Efectividad de bioceramicos en el mantenimiento de la vitalidad pulpar en recubrimiento pulpar directo en denticion primaria y permanente: revisión sistemática con metaanálisis

Introducción: Se han desarrollado materiales bioactivos para el recubrimiento pulpar directo con el objetivo de preservar la pulpa dentaria y mantener el diente por mayor tiempo en la cavidad oral. Objetivo: El objetivo de esta revisión fue evaluar la efectividad del uso de bioceramicos como material de recubrimiento directo pulpar para mantener la vitalidad pulpar en dientes primarios y permanentes con pulpitis reversible. Metodología: Se realizó una revisión sistemática con meta análisis. Se estudió el éxito en el tratamiento del mantenimiento de la vitalidad, el dolor postoperatorio y la decoloración. Se realizó una búsqueda Electrónica en las bases de datos: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Se extrajeron los datos y se analizaron con Rev Man. Resultados: Se incluyeron ensayos clínicos aleatorizados en la cual se realizaron recubrimiento pulpar directo con silicatos tricalcicos comparado con otros materiales de recubrimiento. Comparando tres biocerámicos no se encontraron diferencias significativas en el mantenimiento de la vitalidad pulpar. En cuanto a la decoloración se observaron diferencias estadísticamente significativas a favor de Biodentine (p <0,001). Discusión: la relevancia clínica de estos hallazgos es discutible debido a su pequeña magnitud general y al alto riesgo de sesgo de los estudios incluidos.

Introduction: Bioactive materials have been developed for direct pulp capping in order to preserve the dental pulp and keep the tooth longer in the oral cavity. Objective: The objective of this review was to evaluate the effectiveness of the use of bioceramics as direct pulp capping material to maintain pulp vitality in primary and permanent teeth with reversible pulpitis. Methods: A systematic review with meta-analysis was performed. Success in treating vitality maintenance, postoperative pain, and discoloration was studied. An electronic search was carried out in the databases: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Data were extracted and analyzed with Rev Man. Results: Randomized clinical trials in which direct pulp capping with tricalcium silicates was performed compared with other capping materials were included. Comparing three bioceramics, no significant differences were found in the maintenance of pulp vitality. Regarding discoloration, statistically significant differences were observed in favor of Biodentine (p <0.001). Discussion: the clinical relevance of these findings is debatable due to their small overall magnitude and the high risk of bias of the included studies.

Comparison of Fracture Resistance of Simulated Immature Teeth Using Four Different Commercially Available Apexification Materials ? An invitro Study

Introduction: The aim of this study was to compare the fracture resistance of simulated immature teeth using four different apical plug materials, i.e. Pro? Root MTA, Neo? MTA Plus, Biodentine, and Bioactive Glass. Materials and Methods: 80 extracted human maxillary anterior teeth were divided into 4 groups for this study. They were prepared using Peeso reamers to simulate immature teeth and to mimic Cvek’s stage 3 of root development. A 5 mm apical barrier was placed using different materials. The remaining canal was obturated using gutta?percha and AH plus sealer. The final samples were stored at 37°C and 100% humidity for 4 weeks. Fracture resistance of the teeth was measured in Newtons using a universal testing machine. The comparison of fracture resistance between the four groups was done using Kruskal Walis ANOVA followed by post hoc Mann Whitney U test for pairwise comparison. Results: Biodentine group showed the highest fracture resistance as compared to the other three groups and the difference was highly significant (P < 0.001). Conclusions: Biodentine can be advocated over MTA as an effective material for the management of teeth with wide open apex. Bioactive glass also has shown promising results in increasing the fracture resistance of simulated immature teeth.

Does radiation therapy affect adhesion of tricalcium silicate cements to root dentin?

Abstract Objective This study aimed to analyze the effect of irradiation on the push-out bond strength of mineral trioxide aggregate (MTA) and Biodentine to radicular dentin. Methodology A total of 60 extracted mature human teeth with single root canals were categorized into two groups (irradiated and non-irradiated) (n=30). Each group was further divided into two sub-groups based on cements used (Biodentine and MTA). Then, a cumulative radiation dose of 60 Gy was divided into 30 fractions (two Gy for every fraction) and administered for five successive days per week over six weeks. Obturation was then performed using MTA and Biodentine. Afterwards, 1.5 mm thick horizontal sections were procured from the middle one-third of all the specimens and then subjected to push-out bond test. Results were analyzed using one-way analysis of variance with post-hoc Tukey's test. Results The bond strength of Biodentine and MTA to irradiated teeth was lower than non-irradiated teeth. Highest push-out bond strength was observed in non-irradiated specimens filled with Biodentine (p=0), followed by irradiated specimens filled with Biodentine (p=0); non-irradiated specimens filled with MTA (p=0); and irradiated specimens filled with MTA (p=0.9). Conclusion The push-out bond strength of Biodentine and MTA to root canal dentin decreased significantly post irradiation.

Avaliação da influência da agitação ultrassônica na resistência de união de dois materiais reparadores utilizados para selar perfurações na furca / Assessment of the influence of ultrasonic agitation on the joint resistance of two repairing materials used to seal perforations in the burning / Evaluación de la influencia de la agitación ultrasónica en la resistencia de la unión de dos materiales de reparación utilizados para sellar otras perforaciones

Avaliou-se a influência da utilização da agitação ultrassônica na resistência de união à dentina, por meio de push-out, proporcionada pelos cimentos MTA-Angelus branco (MTA) e Biodentine (BD), empregados no selamento de perfurações de furca. Foram utilizados 48 primeiros ou segundos molares inferiores, com raízes não fusionadas, distantes cerca de 2 mm entre si na porção cervical das mesmas. Os dentes foram acessados e, em seguida, as raízes foram seccionadas transversalmente abaixo da junção cemento-esmalte. Os dentes foram montados em blocos de silicona de adição e perfurações de furca realizadas em seus assoalhos paralelamente ao longo eixo dos dentes e perpendiculares aos assoalhos dentais. A amostra foi dividida em quatro grupos (n = 12) em função do material reparador e da utilização ou não da agitação ultrassônica (AU). Quando empregada, a AU foi aplicada em 2 ciclos de 20 segundos por meio de inserto cônico liso acionado por ultrassom piezoelétrico. Concluídos os selamentos eles foram protegidos com cimento de ionômero de vidro e os dentes imersos em PBS. Decorridos 7 dias discos com 1 mm de altura foram retirados dos assoalhos dentais com auxílio de cortadora metalográfica e levados à máquina de ensaio universal. Os resultados expressos em MPa foram submetidos aos testes ANOVA dois fatores e de Bonferroni. Os maiores valores de resistência obtidos foram no grupo Biodentine com ultrassom (29,41 MPa), seguidos em ordem decrescente pelos grupos Biodentine sem ultrassom; MTA com ultrassom e MTA sem ultrassom (3,72 MPa). Nas condições do estudo concluiu-se que o BD apresentou maior resistência de união à dentina radicular; ainda, que a agitação ultrassônica influenciou positivamente na resistência de união do material à dentina.

