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To investigate the effect of calcium hydroxide intracanal medicament on the push-out bond strength of resin-based and calcium silicate-based endodontic sealers.A comprehensive search of was conducted for all relevant in-vitro studies. All randomized controlled in-vitro studies that evaluated the effect of calcium hydroxide on the push-out bond strength of resin-based or calcium silicate-based endodontic sealers were assessed. The variables of interest were extracted, and the risk of the included studies was evaluated. The standardized mean difference was calculated and the significance level was set at p value0.05.A total of 26 studies were eligible for analysis. There were 45 independent comparison groups and 1009 recruited teeth. The pooled data showed no significant difference in push-out bond strength between calcium hydroxide and control group in the resin-based group (SMD = 0.03; 95% CI = -0.55, 0.60; p = 0.93), and calcium silicate-based group (SMD = 0.02; 95% CI = -0.31, 0.35; p = 0.90). Most of the studies (21 out of 26) were at medium risk of bias and five studies showed a low risk of bias.The available evidence suggests that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of the resin- and calcium silicate-based endodontic sealers.The results of this meta-analysis suggest that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of resin-based and calcium silicate-based endodontic sealers.

The purpose of this study was to compare the antibacterial effects of Allium sativum (garlic extract), calcium hydroxide (Ca [OH]This prospective double-blind, controlled, parallel, superiority, randomized clinical trial was carried out on 66 permanent, necrotic incisors associated with asymptomatic apical periodontitis in 66 male patients. Patients were randomly divided into three groups (n = 22) according to the intracanal medications used. After access preparation, four microbiological samples (S) were taken using sterile absorbent paper points as follows: S1: before canal instrumentation and S2: after cleaning and shaping. The third sample (S3) and fourth sample (S4) were taken after the placement of the tested intracanal medications into their corresponding canals for 7 and 14 days, respectively. Total DNA was extracted from microbiological samples and relative quantitative real-time PCRs were done to quantify the relative gene expression fold change (FC) for Enterococcus faecalis and Streptococcus species. At significance level p ≤ .05, the data were statistically analysed in SPSS software using Kruskal-Wallis and Freidman's tests, followed by Dunn-Bonferroni post hoc test for pairwise comparisons.Both bacterial mean FC decreased significantly after mechanical instrumentation (S1 to S2) in all groups. However, no statistically significant differences were found after intracanal medicament placement (from S2 to S3 and from S3 to S4) except in the garlic group. Garlic significantly reduced Enterococcus faecalis FC in S3 and S4 when compared to Ca (OH)Within the study limitations, garlic intracanal medicament has a comparable anti-Streptococcus efficiency to Ca (OH)

Objectives This study compared and evaluated the clinical and radiographic efficacy of non‐instrumentation triple antibiotic paste pulp therapy and Vitapex pulpectomy in non‐vital primary molars. Material and Methods Healthy, 5–9 years old children with at least one non‐vital primary molar were included in the study. Molars were divided into two groups based on the subject's cooperation level. In the first group, molars received triple antibiotic paste, and a second group received Vitapex pulpectomy followed by a stainless‐steel crown. Triple antibiotic paste was freshly prepared and proportioned in equal parts by volume (metronidazole, minocycline, and ciprofloxacin = 1:1:1) before the scheduled treatment. A clinical and radiographic examination was performed by two trained and calibrated pediatric dentists at the pre‐operative baseline and the 6‐ and 12‐month follow‐up visits. Results A total of 28 molars received triple antibiotic paste pulp therapy and 20 received Vitapex pulpectomy. At the 6‐month follow‐up, the success rate among the molars in the triple antibiotic paste group was clinically (92.85%) and radiographically (85.71%) higher compared to the Vitapex group (91.67%, 62.50% respectively) with p = 0.89 and 0.55 respectively. At the 12‐month follow‐up, the molars in the triple antibiotic paste group showed lower clinical (95.45%) but higher radiographic success rate (72.73%) compared to the Vitapex group (100% and 62.50%) with (p = 0.85 and 0.47) respectively. None of the differences were statistically significant. Conclusions Both triple antibiotic paste and Vitapex can be clinically and radiographically effective in treating non‐vital primary molars.

This study evaluated the effect of different protocols for Ca(OH)2 removal on the bond strength (BS) of epoxy resin-based sealer in long oval root canals. Forty-eight mandibular incisors with long oval root canals were selected by CBCT. Biomechanical preparation was performed, the samples were filled with Ca(OH)2 paste and distributed in four groups (n = 12): G-without Ca(OH)2 paste (C); G2-syringe/needle (SN); G3-SN + XP-Endo® Finisher (XPF); G4-SN + passive ultrasonic irrigation (PUI). After 7 days, Ca(OH)2 was removed and teeth were filled using AHPlus and guttapercha. In four samples from each group, the sealer was manipulated with 0.1% rhodamine to assess sealer penetration by fluorescent laser confocal microscopy (FLCM). Samples were sectioned in slices for BS, scanning electron microscopy, and FLCM analysis. The BS data were analyzed by ANOVA and Tukey tests (α = 0.05). The lowest BS values were found for the SN group (12.89 ± 4.36) compared to C (35.55 ± 10.05), while PUI group presented intermediate values (28.57 ± 9.35) and the XPF group (31.34 ± 9.8) showed values that were sometimes similar to C group and sometimes similar to PUI group (p > .05). The analysis of the adhesive interface showed evident gaps, with the presence of residues between the dentin and the filling material for the SN group, and for C, XPF and PUI groups juxtaposed adhesive interface. FLCM images showed sealer penetration in the dentinal tubules along the entire perimeter for C, XPF, and PUI groups. Ca(OH)2 removal with XPF and PUI from long oval root canals resulted in higher bond strength values compared to SN, besides better sealer penetration on dentinal tubules and juxtaposed adhesive interface.

