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.

Chemical analysis of mineral trioxide agregate mixed with hyaluronic acids as an accelerant

Abstract Mineral trioxide aggregate (MTA) has many clinical applications in dentistry; the main drawback is the long setting. The main objective is to investigate and compare the chemical effect of using two commercially available hyaluronic acid hydrogels (HA) instead of distilled water for mixing MTA as an accelerant of setting time. Materials and method: Test materials were divided into three groups; Group 1: (control) mixing MTA with distilled water supplied by the manufacturer; Group 2: mixing MTA with a hybrid cooperative complex of high and low molecular weight HA (Profhilo®); Group 3: mixing MTA with High molecular weight / non-cross-linked HA (Jalupro®). Mixing time, and setting time (initial and final) were determined, Fourier-transform infrared spectroscopy, Energy-dispersive X-ray spectroscopy, Field emission Scanning Electron Microscopy, and X-ray diffraction were performed. Results: mixing time, initial, and final setting time for (MTA + HA) groups were significantly different and lower in comparison to the control group (p < 0.05). This study revealed higher expression of calcium silicate hydrate and calcium hydroxide expression with higher Ca release in the MTA + HA group than the control group. Conclusion: commercially available HA demonstrated better chemical properties when used as a mixing medium for MTA. The Mixing and setting time for MTA + HA group were significantly shorter than those of the control group were. Thus, commercially available HA can be used as a mixing medium for MTA.

Resumo O agregado de trióxido mineral (MTA) tem muitas aplicações clínicas em odontologia, mas a principal desvantagem é a longa presa. O objetivo principal é investigar e comparar o efeito químico do uso de dois hidrogéis de ácido hialurônico (HA) disponíveis comercialmente em vez de água destilada para misturar o MTA como um acelerador do tempo de presa. Materiais e método: Os materiais de teste foram divididos em três grupos: Grupo 1: (controle) misturando o MTA com água destilada fornecida pelo fabricante; Grupo 2: misturando o MTA com um complexo cooperativo híbrido de HA de alto e baixo peso molecular (Profhilo®); Grupo 3: misturando o MTA com HA de alto peso molecular/não reticulado (Jalupro®). Foram determinados o tempo de mistura e o tempo de presa (inicial e final), a espectroscopia de infravermelho com transformada de Fourier, a espectroscopia de raios X com dispersão de energia, a microscopia eletrônica de varredura com emissão de campo e a difração de raios X. Resultados: o tempo de mistura, o tempo de presa inicial e final dos grupos (MTA + HA) foram significativamente diferentes e menores em comparação com o grupo de controle (p < 0,05). Esse estudo revelou maior expressão de silicato de cálcio hidratado e expressão de hidróxido de cálcio com maior liberação de Ca no grupo MTA + HA do que no grupo de controle. Conclusão: a HA disponível comercialmente demonstrou melhores propriedades químicas quando usada como meio de mistura para o MTA. O tempo de mistura e de presa do grupo MTA + HA foi significativamente menor do que o do grupo de controle. Portanto, a HA disponível comercialmente pode ser usada como meio de mistura para o MTA.

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.

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.

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.

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)

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)

Microdureza de dos materiales endodónticos a base de silicato de calcio. Un ensayo ex vivo / Surface microhardness of two calcium silicate-based endodontic materials. An ex vivo assay

esumen Objetivo: Comparar la microdureza de dos materiales endodónticos a base de silicato de calcio: MTA Densell Endo Sealer y TotalFill BC Sealer. Materiales y métodos: Se evaluó la microdureza de los selladores MTA Densell Endo Sealer (Grupo 1, n=5) y To- talFill BC Sealer (Grupo 2, n=5) contenidos en cilindros de dentina de vacuno a los 14 días posteriores a su fraguado. La medición se realizó a temperatura ambiente mediante la prue- ba de indentación Vickers. Se realizaron cinco indentaciones por probeta con una carga de 100 g durante 10 s cada una. Las mediciones se convirtieron a valores de dureza Vickers (HV) y los promedios de los valores HV de cada grupo se compararon por medio de la prueba t de Student con un nivel de significación de P <0,05. Resultados: A los 14 días, luego del fraguado, la mi- crodureza de MTA Densell Endo Sealer fue significativamen- te mayor (P=0,001) que la de TotalFill BC Sealer. Conclusiones: Los resultados sugieren que a causa de su dureza la remoción de MTA Densell Endo Sealer puede resultar dificultosa cuando está indicado un retratamiento (AU)

Aim: To compare the microhardness of two silicate-based endodontic materials: MTA Densell Endo Sealer and Total Fill BC Sealer. Materials and methods: Samples of MTA Densell Endo Sealer (Group 1, n=5) and Total Fill BC Sealer (Group 2, n=5) contained into cow dentine cylinders were subjected to the Vickers Microhardness Indentation test at room temper- ature and 14 days after setting. Five indentations per sample were performed under a load of 100 g for 10 s. The indenta- tion measurements were converted into hardness values (HV). Mean HV values of each group were compared using the Stu- dent t test at a significance level of P <0,05. Results: 14 days after setting, the microhardness of MTA Densell Endo Sealer was significantly greater (P=0,001) than that of Total Fill BC Sealer. Conclusions: The results of this study suggest that due to its hardness the removal of MTA Densell Endo Sealer could be difficult to perform when a root canal retreatment is indicated (AU)

