial application, 72 h, 7 days, and 6 months). The significance level for statistical analysis was set at p < 0.05. There are statistically significant differences regarding ΔE over time (p < 0.001). Statistical differences are found considering material (p < 0.001), treatment (p = 0.007), or both (p = 0.002). If solely the material or treatment is considered, regardless of time, statistically significant differences are detected (p < 0.001). After a six-month period of evaluation, blood exposure might be a critical factor in biomaterials’ color variation. Biodentine presents the lowest discoloration potential, followed by TotalFill and PCM, albeit without statistically significant differences. MTA exhibited the greatest color variation. The selection of biomaterial should consider the material’s discoloration potential.