Aim To develop a formulation in which calcium hydroxide (Ca(OH)₂) was successfully loaded into poly(lactic-co-glycolic acid) (PLGA) biodegradable nanoparticles (NPs) to be used in the field of endodontics as an intracanal medicament, including NP optimization and characterization, plus drug release profile of the NPs compared with free Ca(OH)₂. Additionally, the depth and area of penetration of the NPs inside the dentinal tubules of extracted teeth were compared with those of the free Ca(OH)₂. Methodology Ca(OH)₂ NPs were prepared using the solvent displacement method. NPs was optimized with a central composite design to obtain a final optimized formulation. The morphology of the NPs was examined under transmission electron microscopy (TEM), and characterization was carried out using X-ray diffraction (XRD), Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC). The drug release profile of the Ca(OH)₂ NPs and free Ca(OH)₂ was evaluated up to 48 h. Finally, the depth and area of penetration inside the dentinal tubules of extracted teeth were examined for both the Ca(OH)₂ NPs and free Ca(OH)₂ using the Mann-Whitney U test to determine any significant differences. Results Utilizing the optimized formulation, the Ca(OH)₂ NPs had an average size below 200 nm and polydispersity index lower than 0.2, along with a highly negative zeta potential and suitable entrapment efficiency percentage. The spherical morphology of the Ca(OH)₂ NPs was confirmed using TEM. The results of the XRD, FTIR and DSC revealed no interactions and confirmed that the drug was encapsulated inside the NPs. The drug release profile of the Ca(OH)₂ NPs exhibited a prolonged steady release that remained stable up to 48 h with higher concentrations than the free Ca(OH)₂. After examination by confocal laser scanning microscopy, Ca(OH)₂ NPs had a significantly greater depth and area of penetration inside dentinal tubules compared with the free drug. Conclusions Ca(OH)₂-loaded PLGA NPs were successfully optimized and characterized. The NPs exhibited a prolonged drug release profile and superior penetration inside dentinal tubules of extracted teeth when compared to Ca(OH)2 .

This study aimed to evaluate the effect of direct pulp capping on the expression of erythropoietin (Epo) and Epo-receptor (Epor) genes in relation to the expression of inflammatory and osteogenic genes in rat pulp. Dental pulps of the first maxillary molars of Wistar Albino rats were exposed and capped with either calcium hydroxide or mineral trioxide aggregate, or were left untreated. After 4 wk, animals were euthanized, and maxillae were prepared for histological and real-time polymerase chain reaction analysis. Histological scores of pulp inflammation and mineralization, and relative expressions of Epo, Epor, inflammatory cytokines, and pulp osteogenic genes were evaluated. The capped pulps showed higher expressions of Epo, while the untreated pulps had the highest expression of Epor. Both calcium hydroxide and mineral trioxide aggregate downregulated the expression of tumor necrosis factor alpha compared to untreated controls, and upregulated transforming growth factor beta compared to healthy controls. Alkaline phosphatase expression was significantly higher in experimental groups. Relative expression of Epo negatively correlated with pulp inflammation, and positively correlated with pulp mineralization. Pulp exposure promoted expression of Epor and pro-inflammatory cytokines, while pulp capping promoted expression of Epo, alkaline phosphatase, and downregulated Epor and pro-inflammatory cytokines.

Background: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. Objectives: The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. Methods: We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis. Results: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. Discussion: This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results. Conclusion: The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. Registration: PROSPERO (CRD42021266350), PRISMA-2020 checklist, PRISMA-S checklist, full search documentation including database accession numbers of records found and details of RoB-assessment are publicly available from a research data repository (DOI: 10.5283/epub.52428): https://doi.org/10.5283/epub.52428

OBJECTIVE To evaluate the effectiveness of two different therapies on oral lichen planus (OLP) treatment through the analysis of OLP symptoms and signs and to analyze the risk of side effects related to the adopted protocols. METHODS Thirty-eight patients with OLP were selected according to van der Meij and van der Waal clinical and histopathological criteria. Through a randomized design, 19 patients received Tacrolimus 0.1% ointment (T group) and 19 an anti-inflammatory mouthwash (M group) composed of calcium hydroxide 10%, hyaluronic acid 0.3%, umbelliferone, and oligomeric proanthocyanidins. The patients were examined on a regular basis for OLP symptoms, signs, and disease severity score changes over a 3-month follow-up period. RESULTS Both treatments were effective in the reduction of OLP signs and symptoms. However, at 3 months (T3), in comparison with the M group, T group patients showed significantly lower mean values of OLP signs (p = 0.035), symptoms (p = 0.045), and disease severity scores (p = 0.041). Moreover, the Spearman test showed that there was a significant correlation between OLP signs and symptoms at each follow-up session in all patients. CONCLUSIONS Both treatments demonstrated a significant approach to control OLP. However, tacrolimus determined a more effective improvement in OLP signs and symptoms compared to anti-inflammatory mouthwash at 3-month follow-up.

