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Introduction: The absence of a barrier in an open root apex makes endodontic treatment challenging as root‐filling material can easily reach the surrounding tissue. The aim of the study was to compare the apical microleakage associated with mineral trioxide aggregate (MTA), biodentine, custom‐made gutta‐percha with MTA plus and custom‐made gutta‐percha with Adseal in immature permanent teeth by dye penetration method. Methods: Apical 2 mm of 60 single‐rooted mandibular premolar teeth was resected to create divergent open apices and 10 teeth each were filled with Biodentine plug, MTA plug, custom‐made gutta‐percha with MTA plus sealer and custom‐made gutta‐percha with Adseal sealer. Ten teeth each acted as positive and negative controls. All the samples were stored at 37°C at 100% humidity for 5 weeks and then immersed in 2% Rhodamine B dye for 24 h. Transverse sectioning was done apically at 1 mm and 3 mm to evaluate dye penetration under a fluorescence microscope using ImageJ software. Results: There was a significantly greater microleakage at 1 mm cross section compared to 3 mm (p < 0.0001). At 1 mm cross section, the apical microleakage was the highest for the MTA plug with a mean leakage percentage of 48.08 ± 16.38, a mean depth of leakage of 0.46 ± 0.10 mm and a mean area of leakage of 1.35 ± 0.74 mm2, compared to other groups, and the difference was statistically significant. However, at a 3 mm cross section, MTA plus sealer with gutta‐percha demonstrated the highest mean leakage percentage (25.01 ± 7.77) compared to other groups and the difference was statistically significant (p = 0.03). Conclusion: It can be concluded that the 3‐mm‐thick apical plug provided better sealing of the open apex compared to the 1 mm apical plug and there was no significant difference in microleakage among the Biodentine plug, MTA plug and Adseal sealer with gutta‐percha plug at 3 mm cross section. [ABSTRACT FROM AUTHOR]

Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial. To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months. An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023). Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001). BD showed significantly higher clinical and radiographic success than CH in pulpotomy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome of apexification using bioceramics in immature permanent teeth, and to study the factors influencing treatment outcome and frequency of spontaneous cervical root fractures. Methods: Forty-six children with 51 non-vital permanent incisors treated with a bioceramic apical plug were included. Mean age at pulp necrosis was 9.8 (SD 2.2) years and mean follow-up time was 3.3 (SD 2.4) years. Data were extracted from dental records and included stage of root development, presence of external root resorptions, clinical signs of infection, size of periapical lesion, type and placement of bioceramic plug, and spontaneous root fracture. Treatment outcome was assessed using periapical index (PAI-score) and presence of clinical symptoms. The statistical analyses were conducted using IBM SPSS Statistics for Windows, version 28 (IBM Corp., Armonk, N.Y., USA). Data were cross-tabulated and tested with chi-square statistic. Results: Biodentine™ was used as apical plug in 78.4% of the teeth and MTA in 21.6%. Complete healing or signs of healing was reported in 86.3% of the teeth, whilst seven teeth (13.7%) were non-healed. All non-healed teeth had preoperative clinical signs of infection. No difference was found in stage of root development, presence of root resorption, and type and placement of bioceramic plug in healed and non-healed teeth (p > 0.05). Five teeth (9.8%) exhibited root fracture 1–6 years after treatment and all had very immature root development. Type of bioceramic or external root resorption was not associated with spontaneous root fracture. Conclusion: Apexification using bioceramics showed favourable prognosis in immature permanent teeth. Very immature teeth were at risk of root fracture after apexification with bioceramics. [ABSTRACT FROM AUTHOR]

The effectiveness of biocements applied in specialistic endodontic procedures can be influenced by multiple factors, including the postplacement chemical action of the irrigating solution. This in vitro study aimed to assess the impact of 2% chlorhexidine digluconate on the surface structure and chemical composition of Biodentine as a perforation repair cement. A total of 54 Biodentine specimens were prepared with strict adherence to the manufacturer's instructions and irrigated with 2% chlorhexidine with or without ultrasonic activation. The material specimens were divided into three setting-time-based groups: group A—rinsed after 12 min of setting, group B—after 45 min, and group C—after 24 h. The control group was not subjected to any irrigation protocol. The evaluation of the microappearance of biocement surface was performed with the aid of a scanning electron microscope (SEM). The chemical composition of Biodentine was analyzed with the energy dispersive spectroscopy (EDS) method. The SEM images of the specimens in group B and C revealed a heterogeneous and layered surface morphology. The EDS results are comparable between pairs of cement specimens in both groups: after 5 min and 20 min CHX irrigation as well as after 5 min and 20 min ultrasonically activated CHX irrigation. To conclude, the 12 min Biodentine setting time is not recommended when used in perforation closure. Irrigation protocol involving 2% chlorhexidine visibly affected the tested material surface. The EDS results did not confirm any significant changes in Biodentine chemical composition. Further research is required to analyze the influence of the observed changes on the outcome of the endodontic treatment. [ABSTRACT FROM AUTHOR]

