Comparative Evaluation of the Mechanical and Physical Properties of Mineral Trioxide Aggregate vs. Bacterial Cellulose Nanocrystal-Reinforced Mineral Trioxide Aggregate: An In Vitro Study.

AIM: This study aims to compare and assess the compression strength, microhardness, and surface texture of two sets of materials: mineral trioxide aggregate (MTA) PlusTM and bacterial cellulose nanocrystal (BCNC)-reinforced MTA PlusTM. MATERIALS AND METHODS: According to the ASTM E384 standard, the cylindrical molds made of plexiglass with an internal diameter of 6 mm and a height of 4 mm were fabricated using computer numerical control laser cutting. A total of 20 samples (n=10) in each group were considered in this experimental study: Group I (control group) MTA PlusTM (Prevest DenPro Limited, India) and Group II (experimental group) BCNC (Vedayukt India Private Limited, India)-reinforced MTA PlusTM. After preparation, the molds were incubated at 37°C in a fully saturated condition for about 24 hours, and then the compression strength, microhardness, and scanning electron microscopy analyses were performed at different magnifications. The obtained data were then statistically analyzed. RESULTS: Quantitative analysis revealed that there is a statistically significant difference between MTA PlusTM and BCNC-reinforced MTA PlusTM  (p<0.002). The Wilcoxon signed-rank test and Mann-Whitney U-test revealed that BCNC-reinforced MTA PlusTM  showed significantly higher compression strength (33.80±3.83 MPa, p=0.00) and surface microhardness (642.85±24.00 µm, p=0.00) than the control group. CONCLUSION: Based on our findings, it was concluded that there is a statistically significant difference between both study groups. Thus, incorporating BCNC into the MTA PlusTM  significantly increased the compression strength and surface microhardness of the MTA PlusTM cement. CLINICAL SIGNIFICANCE: Numerous dental applications have been investigated for bacterial cellulose. Many benefits of bacterial cellulose are available, which include its effects on moldability, low cost, high water retention capacity, biocompatibility, and biodegradability. Furthermore, the addition of BCNC to MTA PlusTM  accelerates the material's hardening process and decreases its setting time, which in turn shortens clinical chairside procedural timing and thereby improves patient satisfaction.

The effects of mineral trioxide aggregate and second-generation autologous growth factor on pulpotomy via TNF-α and NF-kß/p65 pathways.

This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kß/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene's test, and the Shapiro-Wilk test on statistical software. A P value < 0.05 was considered significant. When compared with the control group, both MTAG and CGFG showed increased edematous and inflammatory areas. In MTAG, edematous and inflammatory areas decreased significantly from the 2nd week (2(2-2), 2(1-2)) to the 4th week (1(1-1), 1(0-1)), while in CGFG, edematous areas decreased (2(2-3), 1.5(1-2)), and inflammatory areas increased significantly (2(2-3), 3(2-2.5)). When compared with the control group, TNF-α and NF-kß/p65 positivity were higher in both MTAG and CGFG. In MTAG, TNF-α [2(1.5-2)] and NF-kß/p65 [1.5(1-2)] positivity decreased significantly from the 2nd week to the 4th week [TNF-α: 1(1-1), NF-kß/p65: 1(1-2)], while no significant change was observed in CGFG. In conclusion, this study revealed a reduction in cells showing TNF-α and NF-kß/p65 positivity in the MTA treatment group compared to the CGF group. Although MTA demonstrated more favorable results than CGF in mitigating pulpal inflammation within the scope of this study, further experimental and clinical investigations are warranted to obtain comprehensive data regarding CGF.

Innovative Pulp Preservation: The Use of Platelet-Rich Fibrin (PRF) and Mineral Trioxide Aggregate (MTA) in Treating Dental Pulp Exposure.

