Vital pulp therapy following pulpotomy in immature first permanent molars with deep caries using novel fast-setting calcium silicate cement: A retrospective clinical study.

OBJECTIVES: To compare the success rate of vital pulp therapy following complete pulpotomy in immature first permanent molars, during caries treatment, using novel fast-setting calcium silicate cement (Novel CSC) versus MTA. METHODS: Six- to eight- years old children, who received pulpotomy of first immature permanent molar using one layer novel CSC (Protooth) or two layers slow-setting MTA (MTA Angelus) covered with glass ionomer were recalled for radiographic and clinical evaluation after two years. The effects of cement type, age, gender, jaw, anesthesia type, and restoration type were assessed on the clinical success of pulpotomy and continued root formation (apexogenesis) as the treatment outcome. RESULTS: Out of 366 included teeth in the study, 316 teeth were available for statistical analysis. The mean observation time was 28.2 ±â€¯2.7 months. Novel CSC showed significantly higher clinical success rate (93.1%) compared to MTA (84.5%). Restored teeth with stainless steel crowns after pulpotomy and treatments performed under general anesthesia had a statistically significant effect on treatment outcome in contrast to age, gender, and jaw type. CONCLUSION: The observations of this retrospective study suggested that the success rate of vital pulp therapy following complete pulpotomy using one layer fast-setting novel CSC was significantly higher than slow-setting MTA covered with glass ionomer. Treatment under general anesthesia and restoration using stainless steel crowns influenced the treatment outcome. CLINICAL SIGNIFICANCE: Novel fast-setting calcium silicate cement is a promising new biomaterial for vital pulp therapy in immature permanent molars that allows complete root formation overtime with apexogenesis. Clinicians must also be aware of the importance of immediate definitive restoration and proper sealing and isolation in vital pulp therapy.

Pull-Out Bond Strength of Titanium Post Cemented with Novel Fast-Setting Calcium Silicate Cement.

OBJECTIVE: The aim of this study was to compare the pull-out bond strength of prefabricated titanium posts cemented with novel fast-setting calcium silicate, zinc phosphate, or glass ionomer cements. METHODS: Sixty extracted human maxillary incisors were selected and received root canal treatment. Post space was prepared for titanium ParaPost XP size 5 (diameter=1.25 mm). The posts were cemented using novel calcium silicate cement, zinc phosphate cement, or glass ionomer cement (n=20). Specimens were stored in phosphate-buffered saline for 4 weeks. Subsequently, the posts were subjected to axial tensile force until bond failure. Data were analyzed by one-way ANOVA followed by multiple comparisons. RESULTS: The posts cemented with novel calcium silicate cement (10.5±3.8 MPa) demonstrated significantly higher bond strength than zinc phosphate (8.0±2.6 MPa) and glass ionomer cements (8.0±2.7 MPa) (P<0.05). CONCLUSION: Within the limitation of the study, the pull-out bond strength of titanium post cemented with novel calcium silicate cement in endodontically treated teeth was superior to zinc phosphate and glass ionomer cements.

Bond strength between dentine and a novel fast-setting calcium silicate cement with fluoride.

The aim of this study was to evaluate the dentine bond strength of a novel fast-setting calcium silicate cement (Protooth) versus a calcium hydroxide-based cement (Dycal), a calcium silicate cement (ProRoot MTA), and a glass ionomer cement (Ketac-Molar). Mid-root dentine slices of 1 mm thickness were obtained from human maxillary incisors. After enlarging the lumen of the canal to 1.3 mm, the cavities were randomly filled with test materials. Samples were immersed in physiological-like solution. The push-out bond strength was tested on days 1, 28, and 180 (n = 12). Failure types of bonding were determined using a stereomicroscope. We analysed the data using linear regression. Dycal and day 1 were considered as reference for cement type and assessment time, respectively. Protooth, Ketac-Molar, and ProRoot MTA demonstrated higher push-out bond strength than Dycal. The push-out bond strength in the Protooth group increased on day 28 and 180. The bond strength of Ketac-Molar was significantly reduced on day 28. Dycal showed a significant decrease in bond strength on day 180 compared with that on day 1 and 28. Mixed failure was the dominant failure type. Protooth bonding to dentine was increased with time, in contrast to that of ProRoot MTA, Dycal, and Ketac-Molar, as a function of time.

Direct pulp capping of primary molars using a novel fast-setting calcium silicate cement: a randomized clinical trial with 12-month follow-up.