Background: Apexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth. Methods: From a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece. Results: The Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2–0.16, and G3–1.62, with G2 showing the lowest value and G3 group exhibiting the highest. Conclusions: Biodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the marginal adaptation of a single customized gutta percha cone with calcium silicate-based sealer versus mineral trioxide aggregate (MTA) and Biodentine apical plugs in simulated immature permanent teeth. Methods: Thirty-nine extracted human maxillary anterior teeth were selected, prepared to simulate immature permanent teeth with an apical diameter 1.1 mm, placed in moist foam and divided into three groups. Group 1: Obturation with a single customized gutta percha cone and calcium silicate sealer. Group 2: MTA apical plug. Group 3: Biodentine apical plug. After incubation, teeth were horizontally sectioned at 1 mm and 3 mm from the apex and marginal adaptation was evaluated using scanning electron microscope (SEM). Results: Biodentine showed the least mean gap size at both 1 and 3 mm from the apex with no statistically significant differences compared to MTA (p > 0.05). The single customized cone with calcium silicate based sealer showed the greatest mean gap size at both 1 and 3 mm from the apex with a statistically significant difference compared to the other groups (p < 0.001). Conclusion: Biodentine and MTA apical plugs provide a significantly better marginal adaptation to the dentinal walls than a single customized gutta percha cone with calcium silicate based sealer in simulated immature permanent teeth. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. Methods: Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. Results: The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). Conclusion: BR-modified BD maintains BD's physical properties, with improved flow, making it a promising DPC agent that warrants further study. [ABSTRACT FROM AUTHOR]

Background: Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved. Aim: To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6–24 months. Design: A parallel‐design, non‐inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3–8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6–24 months. A generalized estimating equation model was used to compare the overall success rate in each group. Results: After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6‐ to 24‐month follow‐ups (at 24th month, p =.30). Conclusion: There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of incorporating 1 wt% egg shell powder (ESP) into Biodentine™ (BD) on its physicomechanical properties. Methods: Chicken eggs were ground and sterilized. Then, one wt% ESP was added to BD powder and mixed with BD liquid. The mixture's pH and solubility were measured on 1, 3, 7, and 28 days. The setting time was determined using a Gillmore needle. Compressive strength was measured using a universal testing machine after 1 and 14 days. Surface chemistry was analyzed via FTIR spectroscopy. The findings were compared by independent samples t-test, the repeated measures ANOVA, and the Bonferroni post-hoc test (a = 0.05). Results: pH levels were comparable between the groups (P > 0.05). BD-ESP had a higher setting time than BD (P < 0.001). BD-ESP solubility was significantly higher than BD on day 1 (P = 0.001) but lower on days 7 (P = 0.006) and 28 (P = 0.001). On day 1, BD had higher compressive strength than BD-ESP (P = 0.027), whereas the compressive strength of both groups was comparable on day 14 (P = 0.099). FTIR analysis revealed an additional IR band associated with the phosphate band in the BD-ESP group, suggesting new apatite formation. Conclusions: Incorporating 1% ESP into BD resulted in lower initial solubility but higher solubility after a week and a month, likely due to increased ion dissolution. ESP incorporation also promoted additional apatite formation but negatively impacted the setting time and initial strength of BD. [ABSTRACT FROM AUTHOR]

Abstract Aim to assess and compare the effect of mid-root perforation repair using Biodentine and Portland cement in single-rooted endodontically treated mandibular premolars in terms of stress distribution using finite element analysis (FEA) and fracture resistance test. Methods In the FEA, an extracted human mandibular premolar tooth was scanned using cone beam computed tomography, and a 3-dimensional (3D) solid model was created. A sound tooth model (ST), an endodontically treated model (ET), an instrumented and mid-root perforated and repaired by Biodentine model (BM), and perforated and repaired by Portland cement model (PCM) were the 4 models simulated. A vertical force of 300 N on the occlusal plane was applied. Evaluation of von Mises stress distribution and maximum displacement were investigated. In the fracture resistance in vitro study, 28 extracted premolars were selected and randomized into 4 groups, (n = 7), (A) is the negative control intact group, (B) is the positive control of endodontically treated group, (C) is mid-root perforated and repaired by Biodentine group and (D) is mid-root perforated and repaired by Portland cement. All Teeth were instrumented except for group A, group B was obturated while groups C and D were instrumented, perforated, repaired, and obturated. All groups were restored coronally except group A. Fracture force was measured; subsequently, the fracture repairability was evaluated. Finally, the data were statistically evaluated using one-way analysis of variance (ANOVA); the significance level was set at P ≤ 0.05 and the repairability of teeth after fracture was correlated to the maximum loading using Pearson’s coefficient tests. Results In FEA, Maximum von Mises stress was descending assorted as 121.1 MPa for ET, 115.6 MPa for BM and PCM, and 109 MPa for ST, and in the mid-root area or perforation site were 20 MPa for PCM, 16.17 MPa for BM, 10.16 MPa for ET and 8.1 MPa for ST while the Maximum Displacement was descending assorted as 0.0179 mm for ET, 0.0169 mm for BM and PCM and 0.0151 mm for ST. In the fracture resistance test, Group A showed higher fracture resistance than other groups significantly. There was a non-significant difference between Groups B, C, and D. There was also an insignificant correlation between the maximum loading and the repairability of the tooth after fracture. Conclusion FEA and fracture resistance test showed that the 2 repair materials are acceptable and recommended in iatrogenic mid-root perforation.

