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.

ARE CALCIUM SILICATE SEALERS LESS CYTOTOXIC AND GENOTOXIC THAN EPOXY RESIN SEALERS? A SYSTEMATIC REVIEW OF IN VITRO STUDIES

Aims: This systematic review aimed to evaluate whether calcium silicate-based sealers are less cytotoxicity and genotoxicity than epoxy resin-based sealers. Materials and Methods: Systematic searches were conducted for studies published up to September 27th, 2022, without restriction for language or year of publication, in the following databases: MEDLINE/PubMed, Scopus, Web of Science and Grey Literature Report. Only in vitrostudies that evaluated the cytotoxicity or genotoxicity of calcium silicate and epoxy resin-based sealers were included. The quality assessment was performed. Results: After duplicate removal and eligibility criteria assessment, a total of thirty-four studies were included. Twenty-eight studies had a low risk of bias, and six studies had amoderate risk of bias. In general, calcium silicate-based sealers had a lower cytotoxic and genotoxic potential than epoxy-resin based sealers.Conclusions: Based on the findings from in vitrostudies, calcium silicate-based sealers are less cytotoxic andgenotoxic than epoxy resin-based sealers

The effects of heating on the physicochemical properties of tricalcium silicate root canal sealers

Abstract This study evaluated the effect of heating on the physicochemical properties and surface changes of tricalcium silicate sealers. Three tricalcium silicate root canal sealers (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer), and one epoxy resin-based sealer (AH Plus; control) were tested. The effect of heating on setting time (ST) and flowability were assessed according to ANSI/ADA 57 and ISO 6876 standards. Solubility and dimensional change (DC) of the set sealers were evaluated at 24 hours and after 30 days; the pH of the water used in the DC testing was also measured. Tests were repeated with heated sealers in an oven at 100 °C for 1 min. SEM and EDS analysis were performed. Data were analyzed using One-Way ANOVA and Tukey post-hoc tests (α=5%). Heating decreased the ST for AH Plus and EndoSequence (p<0.05). Heating reduced flowability (p<0.05) and increased pH for AH Plus (p<0.05). The solubility of Bio-C (dried specimens) was not in accordance with the ANSI/ADA standard. The solubility of EndoSequence was significantly higher (p<0.05) when it was heated and dried after 30 days. DC of Bio-C (24 h and 30 days), BioRoot-RCS (30 days) and AH Plus (24 h and 30 days) were not in accordance with the standards. SEM and EDS analysis showed significant changes in sealer microstructure after heating. In conclusion, heating decreased the ST and increased the solubility of EndoSequence BC sealer. No significant changes in flowability, DC, and pH were identified for all three tricalcium silicate sealers after heat application. However, all sealers had significant surface changes.

Resumo Este estudo avaliou o efeito do aquecimento nas propriedades físico-químicas e nas alterações superficiais de cimentos de silicato tricálcico. Três cimentos endodônticos de silicato tricálcico (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer) e um cimento à base de resina epóxi (AH Plus) foram testados para avaliar o efeito do aquecimento no tempo de presa (TP) e escoamento de acordo com as normas ANSI/ADA 57 e ISO 6876. A solubilidade e alteração dimensional (AD) dos cimentos foram avaliadas após 24 horas e 30 dias. O pH da água usada no teste de AD também foi medido. Os testes foram repetidos com cimentos aquecidos em um forno a 100 °C por 1 min. Análises em MEV e EDS foram realizadas. Os dados foram analisados pelos testes de ANOVA-1 via e post hoc de Tukey (α=5%). O aquecimento diminuiu o TP para AH Plus e EndoSequence (p<0,05). O aquecimento reduziu o escoamento (p<0,05) e aumentou o pH do AH Plus (p<0,05). A solubilidade do Bio-C (amostras desidratadas) não estava de acordo com o padrão ANSI/ADA. A solubilidade da EndoSequence foi significativamente maior (p<0,05) quando aquecida e desidratada após 30 dias. As AD de Bio-C (24 h e 30 dias), BioRoot-RCS (30 dias) e AH Plus (24 h e 30 dias) não estavam de acordo com as normas ADA e ISO. A análise em MEV e EDS mostrou alterações significativas na estrutura dos cimentos após aquecimento. Em conclusão, o aquecimento diminuiu o TP e aumentou a solubilidade do cimento EndoSequence BC. Não foram identificadas mudanças significativas no escoamento, AD e pH para os cimentos de silicato tricálcico após aquecimento. Porém, todos os cimentos tiveram alterações significativas na superfície.