Objective: Novel fast-setting calcium silicate cement with fluoride (Protooth) has been developed for potential applications in tooth crowns. The aim of this study was to evaluate the success rate of direct pulp capping in primary molars using two-layer mineral trioxide aggregate (MTA) and overlying glass ionomer cement versus one-layer novel calcium silicate cement with 4 to 10 minutes setting time. Materials and methods: Ninety bilaterally symmetrical primary molars in the same jaw in 45 patients aged 5 to 7 years were included. Exposed pulps following caries removal were randomly capped with one-layer novel calcium silicate cement or two-layer MTA and glass ionomer cement. All cavities were filled with amalgam. Clinical and radiographic evaluations were performed after six and twelve months. 41 patients were available for the evaluations at the end of the 12-month follow-up. Results: The overall success rate of direct pulp capping, in a split-mouth design, using MTA covered with glass ionomer cement or one-layer novel calcium silicate cement after 12 months were 90% (37 out of 41 cases) and 85% (35 out of 41 cases), respectively, without statistically significant differences after 6 and 12 months. Conclusion: Within the limitations of this study, clinical and radiographic evaluations suggested one-layer novel calcium silicate cement would be successfully used in direct pulp capping of primary molars as a practical alternative to two-layer MTA and overlying glass ionomer cement.

In vitro cytotoxic evaluation of novel fast-setting calcium silicate cement compositions and dental materials using colorimetric methyl-thiazolyl-tetrazolium assay.

A novel fast-setting calcium silicate cement with fluoride (CSC) has been developed for potential application in tooth crowns. This study compared the cytotoxicity of CSC compositions and a variety of dental materials. We tested CSC compositions (Protooth), MTA, Biodentine, Ketac Molar, Fuji II LC, Vitrebond, DeTrey Zinc, Dycal, and IRM, DMEM (negative control) and 1% NaOCl (positive control). After setting of cements for 24 h, specimens were immersed in DMEM for 24 h to obtain material elutes. The elutes were serially diluted in serum-free DMEM to obtain three dilutions. L929 mouse fibroblast cells (1 × 104 cells per well) were treated for 24 h with elute dilutions (n = 3). Cytotoxicity was determined using methyl-thiazolyl-tetrazolium assay in triplicate. CSC compositions, MTA, and Biodentine showed no significant reduction in cell viability compared to DMEM. There was no significant difference in cell viability, at any of three dilutions, between CSC compositions and either MTA or Biodentine. Cytotoxicity was significantly lower for CSC compositions than for Vitrebond, DeTrey Zinc, Dycal, IRM, and 1% NaOCl, at all three dilutions, and undiluted Fuji II LC elute. In contrast to resin-modified glass ionomers, zinc phosphate cements, Dycal, and IRM, the CSC compositions showed no cytotoxic potential.

Calcium phosphate precipitation in experimental gaps between fluoride-containing fast-setting calcium silicate cement and dentin.

A novel fast-setting calcium silicate cement containing fluoride (novel-CSC) has been developed for applications in tooth crowns. The aim of this study was to assess the ability of the novel-CSC to close the experimental gaps at the dentin-cement interface. The novel-CSC was tested against Vitrebond and GC Fuji II LC. Experimental gaps of 50 or 300 µm width were created between the materials and dentin. Specimens with the 300-µm-wide gap were immersed in phosphate-buffered saline and the closed gap area was measured during 96 h. All specimens with 50 or 300 µm gap width were analyzed by scanning electron microscopy equipped with energy dispersive X-ray spectroscopy (SEM/EDX) to assess the morphology and chemical composition of the precipitates after 96 h immersion in phosphate-buffered saline. High-resolution micro-computed tomography (µCT) was used to evaluate the integrity and continuity of the precipitiates after 96 h and 180 d. In all novel-CSC samples, precipitates closed the gap area completely after 96 h. The SEM/EDX revealed that the globular precipitates closing the gap area were mainly composed of calcium and phosphorus. After 180 d, µCT indicated thicker precipitates compared with initial precipitates only in the novel-CSC group, whereas no precipitates were observed in resin-modified glass ionomers. Novel-CSC promoted continuous precipitation of calcium phosphate, including apatite, and closed the experimental gaps.

Diametral tensile strength of novel fast-setting calcium silicate cement.

