The influence of calcium silicate-based cement on osseous healing: A systematic review and meta-analysis.

Objectives: The purpose of this systematic review was to analyze the effect of commercially available calcium silicate-based bioactive endodontic cement (BEC) on treatment outcome when used as root repair material in human permanent teeth and to compare it with traditional materials. Methods: PubMed, Embase, and Cochrane Library were searched until June 2020. Randomized clinical studies and observational studies with a minimum 1-year follow-up and sample size of at least 20 were included. Risk of bias (ROB) was assessed using Cochrane's ROB tool and the National Institutes of Health Quality Assessment Tool. Results: Thirty-nine studies were included in the systematic review. Majority of the studies used mineral trioxide aggregate. The pooled success rate for BEC was estimated by a random-effects method as 90.49% (95% confidence interval [CI]: 88.4992.34, I2 = 54%). Eleven studies comparing BEC with traditional materials were included in the meta-analysis. The use of BEC significantly improved the treatment outcome when compared to traditional materials with odds ratio (OR) = 2.15 (95% CI: 1.57-2.96, I2 = 0.8%, P = 0.433). Conclusion: Very low-to-moderate-quality evidence suggests that the use of BEC as root repair material enhanced the treatment outcome. High-quality studies are required for the newer BEC to establish their clinical performance. Registration: PROSPERO CRD42020211502.

Influence of photodynamic therapy and different lasers Er,Cr:YSGG and Er,YAG on dentin conditioning bonded to conventional and bioactive cement.

AIM: The aim of the present study was to evaluate the bond integrity of bioactive cement (BAc) in contrast to conventional cement Calibra (C) after dentin treated with different surface conditioners (PDT, EYL, ECL) MATERIALS AND METHODS: Sixty non-carious permanent mandibular molars were disinfected and embedded in acrylic resin till cement-o-enamel junction. For homogeneity the buccal surface were grounded and polished. Samples were categorized into three main groups based on conditioning technique. Samples in group 1 and 2 dentin conditioned with Er,Cr:YSGG (ECL), group 3 and 4 surface treated with Er:YAG (EYL) and group 5 and 6 treated with photodynamic therapy (PDT).On conditioned surface bonding agent was applied and light cured. Samples from group 1,3,5 were bonded to Calibra (C). Whereas, specimens in group 2,4,6 were conditioned with bioactive cement (BAc) and subjected to ageing followed by shear bond strength testing (SBS) in universal testing machine. To detect significance difference between means of different groups analysis of variance (ANOVA) was performed followed by Tukey's post-hoc tests. RESULTS: The maximum SBS was displayed in group 1, dentin conditioned with ECL and bonded to C (20.23 ±â€¯0.47 MPa). Whereas, group 6, PDT of dentin to BAc demonstrated lowest bond integrity among experimental groups (12.97 ±â€¯0.25 MPa). Bond strength of group 1, ECL-C (21.55 ±â€¯3.08 MPa) and group 3 EYL-C (19.11 ±â€¯0.65 MPa) were comparable (p > 0.05). Group 5 samples treated with PDT, MB-C (13.41±0.32 MPa) and group 6, MB-BAc (12.97 ±â€¯0.25 MPa) were also comparable (p > 0.05) CONCLUSION: BAc bonded to dentin after surface conditioning with ECL, EYL and PDT presented lower SBS in comparison to conventional cement C. Further studies are required to extrapolate the current findings.

Influence of Bioactive, Resin and Glass Ionomer luting cements on the fracture loads of dentin bonded ceramic crowns.

OBJECTIVE: To investigate the failure loads of dentin bonded all-ceramic crowns when luted with Bioactive, resin and glass ionomer cements (GIC) in an in-vitro setting. METHODS: This study was conducted at King Saud University, Saudi Arabia, from Nov.2018 to March 2019. In this study, 60 premolar teeth were prepared for dentin-bonded ceramic crowns. Lithium disilicate ceramic crowns fabricated using CAD-CAM technique were cemented to teeth using Bioactive (ACITVA), Resin (Nexus 3 Gen) and GIC (Ketac Cem- Maxicap). Half of the bonded specimens in each group were thermocycled (50000 cycles), however the remaining half were not aged (n=10). Fracture loads of bonded crowns were assessed by exposing them to static axial occlusal loads (1mm/min) using a round ended metal probe in a Universal testing machine. Means and standard deviations among the study groups were compared with ANOVA and Tukey-Kramer multiple comparisons test. RESULTS: Highest failure loads were observed in resin group without ageing (thermocycling) (689.13±89.41 N), however, the lowest loads were observed in GIC specimens with ageing (243.16±49.03 N). Among non-aged samples, failure loads for Bioactive (480.30±47.26 N) group were less than Resin (689.13±89.41 N) samples but higher than GIC (307.51±45.29 N) specimens respectively. Among the aged specimens, Bioactive (404.42±60.43 N) showed significantly higher failure loads than GIC (243.16±49.03 N), however lower failure loads than Resin (582.33±95.95 N) samples. CONCLUSIONS: Dentin boned crowns with resin cementation showed higher failure loads than Bioactive and GIC luted crowns. Crowns luted with Bioactive cement showed acceptable failure loads for use as restoration on anterior teeth.