Analysis of pH, calcium ion release, and energy dispersive spectroscopy of a bioceramic root canal dressing

Abstract This study compared the pH and calcium ion release of calcium silicate- (Bio-C Temp) and calcium hydroxide-based (Ultracal XS) medications. Intracanal remnants of both medications were also evaluated using SEM-EDS after the removal protocol. Thirty-five bovine teeth were prepared. Fifteen were filled with Bio-C Temp and 15 with Ultracal XS. Five remained without intracanal medication (control group). Five samples from each experimental time (i.e.. 24, 72, and 168 hours) were used to measure pH and calcium ions release using a digital pH meter and microplate reader, respectively. Afterward, the peaks of the chemical elements composing both medications were analyzed in SEM-EDS. One-way ANOVA and Tukey's post hoc test analyzed the pH and calcium ion release data. Student's t-test compared the medications in each experimental time. SEM-EDS described the percentage of chemical elements in the samples. Bio-C Temp and Ultracal XS showed a significant pH increase from 24 to 168 hours (p<0.05). Ultracal XS showed a higher pH value at 24 hours than Bio-C Temp (p<0.05) but were similar at 72 and 168h (p > 0.05). Calcium ion release did not depend on the experimental period (p > 0.05). Bio-C Temp showed lower calcium ions release than Ultracal XS at 24 hours (p<0.05). SEM-EDS analyses showed the remains of both medications, but the concentration of Si, Al, and W ions was present only in the calcium silicate-based medication. Bio-C Temp presented alkaline pH and a satisfactory calcium ion release over the time. The remaining of both medications were present after the protocols for paste removal.

Resumo Este estudo comparou o pH e a liberação de íons cálcio de medicações intracanais a à base de silicato de cálcio (Bio-C Temp) e à base de hidróxido de cálcio (Ultracal XS). Remanescentes de ambas as medicações também foram avaliados usando microscopia eletrônica de varredura e espectroscopia de dispersão de energia após o protocolo de remoção. Trinta e cinco dentes bovinos foram preparados. Quinze dentes foram preenchidos com Bio-C Temp e 15 com Ultracal XS. Cinco permaneceram sem medicação intracanal (grupo controle). Cinco amostras de cada tempo experimental (ou seja, 24, 72 e 168 horas) foram usadas para medir o pH e a liberação de íons de cálcio usando um medidor de pH digital e um leitor de microplacas, respectivamente. Em seguida, os picos dos elementos químicos que compõem os dois medicamentos foram analisados ​​em microscopia eletrônica de varredura e por espectroscopia de dispersão de energia. Os testes One-way ANOVA e post hoc de Tukey analisaram os dados de pH e liberação de íons cálcio. O teste t de Student comparou as medicações em cada tempo experimental. A microscopia eletrônica de varredura e a espectroscopia de dispersão de energia descreveu a porcentagem de elementos químicos nas amostras. O Bio-C Temp e o Ultracal XS mostraram um aumento significativo de pH de 24 a 168 horas (p<0,05). O Ultracal XS apresentou um valor de pH mais alto em 24 horas do que o Bio-C Temp (p<0,05), mas foi semelhante em 72 e 168h (p > 0,05). A liberação de íons cálcio não dependeu do período experimental (p> 0,05). O Bio-C Temp apresentou menor liberação de íons de cálcio do que Ultracal XS em 24 horas (p<0,05). As análises de microscopia eletrônica de varredura e espectroscopia de dispersão de energia mostraram remanescentes de ambas as medicações, mas a concentração de íons Si, Al e W estavam presentes apenas na medicação à base de silicato de cálcio. O Bio-C Temp apresentou pH alcalino e maior liberação de íons cálcio. Remanescentes de ambas as medicações estiveram presentes após os protocolos de remoção da pasta.

Tissue repair capacity of bioceramic endodontic sealers in rat subcutaneous tissue

Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen.

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno.

Efectividad de las Técnicas de Retratamiento Endodóntico en la Remoción de ementos Biocerámicos como Material de Obturación Radicular: Revisión Sistemática

El retratamiento no quirúrgico es la primera opción ante el fracaso del tratamiento endodóntico, por lo que se vuelve importante asegurar el completo retiro del material de relleno del conducto radicular, para mejorar el pronóstico del procedimiento. Los cementos biocerámicos en base a silicatos cálcicos han aparecido en los últimos años, caracterizados principalmente por su bioactividad, lo que adicionalmente se puede traducir en una mayor dificultad para su retiro del conducto radicular. El objetivo de esta revisión es determinar qué técnica de retratamiento es más efectiva en la eliminación de cementos selladores biocerámicos, en base al volumen de material remanente en el conducto radicular, evaluado a través del análisis de imágenes con micro-CT. Se realizó una revisión sistemática mediante la búsqueda de publicaciones en las bases de datos Pubmed, ScienceDirect y SciELO, de los últimos 10 años, en idioma español e inglés. Se incluyeron sólo estudios in vitro de dientes obturados con cemento biocerámico y diferentes técnicas de retratamiento endodóntico, en los que se evalúe la limpieza del conducto post eliminación del relleno mediante micro-CT. De un total de 174 artículos encontrados, 7 fueron seleccionados, analizados y se incluyeron en esta revisión sistemática. Los resultados de los estudios seleccionados no encuentran diferencias significativas en la eliminación de material entre las diferentes técnicas de retratamiento evaluadas. A pesar de la heterogeneidad presente en las metodologías de los artículos analizados, ninguna técnica de retratamiento ni técnicas complementarias lograron dejar completamente limpios los conductos radiculares, por lo que se sugiere realizar nuevos estudios en el futuro que evalúen nuevas técnicas de desobturación radicular.

