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Biocompatibility and Bioactivity of New Endodontic Materials

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (30 December 2020) | Viewed by 29885

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Prof. Dr. Francisco Javier Rodríguez Lozano

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Guest Editor

Special Care Dentistry and Gerodontology Unit, School of Dentistry, University of Murcia, 30100 Murcia, Spain
Interests: oral health; special care in dentistry; gerodontology; oral health and diseases
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

In dentistry, research on biocompatibility of new materials prior to their clinical application is much needed, as the compounds may potentially damage the surrounding tissues, stimulating adverse reactions including toxicity, allergy or carcinogenicity, ultimately affecting the tissue renewal process and leading to the development and/or maintenance of exacerbated inflammatory responses. Substantial developments in materials science have led to the formulation of novel, bioactive materials for use in endodontics. Calcium silicate-based materials have been widely studied due to their resemblance and similar applicability to mineral trioxide aggregate (MTA). As bioactive materials are assumed to directly interact with pulp and/or periapical cells, or through the diffusion of components within the living periradicular tissue, assessing their biocompatibility is critical to ascertain their potential influence on reparative/regenerative responses.

This Special Issue will focus on the biocompatibility and bioactivity of new endodontic materials and their impact on clinical practice. Full papers of original articles, communications, and review articles are all welcome.

Prof. Dr. Francisco Javier Rodríguez Lozano
Guest Editor

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Keywords

Biocompatibility
Cytotoxicity
Endodontics
Regenerative endodontics
Hydraulic cements
Calcium silicate-based materials
Bioactivity
Dental stem cells and endodontics
Mineral trioxide aggregate
Stem cells
Endodontic materials

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Published Papers (6 papers)

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Research

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9 pages, 1908 KiB

Open AccessArticle

Synthesis, Characterization, and Antibacterial Evaluation of a Cost-Effective Endodontic Sealer Based on Tricalcium Silicate-White Portland Cement

by Indra Primathena, Denny Nurdin, Hendra Hermawan and Arief Cahyanto

Materials 2021, 14(2), 417; https://doi.org/10.3390/ma14020417 - 15 Jan 2021

Cited by 3 | Viewed by 2704

Abstract

Mineral trioxide aggregate (MTA) is an ideal yet costly endodontic sealer material. Tricalcium silicate-white Portland cement (TS-WPC) seems to have similar characteristics to those of MTA. This work aims to characterize a modified TS-WPC and evaluate its antibacterial properties as a potential endodontic sealer material. The modified TS-WPC was synthesized from a 4:1 mixture of sterilized Indocement TS-WPC and bismuth trioxide using a simple solution method with 99.9% isopropanol. The mixture was stirred until it was homogenous, centrifuged, and dried. The material was then characterized using infrared spectroscopy, X-ray diffraction, and electron microscopy and subjected to antibacterial evaluation against Enterococcus faecalis using a Mueller–Hinton agar inhibition test. The results showed that the material was characterized by main functional groups of hydroxyls, silicate, bismuth trioxide, and tricalcium silicate, like those of a commercial MTA-based sealer, both tested after hydration. Modified TS-WPC before hydration showed similar powder morphology and size to the commercial one, indicating the ease of manipulation. Both materials exhibited antibacterial activity due to calcium dihydroxide’s ability to absorb carbon dioxide, which is essential for the anaerobic E. faecalis, with minimum inhibitory effect and bactericidal concentrations of 12,500 ppm and 25,000 ppm, respectively. The modified TS-WPC has the potential to become a cost-effective alternative endodontic sealer material. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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12 pages, 5332 KiB

Open AccessArticle

A Microstructure Insight of MTA Repair HP of Rapid Setting Capacity and Bioactive Response

by María Carmen Jiménez-Sánchez, Juan José Segura-Egea and Aránzazu Díaz-Cuenca

Materials 2020, 13(7), 1641; https://doi.org/10.3390/ma13071641 - 2 Apr 2020

Cited by 9 | Viewed by 3021

Abstract

Mineral trioxide aggregate (MTA) is considered a bioactive endodontic material, which promotes natural mineralization at the material-tooth tissue interface. MTA Repair HP stands out because of the short setting time and the quick and effective bioactive response in vitro. The bioactivity, depens on material composition and microstructure. This work is devoted to analyze MTA Repair HP microstructural features, of both the powder precursor and set material, to get insights into the material physicochemical parameters—functionality performance relationships. Transmission electron microscopy (TEM), and field emission gun scanning electron microscopy (FEG-SEM) coupled with energy-dispersive X-ray (EDX) analyses were performed. X-ray diffraction (XRD) measurements were carried out at different times to investigate setting process. Bioactivity evaluation in vitro was carried out by soaking the processed cement disk in simulated body fluid (SBF). The presented results point out those MTA Repair HP precursor material characteristics of tricalcium silicate particles of nanometric size and high aspect ratio, which provide an elevated surface area and maximized components dispersion of calcium silicate and very reactive calcium aluminate. The MTA Repair HP precursor powder nanostructure and formulation, allows a hydration process comprising silicate hydrate structures, which are very effective to achieve both fast setting and efficient bioactive response. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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11 pages, 3663 KiB