Bond integrity and microleakage of dentin-bonded crowns cemented with bioactive cement in comparison to resin cements: in vitro study.

OBJECTIVE: The aim was to compare restorative marginal integrity of ceramic crowns luted with bioactive and resin cements using micro-computed tomography (micro-CT) microleakage evaluations and bond strength assessment. METHODS: Thirty molar teeth were prepared by sectioning and polishing for dentin exposure for resin cement build-ups. Teeth were randomly divided among three groups of cements: (1) bioactive (ACTIVA); (2) glass ionomer cement (GIC; Ketac Cem); and (3) resin luting agent (Nexus 3). Bonding regime and build-ups (4 mm × 2 mm) were performed using the recommended protocol. For microleakage assessment, 30 premolar teeth were prepared for dentin-bonded crowns using lithium disilicate ceramic and the computer-aided design and computer-aided manufacturing technique. Crowns were cemented with standard load, cement amount, and duration using three cements (Group A: bioactive; Group B: GIC; Group C: resin) and photopolymerized. Cemented crowns were evaluated for volumetric infiltration using micro-CT (Skyscan, Bruker 1173- at 86 kV, 93 µA, 620 ms) after immersion in 50% solution of silver nitrate (AgNO3) (24 hours). Shear bond strength (SBS) was assessed by fracture of cement build-ups at a cross-head speed of 0.5 mm/min in a universal testing machine. RESULTS: Mean SBS among bioactive (21.54 ± 3.834 MPa) specimens was significantly higher than that for GIC (14.08 ± 3.25 MPa) specimens (p < 0.01), but they were comparable to resin samples (p > 0.05) (24.73 ± 4.32 MPa). Microleakage was significantly lower in crowns luted with bioactive (0.381 ± 0.134) cement compared to GIC (1.057 ± 0.399 mm3) (p < 0.01) and resin (0.734 ± 0.166 mm3) (p = 0.014) cemented crowns. The type of luting agent had a significant influence on the microleakage of crowns and bond strength to dentin (p < 0.05). CONCLUSION: Bioactive cement exhibited less microleakage and comparable SBS to resin luting agents in in vitro conditions.

Dentin bond strength of bioactive cement in comparison to conventional resin cement when photosensitized with Er,Cr:YSGG Laser.

OBJECTIVE: The purpose of the present study was to assess dentin shear bond strength (SBS) and mode of bond failure of bioactive cement (BA) in comparison to conventional resin cement when photosensitized by Er,Cr: YSGG Laser (ECL). METHODS: The present in-vitro study was carried out from March 2019 to May 2019. Sixty permanent non-carious, intact, non-fractured molars were isolated and mounted vertically in acrylic resin. Buccal surface of each molar tooth was ground, polished and surface treated with ECL. Ketac conditioner was applied on the surface washed and air dried surface. Tetric -N-Bond adhesive was applied on forty-five samples and light cured. The specimens were allocated into four groups (n=15) according to the type of cement used i.e., Calibra (C), BA, Variolink II (V) and Maxcem-Elite (ME). For SBS testing was performed using the universal testing machine. Eight samples from each group were assessed for modes of failure. Means and standard deviations were compared using analysis of variance (ANOVA) and Tukey's post hoc test at a significance level of p < 0.05. RESULTS: The highest mean SBS was observed in group ECL-C (21.55±3.08). The lowest mean SBS was displayed in group ECL-ME (14.25±3.55). Mean SBS values for group ECL-C (21.55±3.08) and group ECL-V (20.74±4.15) were comparable (p <0.05). Similarly, SBS values of group ECL-BA (15.48±3.62) and group ECL-ME (14.25±3.55) were comparable (p <0.05). CONCLUSION: Dentin surface conditioned with Er,Cr: YSGG and bonded to C and V cements exhibit favourable bond strength values.

Influence of luting cement on the clinical outcomes of Zirconia pediatric crowns: A 3-year split-mouth randomized controlled trial.