Non-surgical retreatment is the first option in the case of endodontic treatment failure, so it becomes important to ensure complete removal of the root canal filling material, to improve the prognosis of the procedure. Bioceramic cements based on calcium silicate have appeared in recent years, characterized mainly for their bioactivity, which can additionally translate into greater difficulty in their removal from the root canal. The aim of this review is to determine which retreatment technique is most effective in the removal of bioceramic sealer cements, evaluated through micro-CT image analysis. A systematic review was performed by searching for publications in Pubmed, ScienceDirect and SciELO databases, of the last 10 years in Spanish and English. Only in vitro studies of teeth filled with bioceramic cement and different endodontic retreatment techniques were included, in which the cleaning of the canal after removal of the filling was evaluated by micro- CT. From a total of 174 articles found, 7 were selected, analyzed and included in this systemic review. The results of the included studies did not find significant differences in the removal of material between the different retreatment techniques evaluated. Despite the heterogeneity in the methodologies of the studies, no retreatment technique or complementary techniques were able to completely clean the root canals, it is therefore suggested that new studies be carried out in the future to evaluate new techniques.

Cytotoxicity and genotoxicity of Bio-C Repair, Endosequence BC Root Repair, MTA Angelus and MTA Repair HP

Abstract The aim was to evaluate in vitro cytotoxicity and genotoxicity of Bio-C Repair (BCR), compared to Endosequence BC Root Repair (ERRM), MTA Angelus (MTA-Ang), and MTA Repair HP (MTA-HP). MC3T3 osteoblastic cells were exposed to extracts of the repairing bioceramic cements. After 1, 3, and 7 days, cytotoxicity and genotoxicity were evaluated by MTT and Micronucleus tests, respectively. Cells not exposed to biomaterials were used as a negative control. Data were compared using ANOVA two-way, followed by the Tukey Test (α=5%). MTA-Ang and MTA-HP showed no difference in relation to control regarding cytotoxicity in any experimental times. BCR and ERRM reduced cell viability after 3 and 7 days (p<0.05); however, the reduction caused by BCR was less than that caused by ERRM. Considering the micronucleus formation, all biomaterials caused an increase after 3 and 7 days (p<0.05), being greater for the BCR and ERRM groups. It can be concluded that BCR is non-cytotoxic in osteoblastic cells, as well as MTA-Ang e MTA Repair HP. BCR and ERRM showed greater genotoxicity than others tested biomaterials.

Resumo O objetivo foi avaliar in vitro a citotoxicidade e genotoxicidade do Bio-C Repair (BCR), em comparação com o Endosequence BC Root Repair (ERRM), MTA Angelus (MTA-Ang) e MTA Repair HP (MTA-HP). As células osteoblásticas MC3T3 foram expostas aos extratos dos cimentos biocerâmicos reparadores. Após 1, 3 e 7 dias, a citotoxicidade e a genotoxicidade foram avaliadas pelos testes MTT e Micronúcleo, respectivamente. Células não expostas aos biomateriais foram utilizadas como controle negativo. Os dados foram comparados por ANOVA de dois fatores, seguido do Teste de Tukey (p = 5 %). MTA-Ang e MTA-HP não apresentaram diferença em relação ao controle quanto à citotoxicidade em nenhum dos tempos experimentais. BCR e ERRM reduziram a viabilidade celular após 3 e 7 dias (p < 0,05); no entanto, a redução causada pelo BCR foi menor que aquela causada pelo ERRM. Todos os biomateriais causaram aumento na formação de micronúcleos após 3 e 7 dias (p < 0,05), sendo maior para os grupos BCR e ERRM. O BCR não é citotóxico em células osteoblásticas, assim como cimentos MTA-Ang e MTA Repair HP. BCR e ERRM apresentaram maior genotoxicidade do que outros biomateriais testados.

Mechanism of action of Bioactive Endodontic Materials

Abstract A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.