The cytotoxic and genotoxic effects of commercial endodontic sealers (AH Plus, Sealer 26 and Endomethasone N) incorporated with nanostructured silver vanadate decorated with silver nanoparticles (AgVO3 - at concentrations 2.5, 5, and 10%) on human gingival fibroblast (HGF), and the silver (Ag+ ) and vanadium (V4+ /V5+ ) ions release were evaluated. Cytotoxicity, cell death, and genotoxicity tests were carried out with extract samples of 24-hr and 7-days. The release of Ag+ and V4+ /V5+ was evaluated. Cytotoxicity in HGF was caused by AH Plus (AP) with 5 and 10% of AgVO3 (83.84 and 67.49% cell viability, respectively) with 24-hr extract (p

This study compared the biological effect of Hesperidin, Mineral Trioxide Aggregate (MTA)‐Angelus and calcium hydroxide for direct pulp capping. A total of 126 dogs(,) teeth were divided according to the post‐treatment evaluation period into three groups (42 teeth each), group I: 2 weeks, group II: 4 weeks and group III: 8 weeks. Each group was further subdivided according to the pulp capping material into three subgroups (14 teeth each), subgroup A (Hesperidin), subgroup B (MTA‐Angelus) and subgroup C (Dycal). Both inflammatory response and dentine bridge formation were assessed by histopathology. All data were statistically analysed. Resolution of the inflammation was recorded by the time with a significant difference between subgroups within the same group (P .05). Absence of complete or partial calcified bridge with no odontoblastic layer was reported in all subgroups at 2 weeks while at 4 weeks, the majority of samples in Hesperidin and MTA subgroups showed amorphous calcified deposit. At 8 weeks, there was no significant difference (P > .05) between subgroups except that 78.5% and 92.9% of Hesperidin and MTA‐Angelus samples, respectively, showed moderate dentine bridge. Also, 78.5% of Hesperidin and Dycal samples revealed moderately thick dentine bridge while 78.7% of MTA‐Angelus showed a thin dentine bridge with a significant difference between them (P

The aim of this article was to investigate the unknown radiopacity performances of OrthoMTA and RetroMTA via means of a contemporary image analyzing methods and energy dispersive X-ray spectroscopy. Three commercial hydraulic calcium silicate-based cements and a calcium hydroxide-based paste were used. Pure-grade zirconium oxide, bismuth oxide, zinc oxide, barium sulfate, and calcium hydroxide were as references. An energy-dispersive X-ray spectroscopy instrument was used for the elemental analysis. Radiographic image data was obtained according to the International Organization for Standardization 6876-2012 specifications. The region of interest was determined for each specimen. Mean (±SD) grey values of the X-ray image data was measured with an image analyzing software. The calibration curve was created by curve-plotting software and the mean grey-values were matched versus Al values (mm Al). Data were analyzed with one-way ANOVA followed by Tukey's multiple comparison test. Spectroscopic characterization of the commercial materials was shown with assigned Carbon, oxygen, aluminum, silicon, calcium, zinc, zirconium, barium, tungsten, bismuth, and sulfur elements. The major radiopacifier/s of OrthoMTA is Bi, of RetroMTA is Zr, of BioDentine are Ba and Zr, and of ProCal is Ba. The radiopacity values of all commercial materials are significantly different (p .05). The rank of the radiopacity values: RetroMTA (3.36 ± 0.29mmAl) OrthoMTA (2.56 ± 0.19mmAl) BioDentine (2.02 ± 0.12mmAl) ProCal (1.46 ± 0.60mmAl). The study reported that the radiopacity values and spectral characterization of RetroMTA and OrthoMTA cements. The pixel-based and reproducible method could be used universally to the quantification of the radiodensity of digitally collected X-ray data.

Background This study investigates the influence of insulin on pulp tissue healing after pulp capping in diabetic dogs. Methods Diabetes mellitus was induced in four dogs, and their blood glucose levels were adjusted by insulin to normoglycemic level in two dogs (normoglycemic group) and to hyperglycemic level in two dogs (hyperglycemic group). Class V buccal cavities were performed in 15 teeth in each diabetic dog and two normal dogs (control group). The three groups (30 teeth each) were divided according to the capping materials into three subgroups (10 teeth each) including: subgroup A - mineral trioxide aggregate (MTA), subgroup B - bioaggregate (BA), and subgroup C - calcium hydroxide (Ca(OH)2 ). Each subgroup was divided into two subdivisions according to the evaluation period, subdivision 1: 1 month and subdivision 2: 2 months. Qualitative and quantitative evaluations of the inflammation and dentine bridge formation were assessed histologically. Results The hyperglycemic diabetic group exhibited significant higher inflammatory cell count and scores and lower dentine bridge thickness than those of the normoglycemic diabetic and control groups (P .05). Conclusion Insulin has favourable effects on the pulp tissue healing after pulp capping in diabetic dogs.

To compare the fracture strength of extracted human roots with apical plugs of mineral trioxide aggregate (MTA) mixed with either Ca- and Mg-free phosphate-buffered saline (PBS) or water, with and without calcium hydroxide (CH) canal pre-medication.A total of 180 single-rooted human teeth were prepared to resemble immature roots and divided into groups (n = 20). The negative control received canal irrigation only, and the positive control received intracanal treatment with CH for either two or twelve weeks. MTA mixed with water was used in Group 1: (i) without CH pre-medication - MTA(W); (ii) after 2 weeks CH pre-medication - 2/52CH + MTA(W); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(W). MTA mixed with PBS was used in Group 2: (i) without CH pre-medication - MTA(PBS); (ii) after 2-week CH pre-medication - 2/52CH + MTA(PBS); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(PBS). A compressive force was applied to each root until the point of fracture. The results were analysed by the Kruskal-Wallis and Dunn's multiple comparisons tests (P 0.05).There was no significant difference between groups MTA(W), MTA(PBS) and 2/52CH + MTA(PBS), and all three groups were significantly (P 0.01, P 0.05 and P 0.05, respectively) more resistant to fracture than the negative control. Within Group 1, the samples that received two- (P 0.01) and twelve-week (P 0.001) CH pre-treatment were more prone to fracture than those which did not. No difference was found amongst the control groups. The roots of the MTA(PBS) group had a higher dependability (P 0.05) than the MTA(W) group when compared by the Weibull modulus. The difference was also present when a 2-week CH pre-medication was used.Mineral trioxide aggregate mixed with Ca- and Mg-free phosphate-buffered saline had a significant strengthening effect on the fracture resistance of structurally weak roots, even when short-term calcium hydroxide pre-medication had been used. MTA mixed with water lost its strengthening effect on human roots when 2- or 12-week CH pre-treatment had been used. Use of CH dressing for up to 12 weeks had no negative effect on fracture resistance of human roots.