BACKGROUND: There is no scientific evidence supporting the choice of luting cement for cementation of zirconia crowns. AIM: The purpose of this split-mouth study was to compare the efficacy of using bioactive cement versus packable glass ionomer for cementation of posterior pediatric zirconia crowns. DESIGN: Fifty first mandibular primary molars were restored by zirconia crowns and were randomly divided to be luted with either (a) bioactive cement or (b) packable glass ionomer. Crowns' retention, fracture, and gingival condition were evaluated at 1 week, and 1-, 3-, 6-, 9-, 12-, 18-, 24-, and 36-month intervals. Statistical analysis was carried out using Fisher's exact test, Kaplan-Meier survival analysis, and Wilcoxon signed rank test. RESULTS: At 3- to 36-month follow-ups, there were statistically significant (P = .009-≤.001) less debonded crowns in packable glass ionomer group. There were no fractured crowns for either cements. There was no statistically significant difference between gingival index scores. CONCLUSIONS: Packable glass ionomer is more retentive than bioactive cement when used for cementing zirconia pediatric crowns. Posterior zirconia pediatric crowns have high fracture resistance after 36 months of clinical performance, irrespective of luting cement. Luting cement for zirconia pediatric crowns has no apparent effect on gingival condition around crowns.

Micro-shear bond strength of bioactive cement to translucent zirconia after thermocycyling: a comparative in-vitro study / Resistência de união ao microcisalhamento do cimento bioativo à zircônia translúcida após termociclagem: estudo comparativo in vitro

Objective: the purpose of the study was to evaluate the micro-shear bond strength of different cements to translucent zirconia before and after thermocycling aging. Material and methods: Twelve translucent zirconia ceramic discs were used in the study. Specimens were sandblasted using 50 µm aluminum oxide (Al2 O3 ) particles. The specimens were divided into three groups (n = 4) according to the cement type: Panavia resin cement (control group), resin modified glass ionomer (RMGI), and Activa bioactive cement. Each group was further sub-divided into two equal subgroups (n = 2) according to whether the specimens were subjected to thermocycling or not. Thermocycling was performed in distilled water at 5000 cycles between 5 o C - 55 o C. The micro-shear bond strength test (µSBS) was measured using universal testing machine. Kruskal-Wallis test was used to compare between the three cements. Dunn's test was used for pair-wise comparisons when Kruskal-Wallis test is significant. Mann-Whitney U test was used to compare between micro-shear bond strength before and after thermocycling P ≤ 0.05. Results: In non-aged subgroups, there was no significant difference between Panavia and Activa; both showed significantly the highest mean µSBS values (22.9 MPa, 31.3 MPa respectively). While, RMGI showed the lowest µSBS values (4.7 MPa). In thermocycled subgroups, Panavia showed significantly the highest mean µSBS values (32.2 MPa). There was no significant difference between RMGI and Activa; both showed the lowest significant mean µSBS values (3.2 MPa and 8.7 MPa respectively). Conclusions: RMGI and Activa couldn't be considered long-term reliable materials for cementing zirconia. However, Panavia provided the most durable bond to zirconia. (AU)

Objetivo: O objetivo do estudo foi avaliar a resistência de união ao microcisalhamento de diferentes cimentos à zircônia translúcida antes e após o envelhecimento da termociclagem. Material e métodos: Doze discos de zircônia translúcidos foram utilizados no estudo. As amostras foram jateadas com partículas de óxido de alumínio de 50 µm (Al2 O3 ). Os espécimes foram divididos em três grupos (n = 4), de acordo com o tipo de cimento: cimento resinado Panavia (grupo controle), ionômero de vidro modificado por resina (RMGI) e cimento bioativo Activa. Cada grupo foi subdividido em dois subgrupos iguais (n = 2), dependendo se as amostras foram submetidas ou não a termociclagem. A termociclagem foi realizada em água destilada a 5000 ciclos entre 5°C - 55°C. O teste de resistência de união por microcisalhamento (µSBS) foi medido usando uma máquina de teste universal. O teste de Kruskal-Wallis foi utilizado para comparar os três cimentos. O teste de Dunn foi usado para comparações entre pares quando o teste de Kruskal-Wallis foi significativo. O teste U de Mann-Whitney foi utilizado para comparar a resistência de união ao microcisalhamento antes e após a termociclagem (P ≤ 0,05). Resultados: Nos subgrupos sem envelhecimento por termociclagem, não houve diferença significativa entre Panavia e Activa; ambos mostraram significativamente os maiores valores médios de µSBS (22,9 MPa, 31,3 MPa, respectivamente). Por sua vez, o RMGI apresentou os menores valores de µSBS (4,7 MPa). Nos subgrupos termociclados, Panavia mostrou significativamente os maiores valores médios de µSBS (32,2 MPa). Não houve diferença significativa entre RMGI e Activa; ambos apresentaram os menores valores médios significativos de µSBS (3,2 MPa e 8,7 MPa, respectivamente). Conclusões: RMGI e Activa não puderam ser considerados materiais confiáveis para cimentação à zircônia a longo prazo. No entanto, a Panavia apresentou a ligação mais durável à zircônia. (AU)

Influence of photobio-modulation with an Er,Cr: YSGG laser on dentin adhesion bonded with bioactive and resin-modified glass ionomer cement.