We evaluated the influence of the use of ultrasonic agitation on the resistance to the dentin, by means of push-out, provided by the white MTA-Angelus (MTA) and Biodentine (BD) cements, used in the sealing of drilling holes. 48 first or second lower molars were used, with unfused roots, about 2 mm apart in the cervical portion of them. The teeth were accessed and then the roots were sectioned transversely below the cementenamel junction. The teeth were mounted in addition silicon blocks and hole drills performed on their floors parallel along the axis of the teeth and perpendicular to the dental floorings. The sample was divided into four groups (n = 12) depending on the repair material and whether ultrasonic agitation (AU) was used. When employed, the AU was applied in 2 20-second cycles by means of a smooth conical insert activated by piezoelectric ultrasound. Once the seals were completed, they were protected with glass ionomer cement and the teeth immersed in PBS. After 7 days, 1 mm high disks were removed from the dental floorboards with the aid of a metallographic cutter and taken to the universal test machine. Results expressed in MPa were submitted to two-factor and Bonferroni ANOVA tests. The highest resistance values obtained were in the group Biodentine with ultrasound (29.41 MPa), followed in descending order by the groups Biodentine without ultrasound; MTA with ultrasound and MTA without ultrasound (3.72 MPa). Under the conditions of the study, it was concluded that BD showed greater resistance to root dentin binding; also, that ultrasonic agitation positively influenced the resistance of the material to dentin binding.

influencia del uso de la agitación ultrasónica sobre la resistencia de la unión a la dentina se evaluó mediante un estiramiento, proporcionado por los cementos blancos (MTA) y biodentinos (BD) MTA-Angelus, empleados en el sello de los taladros. Se utilizaron los primeros o segundos molares inferiores, con raíces sin fundir, a unos 2 mm de distancia en la porción cervical de las raíces. Se accedió a los dientes y luego las raíces se seccionaron transversalmente por debajo de la unión cemento-enamel. Los dientes se ensamblaron además bloques de silicona y agujeros de perforación en sus pisos a lo largo del eje de los dientes y perpendiculares al suelo dental. La muestra se dividió en cuatro grupos (n = 12) según el material de reparación y si se utilizó o no la agitación ultrasónica (AU). Cuando se empleó, la UA se aplicó en 2 ciclos de 20 segundos mediante una inserción cónica suave activada por ultrasonido piezoeléctrico. Una vez concluidos los sellos, se protegieron con cemento ionómero de vidrio y los dientes se sumergieron en PBS. Al cabo de 7 días, los discos de 1 mm de altura se retiraron del suelo de corte metálico y se llevaron a la máquina de ensayo universal. Los resultados expresados como MPa se presentaron a las pruebas de dos factores ANOVA y Bonferroni. Los valores de resistencia más altos obtenidos fueron en el grupo de Biodentina con ultrasonido (29,41 MPa), seguidos en orden descendente por los grupos de Biodentina sin ultrasonido; MTA de ultrasonido y MTA libre de ultrasonido (3,72 MPa). En las condiciones del estudio se concluyó que la DB mostró mayor resistencia de la unión a la dentina raíz; y que la agitación ultrasónica tuvo una influencia positiva en la resistencia del material a la dentina.

Influence of etching Mode and composite type on bond strength to biodentine using a ''No-Wait'' universal adhesive / Influencia del modo de grabado y del tipo de resina en la resistencia adhesiva al Biodentine utilizando un adhesivo universal tipo "no-wait"

Abstract: The purpose of this study was to compare the shear bond strength (SBS) of four resin-based composite materials to a silicate-based cement using a ''no-wait'' universal bond with self-etch (SE) and etch-and-rinse (ER) modes. Acrylic blocks (n=80, 2mm depth, 5mm diameter central hole) were prepared. The holes were filled with BiodentineTM (BD) and divided into 4 main groups (n=20) according to the composite resin type used: Group FZ250: FiltekTM Z250 Universal Restorative (microhybrid), Group SDR: SDR Plus U Bulk Fill Flowable (low-viscosity bulk-fill), Group FBP: FiltekTM Bulk Fill Posterior (high-viscosity bulk-fill), Group EF: EsFlow™ Universal Flowable Composite (nanohybrid). A 'no-wait' universal bond (Clearfil Universal Bond Quick) was used for bonding application. Then each group was divided into 2 subgroups according to the etching mode applied (ER and SE). SBSs were measured and stereomicroscope was used to identify the failure modes. Selected samples of fracture surfaces were imaged by SEM. Tukey's post-hoc and One-way ANOVA tests were used to analyze data. There were statistically significant differences among the composite groups (p 0.05). The SBS of BD to the resin composites depends on the composite type but application of the 'no-wait' universal bond in different etching modes is regardless of the SBS of BD to resin composites.

Resumen El objetivo de este estudio fue comparar la resistencia de adhesión al cizallamiento (SBS) de cuatro resinas con un cemento a base de silicato utilizando una adhesivo universal "no-wait" de autograbado (SE) y grabado y lavado (ER). Se prepararon bloques acrílicos (n=80, de 2mm de profundidad y un agujero central de 5mm de diámetro). Los agujeros se rellenaron con BiodentineTM (BD) y se dividieron en 4 grupos principales (n=20) según el tipo de resina compuesta utilizada: Grupo FZ250: FiltekTM Z250 Universal Restorative (microhíbrido), Grupo SDR: SDR Plus U Bulk Fill Flowable (bulk-fill de baja viscosidad), Grupo FBP: FiltekTM Bulk Fill Posterior (bulk-fill de alta viscosidad), Grupo EF: EsFlow™ Universal Flowable Composite (nanohíbrido). Para la aplicación de la adhesión se utilizó un adhesivo universal "no-wait" (Clearfil Universal Bond Quick). A continuación, cada grupo se dividió en 2 subgrupos según el modo de grabado aplicado (ER y SE). Se midieron los SBS y se utilizó el estereomicroscopio para identificar los modos de fallo. Las muestras seleccionadas de las superficies de fractura se analizaron mediante SEM. Se utilizaron las pruebas post-hoc de Tukey y ANOVA de una vía para analizar los datos. Hubo diferencias estadísticamente significativas entre los grupos de composites (p0,05). La SBS de la BD a los composites de resina depende del tipo de composite, pero la aplicación de la unión universal "no-wait" en los diferentes modos de grabado es independiente de la SBS de la BD a los composites de resina.