The response of the dentin-pulp complex in rat teeth was investigated after direct capping with biodentine with or without bone marrow-derived stem cells (BMDSCs). Following mechanical exposure, pulps were randomly capped with one of the followings materials: calcium hydroxide, biodentine or 1 × 105 BMDSCs mL-1 + biodentine. Histological examination was performed by light microscopy after 1, 3 and 5 weeks. Inflammatory reaction, necrotic tissue formation and calcific bridge formation were scored. Analysis showed that compared with the effects of calcium hydroxide or biodentine, BMDSCs + biodentine substantially reduced inflammatory reaction and necrotic tissue while promoting calcified tissue formation. Therefore, the combination of biodentine and BMDSCs could potentially stimulate pulp tissue regeneration after direct pulp capping.

AIM: To evaluate the efficacy of a prototype root canal dressing containing surface pre-reacted glass-ionomer (S-PRG) fillers on repairing induced periapical lesions in a rat model. Calcium hydroxide [Ca(OH)2 ] was applied as a comparison in the healing process. METHODOLOGY: The pulp chambers of the maxillary first molars in 64 male Wistar rats aged 16 weeks were opened to induce periapical lesions. After 28 days, the mesial canal of each tooth was prepared, irrigated with 2.5% sodium hypochlorite (NaOCl) only (control group: irrigation) or followed by the respective dressing [Ca(OH)2 group, irrigation + Ca(OH)2 ; S-PRG group, irrigation + S-PRG], and restored with composite resin for 3 or 7 days (10/group). Four rats with healthy molars were used as blank controls. Descriptive analysis of the periapical radiographs, haematoxylin and eosin staining, and immunohistochemical observation were performed 3 and 7 days after treatment. The periapical gray value, CD68 macrophages, and osteoclasts (cathepsin-K) were quantified and statistically analyzed with Tukey's honest significant difference test. A significant difference was achieved when p values were

To investigate intrinsic physicochemical properties and interactions of three different calcium hydroxide-based medications via means of different analytical methods. Two-commercial premixed medications: TempCanal(TCmx) and ProCalR(PCmx) and powder-form ProCal(PCpw) with glycerin were used. Vibrational modes were analyzed using Raman spectroscopy. Spectral mapping of samples was carried out using characteristic vibrational modes of calcium hydroxide and barium sulfate. Crystalline and amorphous phases were studied with X-rays powder diffraction analysis. Topographic features were examined by scanning electron microscope examination and quantitative analysis was determined using energy-dispersive X-ray spectroscopy analysis. Strong OH stretch of in Raman spectra were observed at 3,697 and 3,615 cm-1 for TCmx and reference, respectively. However, OH mode was not observed for PCmx and PCpw. Moreover, some peaks in the fingerprint areas of TCmx and PCpw overlapped with each other. The characteristic vibration bands of barium sulfate and calcium hydroxide were observed in all samples, and no new peak was observed in the Raman spectra of samples. Calcium hydroxide-based medications were seen as differed in their chemical composition. No new crystalline or amorphous phase peak was observed. Only calcium hydroxide and barium sulfate were matched in X-rays powder-diffraction analysis. Energy-dispersive X-ray spectroscopy analysis showed that amount of Ba and S elements in the PCpw were lower than TCmx and PCmx whereas, for Ca in the PCpw was higher than TCmx and PCmx. The present study revealed the structural difference among different forms of calcium hydroxide-based medications. The vehicle and substrates of the tested medications altered the physicochemical properties of the compound via electrostatic interactions.

This study compared the ultrastructure, chemical composition, and proteases activity (PA) of sound (SD) and caries-affected dentin (CAD) in the dentin hybrid layer after using an experimental bonding system containing pyromellitic dianhydride glycerol methacrylate and biomimetic analogs. The bonding system used a three step and a total-etch procedure. Polyacrylic acid (5%) and sodium trimetaphosphate (5%) were added to the primer and monocalcium phosphate monohydrate (9%), beta-tricalcium phosphate (10.5%), and calcium hydroxide (0.5%) were added to the adhesive. Transmission electron microscopy (TEM) was used to evaluate the resultant structure, particularly the adhesive-dentin and the demineralized-SD interfaces. The chemical composition was evaluated through energy-dispersive X-ray spectroscopy (EDS) and selected area electron diffraction (SAED). The PA was measured with the Coomassie Blue-G250 coloring test, and the PA data were analyzed by ANOVA. EDS identified the presence of isolated calcium phosphate nanoparticles in the demineralized region; however, the SAED analysis did not show any evidences of hydroxyapatite (HA) neoformation in SD and CAD. The biomimetic analog-based adhesive system inhibited the activities of dentin proteases immediately after treatment. Additionally, the proteolytic activity on the affected dentin resembled that of the SD. In conclusion, no HA formed in the demineralized SD and CAD although there were calcium and phosphate deposits. The experimental adhesive system inhibited dentin proteases. The present study uses a new approach to investigate the hybrid layer behavior in dentin. The experimental adhesive system was synthesized and used on sound and affected-caries dentin as the substrate to reproduce real clinical conditions.

