Biodentine: um substituto ao MTA? / Biodentine: an alternative to MTA?

Objetivo: o objetivo desse estudo é realizar uma revisão de literatura em relação às propriedades físico- -químicas e biológicas do Biodentine, seu emprego na Endodontia e discutir, com base nas evidências científicas encontradas na literatura, se esse material poderá ser um substituto ao MTA. Métodos: foi realizada uma busca na literatura na base de dados PubMed, usando os termos em inglês: Biodentine, calcium silicate, MTA, properties, setting time, radiopacity, solubility, physicochemical properties, porosity, hydration, biocompatibility, bioactivity, microhardness, compressive strength, bond strength, irrigants, furcal perforation, retrograde filling material, revitalization, revascularization, endodontics, apexification. Cinquenta artigos foram incluídos. Resultados: os artigos revisados sugerem que o Biodentine tem características favoráveis e que tem alcançado resultados promissores em relação ao MTA. Conclusão: o Biodentine pode ser considerado um eventual substituto ao MTA (AU).

Introduction: This study aim to review the literature about the physicochemical and biological characteristics of Biodentine, a cement used in endodontics, and discussed whether this material might be an alternative to MTA according to the scientific evidence found in the literature. Methods: A literature search was performed on PubMed using the following terms: Biodentine, calcium silicate, MTA, properties, setting time, radiopacity, solubility, physicochemical properties, porosity, hydration, biocompatibility, bioactivity, microhardness, compressive strength, bond strength, irrigants, furcal perforation, retrograde filling, revitalization, revascularization, endodontics, apexification. Fifty studies met inclusion criteria. Results: Biodentine seems to have favorable characteristics, and the results of its use are promising when compared with those of MTA. Conclusion: Biodentine may be a possible alternative to MTA (AU).

Estudo de novos dispositivos, instrumentos e materiais empregados no tratamento endodôntico / Evaluation of new devices, instruments and materials used in endodontic treatment

Introdução: O tratamento endodôntico visa manter ou restabelecer a saúde do periodonto através do preparo biomecânico, utilizando instrumentos de níqueltitânio automatizados e associados com insertos ultrassônicos para potencializar a ação dos irrigantes. Os materiais empregados na endodontia que permanecerão em contato com tecidos devem apresentar biocompatibilidade e preferencialmente ser biomineralizador, a fim de selar comunicações (fisiológicas/iatrogênicas), isolando o sistema de canais radiculares. Objetivos: 1- Avaliar a resistência à fadiga cíclica das limas reciprocantes Genius e EdgeFile X1 Small, comparados à lima WaveOne Gold Primary; 2- Avaliar a capacidade de limpeza de um inserto ultrassônico de níquel titânio em ativação da irrigação de forma contínua e passiva; 3- Avaliar a biocompatiblidade e biomineralização do cimento reparador MTA Flow. Material e Métodos: Para avaliar a resistência à fadiga cíclica dos sistemas Genius, EdgeFile e WaveOne Gold, 80 instrumentos foram utilizados (n=20), divididos em 4 grupos experimentais: Genius 25.04, Genius 30.04; EdgeFile X1 Small e Wave One Gold Primary, acionados em um canal artificial de aço inoxidável com ângulo de curvatura de 60o e raio de curvatura de 5 mm. O tempo decorrido da ativação do motor foi gravado em um cronômetro digital e parado assim que a fratura foi detectada. O número de ciclos até a falha (NCF) e o tempo para fratura (TF) foram calculados e os comprimentos dos segmentos fraturados medidos. Para avaliar a capacidade de limpeza do inserto ultrassônico, 45 prémolares inferiores, padronizados em 16 mm foram utilizados. A instrumentação foi realizada até lima 50.04 sob irrigação com hipoclorito de sódio e foram divididos em 3 grupos (n = 15) de acordo com a técnica de ativação final da solução irrigadora: irrigação convencional (IC) (passiva com pressão positiva/sucção concomitante) como controle; ativação ultrassônica passiva (PUI) e ativação ultrassônica contínua (CUI) do irrigante. Os três grupos tiveram os protocolos de ativação/irrigação final em soluções de hipoclorito de sódio e EDTA. As amostras foram clivadas, as imagens obtidas com microscopia eletrônica de varredura (MEV) e avaliadas quanto à capacidade de remoção da camada de smear layer no terço cervical, médio e apical, por um sistema de escores. Para análise biológica do material reparador MTA Flow, os materiais MTA Angelus e ProRoot MTA foram utilizados para comparação. Quarenta ratos receberam implantes subcutâneo de tubos de polietileno contendo os 3 materiais e tubo vazio como controle (n=10). Após 7, 15, 30 e 60 dias, os animais foram eutanasiados e os tubos removidos com o tecido conjuntivo circundantes. Infiltrado inflamatório e espessura da cápsula fibrosa foram avaliados histologicamente e indução da mineralização analisada por Von Kossa e sob luz polarizada. Os dados foram analisados com testes estatísticos específicos (p<5%). Resultados: Quanto à fadiga cíclica, os instrumentos EdgeFile X1 Small apresentaram maior resistência (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), seguido por ambos instrumentos Genius (p<0.05), de forma significativa comparados ao Waveone Gold Primary. O inserto de NiTi aumentou a limpeza, comparado com IC, principalmente no terço apical e CUI mostrou os melhores resultados (p<0.05). Nos resultados biológicos, MTA Angelus induziu a reação mais leve após 15 dias (p<0.05), seguido do MTA Flow. ProRoot MTA induziu uma inflamação severa no dia 7, reduzindo após 15 dias. Nenhuma diferença foi observada entre os materiais após 30 ou 60 dias (p>0.05). Estruturas coradas por Von Kossa e birrefringentes foram positivas para todos os materiais. Conclusões: 1- Os instrumentos EdgeFile X1 Small demonstraram maior resistência à fadiga cíclica que Genius e WaveOne Gold Primary. Ambos instrumentos Genius apresentaram resistência superior à WaveOne Gold Primary. 2- A ativação final do irrigante com o inserto NiTi melhorou a remoção de smear layer, com protocolo CUI superior à PUI ou IC. 3- O MTA Flow mostrou biocompatibilidade e induziu a biomineralização em todos os períodos observados(AU)