Novel fast-setting calcium silicate cement with fluoride (CSC) has been developed for potential applications in tooth crown. The aim of this study was to test the diametral tensile strength (DTS) of different CSC compositions in humid condition on day1, 28, and 180. We tested 'bond CSC' with 3.5% fluoride and no radiocontrast, 'CSC' with 3.5% fluoride and 10% radiocontrast, 'ultrafast CSC' with 3.5% fluoride and 20% radiocontrast, 'high fluoride CSC' with 15% fluoride and 25% radiocontrast, Biodentine, and MTA. We filled the cements after mixing to cylindrical molds. Specimens were stored in >95% humidity. DTS was measured at each time point. CSC compositions had statistically higher DTS compared to MTA and Biodentine on day1. Bond CSC showed higher DTS versus all cements, except CSC, at all time points. DTS of all cements, except Biodentine, significantly increased in humid condition on day28 and day180 compared to day1.

Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts.

AIM: The aim of this study was to compare the survival of composite resin restorations retained by glass fiber posts or reversed-orientated (upside-down) metal posts in severely decayed primary anterior teeth after 6, 12, and 18 months. MATERIALS AND METHODS: A total of forty-four 3- to 5-year-old children with bilateral severely decayed primary maxillary canines were included. Patients were treated under general anesthesia. After pulpectomy, an intracanal post was seated in the primary maxillary canine on each side: either a glass fiber post or a metallic post in reversed orientation and teeth restored with light-cured composite. Survival rate of each technique was evaluated at predetermined follow-ups and data were analyzed with McNemar's test (α = 0.05). RESULTS: The difference in survival of restorations retained by two types of posts was not statistically significant in clinical and radiographical evaluations after 6, 12, and 18 months. The survival rate of reversed-orientated metal and glass fiber posts after 18 months was 81.1 and 67.6% respectively (p = 0.14). CONCLUSION: Reversed-orientated metal post did not show lower clinical survival compared with glass fiber posts in 18-month follow-up. Hence, reversed-orientated metal post can be considered as a potential method to obtain retention for composite restorations in severely decayed primary anterior teeth. How to cite this article: Vafaei A, Ranjkesh B, L0vschall H, Erfanparast L, Jafarabadi MA, Oskouei SG, Isidor F. Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts. Int J Clin Pediatr Dent 2016;9(2):109-113.

Apatite precipitation on a novel fast-setting calcium silicate cement containing fluoride.

Aim: Calcium silicate cements are widely used in endodontics. Novel fast-setting calcium silicate cement with fluoride (Protooth) has been developed for potential applications in teeth crowns including cavity lining and cementation. Objective: To evaluate the surface apatite-forming ability of Protooth compositions as a function of fluoride content and immersion time in phosphate-buffered saline (PBS). Material and methods: Three cement compositions were tested: Protooth (3.5% fluoride and 10% radiocontrast), ultrafast Protooth (3.5% fluoride and 20% radiocontrast), and high fluoride Protooth (15% fluoride and 25% radiocontrast). Powders were cap-mixed with liquid, filled to the molds and immersed in PBS. Scanning electron microscopy, energy dispersive X-ray analysis, and Raman spectroscopy were used to characterize the precipitations morphology and composition after 1, 7, 28, and 56 days. Apatite/belite Raman peak height indicated the apatite thickness. Results: Spherical calcium phosphate precipitations with acicular crystallites were formed after 1-day immersion in PBS and Raman spectra disclosed the phosphate band at 965 cm-1, supporting the apatite formation over Protooth compositions. The apatite deposition continued and more voluminous precipitations were observed after 56 days over the surface of all cements. Raman bands suggested the formation of ß-type carbonated apatite over Protooth compositions. High fluoride Protooth showed the most compact deposition with significantly higher apatite/belite ratio compared to Protooth and ultrafast Protooth after 28 and 56 days. Conclusions: Calcium phosphate precipitations (apatite) were formed over Protooth compositions after immersion in PBS with increasing apatite formation as a function of time. High fluoride Protooth exhibited thicker apatite deposition.

Macrophage-mediated nanoparticle delivery to the periodontal lesions in established murine model via Pg-LPS induction.

We established a murine periodontitis model by local injection of lipopolysaccharide of Porphyromonas gingivalis (Pg-LPS) into the gingival sulcus of mandibular left incisor four times with 48-h interval. The histological examination of the periodontal tissues demonstrated that significant loss of periodontal bone and ligaments was observed in the lesion side with abundant inflammatory cell infiltration. Two days after the last injection, Cy5-labelled siRNA/chitosan particles were injected intraperitoneally (ip). The chitosan/siRNA particles were taken up by peritoneal macrophages, which subsequently migrated to the inflamed gingival area evaluated by in vivo imaging. The localization of macrophages in the inflamed region was further confirmed by immunofluorescent staining. The present report demonstrates that intragingival injection of Pg-LPS can be used to create an experimental model of periodontal inflammation in mice and that recruitment of macrophages with chitosan/siRNA nanoparticles to the inflamed area opens the possibility of an RNAi-based therapeutic approach using chitosan as a carrier in periodontitis.