This study aims to identify the optimal concentrations of triple antibiotic paste (TAP), modified triple antibiotic paste (mTAP) and double antibiotic paste (DAP) that could completely eradicate Enterococcus faecalis in dentinal tubules. One hundred and ninety extracted human premolars inoculated with E. faecalis were medicated with calcium hydroxide and mixed antibiotic pastes (TAP, mTAP and DAP at 0.1, 1.25, 5, 10 and 20 mg mL-1 of each drug) for seven days before being frozen, pulverised and cultured. Specimens treated with the lowest concentration of the mixed antibiotics capable of eradicating E. faecalis were examined using scanning electron and confocal laser scanning microscopy to confirm the eradication of the microbial. TAP at 10 mg mL-1 of each drug was able to completely eliminate bacteria inside dentinal tubules, whereas mTAP and DAP required 20 mg mL-1 of each drug. Calcium hydroxide was not effective in eradicating E. faecalis inside dentinal tubules.

AIM To evaluate the in vitro effect of the novel adhesive monomer CMET, a calcium salt of 4-methacryloxyethyl trimellitate (4-MET), on the proliferation, mineralization and differentiation of odontoblast-like cells, comparing with 4-MET, calcium hydroxide (CH) and mineral trioxide aggregate (MTA). METHODOLOGY Rat odontoblast-like MDPC-23 cells were cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with 5% foetal bovine serum. The powder of four tested materials (CMET, 4-MET, CH and MTA) was first dissolved in distilled water (dH2O) and then was diluted by DMEM to yield final concentrations. Solvent (dH2O) was used as a control. Cell viability was assessed using CCK-8 assay. Real-time RT-PCR was used to quantify the mRNA expression of odontogenic markers, cytokines and integrins. Mineralization inducing capacity was evaluated by alkaline phosphatase (ALPase) activity and alizarin red S staining. Statistical analyses were performed using one-way anova and post hoc Tukey's HSD test, with the significance level at 1%. RESULTS Cell viability was significantly greater in the CMET- (83 to 828 mmol L-1), CH- and MTA-treated (low concentrations) groups than that in the control group (P

The purpose of this study was to evaluate the effect of different combinations of irrigating solutions and intracanal dressings in the pretreatment of bovine radicular dentin, using an experimental immature tooth model. Eighty healthy bovine teeth, simulated with incomplete rhizogenesis, were randomly distributed according to the protocols of root canal dentin pretreatment for a regenerative endodontic procedure (n = 10): Control (irrigation with distilled water); SH (irrigation with 1.5% Sodium Hypochlorite); EDTA (irrigation with 17% EDTA); SH/EDTA (irrigation with 1.5% SH + 17% EDTA); SH/CH/EDTA (irrigation with 1.5% SH + calcium hydroxide paste +17% EDTA); SH/MTAP/EDTA (irrigation with 1.5% SH + modified triple antibiotic paste + EDTA 17%); SH/TAP/EDTA (irrigation with 1.5% SH + triple antibiotic paste +17% EDTA) and SH/DAP/EDTA (irrigation with 1.5% SH + double antibiotic paste + EDTA 17%). After the completion of the protocol, the demineralization, the exposure of collagen fibers, and the dentin erosion was evaluated under scanning electron microscopy (SEM), by applying a score system (1-3) to classify the observed features. Statistical analysis was performed (Kruskal-Wallis and Dunn Multiple Comparison tests-p < .05). SH/TAP/EDTA and SH/DAP/EDTA groups presented the highest rates of demineralization in both the coronal and middle thirds of the root (p < .05). In the SH/MTAP/EDTA group, the samples presented moderate demineralization. The samples from the SH/CH/EDTA group presented similar findings to the control group (p < .05). Conventional triple antibiotic (TAP) and double antibiotic (DAP) pastes promoted more pronounced morphological changes on the dentin surface.

The aim of this study was to investigate the outcomes of direct pulp capping performed with two types of tricalcium silicate-based materials (mineral trioxide aggregate/MTA and Biodentine/BD); nano-hydroxyapatite (nHAP) crystals or calcium hydroxide (CH) in dogs. Following mechanical exposure, the pulps were randomly capped with one of the four materials. Histological analyses were performed to examine the outcomes after 7 days or 3 months. At 7 days, BD and nHAP showed significantly less inflammatory cell response than MTA and CH. At 3 months, the inflammatory cell response and tissue necrosis were significantly higher in the CH group. There was no significant difference between the tested materials in the calcific bridge formation after 7 days; however, a significant difference was noticed at the 3-month period. Tricalcium silicate-based cements and nHAP are potential alternatives to CH in vital pulp therapy following accidental pulp exposure.