METHODS: One hundred and twenty extracted human molars were allocated in eight groups (n = 15) based on surface conditioning and cement type. Specimens of groups 2 and 6 were conditioned with ECL whereas, groups 3 and 7 were treated with ECL + ethylenediamine tetra acetic acid (EDTA). Specimens in groups 4 and 8 were surface conditioned by ECL + EDTA + Tetric-N-Bond, and groups 1 and 5 were considered as control (non-surface treated). Cement build-ups were performed on the surface-treated dentin with BAC (groups 1-4) and RMGIC (groups 5-8). A universal testing machine was used to measure the SBS and the mode of failure was evaluated using a stereomicroscope. Statistical analysis was performed using an analysis of variance and Tukey's post hoc test, at a significance level of p < 0.001. RESULTS: The highest SBS values were observed in group 8, ECL + EDTA + Tetric-N-Bond + RMGIC (21.54 ± 3.524 MPa) and the lowest SBS values were displayed by group 1, with no surface treatment and BAC application (11.99 ± 0.821 MPa). The majority of failures were found to be mixed in lased dentin-treated dentin surfaces. BAC when bonded to dentin surfaces conditioned with ECL showed lower SBS in comparison to RMGIC. CONCLUSION: Conditioning of dentin with ECL and a bonding agent (Tetric-N-bond) improved bond strength scores for BAC and RMGIC. Use of EDTA improved bond strength values when bonded to BAC and RMGIC; however, this improvement was not statistically significant.

Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: a noninferiority randomized controlled trial.

AIM: To compare the outcome of partial pulpotomy using two cements, ProRoot MTA (Dentsply, Tulsa Dental Specialties, Tulsa, OK, USA) and Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis. Furthermore, the frequencies of perceptible grey discoloration caused by the cements were compared. METHODOLOGY: Sixty-nine permanent first molars with signs and symptoms indicative of irreversible pulpitis, from 69 patients, were included. All operators performed partial pulpotomy under a standardized protocol. Teeth were allocated, using a website-generated number of simple randomization, to partial pulpotomy with either ProRoot MTA (37 teeth) or Biodentine (32 teeth) and were restored with composite resin or stainless steel crowns. Patients were recalled every 6 months. To be categorized as having success, the evaluated tooth must have had both clinical and radiographic success. In addition, photographs of treated teeth were evaluated for frequency of perceptible grey discoloration. Success rates between the two cements were compared using the Fisher exact test. The frequencies of perceptible grey discoloration were compared using the chi-square test. The percentage difference was estimated by 95% confidence interval, and the level of significant difference was P < 0.05. RESULTS: At a mean follow-up of 32.2 ± 17.9 months, a total of 67 teeth, 37 with ProRoot MTA and 30 with Biodentine, were available for evaluation. The mean age of participants was 10 ± 2.1 years and, there were no differences in the baseline variables (gender, age, tooth type, periapical status, stage of root development, final restoration and follow-up period) between the groups. The overall success in both groups was 90%, with 92% for ProRoot MTA and 87% for Biodentine (difference, 5%; 95% confidence interval, -9% to 19%, P = 0.487), suggesting that Biodentine was noninferior to ProRoot MTA. Perceptible grey discoloration was observed in both groups, 80% for teeth treated with ProRoot MTA and 27% for teeth treated with Biodentine, with a significant difference between the materials (P < 0.001). CONCLUSIONS: Permanent teeth with signs and symptoms indicative of irreversible pulpitis in 6- to 18-year-old patients were successfully treated with partial pulpotomy using both cements. Biodentine exhibited significantly less frequency of discoloration than did ProRoot MTA.

Integrating the PILP-mineralization process into a restorative dental treatment.