Endodoncia y ortodoncia. Parte 2: casos clínicos / Endodontics and orthodontics. Part 2: clinical cases

Objetivo: Describir el tratamiento endodóncico de cuatro casos clínicos de reabsorción radicular desarrollada durante o tras un tratamiento ortodóncico. Casos clínicos: Después de la preparación y la desinfección de los conductos radiculares, estos fueron obturados por un tiempo prudencial con una medicación intraconducto de hidróxido de calcio, que luego fue reemplazada por MTA. Luego de un período de entre uno y cuatro años, según el caso, los tratamientos fueron evaluados clínica y radiográficamente. Los dientes que debieron ser extraídos fueron analizados histológicamente. Según la evolución clínica y radiográfica de los casos presentados, el uso inicial de hidróxido de calcio y su posterior reemplazo por MTA parecería ser un protocolo adecuado para completar el proceso de reparación de los tejidos apicales y perirradiculares en casos de reabsorciones radiculares provocadas por fuerzas ortodóncicas excesivas. Las enfermedades sistémicas deben ser tenidas en cuenta para la elección de la terapéutica (AU)

Aim: To describe the endodontic treatment of four clinical cases of permanent teeth suffering root resorption during or after orthodontic treatment. Clinical cases: Four clinical cases of permanent teeth with root resorption were endodontically treated. After the root canals were prepared and disinfected, they were medicated with calcium hydroxide. After an appropriate observation period, the canals were finally filled with MTA. The treatment outcomes were clinically and radiographically assessed at an interval between one to four years according to the clinical case. The histological findings of teeth that required extraction was also described. Our clinical and radiographic observations suggest that a temporary filling with calcium hydroxide and further obturation with MTA can provide a favorable intracanal environment for apical and periradicular tissue reparation. The clinician needs a full medical history to be aware of the systemic diseases in patients with root resorption that will be of importance for the proper selection of treatment (AU)

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 de la actividad antimicrobiana del MTA fillapex® frente al enterococcus faecalis / Evaluation of the Antimicrobial Activity of MTA Fillapex® Against Enterococcus Faecalis

RESUMEN Introducción: El objetivo final de la terapia endodóntica es la eliminación de microorganismos en el interior del conducto radicular. Algunas bacterias pueden sobrevivir a esta terapia; entre las comúnmente detectadas en fallas endodónticas se encuentra el E. faecalis. Los cementos biocerámicos se presentan como una alternativa eiciente en la terapia de endodoncia debido a su capacidad de sellado y sus propiedades antimicrobianas. Métodos: Estudio experimental in vitro, en el que se sembró la bacteria (E. faecalis) en una caja de Petri, se tomaron de 5 a 10 cepas y se disolvieron en caldo de Mueller Hinton, para luego depositar el inóculo más el cemento en diferentes concentraciones en una placa de 96 pozos y medir el nivel de absorbancia de cada muestra en un espectrofotómetro. Para el análisis estadístico se utilizaron las pruebas no paramétricas de Mann-Whitney y Kruskal Wallis. Resultados: Al comparar de dos en dos los datos obtenidos no se obtuvieron datos estadísticamente signiicativos, pero al comparar las diferentes concentraciones de ambos cementos se obtuvo que el cemento de Grossman al 2 % tiene mayor efecto antimicrobiano. Conclusión: No hay diferencia significativa en la actividad antimicrobiana del MTA Fillapex® y el cemento de Grossman contra el E. faecalis, pero al comparar el cemento de Grossman al 2 %, este tiene mayor efecto antimicrobiano en comparación con el mismo cemento a diversas concentraciones.

ABSTRACT Introduction: the ultimate aim of the root canal therapy is elimination or reduction of microorganisms in the root canal system. Although some bacteria can survive this therapy, among bacteria commonly detected in endodontic failure is E. faecalis. The bioceramic sealers are presented as an efficient alternative due its sealing capacity and antimicrobial properties. Methods: the research was experimental in vitro, where the bacteria (E. faecalis) was planted in a box perti, were taken from 5 to 10 strains and dissolved in broth Mueller Hinton then deposit inoculum more sealer at different concentrations in a 96 well plate and measuring the level of absorbance of each sample in a spectrophotometer. For statistical analysis, non-parametric Mann-Whitney and Kruskal Wallis were used. Results: when comparing two at the data no statistically significant data were obtained, but when comparing different concentrations of both sealers was obtained Grossman sealers 2% has greater antimicrobial effect. Conclusion: There is not significant difference in the antimicrobial activity of MTA Fillapex and Grossman cement against E. faecalis, but when comparing Grossman cement to 2%, this has a higher antimicrobial effect compared to the same cement at various concentrations.