Resumo Uma busca contínua de materiais bioativos com capacidade de substituir o tecido pulpar danificado, com efetiva capacidade de selamento e biocompatibilidade, tem representado a atenção e foco de muitos estudos ao longo das últimas décadas. Este estudo envolve uma revisão narrativa da literatura desenvolvida por meio de pesquisas representativas encontradas no PUBMED/MEDLINE e pesquisas em livros didáticos associadas ao mecanismo de ação de materiais bioativos (hidróxido de cálcio, agregado de trióxido mineral (MTA) e cimentos de silicato de cálcio). A presente análise reflexiva das particularidades dos elementos químicos destes materiais bioativos, considerando o mecanismo de ação tecidual e antibacteriano, possibilita um melhor entendimento das características e similaridades no comportamento tecidual. A pasta de hidróxido de cálcio continua sendo a substância antibacteriana de escolha como medicação intracanal para o tratamento das infecções do sistema de canais radiculares. Este fato se deve a disponibilidade química de íons cálcio e hidroxila do hidróxido de cálcio aos tecidos, e a inibição enzimática bacteriana. Os cimentos de silicato de cálcio, dentre os quais inclui o MTA, apresentam uma resposta biológica favorável ao estímulo à deposição de tecido mineralizado nas áreas seladas e em contato com tecido conjuntivo. Este fato é decorrente da similaridade entre os elementos químicos, em especial devido a dissociação iônica, ao potencial estímulo de enzimas teciduais, e a contribuição com um meio alcalino decorrente do pH destes materiais. O comportamento dos materiais bioativos, em especial o MTA e os novos cimentos de silicato de cálcio na atividade de selamento biológico mostraram efetivos. A endodontia contemporânea atualmente conta com o potencial de materiais bioativos com propriedades análogas capaz de estimular o selamento biológico em perfurações radiculares laterais e de furca, em obturações radiculares, capeamento pulpar, pulpotomia, apicificação e procedimentos endodônticos regenerativos, além de outras condições clínicas.

Physicochemical properties, cytotoxicity and bioactivity of a ready-to-use bioceramic repair material

Abstract The aim of this study was to evaluate the physicochemical properties, cytotoxicity and bioactivity of a ready-to-use bioceramic material, Bio-C Repair (Angelus), in comparison with White MTA (Angelus) and Biodentine (Septodont). The physicochemical properties of setting time, radiopacity, pH, solubility, dimensional and volumetric changes were evaluated. Biocompatibility and bioactivity were assessed in Saos-2 osteoblast cell cultures by the MTT assay 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), Neutral Red (NR), Alizarin Red (ARS), and cell migration tests. Statistical analysis was performed by ANOVA, Tukey or Bonferroni tests (α = 0.05). Bio-C Repair had the longest setting time (p < 0.05), but radiopacity and solubility were accordance with the ISO 6876/2012 standards, besides linear expansion. Bio-C Repair and MTA had similar volumetric change (p > 0.05); lower than Biodentine (p < 0.05). All the materials evaluated had an alkaline pH. Bio-C Repair was cytocompatible and promoted mineralized nodule deposition in 21 days and cell migration in 3 days. In conclusion, Bio-C Repair had adequate radiopacity above 3mm Al, solubility less than 3%, dimensional expansion, and low volumetric change. In addition, Bio-C Repair promoted an alkaline pH and presented bioactivity and biocompatibility similar to MTA and Biodentine, showing potential for use as a repair material.

Resumo O objetivo deste estudo foi avaliar as propriedades físico-químicas, citotoxicidade e bioatividade de um novo material biocerâmico pronto para uso, Bio-C Repair (Angelus), em comparação com MTA Branco (Angelus) e Biodentine (Septodont). Foram avaliadas as propriedades físico-químicas de tempo de presa, radiopacidade, pH, solubilidade, alterações dimensionais e volumétricas. A biocompatibilidade, bioatividade e capacidade de reparo foram avaliadas em culturas de células de osteoblastos Saos-2 pelo ensaio MTT brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazólio), vermelho neutro (NR), vermelho de alizarina ( ARS) e testes de migração celular. A análise estatística foi realizada pelos testes ANOVA, Tukey ou Bonferroni (α = 0,05). Bio-C Repair apresentou o maior tempo de presa (p < 0,05), mas radiopacidade e solubilidade de acordo com as normas ISO 6876/2012, além de expansão linear. Bio-C Repair e MTA tiveram variação volumétrica semelhante (p > 0,05), menor que Biodentine (p < 0,05). Todos os materiais avaliados apresentaram pH alcalino. Bio-C Repair foi citocompatível, além de promover deposição de nódulos mineralizados em 21 dias e migração celular em 3 dias. Em conclusão, o Bio-C Repair apresentou radiopacidade adequada acima de 3mmAl, solubilidade menor que 3%, expansão dimensional e baixa perda volumétrica.. Além disso, o Bio-C Repair promoveu um pH alcalino e apresentou bioatividade e biocompatibilidade semelhantes ao MTA e Biodentine, mostrando potencial para uso como material reparador

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment

Abstract Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. Objective This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. Methodology A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). Results For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). Conclusions The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Tooth discoloration induced by endodontic sealers and cervical limit: 1-year in vitro evaluation