This study aims to evaluate the viscoelastic and chemical properties of dentine after different durations of exposure to 5.25% NaOCl, 17% EDTA and Ca(OH)2 solutions, and NaOCl in alternating combination with EDTA. Standard dentine bars were randomly assigned to: (i) formal-saline control-1; (ii) NaOCl; (iii) EDTA; (iv) NaOCl/EDTA; (v) formal-saline control-2; (vi) Ca(OH)2 pH 12.6; and (vii) Ca(OH)2 pH 9.8. Groups 1--4 underwent 10 min cycles of soaking and dynamic mechanical analysis up to 120 min. Groups 5-7 underwent similar tests at days 7, 14, 28 and 84. FTIR spectra of dentine discs exposed to the same regimens assessed surface chemistry. NaOCl or Ca(OH)2 (pH 12.6) solutions reduced the organic (N-H[1], N-H[3], C=0) peak components of dentine. This study demonstrated that accumulative damage of dentine could be facilitated by alternated exposure to NaOCl and EDTA. Exposure of dentine to Ca(OH)2 (pH12.6) for 7 days reduced viscous behaviour, inferring increased potential for fatigue failure.

A novel direct gas–solid mineral carbonation process using carbide slag doped fly ash to capture and mineralize CO2 from flue gas was developed to overcome the barriers of long reaction time and large reactor size from aqueous processes. A laboratory‐scale fixed bed reactor with a thermogravimetric analyser and a pilot‐scale circulating entrained‐flow bed (CEB) rector system were constructed to investigate the intensification method and reaction parameters. The carbonation efficiency (ζCa [%]) was improved four times by carbide slag doped fly ash in a semi‐dry atmosphere; thus, the active calcium hydroxide from carbide slag and fly ash can react with CO2 in a thin liquid film through an ionic reaction route. The key reaction parameters, such as temperature, steam addition and water injection, were studied to promote Ca(OH)2 formation and to facilitate CO2 diffusion. As a result of the pilot‐scale experiment, carbonation efficiency achieved a maximum value of 55% with 15% steam addition in the feed and 6 kg h–1 water injection into CEB at 550 °C. © 2019 Society of Chemical Industry and John Wiley & Sons, Ltd.

Aim To investigate the involvement of Wnt signalling and cell cycle regulation in hard tissue formation after pulp capping with several materials in a rat molar pinpoint exposure model. Methodology Thirty-two rat molar pulps were mechanically exposed and assigned to 4 groups according to the pulp capping materials used Ca(OH)2 , mineral trioxide aggregate (MTA), Biodentine™ and an untreated control group. After 4 weeks, the teeth were collected for microcomputed tomography to quantify reparative dentine formation. Histological analysis was then performed to evaluate the quality of the reparative dentine and the dental pulp tissue inflammatory reaction. Cyclin D1 and β-catenin expression was examined using immunofluorescence staining. The Kruskal-Wallis followed by Dunn's multiple comparison test was performed to determine significant differences. Results The exposed dental pulps treated with Ca(OH)2 , MTA and Biodentine™ exhibited reparative dentine formation near the exposure site. Fibrous tissues adjacent to the exposure site were observed in the untreated group. The microcomputed tomography evaluation of MTA and Biodentine™ groups revealed significantly greater reparative dentine formation compared with the control group (P = 0.0032 in the MTA group and P = 0.05 in the BiodentineTM group). From histological evaluations, the BiodentineTM group exhibited significantly greater reparative dentine formation grading compared with the control group (P = 0.0152). The pulp tissues treated with Ca(OH)2 and Biodentine™ exhibited a lower inflammatory score compared with those of the untreated control (P = 0.0291 in the Ca(OH)2 and P = 0.0110 in the BiodentineTM group). Ca(OH)2 , MTA and Biodentine™ induced cyclin D1 expression in the dental pulp tissues adjacent to the reparative dentine. Moreover, the Biodentine™-treated defects demonstrated β-catenin expression in the pulp tissue adjacent to the newly formed reparative dentine, which was not observed with the other materials. Conclusion All test materials promoted dentine bridge formation and stimulated cyclin D1 expression. The favourable outcome after direct pulp capping with Biodentine™ involved Wnt/β-catenin signalling. However, Wnt/β-catenin signalling did not participate in the mechanism by which Ca(OH)2 and MTA promoted reparative dentine formation.

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta‐analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta‐analyses. At 6‐ and 12‐month follow‐up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18‐month follow‐up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long‐term follow‐up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high‐quality randomized control clinical trials with a long‐term follow‐up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

The purpose of this study was to evaluate the effect of calcium hydroxide [Ca(OH)2 ] on dentine composition and root fracture resistance. Root canals of fifty extracted mandibular premolars were prepared and divided into five groups (N = 10). Canals were filled with non-setting Ca(OH)2 or left empty and were subsequently stored in phosphate buffered saline for 7, 14, 30, or 90 days, respectively. Ca(OH)2 was then washed out, and roots were separated from the crowns and subjected to fracture strength test. Fractured fragments were examined by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). The results showed a significant and progressive reduction in fracture resistance the longer the duration of exposure to Ca(OH)2 , and the fracture resistance in teeth exposed for 90 days was significantly lower than in any other group. SEM revealed cracks in the dentine surfaces that had been exposed to Ca(OH)2 . FTIR showed a significantly lower mineral to matrix ratio in roots exposed to Ca(OH)2 for 30 and 90 days than seen in roots exposed for a shorter duration. XRD analysis revealed a reduction in dentine crystallinity. It was concluded that Ca(OH)2 significantly reduced the fracture resistance of the roots overtime. Exposure to Ca(OH)2 reduced the mineral to matrix ratio and crystallinity of the dentine.