Introduction: The endodontic treatment aims to maintain or restore periodontal health through biomechanical instrumentation with nickel-titanium automatized instruments, associated with an ultrasonic tip to activate the irrigant, enhancing cleanness. Materials used in endodontics that will remain in contact with tissues, should demonstrate properties as biocompatibility and biomineralization ability, in order to seal communications (physiological/iatrogenic) isolating the root canal system. Objectives: 1- Evaluate the cyclic fatigue resistance of reciprocating Genius and EdgeFile X1 Small instruments compared to Waveone Gold Primary instruments; 2- Evaluate the cleaning effectiveness of a nickel-titanium ultrasonic tip in continuous and passive irrigant activation; 3-Evaluate the biocompatibility and biomineralization of MTA Flow repair cement. Materials and Methods: To evaluate the cyclic fatigue resistance of Genius, EdgeFile and WaveOne Gold, 80 instruments were used (n = 20), divided into 4 experimental groups: Genius 25.04, Genius 30.04; EdgeFile X1 Small and Wave One Gold Primary, reciprocating in a stainless steel artificial canal with a 60° angle of curvature and 5mm radius of curvature. The elapsed time of the motor activation was recorded in a digital timer and stopped as soon as the fracture was detected. The number of cycles to fracture (NCF) and time to fracture (TF) were calculated and the fractured segments lengths measured. To evaluate the ultrasonic tip cleanness capacity, forty-five mandibular premolars, standardized at 16 mm were used. The instrumentation was performed until file 50.04 under irrigation with sodium hypochlorite. The specimens were divided into 3 groups (n = 15) according to the final irrigant activation protocol: conventional irrigation (CI) (passive, with positive pressure/simultaneous aspiration) as control; passive ultrasonic irrigant activation (PUI) and continuous ultrasonic irrigant activation (CUI). All groups had the final activation / irrigation protocols with solutions of sodium hypochlorite and EDTA, standardized with same volume. Samples were sodium hypochlorite and EDTA, standardized with same volume. Samples were cleaved and images obtained through scanning electron microscopy (SEM) to assess smear layer removal in the cervical, middle and apical thirds, via a score system. To biologically analyze MTA Flow repair cement, MTA Angelus and ProRoot MTA cements were used as comparison. Forty rats received subcutaneous implants of polyethylene tubes containing the 3 cements and empty tube as control (n = 10). After days 7, 15, 30 and 60, the animals were euthanized and the tubes removed with the surrounding tissues. Inflammatory infiltrate and fibrous capsule thickness were histologically evaluated and mineralization induction assessed by Von Kossa staining and under polarized light. The data were analyzed with specific statistical tests (p<5%). Results: The cyclic fatigue test showed EdgeFile X1 Small with the highest resistance (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), followed by both Genius instruments (p<0.05). The nickel-titanium tip enhanced cleanness, compared to CI, mainly in the apical area, whereas CUI showed the best results (p<0.05). In the biological results, MTA Angelus induced the mildest reaction after 7 (p>0.05) and 15 days (p<0.05), followed by MTA Flow. ProRoot MTA induced severe inflammation on day 7, reducing after day 15 (p>0.05). No difference was observed after 30 or 60 days (p>0.05). Von Kossa staining and birefringents structures were positive for all materials. Conclusion: 1- EdgeFile X1 Small instruments demonstrated superior cyclic fatigue resistance than Genius and WaveOne Gold Primary. In addition, both Genius instruments showed superior resistance than WaveOne Gold Primary. 2- The final irrigant activation with the NiTi tip improved smear layer removal, with CUI protocol superior to PUI or CI. 3 - MTA Flow showed biocompatibility and induced biomineralization in all observed periods(AU)