Abstract This laboratory study aimed to evaluate the influence of endodontic sealer and cervical limit of root filling on the discoloration of root canal treated teeth. Bovine incisors were randomly distributed into six experimental groups and control (n=21/group), according to the endodontic sealer used [AH Plus (AP); MTA Fillapex (MF) and Sealer Plus BC (SPB)] and the cervical limit of root filling [dental cervix (DC) or 2 mm in apical direction (2mm-AD)]. Tooth discoloration (ΔE) was evaluated by a digital spectrophotometer using the CIED2000 method. Color assessments were performed immediately before (baseline), 1 week, 1, 3, 6 months, and 1 year after obturation. Data were analyzed by ANOVA and Tukey's post-hoc tests (α=5%). Teeth filled with the three sealers showed perceptible tooth discoloration (ΔE≥2.7) in 1 week, maintaining similar values over time. There was a significant difference between MF and SPB sealers in the 2mm-AD groups. In addition, 2mm-AD groups promoted significantly lower discoloration than DC groups for AH (3 months) and SPB (1 and 3 months) sealer,s. Teeth filled with AP, MF, and SPB sealers displayed discoloration from 1 week to one year, with differences between MF and SPB sealers. A cervical limit of filling material at 2 mm from the dental cervix seems more advisable, promoting lower crown discoloration.

Resumo O presente estudo laboratorial teve como objetivo avaliar a influência do cimento endodôntico e do limite cervical da obturação radicular na alteração de cor de dentes tratados endodonticamente. Incisivos bovinos foram distribuídos aleatoriamente em seis grupos experimentais e um controle (n=21/grupo), de acordo com o cimento endodôntico utilizado [AH Plus (AP); MTA Fillapex (MF) e Sealer Plus BC (SPB)] e o limite cervical da obturação [Colo dentário (CD) ou 2mm na direção apical (2mm-DA)]. A alteração de cor (ΔE) foi avaliada por um espectofotômetro digital usando o método CIED2000. As avaliações de cor foram realizadas imediatamente antes (baseline), 1 semana, 1, 3, 6 meses e 1 ano após a obturação. Os dados foram analisados pelos testes ANOVA e post-hoc de Tuckey (α=5%). Dentes obturados com os três cimentos apresentaram alteração de cor perceptível (ΔE≥2.7) em 1 semana, mantendo valores semelhantes ao longo do tempo. Houve uma diferença significativa entre os cimentos MF e SPB nos grupos 2mm-DA. Além disso, os grupos 2mm-DA promoveram uma alteração de cor significativamente menor do que o grupos CD para os cimentos AH (3 meses) e SPB (1 e 3 meses). Os dentes obturados com os cimentos AH, MF e SPB apresentaram alteração de cor entre 1 semana a um ano, com diferenças entre os cimentos MF e SPB. O limite cervical do material obturador a 2mm do colo dentário parece mais aconselhável, promovendo menor alteração de cor da coroa dentária.

Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties?

Abstract This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.

Resumo Este estudo teve como objetivo avaliar a influência da ativação ultrassônica nas propriedades físico-químicas de cimentos de silicato de cálcio. Nove condições experimentais foram criadas com base nos cimentos de silicato de cálcio (Bio-C Sealer, Sealer Plus BC e Bio Root RCS) e na ativação ultrassônica (sem ativação [SA], 10 segundos e 20 segundos). Os grupos experimentais foram BC-SA, BC-10, BC-20, SPBC-SA, SPBC-10, SPBC-20, BR-SA, BR-10 e BR-20. A ativação foi realizada com um inserto ultrassônico 20/.01. O molde para a análise físico-química foi preenchido e avaliado de acordo com a especificação ANSI/ADA nº. 57: tempo de presa inicial e final, escoamento, radiopacidade e solubilidade. Também foram realizados testes para avaliação de pH e liberação de íons cálcio com períodos experimentais de 1, 24, 72 e 168 horas com pHmetro e espectrofotômetro colorimétrico. Os dados foram analisados por análise de variância one-way e testes post-hoc de Tukey. O nível de significância foi estabelecido em 5%. O tempo de AU aumentou progressivamente o tempo de presa inicial para todos os cimentos de silicato de cálcio (p < 0,05). Vinte segundos de AU aumentaram os valores médios de escoamento de Sealer Plus BC e Bio-C Sealer em comparação com SA (P < 0,05). A AU não influenciou a radiopacidade e a solubilidade dos cimentos testados (P > 0,05). AU por 20 segundos aumentou os níveis de pH e a liberação de íons cálcio de Sealer Plus BC e Bio-C Sealer em 168h (P < 0,05). AU por vinte segundos interfere em algumas propriedades físico-químicas dos cimentos de silicato de cálcio.

Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Physico-chemical properties of calcium silicate-based sealers in powder/liquid and ready-to-use forms

Abstract Calcium silicate-based root canal sealers have been developed in powder/liquid or premixed ready-to-use forms. The evaluation of the physico-chemical properties of a prototype powder/liquid MTApex Sealer (Ultradent) in comparison to a ready-to-use material EndoSequence BC Sealer (Brasseler) was performed. The paste/paste epoxy resin-based AH Plus (Dentsply) served as control for comparisons. The sealers were evaluated (n = 6) regarding setting time (in dry and moist environments), flow and radiopacity, following the ISO-6876/2012 standard. Also, the pH was assessed. Material's surface and chemical characterization was evaluated using scanning-electron-microscopy (SEM) and energy-dispersive-spectrometry (EDS). Mixed ANOVA, Shapiro-Wilk, Levene, and post-hoc analysis with Bonferroni correction were performed at a significance level of 5%. MTApex Sealer exhibited the highest flow and EndoSequence BC Sealer had a significantly longer setting time in dry compared to the moist environment; however, for MTApex Sealer and AH Plus no significant changes occurred when additional moisture was provided. All materials exceeded 7 mm Al of radiopacity and showed a decreasing alkalinity over the 21 day-analysis. SEM/EDS evaluation resulted in peaks of calcium, silicon, and the respective radiopacifier. The prototype powder/liquid MTApex Sealer had the highest flow and similar setting time in both dry and moist environments; opposingly, EndoSequence BC Sealer was crucially influenced by external moisture. This suggests that the powder/liquid materials' setting seems to be more predictable.

Resumo Os cimentos endodônticos obturadores à base de silicato de cálcio foram desenvolvidos em formas pó/líquido ou pré-misturadas prontas para o uso. Foi realizada a avaliação das propriedades físico-químicas de um protótipo pó/líquido MTApex Sealer (Ultradent) em comparação com um material pronto para uso EndoSequence BC Sealer (Brasseler). O cimento obturador pasta/pasta à base de resina epóxi AH Plus (Dentsply) serviu de controle para as comparações. Os cimentos foram avaliados (n = 6) quanto a: tempo de presa (em ambientes secos e úmidos), escoamento e radiopacidade, seguindo a norma ISO-6876/2012; como também o pH. A superfície do material e a caracterização química foram realizadas utilizando a microscopia eletrônica de varredura (MEV) e espectrometria dispersiva de energia (EDS). ANOVA, Shapiro-Wilk, Levene e análise post-hoc com correção de Bonferroni foram realizadas com nível de significância de 5%. O MTApex Sealer exibiu um escoamento mais alto e o EndoSequence BC Sealer teve um tempo de presa significativamente mais longo em ambiente seco em comparação com o ambiente úmido; entretanto, para MTApex Sealer e AH Plus, nenhuma mudança significativa ocorreu quando umidade adicional foi fornecida. Todos os materiais excederam 7 mm de Al de radiopacidade e mostraram uma alcalinidade decrescente ao longo dos 21 dias de análise. A avaliação MEV/EDS resultou em picos de cálcio, silício e respectivo radiopacificador. O protótipo de pó/líquido MTApex Sealer teve o maior escoamento e tempo de presa semelhante em ambientes secos e úmidos; ao contrário, o EndoSequence BC Sealer foi influenciado de maneira crucial pela umidade externa. Isso sugere que a configuração dos materiais em pó/líquido parece ser mais previsível.

Effect of nonsteroidal anti-inflammatory drugs (NSAIDs) association on physicochemical and biological properties of tricalcium silicate-based cement

Abstract The aim of this study was to investigate the physicochemical and biological properties of an experimental tricalcium silicate-based repair cement containing diclofenac sodium (CERD). For the physicochemical test, MTA, Biodentine and CERD were mixed and cement disc were prepared to evaluate the setting time and radiopacity. Root-end cavity were performed in acrylic teeth and filled with cements to analyze the solubility up to 7 days. Polyethylene tubes containing cements were prepared and calcium ions and pH were measured at 3h, 24h, 72h and 15 days. For the biological test, SAOS-2 were cultivated, exposed to cements extracts and cell proliferation were investigated by MTT assay at 6h, 24h and 48h. Polyethylene tubes containing cements were implanted into Wistar rats. After 7 and 30 days, the tubes were removed and processed for histological analyses. Parametric and nonparametric data were performed. No difference was identified in relation to setting time, radiopacity and solubility. Biodentine released more calcium ion than MTA and CERD; however, no difference between MTA and CERD were detected. Alkaline pH was observed for all cements and Biodentine exhibited highest pH. All cements promoted a raise on cell proliferation at 24h and 48h, except CERD at 48h. Biodentine stimulated cell metabolism in relation to MTA and CERD while CERD was more cytotoxic than MTA at 48h. Besides, no difference on both inflammatory response and mineralization ability for all cement were found. CERD demonstrated similar proprieties to others endodontic cements available.