Objective: This study evaluated the effect of incorporating 1 wt% egg shell powder (ESP) into Biodentine™ (BD) on its physicomechanical properties.Methods: Chicken eggs were ground and sterilized. Then, one wt% ESP was added to BD powder and mixed with BD liquid. The mixture’s pH and solubility were measured on 1, 3, 7, and 28 days. The setting time was determined using a Gillmore needle. Compressive strength was measured using a universal testing machine after 1 and 14 days. Surface chemistry was analyzed via FTIR spectroscopy. The findings were compared by independent samples t-test, the repeated measures ANOVA, and the Bonferroni post-hoc test (α = 0.05).Results: pH levels were comparable between the groups (P > 0.05). BD-ESP had a higher setting time than BD (P < 0.001). BD-ESP solubility was significantly higher than BD on day 1 (P = 0.001) but lower on days 7 (P = 0.006) and 28 (P = 0.001). On day 1, BD had higher compressive strength than BD-ESP (P = 0.027), whereas the compressive strength of both groups was comparable on day 14 (P = 0.099). FTIR analysis revealed an additional IR band associated with the phosphate band in the BD-ESP group, suggesting new apatite formation.Conclusions: Incorporating 1% ESP into BD resulted in lower initial solubility but higher solubility after a week and a month, likely due to increased ion dissolution. ESP incorporation also promoted additional apatite formation but negatively impacted the setting time and initial strength of BD.

Abstract Background Apexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth. Methods From a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece. Results The Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2–0.16, and G3–1.62, with G2 showing the lowest value and G3 group exhibiting the highest. Conclusions Biodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth.

The use of bioceramics in modern dentistry has significantly evolved, offering enhanced clinical outcomes in various procedures. This article reviews the development and application of bioceramic materials, focusing on their biocompatibility, ability to stimulate tissue regeneration, and chemical stability. Notable materials such as Mineral Trioxide Aggregate (MTA) and Biodentine are highlighted for their role in endodontic treatments and bone regeneration. The paper also discusses innovations in the synthesis and functionalization of bioceramics, including doping with various elements and the integration of nanotechnology, which have led to advancements such as faster setting times and improved antimicrobial properties. Furthermore, the article provides a historical perspective on the transition from early bioceramics to bioactive materials like hydroxyapatite, emphasizing their impact on implantology and bone tissue regeneration. The future directions of bioceramics, including their potential in regenerative medicine and the development of materials with enhanced antimicrobial activity, are explored.

Abstract Background This study aimed to compare the marginal adaptation of a single customized gutta percha cone with calcium silicate-based sealer versus mineral trioxide aggregate (MTA) and Biodentine apical plugs in simulated immature permanent teeth. Methods Thirty-nine extracted human maxillary anterior teeth were selected, prepared to simulate immature permanent teeth with an apical diameter 1.1 mm, placed in moist foam and divided into three groups. Group 1: Obturation with a single customized gutta percha cone and calcium silicate sealer. Group 2: MTA apical plug. Group 3: Biodentine apical plug. After incubation, teeth were horizontally sectioned at 1 mm and 3 mm from the apex and marginal adaptation was evaluated using scanning electron microscope (SEM). Results Biodentine showed the least mean gap size at both 1 and 3 mm from the apex with no statistically significant differences compared to MTA (p > 0.05). The single customized cone with calcium silicate based sealer showed the greatest mean gap size at both 1 and 3 mm from the apex with a statistically significant difference compared to the other groups (p

Abstract Background This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. Methods Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. Results The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). Conclusion BR-modified BD maintains BD’s physical properties, with improved flow, making it a promising DPC agent that warrants further study.

This study compared the microshear bond strength (μSBS) of four calcium silicate‐based cements (CSCs), TheraCal PT (TPT), TheraCal LC (TLC), Biodentine (BD), and Dia‐Root Bio MTA (DR), with a short fiber‐reinforced composite resin (SFRC). Forty cylindrical acrylic blocks were used, each with a center hole (diameter 5 mm, depth 2 mm). CSCs were placed in the holes (n = 10/group), and the blocks were incubated for 48 h. G‐Premio BOND, a self‐etching adhesive, was applied to the CSCs surfaces using a micro‐applicator for 10 s and then air‐dried for 5 s, followed by light curing for 20 s. SFRC materials placed in cylindrical polyethylene capsules (diameter 2 mm, height 2 mm) were polymerized for 20 s and placed over the CSCs. The samples were then incubated at 37°C and 100% humidity for 24 h, and their μSBSs were tested using an "Instron Universal Testing Machine." Data were statistically analyzed using chi‐square and Kruskal–Wallis tests. Statistically significant differences were observed between the tested CSCs. The μSBS of TPT (45.17 ± 4.56 MPa) was significantly higher (p <.05) than that of the other materials: BD, TLC, and DR had μSBSs of 29.18 ± 2.86 MPa (p <.05), 23.86 ± 2.84 MPa (p >.05), and 18.08 ± 2.69 MPa (p <.05), respectively. Considering the importance of bond strength for CSC sealing with restorative material, using SFRC over CSC was promising for improving the μSBS, adhesion, and sealing of the material. Research Highlights: Adhesion is critical to the success of vital pulp restorations.To achieve strong adhesion, the bioceramic material and the resin composite to which it is bonded are very important.In our study, short fiber‐reinforced composite resin, which is gaining popularity, was used and found to be a promising material for improved adhesion. [ABSTRACT FROM AUTHOR]