Protección pulpar directa y posterior apexogénesis: informe de un caso clínico / Direct pulp capping followed by apexogenesis: a clinical case report

Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

Evaluation Of Sealing Ability Of Biodentine, MTA Angelus And Zirconia-Reinforced Glass Ionomer Cement For Repairing Furcation Perforations : An In Vitro Study

Background:Background and objective: One of the unfavourable outcomes of endodontic treatment is furcal perforation. Materials such as MTA-Angelus, Biodentine and Zirconomer have been recommended for the repair of furcal perforations.In this study we compared the sealing ability of MTA-Angelus, Biodentine and Zirconia-reinforced GIC in furcal perforations using dye penetration method. Material And Methods:Access cavities were prepared in extracted mandibular molars (n= 40) using round bur in a high speed hand pieceunder water coolant. Perforations were made in the centre of furcation region using 2mm round bur.The teeth were randomly divided into 4 groups based on the material used to seal the perforation: Group I(n= 12) = MTA –Angelus , Group II (n=12)= Biodentine, Group III(n=12) = Zirconomer , Group IV (n= 4) = left unsealed (negative control group).Leakage at the repaired site was then evaluated using methylene blue dye penetration technique under stereomicroscope and data was statistically analyzed.Result:Minimum dye penetration was observed in biodentine followed by MTA, Zirconomer and control group. The results was not statistically significant (p= .08). Conclusion:According to this study, biodentine showed best of the three materials used for furcation repair.

Retratamiento y reparación de una perforación radicular. Informe clínico, radiográfico e histológico / Retreatment and healing of a case of root perforation. Clinical, radiographic and histological report

Objetivo: Describir los aspectos clínicos, radiográfi- cos e histológicos del retratamiento realizado en un segundo molar superior en el que se había producido previamente una perforación radicular durante el tratamiento original. Caso clínico: Un paciente masculino de 50 años con- currió a la consulta para realizar un retratamiento endodóntico en un segundo molar superior derecho. El examen radiográfi- co reveló la presencia de un tratamiento incompleto, un área radiolúcida periapical y una perforación radicular producida por un poste roscado insertado fuera del espacio del conducto mesio vestibular. Una vez retirado el poste, se selló la perfo- ración con Biodentine y se realizó el retratamiento. Luego de dos años, el paciente regresó a la consulta con dolor a la mas- ticación, localizado en el área correspondiente al segundo mo- lar superior derecho previamente tratado. Durante el examen clínico y radiográfico se detectó la presencia de una fractura vertical en la raíz palatina. A causa del severo compromiso radicular el molar fue extraído y derivado para su análisis his- tológico. El informe del laboratorio reveló que la perforación había sido reparada por medio de la aposición de un nuevo tejido calcificado y que el remanente periodontal adherido a la raíz se encontraba dentro de los límites normales. El presente caso clínico resalta la importancia que tiene el conocimiento cabal de la anatomía del sistema de conductos radiculares con el objeto de evitar errores de procedimiento que puedan influir negativamente en el pronóstico del tratamiento (AU)

Aim: To describe the clinical, radiographic and histo- logical aspects of the retreatment of a second upper molar in which root perforation had occurred during the original treatment. Clinical case: A 50-year old male was referred for endo- dontic retreatment of the right second maxillary molar. Radi- ographic examination revealed the presence of an incomplete root canal treatment, a radiolucent periapical area and a root perforation produced by a threaded post placed outside of the mesiobuccal root canal. After post removal, the root perfo- ration was sealed with Biodentine and the root canals were retreated. Two years later, the patient returned to the office com- plaining of severe pain during mastication, in the area of the previously retreated right second maxillary molar. Clinical and radiographic examination revealed the presence of a ver- tical fracture on the palatal root. Since this kind of root dam- age non-restorable, the tooth was extracted and submitted to histologic analysis. The laboratory report revealed that the perforation site had healed by the apposition of new calci- fied tissue, and that the remnants of periodontal tissue which persisted attached to the root were within normal limits. This clinical case highlights the importance of thorough knowl- edge of the anatomy of the root canal system in order to avoid procedural errors which may compromise the prognosis of the treatment (AU)

Subcutaneous tissue reaction and gene expression of inflammatory markers after Biodentine and MTA implantation

Abstract The aim of this study was to evaluate the subcutaneous connective tissue response of isogenic mice exposed to tricalcium silicate (Biodentine) and aggregated mineral trioxide (ProRoot MTA). A total of 120 mice were divided into 4 groups in 3 different experimental periods (7, 21 and 63 days): Biodentine; Pro-Root MTA; zinc oxide-eugenol and; Negative control - Sham. After the experimental periods microscopic descriptive, semi-quantitative and quantitative analysis of the inflammatory process were analyzed on H&E sections and evaluation of the gene expression of Il10, Infg, Il6, Il1r1 and Tnf (qRT-PCR) were performed. The data obtained were analyzed using the chi-square test and two-way analysis of variance (ANOVA) followed by the Bonferroni post-test (5% significance level). Results: In the microscopic analysis, a slight inflammatory infiltrate was observed, with a predominance of sparse macrophages and polymorphonuclear cells, slight tissue fibrosis, regular fibrous capsule and with dystrophic calcifications, in all groups that received the materials (Biodentine and Pro-Root MTA). In parallel, all materials modulated the gene expression of the different cytokines and receptors evaluated. Conclusion: Pro-Root MTA and Biodentine showed a tissue compatibility, mediated inflammation, with increased fibrous tissue and production of pro- and anti-inflammatory cytokines.