Resumo O objetivo deste estudo foi investigar as propriedades físico-químicas e biológicas de um cimento reparador experimental à base de silicato de tricálcio contendo diclofenaco de sódio (CERD). Para o teste físico-químico, MTA, Biodentine e CERD foram manipulados e discos de cimentos foram preparados para avaliar o tempo de presa e a radiopacidade. Retrocavidades foram feitas em dentes de acrílico e preenchidas com cimentos para análise de solubilidade por 7 dias. Tubos de polietileno contendo cimentos foram preparados e os íons cálcio e o pH foram mensurados às 3h, 24h, 72h e 15 dias. Para o teste biológico, SAOS-2 foram cultivadas, expostas aos extratos de cimentos e a proliferação celular foi investigada pelo ensaio de MTT às 6h, 24h e 48h. Tubos de polietileno contendo cimentos foram implantados em ratos Wistar. Após 7 e 30 dias, os tubos foram removidos e processados para análises histológicas. Dados paramétricos e não paramétricos foram realizados. Nenhuma diferença foi identificada em relação ao tempo de presa, radiopacidade e solubilidade. Biodentine liberou mais íons de cálcio do que MTA e CERD; no entanto, nenhuma diferença entre MTA e CERD foi detectada. O pH alcalino foi observado para todos os cimentos e o Biodentine exibiu o pH mais alto. Todos os cimentos promoveram aumento na proliferação celular às 24h e 48h, exceto o CERD às 48h. Biodentine estimulou o metabolismo celular em relação ao MTA e CERD, enquanto CERD foi mais citotóxico do que MTA em 48h. Além disso, nenhuma diferença foi encontrada na resposta inflamatória e na capacidade de mineralização para todos os cimentos. CERD demonstrou propriedades semelhantes a outros cimentos endodônticos disponíveis.

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)

Effect of bioceramic root canal sealers on the bond strength of fiber posts cemented with resin cements

Abstract This study aimed to evaluate the influence of calcium silicate-based sealers on the bond strength of fiber posts using conventional and self-adhesive resin cement. Sixty single-rooted teeth were selected. The canals were prepared with a reciprocating instrument 40.06. The roots were randomly distributed in six groups (n = 10) according to the strategies for root canal filling and fiber posts cementation: AH Plus/RelyX ARC; AH Plus/RelyX U200; Bio C Sealer/RelyX ARC; Bio C Sealer/RealyX U200; Sealer Plus BC/RelyX ARC; and Sealer Plus BC/RelyX U200. The roots were transversally sectioned, and one slice per post-third was obtained. The push-out test was performed at a crosshead speed of 1mm/min. The failure patterns were described after assessment with a stereomicroscope with a 10× magnification. Bond strength was calculated and analyzed using the ANOVA and Tukey test. AH Plus did not influence the bond strength of fiber posts cemented with conventional (RelyX ARC) or with self-adhesive resin cement (RelyX U200). The lowest bond strength values were obtained when calcium silicate-based sealers were associated with conventional resin cement (Bio C Sealer/RelyX ARC and Sealer Plus BC/RelyX ARC). Except for Sealer Plus BC/RelyX ARC, all groups presented lower bond strength at the apical portion compared to the cervical portion of the post. Adhesive failures between cement and post and cement and dentin were predominant (55.3%). Calcium silicate-based sealers decreased the bond strength of fiber posts cemented with conventional resin cement.

Resumo Este estudo teve como objetivo avaliar a influência de cimentos à base de silicato de cálcio na resistência de união de pinos de fibra utilizando cimentos resinosos convencionais e autoadesivos. Sessenta dentes humanos monorradiculares foram selecionados. Os canais foram preparados um instrumento reciprocante 40.06. As raízes foram distribuídas aleatoriamente em seis grupos (n = 10) de acordo com as estratégias de obturação do canal e cimentação dos pinos de fibra: AH Plus/RelyX ARC; AH Plus/RelyX U200; Bio C Sealer/RelyX ARC; Bio C Sealer/RealyX U200; Sealer Plus BC/RelyX ARC; e Sealer Plus BC/RelyX U200. As raízes foram seccionadas transversalmente e foi obtido um espécime por terço. O teste de push-out foi realizado em uma velocidade de 1mm/min. Os padrões de falha foram descritos após avaliação em estereomicroscópio com aumento de 10×. A resistência de união foi calculada e analisada por ANOVA e teste de Tukey. AH Plus não influenciou na resistência de união dos pinos de fibra cimentados com cimento resinoso convencional (RelyX ARC) ou autoadesivo (RelyX U200) (p > 0,05). Os menores valores de resistência de união foram obtidos quando os cimentos à base de silicato de cálcio foram associados ao cimento resinoso convencional (Bio C Sealer/RelyX ARC e Sealer Plus BC/RelyX ARC) (p < 0,05). Com exceção do Sealer Plus BC/RelyX ARC, todos os grupos apresentaram menor resistência de união na porção apical em comparação com a porção cervical do pino (p < 0,05). Falhas adesivas entre cimento e pino e cimento e dentina foram predominantes (55,3%). Cimentos a base de silicato de cálcio diminuíram a resistência de união de pinos de fibra cimentados com cimento resinoso convencional.