The microbial‐induced calcite precipitation (MICP) process for ground improvement uses microorganisms to hydrolyze urea, producing carbonate ions to induce in situ calcium carbonate (CaCO3) precipitation in soil to improve its strength. This paper proposes using the hydroxide‐based absorption of CO2 instead to provide the carbonate ion source. This study utilizes direct air capture (DAC) to absorb atmospheric CO2 using potassium hydroxide (KOH) in a semi‐batch bubble absorption column. Potassium carbonate (K2CO3) was then injected into sand with calcium hydroxide (Ca(OH)2 as a calcium source to precipitate CaCO3 and regenerate KOH. Batch and continuous flow precipitation methods produced a poor distribution of CaCO3, with more CaCO3 precipitated on top, resulting in unconfined compressive strength (UCS) of 6.9 to 19.6 kPa. Sand pre‐mixed with Ca(OH)2 gave well distributed CaCO3, precipitated throughout the sample with 7.56 wt% and 6.87 wt% CaCO3 content and UCS of 39.2 and 35.3 kPa before failing for batch and continuous flow precipitation respectively. This differs from MICP strength improvement of 1000 kPa with 5.3 wt% CaCO3 due to poor binding of sand with the precipitated CaCO3 crystals. However, this application provides a stable sequestration source for atmospheric CO2 in soil.

BACKGROUND: Methyl vinyl ether (MVE), which polymers and copolymers are widely used in industry and medical chemistry, is produced mainly through base‐catalysed vinylation of methanol with acetylene under pressure. The most well‐known and sustainable acetylene source is calcium carbide. Significant economic benefits can be achieved by using calcium carbide as the source of acetylene directly in the industrial production of MVE. RESULTS: Eco‐friendly and operationally simple method for vinylation of methanol, one of a major objects of C1 chemistry, using calcium carbide in water in the presence of potassium or sodium carbonates (140–150 °C, 1‐L steel rotating autoclave, maximum autogenic pressure 18–30 atm) has been developed and realized on 10‐g scale. The major co‐product of this reaction is a mixture of calcium hydroxide and calcium carbonate with minor content of potassium or sodium carbonates, which can be safely used for improving acidic soils. CONCLUSION: Novel efficient method for vinylation of methanol with calcium carbide in water in the presence of alkali metal carbonates has been developed. The method allows avoiding acetylene gas under pressure that demands special equipment and safety measures. The major advantages of this technology are also availability and low cost of the catalysts. © 2019 Society of Chemical Industry

Enterococcus faecalis and Candida albicans have been associated with cases of secondary and persistent root canal infections, been resistant to calcium hydroxide. So, the evaluation of the susceptibility of these microorganisms biofilms to new drugs is an important practice for establishing the best drug and consequently success of treatment. For this, in vitro biofilm formation of E. faecalis and C. albicans was induced separately on blocks obtained from bovine teeth. After the period of specimen incubation for biofilm maturation, the samples were immersed in the pastes: 1 - calcium hydroxide (CH), 2 - chlorhexidine (C), 3 - ciprofloxacin (CP), 4 - metronidazole (MT), 5 - ketoconazole (KE), 6 - double antibiotic (DB), 7 - triple antibiotic (TA), 8 - ciprofloxacin + ketoconazole (CPKE); 9 - ciprofloxacin + metronidazole + ketoconazole (CPMTKE), 10 - metronidazole + ketoconazole (MTKE), and 11 - control (CO) for 7 days. Next, the specimens were live/dead stained for analysis by confocal microscopy. By means of the Bioimage program, the biovolume and percentage of live cells were measured. The data were statistically compared (p = .05). For the C. albicans biofilm, the best antimicrobial action was found for MTKE, CPKE, and MT groups. Whereas for E. faecalis biofilm, the lowest percentage of live bacteria was found in TA, DB, and CP groups; however, KE, CPKE, CPMTKE, and MTKE groups shown to be effective. The authors concluded calcium hydroxide paste and chlorhexidine was not effective for both biofilms. The MTKE and CPKE pastes presented effectiveness for both biofilms. TA and DB pastes were effective just in the E. faecalis biofilms.

This report shows the healing process of an exposed pulp carbonised by CO2 laser irradiation prior to the application of a capping material. Six intact teeth from four volunteers were irradiated by CO2 laser and randomly capped with either an adhesive resin (SE bond) (n = 3) or calcium hydroxide-based cement (Dycal) (n = 3). The laser was operated in super-pulsed mode (power output, 0.5 W) for an irradiation time of 30 s. All cavities were restored with composite resin. Each tooth was extracted at approximately 30, 50 or 260 days post treatment and prepared for histological evaluation. CO2 laser irradiation controlled exudate and bleeding from each exposed pulp. Histological images revealed Dycal promoted complete dentine bridge formation at the carbonised pulp surface, and laser energy affected not only the pulp surface but also the deeper part of the pulp chamber.

The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet‐rich fibrin have been utilized in regenerative endodontics. This approach has been described as a ‘paradigm shift’ and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient‐centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.

Cellulose-based artefacts are highly prone to degradation, especially in the presence of acidic compounds, which trigger the depolymerization of cellulose chains and lead to a loss in the original mechanical resistance of the material. Calcium hydroxide nanoparticles dispersed in organic solvent have been recently proposed for the deacidification of cellulose-based artworks. In this work, changes induced on paper by a deacidification treatment, following an acidification bath, were studied by nuclear magnetic resonance (NMR) relaxometry and by the so-called NMR diffraction of water trapped in the cellulose network. The deacidification treatment modifies intrachain and interchain bonds in hydrolyzed and degraded cellulose, leading to a buffered cellulose network configuration, which is similar to that characterizing the untreated reference sample in terms of relaxation parameters. Overall, calcium hydroxide nanoparticles are demonstrated effective in hindering the degradation of cellulose induced by acids and ageing in strong environmental conditions, even from the standpoint of cellulose network arrangement. It is worth noting, too, that the unilateral NMR device used for the relaxation measurements may represent a powerful tool for the preservation of cellulose-based artworks because it allows for the monitoring of the conservation status of cellulose in a completely non-invasive manner.