Resumo Objetivo: Avaliar a resposta do tecido conjuntivo subcutâneo de camundongos isogênicos expostos à Biodentine™ e ao Trióxido Mineral Agregado (MTA). Métodos: Um total de 120 camundongos foram divididos em 4 grupos e 3 períodos experimentais diferentes (7, 21 e 63 dias): Biodentine™ (Septodont, Saint Maur des Fosses, França); Pro-Root MTA (Dentsplay, Tulsa, EUA); óxido de zinco eugenol (Biodinâmica Química e Farmacêutica LTDA., Ibiporã, PR - Brasil); e controle negativo - Sham. Após os períodos experimentais, análises microscópicas descritivas, semiquantitativas e quantitativas do processo inflamatório foram analisadas nos cortes de H&E e ainda, foi realizada a avaliação da expressão gênica de Il10, Infg, Il6, Il1r1 e Tnf (qRT-PCR). Os dados obtidos foram analisados por meio do teste do qui-quadrado e da análise de variância (ANOVA) two-way, seguido do pós-teste de Bonferroni (nível de significância de 5%). Resultados: Na análise microscópica observou-se discreto infiltrado inflamatório, com predomínio de macrófagos esparsos e polimorfonucleares, leve fibrose tecidual, cápsula fibrosa regular e com calcificações distróficas, em todos os grupos que receberam os materiais (Biodentine ™ e Pro-Root MTA). Paralelamente, todos os materiais modulam a expressão gênica das diferentes citocinas e receptores avaliados. Conclusão: Pro-Root MTA e Biodentine™ mostraram compatibilidade tecidual, inflamação mediada, com aumento do tecido fibroso e produção de citocinas pró- e antiinflamatórias.

Outcomes of furcal perforation management using Mineral Trioxide Aggregate and Biodentine: a systematic review

Abstract Furcal perforation is an iatrogenic or pathologic communication between the pulp chamber floor and the alveolar bone. The outcome of perforation sealing depends greatly on the tissue compatibility and bioactivity and sealing properties of the repair materials. Mineral trioxide aggregate (MTA) and Biodentine are currently the most used materials to treat this condition. The present systematic review aimed to report the treatment outcome of repaired furcal perforation using MTA and Biodentine and identify which material would yield a better outcome. Methodology: A comprehensive search was conducted using the PubMed database to identify experimental studies and case reports that describe treatment of furcal perforation. Studies and case reports that evaluated the outcome of repaired furcal perforations using MTA and Biodentine, published in English from 2018 to April 2022, were identified. Unavailable full texts were excluded. Results: Initial screening of 724 articles (670 studies and 54 case reports). After discarding the duplicated studies, we reviewed 50 studies, selecting 13 for abstract analysis. We retrieved and evaluated full texts of eight studies and five case reports. Both materials had an equivalent success rate in the first three months but by 12 months Biodentine performed better than MTA clinically and radiographically. Conclusions: Repair of furcal perforation with Biodentine yields a better outcome compared to MTA.

Experimental nano calcium aluminate/tri calcium silicate root repair: Synthesis, physical and mechanical properties compared to mineral trioxide aggregate and Biodentine / Reparo radicular experimental de nano aluminato de cálcio/silicato de tri cálcio: Síntese, propriedades físicas e mecânicas em comparação com agregado de trióxido mineral e Biodentine

Objective: Endodontic perforation is a challenging mishap that should be repaired with a biocompatible material, Mineral trioxide aggregate (MTA) and Biodentine are the most commonly used repair materials. However, these materials are expensive, (MTA) has prolonged setting time and difficult manipulation. The purpose of this study is to prepare the experimental nano calcium-aluminate/tri-calcium-silicate (CA/C3S) material and comparing its physical properties with biodentine and MTA, to evaluate the experimental material eligibility to compete the commercial repair materials. And to perform part two (animal study) that will evaluate the cytotoxicity, the biocompatibility and the efficacy of (CA/C3S) in furcal perforation repair compared to diode laser. Material and Methods: A mixture of calcium carbonate and aluminum oxide was used to formulate calcium aluminate phase (CA), tri-calcium-Silicate phase (C3S) was formulated by firing of calcium carbonate and quartz. The produced powders were investigated by X-ray diffraction, then (CA) and (C3S) mixed with water.(CA/ C3S) compared with MTA and biodentine for setting-time, micro-hardness, dimensional-stability and solubility. Results: Mean setting time of (CA/C3S) was (32.70±0.75min) which is significantly higher than MTA and Biodentine. The Mean microhardness of (CA/C3S) was (56.50±7.41VHN) which has no statical difference with MTA and Biodentine. Solubility results showed weight increase for (CA/C3S) as following (6.29±3.05)and loss of weight for MTA and Biodentine. The percentage of change in dimensions for(CA/C3S) increased as following (0.64±0.78) while decreased for MTA and Biodentine. Conclusion: The experimental (CA/C3S) material showed good microhardness, dimensional stability and acceptable setting time that could be improved in further work (AU)

Objetivo: A perfuração endodôntica é um percalço desafiador que deve ser reparado com um material biocompatível, Agregado de trióxido mineral (MTA) e Biodentina são os materiais de reparo mais comumente usados. No entanto, esses materiais são caros, (MTA) tem tempo de presa prolongado e difícil manipulação. O objetivo deste estudo é preparar o material experimental de nano aluminato de cálcio/silicato tricálcico (CA/C3S) e comparar suas propriedades físicas com biodentina e MTA, para avaliar a elegibilidade do material experimental para competir com os materiais de reparo comerciais. E realizar a segunda parte (estudo animal) que avaliará a citotoxicidade, a biocompatibilidade e a eficácia do (CA/C3S) no reparo de perfuração de furca em comparação ao laser de diodo.Material e Métodos: Uma mistura de carbonato de cálcio e óxido de alumínio foi usada para formular a fase de aluminato de cálcio (CA), a fase tri-cálcio-silicato (C3S) foi formulada por queima de carbonato de cálcio e quartzo. Os pós produzidos foram investigados por difração de raios X, em seguida (CA) e (C3S) misturados com água. (CA/ C3S) comparados com MTA e biodentina para tempo de presa, microdureza, estabilidade dimensional e solubilidade. Resultados: O tempo médio de presa de (CA/C3S) foi (32,70±0,75min) que é significativamente maior que MTA e Biodentine. A microdureza média de (CA/C3S) foi (56,50±7,41VHN) que não tem diferença estática com MTA e Biodentine. Os resultados de solubilidade mostraram aumento de peso para (CA/C3S) conforme a seguir (6,29±3,05) e perda de peso para MTA e Biodentine. A porcentagem de mudança nas dimensões para (CA/C3S) aumentou como segue (0,64±0,78), enquanto diminuiu para MTA e Biodentine. Conclusão: O material experimental (CA/C3S) apresentou boa microdureza, estabilidade dimensional e aceitável tempo de presa, que pode ser melhorado em trabalhos futuros (AU)