Open AccessArticle

In Vitro Evaluation of the Biological Effects of ACTIVA Kids BioACTIVE Restorative, Ionolux, and Riva Light Cure on Human Dental Pulp Stem Cells

by Sergio López-García, María P. Pecci-Lloret, Miguel R. Pecci-Lloret, Ricardo E. Oñate-Sánchez, David García-Bernal, Pablo Castelo-Baz, Francisco Javier Rodríguez-Lozano and Julia Guerrero-Gironés

Materials 2019, 12(22), 3694; https://doi.org/10.3390/ma12223694 - 8 Nov 2019

Cited by 25 | Viewed by 5231

Abstract

This study aimed to analyze the biological effects of three new bioactive materials on cell survival, migration, morphology, and attachment in vitro. ACTIVA Kids BioACTIVE Restorative (Pulpdent, Watertown, MA, USA) (Activa), Ionolux (Voco, Cuxhaven, Germany), and Riva Light Cure UV (SDI, Bayswater, Australia) (Riva) were handled and conditioned with a serum-free culture medium. Stem cells from human dental pulp (hDPSCs) were exposed to material extracts, and metabolic activity, cell migration, and cell morphology were evaluated. Cell adhesion to the different materials was analyzed by scanning electron microscopy (SEM). The chemical composition of the materials was evaluated by energy-dispersive X-ray (EDX). One-way analysis of variance followed by a Tukey test was performed (p < 0.05). Ionolux promoted a drastic reduction in metabolic activity and wound closure compared to the control (p < 0.05), whereas Activa induced adequate metabolic activity and cell migration. Moreover, SEM and immunofluorescence analysis showed abundant cells exposed to Activa. The materials showed different surface morphologies, and EDX spectra exhibited different peaks of C, O, Si, S, Ca, and F ions in glass ionomer cements. The results showed that Activa induced cell migration, cell attachment, and cell viability to a greater extent than Riva and Ionolux. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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12 pages, 7151 KiB

Open AccessArticle

Comparative Cytocompatibility and Mineralization Potential of Bio-C Sealer and TotalFill BC Sealer

by Sergio López-García, Miguel R. Pecci-Lloret, Julia Guerrero-Gironés, María P. Pecci-Lloret, Adrián Lozano, Carmen Llena, Francisco Javier Rodríguez-Lozano and Leopoldo Forner

Materials 2019, 12(19), 3087; https://doi.org/10.3390/ma12193087 - 22 Sep 2019

Cited by 61 | Viewed by 5829

Abstract

The aim of this study was to investigate the cytocompatibility and mineralization potential of two premixed hydraulic endodontic sealers compared with an epoxy resin-based root canal sealer. The cellular responses and mineralization capacity were studied in human periodontal ligament stem cells (hPDLSCs) that were exposed to premixed hydraulic sealers, Bio-C Sealer (Angelus, Londrína, PR, Brazil), TotalFill BC Sealer (FKG Dentaire SA, La-Chaux-de-fonds, Switzerland) and an epoxy resin-based material, AH Plus (Dentsply De Trey, Konstanz, Germany). Non-exposed cultures served as the control. The endodontic sealers were assessed using scanning electron microscopy (SEM) and energy dispersive X-ray microanalysis (EDX). Statistical analyses were done using Analisis of Variance (ANOVA), with Bonferroni adjusted pairwise comparison (p = 0.05). AH Plus reduced cell viability and cell migration, whereas increased cell viability and cell migration were observed in the Bio-C Sealer and the TotalFill BC Sealer (p < 0.05). The lowest cell attachment and spreading were observed for all concentrations of AH Plus, whereas the highest were observed for TotalFill BC Sealer. At the end of 21 days, only the Bio-C Sealer and the TotalFill BC Sealer supported matrix mineralization (p < 0.05). Additionally, SEM-EDX revealed high content of calcium, oxygen, and silicon in the Bio-C Sealer and the TotalFill BC Sealer. Based on the results from this study, Bio-C Sealer and TotalFill BC Sealer demonstrated better cytocompatibility in terms of cell viability, migration, cell morphology, cell attachment, and mineralization capacity than AH Plus. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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Review

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51 pages, 2625 KiB

Open AccessReview

Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents towards Human Tooth-Pulp Cells: A Systematic Review of In-Vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials

by Mariano S. Pedano, Xin Li, Kumiko Yoshihara, Kirsten Van Landuyt and Bart Van Meerbeek