Effects of dodecacalcium hepta-aluminate content on the setting time, compressive strength, alkalinity, and cytocompatibility of tricalcium silicate cement

Abstract Objective This study aimed to investigate the effects of dodecacalcium hepta-aluminate (C12A7) content on some physicochemical properties and cytocompatibility of tricalcium silicate (C3S) cement using human dental pulp cells (hDPCs). Material and Methods High purity C3S cement was manufactured by a solid phase method. C12A7 was mixed with the cement in proportions of 0, 5, 8, and 10 wt% (C12A7-0, −5, −8, and −10, respectively). Physicochemical properties including initial setting time, compressive strength, and alkalinity were evaluated. Cytocompatibility was assessed with cell viability tests and cell number counts. Statistical analysis was performed by using one-way analysis of variance (ANOVA) and Tukey's test (p<0.05). Results The initial setting time of C3S-based cement was shorter in the presence of C12A7 (p<0.05). After 1 day, C12A7-5 showed significantly higher compressive strength than the other groups (p<0.05). After 7 days, the compressive strength of C12A7-5 was similar to that of C12A7-0, whereas other groups showed strength lower than C12A7-0. The pH values of all tested groups showed no significant differences after 1 day (p>0.05). The C12A7-5 group showed similar cell viability to the C12A7-0 group (p>0.05), while the other experimental groups showed lower values compared to C12A7-0 group (p<0.05). The number of cells grown on the C12A7-5 specimen was higher than that on C12A7-8 and −10 (p<0.05). Conclusions The addition of C12A7 to C3S cement at a proportion of 5% resulted in rapid initial setting time and higher compressive strength with no adverse effects on cytocompatibility.

Biocompatibility of a new titanium alloy containing copper / 中国组织工程研究

BACKGROUND:Copper-titanium aloy has been fabricated in previous studies to improve the antibacterial property and biocompatibility of titanium materials. OBJECTIVE:With reference to the principle and experimental method specified by GB/T16886-ISO10993, to fuly and systematicaly assess the biocompatibility of copper-titanium aloy. METHODS:Based on the pre-experimental results, titanium aloy containing 10% copper was selected and subjected to oral mucosa stimulation experiment, skin stimulation test, acute systemic toxicity test, hemolytic test, prothrombin time test and dynamic coagulation test for biocompatibility evaluation. RESULTS AND CONCLUSION:The copper-titanium aloy has no oral mucous membrane irritation, no short-term systemic toxicity, no skin sensitization, and no hemolysis, indicating it has a good biocompatibility.

Effect of MTA-based sealer on the healing of periapical lesions

Some manufacturers have recently added specific components to improve the ease of handling and insertion material properties of MTA in order to create MTA-based sealers. Objective The aim of this study was to evaluate the healing of periapical lesions in canine teeth after a single session of endodontic treatment with MTA Fillapex® compared with Sealapex® or Endo-CPM-Sealer®. Material and Methods Sixty-two root canals were performed on two 1-year-old male dogs. After coronal access and pulp extirpation, the canals were exposed to the oral cavity for 6 months in order to induce periapical lesions. The root canals were prepared, irrigated with a solution of 2.5% sodium hypochlorite and filled with gutta-percha and different sealers, according to the following groups: 1) Sealapex®; 2) Endo-CPM-Sealer®; and 3) MTA Fillapex®. Some teeth with periapical lesions were left untreated for use as positive controls. Healthy teeth were used as negative controls. After 6 months, the animals were sacrificed and serial sections from the roots were prepared for histomorphologic analysis and stained with hematoxylin and eosin and the Brown and Brenn technique. The lesions were scored according to pre-established histomorphologic parameters and the scores statistically analyzed using the Kruskal-Wallis test. Results All 3 materials produced similar patterns of healing (p>0.05); in particular, persistent inflammation and absence of complete periapical tissue healing were consistently noted. Conclusions Preparation of the infected root canals followed by filling with the materials studied was insufficient to provide complete healing of the periapical tissues. .