Aplicación de Biodentine en Endodoncia Regenerativa: Presentación de Tres Casos Clínicos / Application of Biodentine in Regenerative Endodontics: Presentation of Three Clinical Cases

El Biodentine es un material biocerámico y bioacti-vo que puede emplearse como sustituto activo de la dentina. Entre sus numerosos usos se incorpora su utilización como sellador del coágulo en los procedi-mientos endodónticos regenerativos, logrando me-jores propiedades con respecto al Gold standard. Se presenta la resolución clínica y radiográfica de tres situaciones clínicas, mediante la aplicación del proto-colo de los procedimientos endodónticos regenerati-vos, en los que se utilizó Biodentine como alternativa para el sellado del coágulo a nivel cérvico-radicular, en la obturación a nivel del límite amelocementario (AU)

Biodentine is a bio-ceramic and bioactive material that can be used as an active substitute for dentin. Its many uses include its use as a clot sealer in regenerative endodontic procedures, achieving better properties compared to the Gold standard. The clinical and radiographic resolution of three clinical situations is presented, by applying the protocol of regenerative endodontic procedures, where Biodentine was used as an alternative for sealing the clot at the cervical-radicular level in the obturation at the level of the cementoenamel limit (AU)

The effect of adding ytterbium trifluoride on the radiopacity, compressive strength, setting time and bioactivity of biodentine: an in vitro study / Efeito da adição de trifluoreto de itérbio na radiopacidade, resistência à compressão, tempo de presa e bioatividade da biodentina: estudo in vitro

Objective: This study aimed to evaluate the radiopacity, compressive strength, setting time and bioactivity of Biodentine after modification with Ytterbium Tri-Fluoride (YbF3) in three different concentrations. Material and Methods: Radiopacity was determined using the equivalence in millimeters of aluminum (mm Al) from digital radiographs. Compressive strength was evaluated using a universal testing machine. The initial and final setting times were evaluated using Gillmore needle. The bioactive potential was evaluated using the environmental scanning electron microscope (ESEM) connected with Energy Dispersive X-ray analysis (EDX) and X-ray Diffractometer (XRD) at three different time intervals. pH was measured using a pH-meter. Data were analyzed using one-way ANOVA followed by Tukey's post hoc tests (P≤ 0.05). Results: Radiopacity of Biodentine with 2.5%, 5% and 7.5% YbF3 was significantly higher than unmodified Biodentine (P ≤ 0.05). Unmodified Biodentine showed the highest mean compressive strength values compared to all other groups (p≤ 0.05). The addition of YbF3 to Biodentine has extended the final setting time except for the 2.5% YbF3 group that showed no significant difference compared to the control. All groups showed an alkaline pH at 28 days, ESEM coupled with EDX analysis showed evidence of dense globules of calcium phosphate on the surface indicating enhancement of bioactivity. Conclusion: 2.5% YbF3 can be a promising radiopacifying agent to Biodentine with improvement in radiopacity, bioactive potential and maintaining the setting time and compressive strength at acceptable level as indicated by the ISO standards (AU)

Objetivo: O estudo buscou avaliar a radiopacidade, resistência à compressão, tempo de presa e bioatividade da Biodentina modificada por Trifluoreto de itérbio (YbF3). Materiais e Métodos: YbF3 foi incorporado ao pó de Biodentina e dividido em 4 grupos (X0, X1, X2 e X3) de acordo com a concentração de YbF3; 0%, 2.5%, 5% e 7.5% do peso, respectivamente. Os espécimes foram preparados para cada experimento com um total de 40 espécimes para cada teste (n=10 por grupo). A radiopacidade foi determinada através do uso equivalente em milímetros de alumínio. A resistência a compressão foi avaliada através do uso de uma máquina de teste universal. O tempo inicial e final foi avaliado através de uma agulha de Gillmore. O potencial bioativo foi avaliado através do Microscópio Eletrônico de Varredura (ESEM), conectado com a análise de espectroscopia de raios X por energia dispersiva (EDX) e difração de raio X (DRX). O pH foi mensurado através do uso de um pHmetro. Os dados foram analisados pelo ANOVA seguido do Test Tukey. Resultados: A radiopacidade nos grupos X1, X2 e X3 foi significantemente maior do que no grupo X0. O grupo X0 mostrou a maior resistência à compressão comparado com os outros grupos. A adição de YbF3 a Biodentina excedeu o tempo final exceto pelo grupo X1, que não apresentou diferença estatística significante quando comparado com o grupo X0. Todos os grupos apresentaram um pH alcalino com 28 dias. ESEM com análise EDX mostrou evidência de densos glóbulos de fosfato de cálcio na superfície, indicando uma melhora na bioatividade. Conclusão: 2.5% YbF3 é um promissor radiopacificador para Biodentina, que aumentou a radiopacidade e potencial bioativo enquanto manteve o tempo definido e a resistência à compressão em níveis aceitáveis como indica a norma ISO.(AU)

Decoloración coronaria inducida por la utilización de Biodentine y MTA blanco en procedimientos de regeneración pulpar: estudio ex vivo / Coronal discoloration induced by the use of Biodentine and white MTA in pulp regeneration procedures: an ex-vivo study

Se comparó el grado de decoloración de la corona clínica en piezas dentarias anteriores humanas ex-traídas, sometidas a procedimientos de regeneración endodóntica, utilizando MTA blanco o sustituto bioac-tivo de la dentina (Biodentine) como barrera cervical, en presencia de coágulo sanguíneo como andamio. En total se prepararon 24 piezas dentarias anterio-res superiores humanas que fueron divididas en dos grupos control (GC) y dos grupos experimentales (GE). Cada uno incluía 6 piezas dentarias. En los GE se colo-có sangre humana fresca en el interior del conducto, y se confeccionó una barrera de Biodentine (GE3) o MTA (GE4). En los GC se colocó una torunda de algo-dón estéril saturada con solución fisiológica estéril, y se confeccionó una barrera de Biodentine (GC1) o MTA (GC2). El color se evaluó de acuerdo con el espa-cio de color CIE L* a* b* utilizando imágenes fotográfi-cas digitales estandarizadas en dos puntos de tiempo: día 0 (T0) y día 35 (T35). La descripción de los datos in-cluyó mediana (Md), primer cuartil (Q1), tercer cuartil (Q3), media y desviación estándar (DE). Se emplea-ron las pruebas de los rangos con signo de Wilcoxon (RSW) y ANOVA de una vía; p < 0,05 fue considerado significativo. Cuando se comparó ∆E se observaron diferencias significativas entre GC1 y el resto de los materiales (p < 0,05). ∆E fue menor en GC1 (media ± DE; 2,1 ± 1,6) que en los grupos restantes que no pre-sentaron diferencias significativas entre sí. En base a estos resultados, la estabilización del coágulo san-guíneo, como así la limpieza de la cavidad previa a la colocación del Biodentine y el uso de barreras cervi-cales, es imprescindible para evitar la coloración de la corona clínica (AU)