Materials 2020, 13(12), 2670; https://doi.org/10.3390/ma13122670 - 12 Jun 2020

Cited by 57 | Viewed by 7767

Abstract

Background. In the era of biology-driven endodontics, vital pulp therapies are regaining popularity as a valid clinical option to postpone root-canal treatment. In this sense, many different materials are available in the market for pulp-capping purposes. Objectives. The main aim of this systematic review and meta-analysis was to examine literature regarding cytotoxicity and bioactivity of pulp-capping agents by exposure of human dental pulp cells of primary origin to these materials. A secondary objective was to evaluate the inflammatory reaction and reparative dentin-bridge formation induced by the different pulp-capping agents on human pulp tissue. Data sources. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 May 2020. No filters or language restrictions were initially applied. Two researchers independently selected the studies and extracted the data. Study selection included eligibility criteria, participants and interventions, study appraisal and synthesis methods. In vitro studies were included when human dental pulp cells of primary origin were (in) directly exposed to pulp-capping agents. Parallel or split-mouth randomized or controlled clinical trials (RCT or CCT) were selected to investigate the effects of different pulp-capping agents on the inflammation and reparative bridge-formation capacity of human pulp tissue. Data were synthesized via odds ratios (95% confidence interval) with fixed or random effects models, depending on the homogeneity of the studies. The relative risks (95% confidence interval) were presented for the sake of interpretation. Results. In total, 26 in vitro and 30 in vivo studies were included in the systematic review and meta-analysis, respectively. The qualitative analysis of in vitro data suggested that resin-free hydraulic calcium-silicate cements promote cell viability and bioactivity towards human dental pulp cells better than resin-based calcium-silicate cements, glass ionomers and calcium-hydroxide cements. The meta-analysis of the in vivo studies indicated that calcium-hydroxide powder/saline promotes reparative bridge formation better than the popular commercial resin-free calcium-silicate cement Pro-Root MTA (Dentsply-Sirona), although the difference was borderline non-significant (p = 0.06), and better than calcium-hydroxide cements (p < 0.0001). Moreover, resin-free pulp-capping agents fostered the formation of a complete reparative bridge better than resin-based materials (p < 0.001). On the other hand, no difference was found among the different materials tested regarding the inflammatory effect provoked at human pulp tissue. Conclusions. Calcium-hydroxide (CH) powder and Pro-Root MTA (Dentsply-Sirona) have shown excellent biocompatibility in vitro and in vivo when tested on human cells and teeth. Their use after many years of research and clinical experience seems safe and proven for vital pulp therapy in healthy individuals, given that an aseptic environment (rubber dam isolation) is provided. Although in vitro evidence suggests that most modern hydraulic calcium-silicate cements promote bioactivity when exposed to human dental pulp cells, care should be taken when these new materials are clinically applied in patients, as small changes in their composition might have big consequences on their clinical efficacy. Key findings (clinical significance). Pure calcium-hydroxide powder/saline and the commercial resin-free hydraulic calcium-silicate cement Pro-Root MTA (Dentsply-Sirona) are the best options to provide a complete reparative bridge upon vital pulp therapy. Systematic review registration number. PROSPERO registration number: CRD42020164374. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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15 pages, 1093 KiB

Open AccessReview

Viability and Stimulation of Human Stem Cells from the Apical Papilla (hSCAPs) Induced by Silicate-Based Materials for Their Potential Use in Regenerative Endodontics: A Systematic Review

by José Luis Sanz, Leopoldo Forner, Alicia Almudéver, Julia Guerrero-Gironés and Carmen Llena

Materials 2020, 13(4), 974; https://doi.org/10.3390/ma13040974 - 21 Feb 2020

Cited by 31 | Viewed by 4035

Abstract

Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the deposition of mineralized tissue, resulting in an advancement from traditional apexification procedures to a regenerative endodontic treatment (RET) for non-vital immature permanent teeth. Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements, emerged as bright candidates for their use in RET as coronal barriers, sealing the previously induced blood clot scaffold. Human stem cells from the apical papilla (hSCAPs) surviving the infection may induce or at least be partially responsible for the regeneration or repair shown in RET. The aim of this study is to present a qualitative synthesis of available literature consisting of in vitro assays which analyzed the viability and stimulation of hSCAPs induced by silicate-based hydraulic biomaterials. A systematic electronic search was carried out in Medline, Scopus, Embase, Web of Science, Cochrane and SciELO databases, followed by a study selection, data extraction, and quality assessment following the PRISMA protocol. In vitro studies assessing the viability, proliferation, and/or differentiation of hSCAPs as well as their mineralization potential and/or osteogenic, odontogenic, cementogenic and/or angiogenic marker expression in contact with commercially available silicate-based materials were included in the present review. The search identified 73 preliminary references, of which 10 resulted to be eligible for qualitative synthesis. The modal materials studied were ProRoot MTA and Biodentine. Both bioceramic materials showed significant positive results when compared to a control for hSCAP cell viability, migration, and proliferation assays; a significant up-regulation of hSCAP odontogenic/osteogenic marker (ALP, DSPP, BSP, Runx2, OCN, OSX), angiogenic growth factor (VEGFA, FIGF) and pro-inflammatory cytokine (IL-1α, IL-1β, IL-6, TNF-α) expression; and a significant increase in hSCAP mineralized nodule formation assessed by Alizarin Red staining. Commercially available silicate-based materials considered in the present review can potentially induce mineralization and odontogenic/osteogenic differentiation of hSCAPs, thus prompting their use in regenerative endodontic procedures. Full article

(This article belongs to the Special Issue Biocompatibility and Bioactivity of New Endodontic Materials)

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