Hypocalcified type of amelogenesis imperfecta in a large family: clinical, radiographic, and histological findings, associated dento-facial anomalies, and resulting treatment load.

OBJECTIVE: The purpose of this study was to report on the clinical, radiographic, and histological dental findings and the resulting treatment load in a five-generation family with amelogenesis imperfecta (AI). MATERIAL AND METHODS: Thirteen affected and 15 unaffected individuals were examined clinically and radiographically. In addition, four exfoliated deciduous teeth were examined by scanning electron microscopy and microradiography. RESULTS: The mode of inheritance of AI was autosomal-dominant. At eruption, most of the tooth enamel was yellow, lacking translucency, and prone to gradual loss in subjects with AI. Post-eruptive breakdown of enamel was extensive in accordance with the histological observations of hypomineralized and porous enamel. Extensive enamel loss and discoloration were observed in older affected individuals. The treatment need had been extensive: 76.2% of the total number of teeth present in affected individuals had been treated with partial or full coverage compared to 1.7% of the teeth in unaffected relatives. Unaffected individuals had more endodontically treated teeth than AI-affected relatives. Adjunctive findings, e.g. tooth agenesis, tooth impaction, pulp stones, enlarged follicular space, and taurodontism, were rare in both groups. CONCLUSIONS: Affected family members had the hypocalcified type of AI, which is characterized by severe hypomineralization, extensive post-eruptive loss, and discoloration of the enamel. Adjunctive findings were rare. Individuals with the hypocalcified type of AI have an extensive restorative treatment load compared to unaffected relatives.

Amelogenesis imperfecta - a systematic literature review of associated dental and oro-facial abnormalities and their impact on patients.

OBJECTIVE: Amelogenesis imperfecta (AI) is a disease primarily affecting amelogenesis, but other aberrations have been reported. The purposes of this review were: (1) to identify other anomalies associated with AI, and (2) to describe the impact of the disease and its associated conditions on the oral health-related quality of life of patients, and the economic consequences. MATERIAL AND METHODS: A literature search was conducted in the following databases: PubMed, EMBASE, Bibliotek.dk, The Cochrane Library, Web of Science, and OMIM, supplemented by a search for selected authors. Based on titles and abstracts, 137 papers were identified. RESULTS: Most articles were case reports or case series with few cases. Aberrations were reported in the eruption process, in the morphology of the crown, in the pulp-dentine organ, and in the number of teeth. Gingival conditions and oral hygiene were usually reported to be poor, and calculus was a common finding. Open bite was the most commonly reported malocclusion. A negative impact on patients' oral health-related quality of life was described, but information was scarce. No information was found on the economic impact. CONCLUSIONS: A number of aberrations associated with AI have been reported, but not sufficiently systematic to allow for a secondary analysis and synthesis of the findings. The impact on patients in terms of reduced quality of life and economic burden needs to be studied.

Coexpression of Notch3 and Rgs5 in the pericyte-vascular smooth muscle cell axis in response to pulp injury.

Recent studies have shown that the pulp of human teeth contains a population of cells with stem cell properties and it has been suggested that these cells originate from pericytes. Molecules of the Notch signaling pathway regulate stem cell fate specification, while Rgs5 represents an excellent marker for pericytes. Pathological conditions such as dental trauma and carious lesion stimulate pulp stem cells to elaborate reparative dentin. Previous studies have shown that genes involved in the Notch pathway are activated in response to pulp injury in rodent and humans. To demonstrate the importance of pericytes as a source of stem cells during dental repair, we have studied Rgs5 and Notch3 mRNA expression by in situ hybridization in developing, adult intact and injured rodent teeth. Furthermore, we have examined the distribution of Notch3 protein in carious and injured human teeth using immunohistochemistry. Overlapping expression patterns of Rgs5 and Notch3 were observed during rodent tooth development as well as immediately after injury. Both genes were expressed in vascular structures during development and in perivascular and single capillary cells of injured teeth. However, the expression patterns of Rgs5 and Notch3 were different during tooth repair, with relatively extensive Rgs5 expression along the pericyte-vascular smooth muscle cell axis in central pulp arterioles. These results show co-expression of Rgs5 and Notch3 in pericytes of developing and injured teeth and furthermore indicate the importance of vascular-derived stem cells during pulp healing.