Discoloration remains an unfavorable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. Objective: Compare the degree of discoloration of extracted human teeth after regenerative endodontic procedures, using MTA or Biodentine as a cervical barrier with a blood clot as a scaffold. In total 24 human upper anterior teeth were prepared and divided into two control groups (CG) and two experimental groups (EG). In the EG, fresh human blood was placed inside the root and a Biodentine (GE3) or MTA (GE4) barrier was made in. A sterile cotton swab saturated with sterile physiological solution was placed in the GCs and a Biodentine (GC1) or MTA (GC2) barrier was made in. The color was evaluated according to the CIE L* a* b* color space using standardized digital photographic images at two time points: day 0 (T0) and day 35 (T35). The description of the data included median (Md), first quartile (Q1), third quartile (Q3), means, and standard deviation (SD). Wilcoxon signed rank tests (RSW) and one-way ANOVA were used. p < 0.05 was considered significant. When ∆E was compared, significant differences were observed between GC1 and the rest of the materials (p < 0.05). ∆E was lower in CG1 (mean ± SD; 2.1 ± 1.6) than in the remaining groups, which did not present significant differences between them. There was no significant difference between tooth discolorations with materials in the presence of blood. However, in the absence of blood, Biodentine exhibited less tooth discoloration than MTA (AU)

Silicato Tricálcico en Endodoncia Compleja

RESUMEN: En casos complejos como el que se presenta, es necesario detallar cada una de las dificultades que se debe sortear, para brindar al diente la posibilidad de seguir formando parte del sistema estomatognático. Para planificar un tratamiento endodóntico integral es necesario evidenciar la complejidad de los diferentes ítems: desde el retiro del instrumento separado en el conducto distal, la localización del conducto mesiolingual parcialmente calcificado, la desobturación del conducto mesiobucal, el sellado de la perforación en la zona de la furcación y la limpieza exhaustiva del sistema de conductos radiculares, así, se le entrega a la biología, el tiempo necesario para reaccionar y reparar las lesiones osteolíticas presentes tanto a nivel de la furcación como en apical en ambas raíces; para, por último, rehabilitar el diente devolviéndole su funcionalidad y estética. En este caso clínico, se aprecia la perforación en la zona de la furcación, a nivel de la cresta ósea en el tercio corono radicular. Cuanto mayor es el tamaño de la perforación menor posibilidad de éxito. En la actualidad, con el empleo de los nuevos biomateriales de obturación y sellado endodóntico, como los cementos biocerámicos de última generación, se logra mejorar los aspectos clínicos, mecánicos y biológicos, con la posibilidad de realizar procedimientos que antes eran impensados, mejorando así su pronóstico.

ABSTRACT: In cases as complex as the one that is presented, it is necessary to detail each of the difficulties that must be overcome, to give the tooth the possibility of continuing to form part of the stomatognathic system. To plan a comprehensive endodontic treatment, it will be necessary to demonstrate the complexity of the different items present: from the removal of the file separated from the distal canal, the location of the calcified mesiolingual canal, the deobturation of the mesiobuccal canal, the sealing of the perforation in the area of the furcation, up to the exhaustive cleaning of the root canal system, are important to give biology the time necessary to repair the osteolytic lesions present both at the level of the furcation and apically in both roots; to finally rehabilitate the tooth, restoring its functionality and aesthetics.In this particular case, the perforation can be seen in the furcation area, at the level of the bone crest in the Root crown third. The larger the piercing, the less success is expected of the treatment. Thanks to the use of technologies applied to obtain new endodontic filling and sealing materials such as the latest generation of bioceramic cements, clinical, mechanical and biological aspects are improved, providing the possibility of performing procedures that were previously unthinkable, thus improving prognosis.

Ex Vivo Analysis of MTA FLOW® Biomineralization and Push-Out Strength: A Pilot Study / Análisis ex vivo del proceso de biomineralización y resistencia al desplazamiento del MTA FLOW®: Estudio piloto

Abstract: This study evaluated the biomineralization processes and push-out strength of MTA Flow® with radicular dentine in three different consistencies. The push-out test was performed on an ex vivo model, using 2mm thick dentin discs from the middle third of the root with standardized cavities of 1.5 mm. Samples were filled with MTA-Angelus (Angelus Dental, Brazil), Biodentine (Septodont, France), MTA Flow® Putty (Ultradent, USA), MTA Flow® Thick or MTA Flow® Thin. The samples were divided into 3 groups: subgroup 1 (n=5), analysis of the biomineralization process; 2 (n=20), evaluation of the bonding strength and push-out resistance; and 3 (n=5), evaluation of the cement/ dentin interface. The samples filled with Biodentine had a higher precipitation of carbonate apatite. However, there was no significant difference between MTA-Angelus, MTA Flow® Putty, or Thick (p=0.0536), but there was a significant difference in the Thin group (P<0.05). The samples with Biodentine displayed the greatest release of calcium ions. The formation of a partially carbonated intermediate apatite layer was observed in all groups. Zones of biomineralization were observed at the interface but were not continuous. After 72 hours, a significant difference was found between the Biodentine and MTA Flow® Thin groups (p=0.0090) in the push-out test. The samples submerged in phosphate-buffered saline (PBS) for 15 days showed a significant difference between all groups and MTA Flow® Thin (p=0.0147). Putty or Thick consistencies presented a similar bonding strength to MTA-Angelus and Biodentine. MTA Flow® Putty and Thick consistencies show a good adaptation to dentin, similar to MTA-Angelus. However, the thickness of the interface was lower compared to that of Biodentine. MTA Flow® Thin, despite their tubular infiltration, results in gaps and a defective peripheral seal.Therefore, MTA Flow®, in Putty or Thick consistencies, presents a biomineralization process and push-out strength similar to MTA Angelus and Biodentine, however, both characteristics decreases considerably in Thin consistency.