The addition of charged polymers, like poly-aspartic acid (pAsp), to mineralizing solutions allows for transport of calcium and phosphate ions into the lumen of collagen fibrils and subsequent crystallization of oriented apatite crystals by the so-called Polymer-Induced Liquid Precursor (PILP) mineralization process, leading to the functional recovery of artificial dentin lesions by intrafibrillar mineralization of collagen. OBJECTIVE: To evaluate the feasibility of applying the PILP method as part of a restorative treatment and test for effectiveness to functionally remineralize artificial lesions in dentin. MATERIALS AND METHODS: Two methods of providing pAsp to standardized artificial lesions during a restorative procedure were applied: (A) pAsp was mixed into commercial RMGI (resin modified glass ionomer) cement formulations and (B) pAsp was added at high concentration (25mg/ml) in solution to rehydrate lesions before restoring with a RMGI cement. All specimens were immersed in simulated body fluid for two weeks to allow for remineralization and then analyzed for dehydration shrinkage, integrity of cement-dentin interface, degree of mineralization, and changes in the nanomechanical profile (E-modulus) across the lesion. RESULTS: After the remineralization treatment, lesion shrinkage was significantly reduced for all treatment groups compared to demineralized samples. Pores developed in RMGI when pAsp was added. A thin layer at the dentin-cement interface, rich in polymer formed possibly from a reaction between pAsp and the RMGI. When analyzed by SEM under vacuum, most lesions delaminated from the cement interface. EDS-analysis showed some but not full recovery of calcium and phosphorous levels for treatment groups that involved pAsp. Nanoindentations placed across the interface indicated improvement for RMGI containing 40% pAsp, and were significantly elevated when lesions were rehydrated with pAsp before being restored with RMGI. In particular the most demineralized outer zone recovered substantially in the elastic modulus, suggesting that functional remineralization has been initiated by pAsp delivery upon rehydration of air-dried demineralized dentin. In contrast, the effectiveness of the RMGI on functional remineralization of dentin was minimal when pAsp was absent. SIGNIFICANCE: Incorporation of pAsp into restorative treatments using RMGIs promises to be a feasible way to induce the PILP-mineralization process in a clinical setting and to repair the structure and properties of dentin damaged by the caries process.

Guided tooth preparation for a pediatric zirconia crown.

BACKGROUND AND OVERVIEW: Unesthetic primary incisors can produce negative self-perceptions in preschool-aged children. In recent years, because of increased esthetic demands, prefabricated zirconia crowns have become increasingly popular. However, zirconia crowns cannot be crimped, and the clinician must prepare the teeth to fit the zirconia crowns. Therefore, extended preparation and fitting times are necessary, especially for inexperienced practitioners. A 1- to 2-millimeter subgingival feather margin also is required. Gingival hemorrhage after subgingival preparation compromises the retention of zirconia crowns. CASE DESCRIPTION: In this clinical report, the author presents a step-by-step description of the clinical and laboratory procedures for restoring a discolored traumatized incisor with a zirconia crown. The author used a polyvinyl siloxane occlusal registration material as an impression material and made 2 identical casts. The author fabricated 3 reduction guides after prospective tooth preparation on the casts. The author rapidly prepared the discolored incisor with the reduction guides and ultrasonic burs. A zirconia crown provided an optimal esthetic result and gingival health. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Because the reduction guides provided a visibility intraorally, fast tooth reduction, less trial placement, and passive adaptation of the crown were successful. Because the ultrasonic burs prevented gingival injuries, hemorrhage control was not necessary. The presented technique reduced the patient's discomfort and total chair time. Therefore, this alternative technique is helpful for inexperienced practitioners.

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.

Comparative Evaluation of Marginal Adaptation of Biodentine(TM) and Other Commonly Used Root End Filling Materials-An Invitro Study.

AIM: The purpose of this investigation was to evaluate the marginal adaptation of three root-end filling materials Glass ionomer cement, Mineral trioxide aggregate and Biodentine(TM). METHODOLOGY: Thirty human single-rooted teeth were resected 3 mm from the apex. Root-end cavities were then prepared using an ultrasonic tip and filled with one of the following materials Glass ionomer cement (GIC), Mineral trioxide aggregate (MTA) and a bioactive cement Biodentine(TM). The apical portions of the roots were then sectioned to obtain three 1 mm thick transversal sections. Confocal laser scanning microscopy (CLSM) was used to determine area of gaps and adaptation of the root-end filling materials with the dentin. The Post hoc test, a multiple comparison test was used for statistical data analysis. RESULTS: Statistical analysis showed lowest marginal gaps (11143.42±967.753m2) and good marginal adaptation with Biodentine(TM) followed by MTA (22300.97±3068.883m(2)) and highest marginal gaps with GIC (33388.17±12155.903m(2)) which were statistically significant (p<0.0001). CONCLUSION: A new root end filling material Biodentine(TM) showed better marginal adaptation than commonly used root end filling materials.