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.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Pulpotomía parcial con agregado de trióxido mineral (MTA) comparado con hidróxido de calcio en caries dentinaria profunda en pacientes con dientes permanentes inmaduros / Partial pulpotomy with mineral trioxide aggregate (MTA) versus calcium hydroxide in immature permanent teeth with deep caries

RESUMEN: Introducción: La pulpotomía parcial se utiliza para el tratamiento de caries con exposición pulpar en dientes permanentes inmaduros. El agregado de trióxido mineral (MTA) ha sido propuesto como uno de los biomateriales de elección para el tratamiento, pero existe incertidumbre en relación a su efectividad comparado con la del hidróxido de calcio. 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 preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Encontramos cinco revisiones sistemáticas, que incluyeron tres estudios primarios, de los cuales todos corresponden a ensayos aleatorizados. Concluimos que la pulpotomía parcial con agregado de trióxido mineral (MTA) podría resultar en poca o nula diferencia en la tasa de éxito comparado a la pulpotomía parcial con hidróxido de calcio, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Partial pulpotomy is the treatment of choice following carious pulp exposure in immature permanent teeth. Mineral trioxide aggregate (MTA) has been suggested as the biomaterial first option for treatment, but there is still uncertainty regarding its effectiveness compared to calcium hydroxide. 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 five systematic reviews including three studies overall, of which all were randomized trials. We conclude that partial pulpotomy with mineral trioxide aggregate (MTA) may make little or no difference to success rate compared to partial pulpotomy with calcium hydroxide, however, the certainty of the evidence has been assessed as low.

Antibacterial Efficacy of Nanoparticle-Incorporated Root Canal Sealer against Common Endodontic Pathogens - An in vitro Study

Infection caused by microorganisms play a crucial role in the induction of inflammation of pulpal as well as the periapical tissues. Factors like improper disinfection or obturation of the root canal space contributes to the failure of the root canal treatment. The aim of the study was to modify the contents of MTA-based sealer with nanoparticles and check for its antibacterial efficacy against E. faecalis. Silver nanoparticles (10 nm) were incorporated in MTA based sealer at various concentrations to form the test product. The antibacterial efficacy of the modified sealer was tested by well diffusion test on E. faecalis. The zone of inhibition (mm) was checked for each test product. Analysis of the results showed significant diameters of zones of inhibition (mm) as compared to sealer without nanoparticles. The zone of inhibition increased with the increase in the concentration of silver nanoparticles. The silver nanoparticle incorporated sealer can be used in the clinical setup to prevent reinfection of the root canal system and ensure the success of the root canal treatment.

A Comparative Evaluation between Propolis and Mineral Trioxide Aggregate as Pulpotomy Medicaments in Primary Molars.

Pulpotomy is defined as the complete removal of coronal portion of dental pulp followed by placement of a suitable dressing or medicament that will promote healing and preserve the vitality of the tooth.1 This treatment helps to maintain the primary tooth in the arch and to fulfil its function in primary and mixed dentition period.2 Since its introduction by Sweet (1932), Formocresol (FC) has been a popular pulpotomy medicament in the primary dentition for the past 80 years.3 However, it has many disadvantages like cytotoxicity, pulpal inflammation and necrosis, systemic disturbances, mutagenic and carcinogenic potential and immunologic responses.4METHODS40 carious primary molars selected from 32 children aged between 4-9 years were included in the study. The selected teeth were randomly divided into 2 groups. Group A: 20 primary molars to be pulpotomised with MTA. Group B: 20 primary molars were treated with 15% Propolis tincture. The children were recalled at 3, 6- and 12-months interval for clinical and radiographical evaluation.RESULTSThere was also absence of periapical radiolucency in propolis group at 3 months whereas in the MTA group periapical radiolucency was present in 1 (5.6%) tooth at 3 months. There was absence of sinus/ fistula in MTA group, while one (5.9%) tooth developed sinus/ fistula in propolis group at 6 months. There was also absence of sinus/ fistula in MTA group, while two (11.1%) teeth developed sinus/ fistula in propolis group at 12 months. At 12 months success rate was higher in MTA group (6 months- 100% and 12 months – 94.4%) as compared to Propolis (6 months- 88.2% and 12 months – 88.9%).CONCLUSIONSClinical outcome of Propolis is comparable to that of MTA at both 6 and 12 months follow up period. Hence, Propolis seems to be a promising and a reliable medicament for pulpotomy.

Agreements in clinical studies at German university clinics

The article aims to give an overview of the contractual situation in Germany, which arise in clinical studies. The goal of the authors is to show any potential sponsor of a clinical study, who is interested in cooperation with German partners such as universities or other study sites, what kind of agreements may be expected and to give a brief overview about necessary themes included within the contractual negotiations. The different contractual settings are considered from the perspective each different type of agreement. The authors have chosen amongst all possible types the ones which are the most common in a clinical study, such as CDA, MTA, grant agreement, clinical study agreement, CRO-service agreement etc. The authors show the complexity of the contractual setting of a clinical study and emphasize to pay close attention to the contractual settings. Even though the content of the agreement is mostly universal in nature, in some cases, Germany has some very special rules (e.g. regarding employees’ inventions), which any potential sponsor should keep in mind.