Objective The aim of this study was to evaluate the efficacy of different irrigation protocols in removing two tricalcium silicate-based sealers from simulated root canal irregularities and root canal walls. Material and methods Root canals of 140 single-rooted teeth were instrumented. In one-half of each root, an apical groove was created. The samples were divided into two main groups (n = 70) based on the sealer used. In group 1, the grooves were filled with MTA Fillapex; in group 2, BioRoot RCS. The reassembled root halves were divided into six experimental and one control groups: 2.5% NaOCl-17% EDTA (Passive ultrasonic irrigation [PUI]), 5% NaOCl/9% DualRinse HEDP (PUI), 2.5% NaOCl-7% Maleic acid (PUI), 2.5% NaOCl-17% EDTA (Er:YAG laser activated irrigation [LAI]), 2.5% NaOCl/9% DualRinse HEDP (LAI), 2.5% NaOCl-7% Maleic acid (LAI), Distilled water (Control). Specimens were scored using SEM. The data were analysed using Kruskal-Wallis and Mann Whitney U tests. Results Maleic acid and DualRinse HEDP removed higher amounts of MTA Fillapex from the grooves compared to EDTA, when used with both activation methods (p < .001). Conclusions Ultrasonically activated maleic acid or DualRinse HEDP can be an effective irrigation regimen in removing tricalcium silicate-based sealers.

AIM To evaluate setting time, pH, solubility and surface roughness of MTA+ and ProRoot MTA and characterize their hydration under several curing conditions. METHODOLOGY Specimens were prepared to evaluate setting time (n = 6 for each group, specimen dimensions 10 × 8 × 5 mm), solubility (n = 6 for each group, specimen dimension 20 mm in diameter and 1.5 mm thick) after 1 and 28 days, pH (n = 10 for each group, specimen dimensions 10 mm in diameter and 1 mm thick) after 1, 7, 14, 21 and 28 days and surface roughness (n = 10 for each group, specimen dimensions 4 mm in diameter and 3 mm high) after 28 days when cements were cured at 95% humidity or immersed in saline or HBSS at 37 °C. The powder and liquid were mechanically mixed by an amalgamator. The set materials were characterized using X-ray diffraction analysis, scanning electron microscopy and X-ray energy-dispersive analysis. Statistical comparisons were employed using one-way anova. The level of significance was set at P = 0.05. RESULTS Setting time was significantly shorter when cements were cured at 95% humidity compared to those in saline (P

Bioactive hydraulic tricalcium silicate materials are commonly used in several dental procedures. Mineral Trioxide Aggregate (MTA) is one such material, which is used in a variety of clinical applications, the most recent of which is root canal sealing material, during which, the MTA potentially comes in contact with remnants of the chemical agents used for disinfecting root canals. The effects of commonly used root canal irrigating solutions on MTA have not been investigated in depth, thus far. The aim of this study was to determine the effect of five common chemical agents used in root canal preparation (sodium hypochlorite/NaOCl, ethylene diaminetetraacetic acid/EDTA, mixture of sodium hypochlorite and etidronic acid/NaOCl + EA, mixture of EDTA and Chlorhexidine/QMix, or saline) on a commercial tricalcium silicate (MTA Plus). Samples were analyzed using scanning electron microscopy with energy dispersive spectroscopy, X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy and Inductively coupled plasma techniques to see effects of phases formed and calcium ion release. Specimens immersed in NaOCl and NaOCl + EA had strong peaks for calcium hydroxide, but materials exposed to EDTA and QMix had lesser XRD peaks for calcium hydroxide. The calcium hydroxide peak in the XRD indicates hydration of tricalcium silicate and formation of amorphous calcium silicate hydrate. Calcium released from samples immersed in EDTA and NaOCl was less than in NaOCl + EA and QMix solutions. Fewer calcium phosphate crystals and less calcium hydroxide were observed with the samples in NaOCl, EDTA and QMix, which could have an important impact as it negatively influences the bioactivity. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 377-387, 2019.

AIM To investigate the antibacterial activity of a novel intracanal medicament, iRoot FM, against Porphyromonas endodontalis and its effects on the proliferation and osteo-/odontogenic differentiation of stem cells from apical papilla (SCAP). METHODOLOGY The agar diffusion test was used to compare the antimicrobial efficacy of iRoot FM with two traditional intracanal medicaments, calcium hydroxide [Ca(OH)2 ] and triple antibiotic paste (TAP). The CCK-8 assay was used to assess the proliferation rate of SCAP when exposed to the three intracanal medicaments. The expression levels of ALP and DMP-1 and the capacity to form mineralized nodules were used to evaluate the osteo-/odontogenic differentiation of SCAP, as assessed by real-time PCR, Western blotting and alizarin red S staining. Data were statistically analysed with one-way analysis of variance (anova), and comparisons between each of two groups were analysed by the least significance difference method. P values less than 0.05 were considered statistically significant. RESULTS The zone of inhibition against P. endodontalis produced by iRoot FM was 20.74 ± 4.35 mm, whilst the zones of inhibition of Ca(OH)2 and TAP were 24.89 ± 3.84 mm and 34.51 ± 1.20 mm. The antibacterial capacity of iRoot FM was similar to that of Ca(OH)2 (P > 0.05). SCAP, cultured in conditioned medium with iRoot FM, was associated with greater proliferation and osteo-/odontogenic differentiation capacity than those cultured in conditioned medium with Ca(OH)2 and TAP (P