Resumen: El objetivo de este estudio fue evaluar, en un modelo ex vivo, el proceso de biomineralización y fuerza de adhesión del MTA Flow® en sus tres diferentes consistencias por medio de la prueba de resistencia al desplazamiento (Push-out). Se utilizaron discos de dentina de 2mm de espesor del tercio medio radicular con cavidades estandarizadas de 1.5mm de diámetro, las cuales se obturaron con diferentes materiales entre ellos: MTA Angelus (Angelus Dental, Brasil), Biodentine (Septodont, Francia), MTA Flow® Consistencia Putty (Ultradent, E.E.U.U), MTA Flow® Consistencia Thick (Ultradent, E.E.U.U) y MTA Flow® Consistencia Thin (Ultradent, E.E.U.U). Las muestras se sometieron al proceso de biomineralización y a pruebas de Push-out. Las muestras obturadas con Biodentine promovieron una mayor precipitación de apatita carbonatada, sin embargo, no se presentó diferencia estadística significativa con respecto al MTA Angelus, MTA Flow® Putty ni Thick (p=0.0536). No obstante, si presentó una diferencia significativa con respecto al grupo de MTA Flow® consistencia Thin (P<0.05). Las muestras con Biodentine presentaron la mayor liberación de iones calcio. De acuerdo a las pruebas de resistencia al desplazamiento, a las 72 horas post-obturación, solamente se encontró diferencia significativa entre las muestras obturadas con Biodentine y las correspondientes al MTA Flow consistencia Thin (p=0.0090), sin embargo las muestras sumergidas 15 días en PBS presentaron diferencia significativa entre todos los grupos con respecto al MTA Flow Thin (p=0.0147). En general se observaron zonas de biomineralización en la interface, sin embargo, no fueron continuas. Se concluye que el MTA Flow en consistencia Putty o Thick presenta un proceso de biomineralización y una resistencia al desplazamiento similar al MTA Angelus y al Biodentine, sin embargo, esta última disminuye considerablemente en presentación Thin.

Evaluación comparativa de las características de porosidad entre el cemento Portland, MTA y Biodentine con microscopio electrónico de barrido / Comparison of the porosity characteristics of Portland cement, mineral trioxIde aggregate and Biodentine by scanning electron microscopy

Objetivo: El propósito del presente estudio fue evaluar comparativamente las características de porosidad entre el cemento Portland, MTA Angelus® y Biodentine Septodont®, observados con un microscopio electrónico de barrido. Materiales y métodos: Se prepararon los cementos según las indicaciones del fabricante y se empaquetaron en tubos cilíndricos de polietileno con un diámetro interno de 10 mm y una altura de 5 mm. Se analizó la porosidad de las muestras mediante el microscopio electrónico de barrido. El análisis estadístico se realizó utilizando la prueba Kruskal-Wallis. El nivel de significancia se estableció en 0,05 Resultados: Se observó la descripción de la media de los valores del diámetro de los poros, y el tamaño mayor correspondió al cemento Portland (11,07). Existen diferencias significativas entre las medias del diámetro de los poros con un p = 0,05. Se identificó que el MTA Angelus® tiene la mayor cantidad de poros, le sigue el Biodentine Septodont® y, por último, el Portland. Se comparó la cantidad de poros entre los tres cementos y no se encontraron diferencias significativas, con un p = 0,09. Conclusión: Los análisis realizados en los cementos endodónticos dieron como resultado que el cemento Portland tiene mayor diámetro de poro a diferencia de los otros dos, lo cual implica que tanto el Biodentine Septodont® como el MTA Angelus® tienen mejores propiedades de resistencia y permeabilidad para evitar la microfiltración, y por tanto son mejores para la solución de casos clínicos. (AU)

Objective: The purpose of this study was to compare the porosity characteristics of Portland cement, mineral trioxide aggregate (MTA) Angelus® and Biodentine Septodont® by scanning electron microscopy. Materials and Methods: Cements were prepared according to the manufacturer's instructions and packed in cylindrical polyethylene tubes with an internal diameter of 10 mm and a height of 5 mm. The porosity of the samples was analyzed using scanning electron microscopy. Statistical analyses were performed using the Kruskall Wallis test. The level of significance was established at 0.05. Results: The largest size mean diameter valus was found with Portland cement (11.07). There were significant differences between the mean pore diameters (p = 0.05). MTA Angelus® had the largest number of pores, followed by Biodentine Septodont®, and finally, Portland. There were no significant differences in the pores of the three cements (p = 0.09). Conclusion: The results of this comparative analysis of endodontic cements showed that Portland cement has a larger pore diameter than MTA Angelus® and Biodentine Septodont®, demonstrating that these latter two cements present better resistance and permeability properties, and thereby prevent microleakage. (AU)

Tooth discoloration using calcium silicate-based cements for simulated revascularization in vitro

Abstract The endodontic revascularization may be an alternative treatment for necrotic immature teeth, however, several treatment steps may cause tooth discoloration. This study evaluated the use of three calcium silicate-based cements with different radiopacifying agents on the color alteration (∆E) of extracted premolars after simulation of revascularization. Forty single rooted extracted premolars were shaped with #1-6 gates Glidden drills, rinsed with sodium hypochlorite, and filled with fresh human blood. Three calcium silicate-based cements with different radiopacifying agents (bismuth oxide - CSBi, calcium tungstate - CSW, and zirconium oxide - CSZr) were applied over the blood clot (n=10). The control group received the application of a temporary zinc oxide-based cement (TFZn) (n=10). ∆E was measured with a spectrophotometer, using the L*a*b* color system of the International Commission on Illumination (CIELab), in different times: prior to the preparation of the access cavity (t0); right after treatment (t1); and after one (t2), two (t3), three (t4) and four (t5) months. The tooth site for color evaluation was standardized by silicon matrix, the color reading was performed 3 times per tooth, and the teeth were stored in 37º water between evaluations. ∆E, whiteness (WID index) and yellowness (b*) were evaluated. Data were subjected to one-way ANOVA and repeated measures ANOVA, followed by Tukey's post hoc test (α=0.05). All groups were similar in ∆E1 (t0-t1). The ∆E was the lowest and constant in the control group. In all evaluation times, CSBi presented the highest ∆E (p<0.01). CSW and CSZr were similar in all evaluated times and presented intermediate ∆E values. WID index from CSBi and CSW presented more distancing from 'white' reference. CSBi presented the greatest decrease in yellowness (b* value). The cement containing bismuth oxide presented the highest color alteration values. All tested calcium silicate-based cements presented clinically perceptible discoloration. Calcium tungstate and zirconium oxide may be used as alternative radiopacifiers to decrease tooth discoloration after endodontic tooth revascularization.