Effect of surface area and air-drying distance on shear bond strength of etch-and-rinse adhesive

We evaluated the effects of air-drying distance and bond surface area on the shear bond strength of a 2-step etch-and-rinse adhesive. A total of 120 bovine anterior teeth were equally divided into 6 main groups based on bonding surface area. The main groups were divided into sub-groups (n = 5) according to air-drying distance. The shear strength was determined using a universal testing machine at a crosshead speed of 0.5 mm/min. The averaged results were subjected to two-way ANOVA and Tukey's test (α = 0.05). Two-way ANOVA testing identified no significant cross-product interactions (p > 0.05), but the main factors of area (p < 0.0001) and air-drying distance (p < 0.00001) significantly affected the mean bond strength. Shorter air-drying distances improved bond strength, and increased surface area decreased the bond strength.

Reação histológica ao cimento endodôntico à base de MTA (Fillapex®) em subcutâneo de ratos / Histological reaction to the endodontic MTA-based sealer (Fillapex®) in rat subcutaneous

O agregado de trióxido mineral (MTA) tem sido amplamente utilizado em Endodontia, devido à sua boa adaptação marginal e biocompatibilidade. Na tentativa de associar propriedades físico-químicas de um cimento obturador de canal radicular a biocompatibilidade do MTA, algumas modificações foram feitas no MTA para possibilitar seu uso como um cimento obturador de canal radicular. Assim, a reação de promovida por um cimento a base de MTA (MTA Fillapex) em subcutâneo de ratos foi investigada por análise morfológica e morfométrica. Oitenta ratos foram distribuídos em 4 grupos (n=20); em cada animal, um tubos de polietileno preenchido com MTA Fillapex, MTA, AH Plus ou Fill Canal foi implantado no subcutânea dorsal. Após 7, 15, 30 e 60 dias, os tubos rodeados por tecido conjuntivo foram removidos, fixados em formaldeído 4% e incluídos em parafina. Nos cortes corados com HE, foi avaliada a densidade numérica de células inflamatórias na cápsula e análises estatísticas realizadas usando ANOVA e do Student-Newman-Keuls (p≤0.05). Alguns cortes foram submetidos a imuno-histoquímica para marcação de macrófagos; o método de von Kossa foi usado para detecção de estruturas calcificadas. Nossos resultados revelaram que, nos períodos de 7 para 15 dias, o número de células inflamatórias foi significantemente mais elevado na cápsula do MTA Fillapex em comparação com outros materiais. No entanto, uma redução significante na densidade numérica de células inflamatórias foi verificada na cápsula do MTA Fillapex aos 30 e 60 dias quando comparado com os períodos iniciais. Aos 30 dias, macrófagos imunopositivos foram observados principalmente na superfície da cápsula em íntima justaposição ao MTA Fillapex, MTA e AH Plus. No entanto, o intenso processo inflamatório crônico adjacente ao Fill Canal exibiu numerosas células imunopositivas por toda extensão da cápsula. No período de 60 dias, a reação inflamatória promovida pelo MTA Fillapex foi semelhante do MTA e significantemente menor ao Fill Canal de preenchimento. Em contrapartida, observou-se um aumento gradual e significante de células inflamatórias na cápsula adjacente ao Fill Canal. Estruturas von Kossa-positivas foram observadas na cápsula adjacente para o MTA Fillapex, o MTA e AH Plus; estruturas positivas não foram encontradas na cápsula ao redor do Fill Canal. Os nossos resultados indicam que MTA Fillapex apresente, no período de 60 dias, biocompatibilidade semelhante ao MTA