Background and purpose: Regenerative treatments in endodontics are biological treatments to manage immature teeth, remove inflamed and necrotic tissue, and create a suitable environment for tissue repair. In these treatments, substances with reparative properties of dental pulp and dentin are placed on the pulpal tissue. Interleukin-6 is one of the cytokines secreted in response to various immune activities of the body and studies have demonstrated its vital role in mineralization induction and hard tissue formation. Recently, calcium silicate-based materials have been widely implemented in dentistry due to their great biocompatibility and hard tissue formation induction. Considering the role of IL-6 in the regulation of stem cells, the purpose of this study is to compare the effect of CEM cement, Biodentine, TheraCal LC, and MTA on the level of IL-6 secretion by dental pulp stem cells. Materials and methods: In this laboratory study, 4 types of cement were used as the main groups, and 1 control group contained culture medium without cement. Discs were prepared under sterile conditions in six-well plates with a diameter of 35 mm and a height of 2 mm and they were given time to set for 48 hours. Human pulp stem cells were obtained from Iran's Center for Biological Resources and cultured in a culture medium containing DMEM with 15% FBS and 1% penicillin-streptomycin (10,000 units/ml) as antibiotics. Pulp stem cells at passages 3-5 were used for experiments. Discs of each cement were prepared under sterile conditions and according to the manufacturer's instructions. To prepare the extract of each cement, the DMEM cell culture medium was placed near these discs for 24 hours. Then, human dental pulp stem cells (hDPSCs) were cultured in the vicinity of the disc extract for 72 hours. After that, this extract was collected and the level of IL-6 secretion in it was measured by the ELISA method. The experiments were repeated 3 times. Then the obtained data were entered into SPSS 16 software and analyzed using analysis of variance and the Kruskal-Wallis test. Results: The results showed that the highest level of IL-6 secretion by cells was in the presence of TheraCal LC, Biodentine, and CEM, respectively; But there was no significant difference between the groups. The average level of IL-6 secretion in the presence of MTA was lower than in other groups and this difference was significant (P

Abstract Background Matrix metalloproteinases (MMPs) are critical enzymes involved in the remodeling and defense mechanisms of dental pulp tissue. While their role in permanent teeth has been extensively studied, research focusing on MMPs in primary teeth remains limited. This gap highlights the need for further investigations to understand the specific contributions of MMPs to pulpal defense in primary teeth. Moreover, the clinical efficacy of Biodentine as a pulpotomy material in primary teeth warrants further exploration through well-designed studies to establish its success and long-term outcomes in pediatric dentistry. Aim This study aims to compare the expression levels of MMP-2, MMP-8, and MMP-9 in cases of reversible and irreversible pulpitis. Additionally, it seeks to evaluate the clinical success of Mineral Trioxide Aggregate (MTA) and Biodentine when used as pulpotomy agents in primary molars. By analyzing the differential expression of these MMPs, the study will contribute to a better understanding of their role in pulpal inflammation and the potential therapeutic outcomes of MTA and Biodentine in primary molars. Design In this parallel randomized controlled trial, 63 mandibular primary second molars were assigned to two main groups: Group 1, consisting of 42 teeth diagnosed with reversible pulpitis, and Group 2, consisting of 21 teeth diagnosed with irreversible pulpitis. Group 1 was further divided into two randomized subgroups, each containing 21 teeth. The expression levels of MMP-2, MMP-8, and MMP-9 were evaluated in all samples. Pulpotomy treatments were performed using MTA and Biodentine in Group 1. Clinical and radiographic evaluations were conducted over an 18-month follow-up period. Statistical analyses were carried out using The Kolmogorov-Smirnov test, t-test and Fisher’s exact test (p