Physicochemical Properties and Antibiofilm Activity of Tricalcium Silicate Cement and its Association with Cetrimide / Propiedades físico-químicas y actividad antibiofilm del cemento de silicato tricálcico y su asociación con cetrimida

Abstract Cetrimide (CTR) is a cationic surfactant detergent with antimicrobial and antibiofilm activity. The aim of this study was to evaluate setting time, pH, solubility and antibiofilm activity of tricalcium silicate cement (TSC) with zirconium oxide (ZrO2) and its association with 0.2 and 0.4% cetrimide. Initial and final setting times (IST and FST) were assessed based on ISO-6876. pH was evaluated at periods of 1,3,7,14 and 21 days. Solubility was analyzed by weight loss. A modified direct contact test (MDCT) on the biofilm of Enterococcus faecalis formed on bovine root dentin blocks was performed, after 6 hours of manipulation and 15 hours of contact time. The analysis was performed by UFC mL ¯¹ counting. The data were analyzed by ANOVA and Tukey's tests (α=0.05). Higher IST was observed for TSC/ZrO2+CTR in both concentrations than for TSC/ZrO2 and lower FST for TSC/ZrO2+0.4% CTR (p0.05). All materials exhibited increased mass. TSC/ZrO2+CTR 0.4% had lower mass gain than the other materials (p<0.05). The highest antibiofilm activity was observed for TSC/ZrO2+CTR in both concentrations, when compared with the positive control (p<0.05). In conclusion, CTR exhibited potential to promote greater antibiofilm activity to tricalcium silicate cement, without harming its physicochemical properties of setting time, pH and solubility.

Resumen Cetrimida (CTR) es un detergente y surfactante catiónico con actividad antimicrobiana y antibiofilm. El objetivo de este estudio fue evaluar el tiempo de fraguado, pH, solubilidad y actividad antibiofilm del cemento de silicato tricálcico (CST) con óxido de zirconio (ZrO2) y su asociación con CTR a 0.2% y 0.4%. Tiempo de fraguado inicial y final (TFI y TFF) fueron determinados con base en las normas ISO-6876. pH fue evaluado en los períodos de 1,3, 7,14 y 21 días. Solubilidad fue analizada por la pérdida de masa/peso. El test de contacto directo modificado (TCDM) fue realizado sobre biofilm de Enterococcus faecalis formado en dentina radicular bovina, después de 6 horas de manipulación de los cementos y 15 horas de contacto. El análisis fue realizado por la cuantificación de UFC mL¯¹. Los datos fueron analizados usando las pruebas de ANOVA y Tukey (α=0.05). Mayor TFI fue observado para CST/ ZrO2+CTR en las dos concentraciones que para TSC/ZrO2 y menor TFF para TSC/ ZrO2+CTR 0.4% (p0.05). Todos los materiales mostraron aumento de masa. TSC/ZrO2+CTR 0.4% tuvo menor gano de masa que los otros materiales (p<0.05). Mayor actividad antibiofilm fue observado para CST/ZrO2+CTR en las dos concentraciones, cuando comparados con el grupo control positivo (p<0.05). En conclusión, CTR demostró potencial para promover superior actividad antibiofilm al cemento de silicato tricálcico (CST), sin perjudicar sus propiedades físico-químicas de tiempo de fraguado, pH y solubilidad.

Cementos a base de silicato de calcio: factor clave en el éxito del recubrimiento pulpar directo. Revisión de la literatura / Calcium silicate based cements: key factor in the success of direct pulp capping. Literature review

RESUMEN Tradicionalmente, el hidróxido de calcio (HC) era considerado el material de elección para el recubrimiento pulpar directo (RPD); pero esto ha cambiado con los años debido a las distintas desventajas que presenta. Los cementos a base de silicato de calcio (CSC) tienen propiedades ventajosas al compararlos con el HC como: bioactividad, biocompatibilidad, menor tiempo de fraguado, capacidad de sellado y resistencia, por lo que son usados en una variedad de procedimientos endodónticos, entre ellos el RPD. El presente artículo de revisión recopila información a partir de la búsqueda manual de artículos originales de investigación científica y revisiones de literatura de la base de datos de Medline/PubMed. Se describen las variedades de CSC, su mecanismo de acción, desventajas, factores relacionados y tasas de éxito clínico en su aplicación en casos de RPD.

ABSTRACT Traditionally, calcium hydroxide (HC) was considered the material of choice for direct pulp capping (RPD); but this has changed over the years due to the various disadvantages it presents. Calcium silicate-based cements (CSC) have properties that are advantageous to HC such as: bioactivity, biocompatibility, shorter setting time, sealing capacity and resistance, which they are used in a variety of endodontic procedures, including RPD.This review article compiles information from the manual search of original scientific research articles and literature reviews of the Medline / PubMed database. The varieties of CSC, their mechanism of action, disadvantages, related factors and rates of clinical success in their application in cases of RPD are described.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.