The dental pulp, essential for tooth vitality, often becomes inflamed when exposed due to caries, fractures, or dislodged restorations. Untreated inflammation can lead to pulpal death, necessitating vital pulp therapies (VPTs) such as pulp capping and pulpotomy. Recent trends favor partial caries removal to avoid overtreatment and preserve pulp health. This shift is illustrated through two cases of young female patients with dislodged restorations and deep caries. Both underwent direct pulp capping using platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA), followed by composite restorations. These cases underscore the importance of biocompatible materials like MTA and PRF in maintaining pulp vitality and promoting dental tissue repair.

Comparison of clinical outcomes between mineral trioxide aggregate and bioceramic materials in pulpotomy for treating early chronic pulpitis in deciduous teeth.

This study aims to elucidate the clinical efficacy of Mineral Trioxide Aggregate (MTA) and Bioceramic Materials in pulpotomy procedures for early-stage chronic pulpitis in deciduous teeth. The clinical data of 100 children with early chronic pulpitis in deciduous teeth treated at our institution between January 2021 and January 2023 were included retrospectively, which were divided into an experimental group (n = 50) and a control group (n = 50) according to the treatment methods. Experimental group received pulpotomy with Thera Cal LC as bioceramic pulp-capping material versus control group with MTA as pulp-capping agent. Comparative studies were conducted to assess the clinical effectiveness and differences between both pulp-capping techniques. At 12 months postoperatively, the experimental group showed a significantly higher success rate than the control group (96.00% vs. 80.00%, p < 0.05). Post-treatment inflammatory markers (Tumor Necrosis Factor-alpha (TNF-α), Interleukin-6 (IL-6) and Interleukin-8 (IL-8)) were substantially lower in the experimental group (p < 0.05). Furthermore, significantly lower pain scores and higher comfort and satisfaction scores were obtained in the experimental group (p < 0.05). Experimental group adverse reactions were also lower in the experimental group (p < 0.05). TheraCal LC bioceramic material treats early chronic pulpitis in deciduous teeth effectively. Clinically, it is an excellent therapeutic option for emergence of permanent dentition, pain relief, comfort and improvement of patient satisfaction.

Histological response of inflamed pulp to hydraulic calcium silicate cements in direct pulp capping: Systematic review of pulpitis models.

This systematic review aimed to compare the histological response of inflamed pulpodentinal complex to the hydraulic calcium silicate cements in experimental animal models of pulpitis. Articles that evaluated the histological response of inflamed pulp to mineral trioxide aggregate (MTA) in comparison with other restorative materials were selected and analysed in detail. The risk of bias assessment was conducted using SYRCLE's RoB tool. The GRADEpro tool was used to determine the overall quality of evidence. Out of the 2947 retrieved articles from databases, five articles fulfilled the inclusion criteria. MTA induced significantly more hard tissue formation compared to calcium hydroxide. The use of pulp-capping material containing fluocinolone acetonide and ASP/PLGA-ASP/ACP/PLLA-PLGA composite membrane was comparable. This systematic review could not demonstrate enhanced efficiency of capping materials compared to MTA. Future well-conducted animal studies are warranted for demonstrating the hard tissue formation abilities of pulp-capping materials with convenient inflammatory conditions.

Assessing the efficacy of Laser pulpotomy versus conventional pulpotomy in primary teeth: A systematic review and meta-analysis of clinical trials.

PURPOSE: This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment. METHODOLOGY: An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05. RESULTS: Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy. CONCLUSION: Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study.