Introduction: Root resorption poses a significant challenge in dental practice, with external cervical resorption (ECR) being a common manifestation. ECR is often asymptomatic until advanced stages, complicating its diagnosis and management. Various factors contribute to its etiology, ranging from trauma to orthodontic treatment. The classification system proposed by Patel et al. (2018) offers a comprehensive framework for characterizing ECR lesions based on location and extent. Treatment strategies for ECR involve a combination of endodontic intervention and restorative techniques, with bioactive materials like mineral trioxide aggregate (MTA) and Biodentine emerging as promising options. However, the biomechanical behavior of teeth restored with these materials in the context of ECR remains underexplored. Materials and methods: This study utilized finite element analysis (FEA) to assess stress distribution in teeth with simulated ECR lesions of varying sizes and locations, restored with MTA or Biodentine. Three-dimensional models of maxillary central incisors were generated based on CBCT scans, incorporating periodontal ligament and surrounding bone structures. Eight experimental models representing different ECR configurations were created and subjected to FEA using Optistruct software based on dimensional classification given by Patel et al., in 2018, A70 M & A70B: 1Ap, A130 M & A130B: 1Bp, B70 M & B70B: 2Ap, B130 M & B130B: 2Bp. All the models were tested for stress distribution by restoring the lesions with either M: MTA or B: Biodentine. Oblique load of 100 N was applied at 45°angle to the long axis 2 mm lingual to incisal edge. vonMises Stress distribution in enamel, dentine, restoration and at all the interfaces were observed. Results: The analysis revealed that both MTA and Biodentine restorations exhibited uniform stress distribution around ECR lesions, with no significant differences based on lesion location or size. Maximum stress concentrations were observed around the restorations, particularly in subcrestal lesions. However, overall stress levels were comparable between MTA and Biodentine restorations, indicating similar biomechanical performance. Conclusion: Finite element analysis provides valuable insights into the biomechanical behavior of teeth with ECR lesions restored with MTA and Biodentine. Both materials exhibit similar stress distribution patterns and offer adequate reinforcement against mechanical forces. Clinicians can confidently utilize MTA or Biodentine in the management of ECR, considering their favorable biomechanical properties and clinical outcomes. Further research is necessary to validate these findings and optimize treatment protocols for ECR.

Highlights • Biodentine has undergone thorough research as a bone grafting substance due to its ability to promote bone regeneration and effectively treat root or tooth fractures. • PRF and Biodentine can stimulate osteogenesis, affecting bone repair, particularly in mandibular fractures. Abstract Background: Mandibular fracture is one of the most common fractures. The most common treatment for mandibular fractures is fixation. Therefore, xenogeneic agents such as platelet-rich fibrin (PRF) and Biodentine accelerate the reparative process. Biodentine is an interesting active ingredient that can induce bone regeneration. PRF and Biodentine can promote bone healing, but no literature discusses the differences between PRF and Biodentine osteoinduction mechanisms in treating mandibular fractures. Objective: This article aimed to compare the effect of osteoinductive PRF with Biodentine for mandibular fractures. Material and Method: The research was conducted as a scoping review by performing a thorough search of the PubMed, Scopus, Science Direct, Elsevier, and Google Scholar databases. The study was obtained based on literature studies in the form of journals and textbooks in the last ten years (2013-2023). Result: The osteoinductive effect and mechanism of Biodentine in enhancing bone repair are likely correlated with releasing biologically active ions from calcium silicate cement and stimulating gene expression Runx-2. PRF has an osteoinductive role, causing the mechanism of releasing growth factors such as PDGF, VEGF, TGF-β, and IGF that promote the osteogenic process. Conclusion: There was no significant difference in the osteoinduction effect of PRF and Biodentine because these materials have different mechanisms of action for bone repair.

Background: Matrix metalloproteinases (MMPs) are critical enzymes involved in the remodeling and defense mechanisms of dental pulp tissue. While their role in permanent teeth has been extensively studied, research focusing on MMPs in primary teeth remains limited. This gap highlights the need for further investigations to understand the specific contributions of MMPs to pulpal defense in primary teeth. Moreover, the clinical efficacy of Biodentine as a pulpotomy material in primary teeth warrants further exploration through well-designed studies to establish its success and long-term outcomes in pediatric dentistry. Aim: This study aims to compare the expression levels of MMP-2, MMP-8, and MMP-9 in cases of reversible and irreversible pulpitis. Additionally, it seeks to evaluate the clinical success of Mineral Trioxide Aggregate (MTA) and Biodentine when used as pulpotomy agents in primary molars. By analyzing the differential expression of these MMPs, the study will contribute to a better understanding of their role in pulpal inflammation and the potential therapeutic outcomes of MTA and Biodentine in primary molars. Design: In this parallel randomized controlled trial, 63 mandibular primary second molars were assigned to two main groups: Group 1, consisting of 42 teeth diagnosed with reversible pulpitis, and Group 2, consisting of 21 teeth diagnosed with irreversible pulpitis. Group 1 was further divided into two randomized subgroups, each containing 21 teeth. The expression levels of MMP-2, MMP-8, and MMP-9 were evaluated in all samples. Pulpotomy treatments were performed using MTA and Biodentine in Group 1. Clinical and radiographic evaluations were conducted over an 18-month follow-up period. Statistical analyses were carried out using The Kolmogorov-Smirnov test, t-test and Fisher's exact test (p < 0.05). Results: The study revealed that MMP-2 and MMP-9 expression levels were significantly elevated in specimens with irreversible pulpitis (p = 0.01), indicating a potential correlation between these matrix metalloproteinases and the severity of pulpal inflammation. However, no significant difference was observed in the clinical success rates of pulpotomies performed with MTA and Biodentine, suggesting that both materials are equally effective in the treatment of primary molars with reversible pulpitis. Conclusions: The expression of MMP-2 and MMP-9 in pulpal blood presents a promising biomarker for assessing the degree of pulpal inflammation in primary teeth, offering a potentially valuable diagnostic tool. Additionally, the clinical success of Biodentine in pulpotomy procedures supports its viability as an effective alternative to MTA, providing a reliable option. Clinical Trial Registration ID: The study protocol has been registered with an ID: NCT05145686. Registration Date: 9th November 2021. [ABSTRACT FROM AUTHOR]