Mineral Trioxide Aggregate (MTA) has been widely used in Endodontics due to its good marginal adaptation and biocompatibility. In attempt to associate physicochemical properties of a root canal sealer with biocompatibility of the MTA, some modifications have been made in the MTA to provide its use as a root canal sealer. Thus, the tissue reaction promoted by a MTA-based sealer (MTA-Fillapex) in rat subcutaneous was investigated by morphological and morphometric analyses. Eighty male rats were distributed into 4 groups (n=20); in each animal, one polyethylene tubes filled with MTA-Fillapex, MTA, AH-Plus or Fill Canal was implanted in the dorsal subcutaneous. After 7, 15, 30 and 60 days, the tubes surrounded by connective tissue were removed, fixed in 4% formaldehyde and embedded in paraffin. In the HE-stained sections, the numerical density of inflammatory cells in the capsule was evaluated and statistical analyses performed using ANOVA and Student-Newman-Keuls test (p≤0.05). Sections were submitted to immunohistochemistry for the detection of macrophage; von Kossa method was used for detection of calcified structures. Our results revealed that, in the periods of 7 and 15 days, the number of inflammatory cells was significantly higher in the capsule of the MTA-Fillapex in comparison to other materials. However, significant reduction in the density numerical of inflammatory cells was verified in the capsule of the MTA-Fillapex in the 30 and 60 days when compared to the initial periods. At 30 days, immunolabelling for macrophages was mainly detected in the surface of capsule in close juxtaposition to the MTA Fillapex, MTA and AH Plus. However, the intense chronic inflammatory process adjacent to the Fill Canal exhibited numerous immunolabelled cells. At 60 days, the inflammatory reaction promoted by MTA Fillapex was similar to the MTA and significantly lower than Fill Canal. Otherwise, a gradual and significant increase was observed in the number of inflammatory cells in the capsule adjacent to the Fill Canal. Structures von Kossapositive were observed in the capsule adjacent to the MTA-Fillapex, MTA and AHPlus; positive structures were not seen in the capsule surrounding the Fill Canal. In the period of 60 days, our results indicate that MTA-Fillapex, exhibits biocompatibility similar to MTA

Endoprótese revestida de jugular preservada de bovino: estudo comparativo da resposta tecidual em aorta torácica descendente e veia cava inferior de suínos / Bovine preserved jugular covered stent-graft: comparative study of tissue response at swine thoracic descendent aorta and inferior vena cava

OBJETIVO: Avaliar e comparar a resposta tecidual de uma endoprótese biosintetica implantada na aorta torácica descendente e veia cava inferior de suínos. MÉTODO: Foi implantada uma endoprótese auto-expansível composta de aço inoxidável, revestida por veia jugular de bovino, processada pelo método L-hydro, com auxilio de uma bainha de liberação Taheri-Leonhardt (Flórida, EUA) na aorta torácica descendente, e a veia cava infra-renal de 10 suínos. Sessenta dias após, as endopróteses foram retiradas e analisadas sob o ponto de vista macro e microscópicos. Foram observados: perviedade, grau de incorporação a parede do vaso, tipo de reação inflamatória, e local de maior resposta, tanto em relação a camada do vaso quanto ao local de contato com o anel de aço RESULTADOS: Todas as endopróteses encontravam-se pérvias, e incorporadas à parede. No setor venoso, seis apresentaram traves fibrosas em sua luz, e quatro apresentaram fibrose perivascular. No setor arterial somente uma prótese apresentou discreta estenose, sem fibrose perivascular. A reação inflamatória crônica tipo corpo estranho ocorreu em 100 por cento das peças, a camada média foi a mais acometida no setor venoso, enquanto a íntima foi mais constante na artéria, o grau de incorporação foi mais firme na veia em comparação a artéria. A reação tecidual mostrou maior tendência nas áreas em intimo contato com o anel de aço (intra-anelar), mais intensa na artéria do que na veia. CONCLUSÃO: A prótese apresentou baixa trombogenicidade em ambos os sistemas, houve maior reação tecidual e baixa biocompatibilidade no setor venoso.

BACKGROUND: To evaluate and compare the tissue response, in swine, to a biosynthetic stent-graft when implanted in both thoracic aorta and inferior vena cava. METHOD: It was used a self-expanding stainless stent, covered by segment of bovine jugular veins, processed by the method L-hydro, and delivered by Taheri-Leonhardt system (Florida, USA) . The implants were done in the descending thoracic aorta, and in the infra-renal vena cava of 10 swines. Sixty days after, the endoprosthesis were removed and analyzed under macro and microscopic view. The following parameters were analyzed: patency, incorporation to the vessel wall, type of inflammatory reaction, tissue response concerning the layer of the vessel as for the contact with the ring steel. RESULTS: All implanted stent-grafts were patent, and incorporated to the vessel wall. Six presented fibrous bars, and four presented perivascular fibrosis at the venous section. At the arterial section, only one prosthesis developed a very small stenosis, without perivascular fibrosis. We observed chronic inflammatory reaction with a foreign body granulomatous response in 100 percent of the samples, the medium layer was the more prevalent at the vein section, while the intima layer was more constant at the artery, venous incorporation was stronger than artery incorporation, and tissue response was enhanced in the inner contact between the vessel wall and the ring steel. CONCLUSION: The prosthesis in study presented low thrombogenicity in both systems. It was also present, larger tissue response and low biocompatibility at the venous system, and better biocompatibility at the arterial system.

An experimental study on sterilized barium sulfate (BaSO_4) for vertebroplasty / 介入放射学杂志

0.05), while the strength and stiffness were significantly different (P