AIM: This investigation aimed to observe the effects of Dycal, mineral trioxide aggregate (MTA), and TheraCal LC, as indirect pulp-capping materials in primary molars. MATERIALS AND METHODS: About 75 children with lower primary molars aged between 4 and 7 years suggested for IPC were selected and randomly allocated into: Group I - Dycal, group II - MTA, and group III - TheraCal LC. An immediate postoperative radiograph was taken after the procedure. Recall examination was done after 3 and 6 months for clinical and radiographic assessment. The radiographs were digitized, and the amount of thickness of dentin was assessed using Corel Draw software. The values were tabulated and subjected to paired t-tests and independent t-tests for intra and intergroup analysis, respectively. The p-value < 0.05 was considered statistically significant. RESULTS: There was a statistically significant increase in dentin thickness in the first 3 months compared to the 6-month follow-up. At the end of the research phase, TheraCal LC had more tertiary dentin deposited than MTA, followed by Dycal. CONCLUSION: TheraCal LC can be a reliable indirect pulp-capping agent in primary teeth. CLINICAL SIGNIFICANCE: Indirect pulp capping (IPC) is a very extensively employed treatment regimen to manage extensive caries. For many decades, calcium hydroxide has been regarded as the benchmark of pulp capping materials. With several advancements in materials for restoration, TheraCal LC a resin-modified, light-cured calcium silicate-filled liner serves as a pulp-capping agent and dentin protector, promoting pulp healing and preserving vitality as an obstacle cum protector of the dental pulp complex. How to cite this article: Thomas NA, Jobe J, Thimmaiah C, et al. Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study. J Contemp Dent Pract 2024;25(4):365-371.

Mineral trioxide aggregate in membrane form as a barrier membrane in guided bone regeneration.

Background/purpose: In the field of conservative dentistry and endodontics, mineral trioxide aggregate (MTA), commonly used, possesses advantages such as biocompatibility, antimicrobial properties and osteogenic potential. This study investigated the feasibility of utilizing membrane form mineral trioxide aggregate (MTA) as a barrier membrane in guided bone regeneration (GBR) procedures. Materials and methods: Membranes were electrospun from three different formulations: 15 w/v% Polycaprolactone (PCL), 13 w/v% PCL + 2 w/v% MTA (2MTA), and 11 w/v% PCL + 4 w/v% MTA (4MTA). Physicochemical and mechanical properties of the electrospun membrane were compared, encompassing parameters such as surface morphology, fiber diameter distribution, chemical composition, phase identification, tensile stress, pH variation, and water contact angle. Moreover, the antimicrobial properties against of the electrospun membranes were assessed through direct exposure to streptococcus aureus (S. aureus) and candida albicans (C. albicans). Additionally, on the 7th day, biocompatibility and cell attachment were investigated with respect to L929 (fibroblast) and MC3T3 (pre-osteoblast) cells. Inhibition of L929 cell infiltration and the expression of osteogenic related genes including osteocalcin (OCN), alkaline phosphatase (ALP), and runt related transcription factor 2 (RUNX2) in MC3T3 cells on 7th and 14th days were also investigated. Results: PCL, 2MTA, and 4MTA exhibited no statistically differences in fiber diameter distribution and tensile stress. However, as the MTA content increased, wettability and pH also increased. Due to the elevated pH, 4MTA demonstrated the lowest viability S.aureus and C.albicans. All membranes were highly biocompatibility and promoted cell attachment, while effectively preventing L929 cell infiltration. Lastly 4MTA showed increase in OCN, ALP, and RUNX2 expression on both 7th and 14th day. Conclusion: The membrane form MTA possessed characteristics essential for a novel barrier membrane.

Preserving Vitality: A Case Report of Partial Pulpotomy in Dental Practice.

This paper aims to evaluate the outcomes of a partial pulpotomy with mineral trioxide aggregate (MTA) in a maxillary first premolar with reversible pulpitis symptoms and signs. An intraoral periapical radiograph revealed a deep pulp-involving carious lesion without any indications of a periapical lesion, no history of night pain, and no tooth tenderness when percussion was applied. Caries removal is done using a round bur, 2-3 mm of inflamed pulp from the crown portion was removed, and bleeding was controlled within four minutes using 2.5% sodium hypochlorite, over which MTA was placed. After the setting of MTA, resin-modified glass ionomer cement was placed over it, and the tooth was restored using composite. The patient was asymptomatic in six months and one-year follow-up with no periapical changes and showed dentin bridge formation. Careful case selection, a precise selection of biomimetic material, and long-term follow-up validate the success of the treatment.

Repair of Iatrogenic Furcal Perforation With Mineral Trioxide Aggregate: A Case Report.