Endo–perio lesions are lesions involving pulp tissue with periodontal tissue. The bacterial infection of the pulp can spread to the furcation area through the accessory canal, causing damage to the furcation area. Regeneration therapy has good success when performed with flap surgery and is performed in cases of Grades I and II furcation involvement. Demineralized freeze‐dried bone allograft (DFDBA) is a regenerating material that has osteoinductive and osteoconductive abilities. It has the advantage of successful treatment of bone defects. Biodentine is an agent used for direct pulp capping, root perforation and furcation repair, and apexification. It can bind and enter the dentinal tubules and create interlocking crystals with dentin. This case report presents the treatment of furcation involvement Grade II originating from endo–perio lesions by using DFDBA and Biodentine as regeneration materials with 6 months of follow‐up. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether calcium silicate root fillings prevent bacterial penetration and to determine how bacteria penetrate roots. Extracted single‐rooted, single‐canal human teeth were decoronated, prepared and filled with ProRootMTA or Biodentine (n = 12 each). Positive and negative (n = 2 each) controls were not filled. A two‐chamber model was used with Streptococcus gordonii. The lower compartment was evaluated for turbidity over 150 days. Roots were split and examined for bacteria via SEM. The chi‐squared test was used for comparisons (α = 0.05). Experimental groups had bacteria in their coronal thirds. Tubules contained bacteria in 90.9% and 91.7% of areas examined in the Biodentine and ProRootMTA groups, respectively, with no significant difference (p = 0.914). Experimental and negative roots had no turbidity with no significant difference between Biodentine and ProRootMTA (p = 1.000). Positive controls had turbidity. Bacteria penetrate roots via dentine tubules of root‐filled teeth. Biodentine was comparable to ProRoot MTA. [ABSTRACT FROM AUTHOR]

Background: New and innovative materials are being marketed for the treatment of coronal pulpotomy. It is crucial to compare their efficacy with already-established materials. TheraCal PT (TP) is such a new material that studies are scarce. Aim: This study aim to compare and evaluate the outcome of coronal pulpotomy using Biodentine and a newly introduced calcium silicate-based dual-cure resin cement, TP, in patients with symptoms of irreversible pulpitis. Materials and Methods: Sixty patients with exposed carious pulp and symptomatic irreversible pulpitis were included, aged 18-40, randomly allocated to two groups: TP (group I) and Biodentine (group II). Coronal pulpotomy was performed following a standardized protocol, with TP or Biodentine applied accordingly. The pain was recorded using Visual Analog Scale preoperatively for up to 1 week. Success was assessed clinically and radiographically for up to 12 months. Statistical Analysis Used: The data were analyzed using the Friedman test and the Mann-Whitney U-test. Intragroup pain was analyzed using the Wilcoxon signed-rank test. Results: Among 60 patients, intervention was done in 53. By removing dropout patients, 47 were analyzed, with 38 available for follow-up at 3, 6, and 12 months. The Biodentine group exhibited a 12-month success rate of 84%, while the TP group revealed 77.3%, with statistically insignificant difference (P = 0.563). Conclusion: TP can be effectively utilized as a pulpotomy material in cases of symptomatic irreversible pulpitis in mature permanent teeth, offering rapid setting and ease of use, although Biodentine yielded slightly better results in this study. [ABSTRACT FROM AUTHOR]

Introduction: Perforation is a pathological connection between the root canal system and the external surface of the tooth that can occur unintentionally during pulp chamber preparation. The consequence of this complication is inflammation and destruction of the periodontal tissues. Therefore, it is essential to seal the perforation to avoid tooth loss. Among different bioactive materials, mineral trioxide aggregate (MTA) and Biodentine (BD) ensure a favorable prognosis in therapeutic dental procedures due to their healing properties. Materials and methods: The present case series report describes successful treatments of different sizes, locations, and immediate and mediated perforations. Results: Clinical and radiographic follow-up showed asymptomatic teeth without discomfort, swelling, fistula, or radiolucency in the furcal area. Conclusion: Mineral trioxide aggregate and BD can be successfully used as a biocompatible material for the repair of furcal and root canal perforations. [ABSTRACT FROM AUTHOR]