Resumo A revascularização endodôntica pode ser um tratamento alternativo para dentes imaturos necrosados, porém, várias etapas do tratamento podem causar alteração de cor dental. Este estudo avaliou o uso de três cimentos a base de silicato de cálcio com diferentes agentes radiopacificadores na alteração de cor (∆E) de pré-molares extraídos após a simulação de revascularização. Quarenta pré-molares unirradiculares extraídos foram conformados com brocas gates glidden #1-6, irrigados com hipoclorito de sódio, e preenchidos com sangue humano fresco. Três cimentos a base de silicato de cálcio com diferentes agentes radiopacificadores (óxido de bismuto - CSBi, tungstato de cálcio - CSW, e óxido de zircônio - CSZr) foram aplicados sobre o coágulo sanguíneo (n=10). O grupo controle recebeu a aplicação de um cimento temporário a base de óxido de zinco (TFZn) (n=10). ∆E foi medida com um espectrofotômetro, utilizando o sistema de cor L*a*b* da International Commission on Illumination (CIELab), em tempos diferentes: previamente ao preparo da cavidade de acesso (t0); logo após o tratamento (t1); e após um (t2), dois (t3), três (t4) e quatro (t5) meses. O local do dente para a avaliação de cor foi padronizado por uma matriz de silicone, a leitura da cor foi realizada 3 vezes por dente, e os dentes foram armazenados em água a 37ºC entre as avaliações. ∆E, 'clareamento' (índice WID) e tom amarelado (b*) foram avaliados. Os dados foram submetidos ao teste de ANOVA um fator e teste ANOVA de medidas repetidas, seguidos pelo teste post hoc de Tukey (α=0,05). Todos os grupos foram semelhantes em ∆E1 (t0-t1). A ∆E foi menor e constante no grupo controle. Em todos os tempos de avaliação, CSBi apresentou os maiores valores de ∆E (p<0.01). CSW e CSZr foram semelhantes em todos os tempos avaliados e apresentaram valores intermediários de ∆E. O índice WID de CSBi e CSW se distanciaram mais da referência 'branco'. CSBi apresentou maior diminuição no tom amarelado (valor de b*) os outros grupos. O cimento contendo óxido de bismuto apresentou os maiores valores de alteração de cor. Todos os cimentos testados apresentaram alteração de cor clinicamente perceptível. O tungstato de cálcio e óxido de zircônio podem ser usados como radiopacificares alternativos para a diminuição da alteração de cor dental após o processo de revascularização endodontica.

Research on the color stability of Biodentine and MTA within the blood environment / 口腔疾病防治

Objective@#To compare the color stability of Biodentine and mineral trioxide aggregate (MTA) within the blood environment in vitro and to further investigate the underlying reasons for such color instability. @*Methods @#We first generated Biodentine and MTA discs with a diameter of 5 mm and a height of 3 mm. 24 discs of each material were randomly divided into two groups: the deionized water group and the defibrinated sheep blood group. Discs of each group were immersed for 1 day or 7 days before assessments. First, all discs were photographed to directly compare the discoloration of Biodentine and MTA. The color degree of the two materials was tested by a spectrophotometer. Then, the high-resolution morphological characteristics were observed by scanning electron microscopy. Finally, the chemical contents of each element in the material were measured by energy-dispersive spectroscopy.@*Results @#Compared to immediately after stripping, a change in the brightness of discs after immersion in defibrinated sheep blood for 1 day was observed only in MTA. On the 7th day after being immersed in blood, the colors of both the Biodentine and MTA discs darkened and turned deep red, but the darkness of the MTA discs increased significantly. The color change of MTA immersed in blood was measured on a spectrophotometer with a greater 7-day ∆E (21.257 ± 0.955) than the Biodentine 7-day ∆E (5.833 ± 0.501) (t=24.781, P < 0.001). MTA exhibits more discoloration as the immersion time goes on. A significant difference was noted between the 1-day ∆E(6.233 ± 0.888) and the 7-day ∆E(t=19.956, P < 0.001) of MTA immersed in blood. However, there was no statistically significant difference between the 1-day ∆E (6.790 ± 0.831) and the 7-day ∆E(t=1.707, P=0.163) of Biodentine immersed in blood. It was observed by scanning electron microscopy that after 7 days of immersion in the defibrinated sheep ablood, the surface porosity of MTA was larger than that of Biodentine, and the crystal edge of MTA became rounded and blunt. The analysis by energy-dispersive X-ray spectroscopy showed that the oxygen content decreased and the bismuth content increased in MTA after immersion in defibrinated sheep blood for 7 days. Zirconium was not detected in Biodentine due to its low radiodensity, but the contents of other elements were stable in Biodentine after immersion in defibrinated sheep blood for 7 days. @* Conclusion@#The color stability of Biodentine within the blood environment is better than that of MTA in vitro, which is mainly related to the low surface porosity and stable composition of the anti-radiation agent of Biodentine.

Pulpotomía con biodentine comparado con formocresol en pacientes con dentición primaria / Biodentine versus formocresol for pulpotomy in primary teeth

RESUMEN: Introducción: En dentición primaria, la pulpotomía con formocresol ha sido convencionalmente utilizada para el tratamiento de caries cercanas a la pulpa. Sin embargo, la seguridad de este material ha sido cuestionada. Por otro lado, el biodentine ha sido propuesto como un biomaterial sustituto bioactivo de la dentina, pero no está clara su efectividad. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y una tabla GRADE para el resumen de los resultados. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos correspondientes a ensayos aleatorizados. Concluimos que no se puede establecer con claridad si biodentine comparado con formocresol aumenta el éxito clínico y el éxito radiográfico en pulpotomía en pacientes con dentición primaria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Pulpotomy with formocresol is the main treatment protocol following carious pulp exposure in primary teeth, but many concerns have been raised regarding its safety. Biodentine has been proposed as a bioactive dentine substitute, but there is still uncertainty regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which both were randomized trials. We are uncertain whether biodentine compared to formocresol for pulpotomy improves clinical and radiographic success, as the certainty of the evidence has been assessed as very low.