In endodontic and restorative procedures, an accidental perforation of the pulp chamber floor or roots presents a considerable risk, potentially leading to persistent inflammatory responses and ultimately tooth loss. Accidental root canal perforations are primary complications encountered by clinicians, requiring either surgical or non-surgical intervention, depending on the severity of the perforation. Over the years, various materials have been utilized for the treatment of such complications, but mineral trioxide aggregate (MTA) stands out prominently due to its exceptional biocompatibility, remarkable sealing capacity, and potent antibacterial properties. The unique ability of MTA to set in the presence of moisture facilitates the formation of a robust seal, thereby making it highly effective in managing root perforations and fostering tissue regeneration within the affected area. Its versatility and effectiveness have made MTA a cornerstone material in modern endodontic therapy, offering clinicians a reliable solution for enhancing the long-term prognosis of teeth affected by perforations.

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study.

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

The influence of bioceramic cements on the activity of macrophages of different lineages: a laboratory study.

INTRODUCTION: The repair process of periradicular tissues depends, among other factors, on the properties of endodontic cements. One of the main cells involved in this process are macrophages. MATERIALS AND METHODS: Murine peritoneal macrophages obtained from C57BL/6 (MBL6) and BALB/c (MBalb) mice, respectively, were cultured with capillaries containing or not Endosequence BC Sealer® (BC), Sealer Plus BC® (MK), Bio C Sealer (Ang) and MTA®. Cell viability was measured by trypan blue and MTT methods at 24, 48 and 72 hours. Cell adhesion, phagocytosis of S. boulardii, production of reactive oxygen species (ROS), nitric oxide (NO), and the cytokines TNF-α and TGF-ß, were also evaluated. The data were analysed using the ANOVA test (p<0.05). RESULTS: Cell viability was similar between bioceramic sealers and MTA (p>0.05). There was no statistical difference between both macrophages when adherence and phagocytose were assayed. The presence of inflammation stimulus significantly altered the production of ROS by MBL6 macrophages in contact with the cements. The production of TGF-ß was similar for both lineages of macrophages. CONCLUSIONS: This study shows that the evaluated bioceramic cements do not interfere with MBL6 and MBalb macrophages adhesion, phagocytic capacity, as well as TGF-ß production. The cements stimulated the production of ROS by MBL6 macrophages in response to induced inflammation, potentially favouring the elimination of residual pathogens.

Advanced Management of Open Apex Utilizing Platelet-Rich Fibrin and Bone Graft As Apical Barriers With Mineral Trioxide Aggregate (MTA) Obturation: A Detailed Case Report.

Management of open apex cases in endodontics poses a significant challenge, especially in immature teeth with necrotic pulps. Traditional apexification techniques have been the mainstay of treatment, aiming to induce the formation of a calcific barrier at the root apex. However, newer approaches incorporating biological materials such as platelet-rich fibrin (PRF) and demineralized bone matrix (DMBM) have emerged as promising alternatives. This article presents a case report of an 18-year-old male patient who presented with fractured upper central incisors, with the upper right central incisor displaying an open apex due to trauma sustained eight years prior. The treatment plan involved apexification using a combination of DMBM and PRF, with mineral trioxide aggregate (MTA) utilized as an apical barrier. The procedure was performed under rubber dam isolation, meticulously removing necrotic pulp tissue, irrigating with sodium hypochlorite solution, and placing a calcium hydroxide medicament. Subsequent visits included the placement of DMBM and PRF mixture into the canal space to create an apical barrier, followed by MTA placement and final restoration. Follow-up examinations at 3 and 12 months revealed the tooth to be asymptomatic and functionally normal, with radiographic evidence of osseous repair and complete apical closure. This case underscores the efficacy of a multimodal approach utilizing DMBM, PRF, and MTA in successfully managing open apex cases. Further research and long-term follow-up studies are warranted to validate this treatment modality's predictability and long-term success.

Apexogenesis of an Immature Permanent Molar with Irreversible Pulpitis Using Mineral Trioxide Aggregate Pulpotomy: A Case Report.