Root resorption poses a significant challenge in dental practice, with external cervical resorption (ECR) being a common manifestation. ECR is often asymptomatic until advanced stages, complicating its diagnosis and management. Various factors contribute to its etiology, ranging from trauma to orthodontic treatment. The classification system proposed by Patel et al. (2018) offers a comprehensive framework for characterizing ECR lesions based on location and extent. Treatment strategies for ECR involve a combination of endodontic intervention and restorative techniques, with bioactive materials like mineral trioxide aggregate (MTA) and Biodentine emerging as promising options. However, the biomechanical behavior of teeth restored with these materials in the context of ECR remains underexplored. This study utilized finite element analysis (FEA) to assess stress distribution in teeth with simulated ECR lesions of varying sizes and locations, restored with MTA or Biodentine. Three-dimensional models of maxillary central incisors were generated based on CBCT scans, incorporating periodontal ligament and surrounding bone structures. Eight experimental models representing different ECR configurations were created and subjected to FEA using Optistruct software based on dimensional classification given by Patel et al., in 2018, A70 M & A70B: 1Ap, A130 M & A130B: 1Bp, B70 M & B70B: 2Ap, B130 M & B130B: 2Bp. All the models were tested for stress distribution by restoring the lesions with either M: MTA or B: Biodentine. Oblique load of 100 N was applied at 45°angle to the long axis 2 mm lingual to incisal edge. vonMises Stress distribution in enamel, dentine, restoration and at all the interfaces were observed. The analysis revealed that both MTA and Biodentine restorations exhibited uniform stress distribution around ECR lesions, with no significant differences based on lesion location or size. Maximum stress concentrations were observed around the restorations, particularly in subcrestal lesions. However, overall stress levels were comparable between MTA and Biodentine restorations, indicating similar biomechanical performance. Finite element analysis provides valuable insights into the biomechanical behavior of teeth with ECR lesions restored with MTA and Biodentine. Both materials exhibit similar stress distribution patterns and offer adequate reinforcement against mechanical forces. Clinicians can confidently utilize MTA or Biodentine in the management of ECR, considering their favorable biomechanical properties and clinical outcomes. Further research is necessary to validate these findings and optimize treatment protocols for ECR. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim was to compare the effect of different endodontic surgical treatments on the stress distributions in dentin of a simulated first mandibular molar tooth using the finite element analysis method. Three surgical endodontic procedures (apical resection, root amputation, and hemisection) were simulated in a first mandibular molar. Biodentine or mineral-trioxide-aggregate was used to repair the surgery site in apical resection and root amputation models; the remaining root canal spaces were filled with gutta-percha. Access cavities were restored using resin composite. In hemisection model, root canal was filled with gutta-percha, and coronal restoration was finished with a monolithic zirconia crown. A sound tooth model was created as a control model. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Maximum von Mises stresses were evaluated in dentin near the surgery regions and the entire tooth. Apical resection/Biodentine and apical resection/mineral-trioxide-aggregate models generated maximum von Mises stresses of 39.001 MPa and 39.106 MPa, respectively. The recorded maximum von Mises stresses in root amputation models were 66.491 MPa for root amputation/Biodentine and 73.063 MPa for root amputation/mineral-trioxide-aggregate models. The highest maximum von Mises stress value among all models was observed in the hemisection model, measuring 138.87 MPa. Hemisection induced the highest von Mises stresses in dentin, followed by root amputation and apical resection. In apical resection, Biodentine and mineral-trioxide-aggregate did not show a significant difference in stress distribution. Biodentine in root amputation may lead to lower stresses compared to mineral-trioxide-aggregate. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to assess the shear bond strength of bulk-fill flowable composite resin smart dentin replacement plus when bonded to mineral trioxide aggregate (MTA)-angelus, biodentine, and calcium-enriched mixture (CEM) at two different aging periods (15 min and 72 h) using three distinct adhesive systems. In addition, the study identified the specific modes of failure (adhesive, cohesive, or mixed) using a stereomicroscope and scanning electron microscope. Materials and Methods: One hundred and twenty-six cylindrical acrylic blocks used in the study were sorted into three groups based on the bioactive substance used to fill the 3-mm diameter and 3-mm high hole in the center of each block. The groups were MTA, Biodentine, and CEM. The specimens were then divided into subgroups based on the aging interval (15 min and 72 h) of the bioactive material and the adhesive system used (two-step total-etch, two-step self-etch [SE], and one-step SE) while bonding to the restorative bulk-fill flowable composite. The shear bond strength values were measured with a universal testing machine, and the data were analyzed using two-way and one-way analysis of variance, followed by a post hoc test. The specimens were assessed under stereomicroscope and scanning electron microscope to characterize the mode of bond failure (cohesive, adhesive, or mixed). Results: The study showed that the type of adhesive system and the time of bonding affected the shear bond strength of bulk-fill composite to the pulp capping agents (P < 0.05). For MTA, the highest bond strength was observed with two-step SE group at 15 min (18.16 ± 2.97 MPa) (P < 0.05). CEM exhibited the highest bond strength with two-step SE group at 72 h intervals (8.77 ± 1.76) (P < 0.05). The highest bond strength for biodentine group was observed with total-etch group (8.54 ± 1.35 Mpa) and two-step SE (8.19 ± 1.94 Mpa) bonded at 72 h interval (P < 0.05). The majority of the samples in the MTA group (29/42) and CEM group (20/42) showed a cohesive fracture, whereas Biodentine group (22/42) had an adhesive fracture in most of its samples. Conclusion: MTA demonstrated the highest bond strength with two-step SE group at 15 min, and CEM exhibited the highest bond strength with two-step SE groups at 72 h interval. For biodentine group, the type of adhesive used did not impact the bond strength values. [ABSTRACT FROM AUTHOR]