Carious exposure of an irreversibly inflamed vital pulp in a young permanent tooth presents a significant clinical challenge to clinicians to maintain the vitality. Direct pulp capping, partial pulpotomy, and complete pulpotomy are the available procedures to treat young permanent tooth. Mineral trioxide aggregate and biodentine are currently the material of choice for these procedures. The present case report describes the successful apexogenesis of mandibular left first permanent molar using mineral trioxide aggregate. The 18-month follow-up of the case demonstrated clinical and radiographic success with absence of any signs and symptoms and continued root formation.

From Crisis to Victory: Rescuing Root Canal Treatment With Bioactive Material in a Nail-Biting Case of Furcal Perforation.

This case report illustrates the successful treatment of an iatrogenic furcal perforation using mineral trioxide aggregate (MTA) and its reinforcement with fiber-reinforced composites (FRCs). Endodontic perforations, particularly in the furcal area, present unique challenges that demand effective management strategies. MTA, known for its multifaceted properties including osteoinductive activity and sealing capabilities, has emerged as the gold standard material for perforation repair. This case report demonstrates the application of MTA in repairing the perforation site following thorough cleaning and shaping of the root canals. Furthermore, the use of FRCs, specifically glass fiber-reinforced composite (GFRC), is introduced to reinforce the repaired site, enhancing its mechanical properties and long-term stability. The discussion emphasizes the importance of selecting appropriate materials for endodontic perforation repair and highlights the advantages of FRCs in preventing structural failures. Future directions suggest further research to refine FRC formulations and standardize clinical protocols to maximize treatment outcomes. This case report contributes valuable insights to the advancement of endodontic therapy, showcasing the combined benefits of MTA and FRCs in achieving favorable treatment outcomes for iatrogenic furcal perforations.

Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects.

Background and Objectives: The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods: The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results: A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions: Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics.

Immunohistochemical study of mixing mineral trioxide aggregate with hyaluronic acid as a pulp-capping agent in dog teeth.

Objective: The purpose of this study was to evaluate the immunohistochemical effect of hyaluronic acid (HA) on the mineralization rate of the reparative dentin when it is used as a mixing medium with mineral trioxide aggregate (MTA). Materials and Methods: Direct pulp capping (DPC) was performed on 90 teeth from 10 dogs that had been experimentally exposed. The exposed pulps were divided into three groups according to the mixing medium with MTA: Group I: MTA + distilled water (control group), Group II: MTA + hybrid cooperative complex HA (HCC-HA), Group III: MTA + high molecular weight HA (HMW-HA). After pulp capping, all cavities were restored with final restoration. The dogs were divided randomly into five groups (two dogs each) according to the evaluation periods (7, 14, 21, 30, and 60) days. At the end of the study, the dogs were euthanized, and the sampled teeth were processed for immunohistochemical investigation. Results: Both types of HA (HCC-HA, HMW-HA) showed an increase in the expression of alkaline phosphatase (ALP) at a higher rate than using distilled water with MTA. Conclusions: Within the limitations of this study, HA proved to be an effective additive to MTA for DPC.

Biological evaluation of novel phosphorylated pullulan-based calcium hydroxide formulations as direct pulp capping materials: An in vivo study on a rat model.

AIM: Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL-based CH formulations on rat molars after DPC. METHODOLOGY: This study consisted of six groups: CH with 1% PPL (CHPPL-1); 3% PPL (CHPPL-3); 5% PPL (CHPPL-5); Dycal and NEX MTA Cement (N-MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4-META/MMA-TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal-Wallis followed by Mann-Whitney U-test was performed with a significance level of 0.05. Immunohistochemical expression of IL-6, Nestin, and DMP-1 was observed. RESULTS: At day 1, CHPPL-1, N-MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC showed mild to moderate inflammation, and the results were significantly different (p < .05). At day 7, mild to moderate inflammation was observed in CHPPL-1, N-MTA, and Dycal, whereas CHPPL-3, CHPPL-5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL-1 and N-MTA with NC (p < .05), CHPPL-1 and CHPPL-3 with CHPPL-5 and Dycal (p < .05), and CHPPL-3 with N-MTA (p < .05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL-1, Dycal, and N-MTA showed no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p < .05). CHPPL-1, Dycal, and N-MTA exhibited continuous MTF, whilst CHPPL-3, CHPPL-5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL-1, CHPPL-3, and N-MTA with NC group (p < .05). Variable expressions of IL-6, Nestin, and DMP-1 indicated differences in the materials' impact on odontoblast-like cell formation and tissue mineralization. CONCLUSIONS: These findings suggest that CHPPL-1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement.

Comparative evaluation of the antibacterial efficacy of two experimental calcium silicate-based intracanal medicaments: An in-vitro study.

Introduction: Success of endodontic treatment relies on minimizing microbial load by chemo-mechanical preparation and intra-canal medication(ICM). Calcium hydroxide based ICMs have known disadvantages. Calcium silicate-based cements(CSC) exhibit antibacterial activity, thus promoting researchers to experiment with their formulations to use them as ICMs. Aim: Evaluation and comparison of the antimicrobial efficacy of two experimental CSC (MTA & Biodentine + 2%chlorhexidine) and Bio-C Temp against E.faecalis. Methods and Material: Test materials were divided into four groups namely Group1-Bio-C Temp, Group2-UltraCAL XS, Group3-Biodentine+2%CHX and Group4-MTA+2%CHX. Direct contact test was done by placing a standardized suspension of E.faecalis on test materials and bacterial growth was assessed spectrophotometrically using ELISA at one, three and seven days. Statistical Analysis: Data was analysed using one-way ANOVA, Tukey's multiple post hoc test and paired-t test. Results: Intragroup comparison revealed decreased mean optical density(OD) in groups 1, 2, and 4; no significant difference in group 3. Intergroup comparison showed statistical differences in mean OD values between groups (3 and 4); groups (1 and 2) at days one(p-0.018) and three(p-0.035), but no difference individually. Group 4 showed the highest antimicrobial efficacy on day seven. Conclusion: MTA+2%CHX & Biodentine+2%CHX showed better antimicrobial efficacy and hence could be used as potential ICMs.

Evaluation of various obturation techniques with bioceramic sealers in 3D-printed C-shaped canals.

This in vitro study compared various obturation techniques with bioceramic sealers for filling C-shaped 3D-printed replicas. A mandibular molar with a C-shaped root canal with a C1 configuration was obtained. After instrumenting with M3 Pro Gold files (United Dental, Shanghai, China) up to size #30/0.04, a CBCT scan of the tooth was taken. Sixty 3D-printed replicas of the tooth were created. The samples were obturated with EndoSeal TCS sealer (E. TCS; Maruchi, Wonju, Korea) or EndoSeal MTA (E. MTA; Maruchi, Wonju, Korea) (n = 30). The samples in each group were obturated with the following techniques (n = 10): (1) single-cone technique (SC), (2) SC with ultrasonic activation (UA), and (3) cold hydraulic compaction (CHC). Following incubation, the replicas' apical, middle, and coronal thirds were inspected under a digital microscope, and the proportion of filling material and void were calculated. Also, the obturation time and sealer extrusion were recorded. Data were analyzed using ANOVA, LSD post-hoc, and the chi-square tests (α = 0.05). The results indicated that in the apical third, E. TCS-SC, E. TCS-UA, and E. MTA-UA had the lowest void percentage among groups (p < 0.05). In the middle thirds, samples obturated with E. TCS-UA showed a significantly lower void percentage among all groups (p < 0.05). However, in the coronal third, E. TCS-CHC showed the least void percentage (p < 0.05), followed by E. TCS-UA and E. MTA-CHC. The E. TCS-SC and E. TCS-UA were the least time-consuming methods (p < 0.05). Sealer extrusion significantly differed among the groups, with E. MTA-UA and E. TCS-UA showing higher incidence (p = 0.019). It was concluded that E. TCS-UA was the most convenient obturation technique. However, care must be taken when obturating the canals with high flow and ultrasonic activation near the vital anatomical landmarks.