The use of bioceramics in modern dentistry has significantly evolved, offering enhanced clinical outcomes in various procedures. This article reviews the development and application of bioceramic materials, focusing on their biocompatibility, ability to stimulate tissue regeneration, and chemical stability. Notable materials such as Mineral Trioxide Aggregate (MTA) and Biodentine are highlighted for their role in endodontic treatments and bone regeneration. The paper also discusses innovations in the synthesis and functionalization of bioceramics, including doping with various elements and the integration of nanotechnology, which have led to advancements such as faster setting times and improved antimicrobial properties. Furthermore, the article provides a historical perspective on the transition from early bioceramics to bioactive materials like hydroxyapatite, emphasizing their impact on implantology and bone tissue regeneration. The future directions of bioceramics, including their potential in regenerative medicine and the development of materials with enhanced antimicrobial activity, are explored. [ABSTRACT FROM AUTHOR]

External cervical root resorption may be occasionally mistaken for root caries and vice versa. Radiographical and clinical differential diagnoses of cervical root resorption and root caries are essential for correct treatment planning and a successful treatment outcome. This article reviews the contemporary literature and summarises the prevailing professional consensus pertaining to external cervical root resorption. Clinical diagnostics which help distinguish cervical root resorption from root caries are outlined and treatment approaches of external cervical root resorption are discussed. [ABSTRACT FROM AUTHOR]

Compressive strength and calcium ion release are integral properties of Biodentine for its enhanced efficiency. The present study evaluated the effects of Dual Rinse HEDP (DR HEDP), ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) on the calcium ion release and compressive strength of Biodentine. Eighty Biodentine specimens were moulded and randomly divided into four groups (n = 20). Samples in group 1 were treated with 17 % EDTA; group 2 with DR HEDP; group 3 with 2.5 % NaOCl; and group 4 with distilled water. Samples were immersed in 10 mL of the test solutions for 1 min. The mean concentration of the calcium ion released was measured using atomic absorption spectrophotometry. The remaining 40 samples were tested for their compressive strength. Significant differences were determined among all the irrigants tested for calcium ion release and compressive strength. Samples treated with NaOCl had the lowest calcium ion release, while samples treated with 17 % EDTA had the largest calcium ions. No significant differences were measured between DR HEDP or distilled water. For compressive strength, samples treated with 2.5 % NaOCl had the lowest strength, while the highest values were obtained with distilled water. There was a significant difference between DR HEDP and EDTA, in which EDTA reduced the compressive strength significantly more than DR HEDP. DR HEDP had less detrimental effect on the calcium ion release and compressive strength of Biodentine.

Pediatric dentistry plays a critical role in ensuring the oral health and well-being of children and adolescents. The quest for effective dental materials that are safe, biocompatible, and capable of promoting natural remineralization has led to the emergence of biosilicate cements as a promising advancement in this field. Biosilicate cements are bioactive materials composed of amorphous silica, calcium oxide, phosphorus pentoxide, and other trace elements. The bioactivity of biosilicate cements allows them to interact with living tissues, promoting remineralization and stimulating the formation of hydroxyapatite, a vital component of teeth and bones. Their ability to release essential ions, such as calcium, phosphate, and fluoride, supports the natural healing processes, aiding in the preservation of pulp vitality and reducing the risk of secondary caries. Biosilicate cements offer versatility in pediatric dentistry, finding application indirect pulp capping, indirect pulp capping, and small-sized restorations. Their rapid setting time proves advantageous when treating young patients with limited cooperation. Furthermore, the continuous release of fluoride contributes to caries prevention and enhances the long-term oral health of children. While the advantages of biosilicate cements in pediatric dentistry are promising, this manuscript also discusses the limitations and challenges associated with their use. Some biosilicate cements may have different handling characteristics compared to traditional materials, necessitating adaptations in clinical techniques. In addition, long-term clinical data on the performance of these materials in pediatric patients are still limited, requiring further research to establish their efficacy and longevity. This manuscript explores the potential of biosilicate cements in pediatric dentistry.

BackgroundBioactivity refers to the ability of a material to interact with living organisms or biological systems in a way that elicits a specific response. In the context of materials science and medicine, bioactivity is particularly important because it can determine the suitability of material for various applications. ObjectiveTo evaluate and compare different commercially available calcium silicate-based materials regarding: 1. Morphological and elemental analysis at the dentin/material interface. 2. Calcium and silicon release and uptake by adjacent root canal dentine by evaluating the calcium and silicon incorporation depth in adjacent root canal dentin. Materials and MethodsThis study examined four calcium silicate-based cements: Biodentine, MTA Angelus, BioAggregate, and MTA Plus. One hundred extracted human teeth with intact apices and no cavities were selected. Root sections measuring 3 mm in length were created at the mid-root level using low-speed diamond discs. Bioactivity was evaluated at 1, 7, 30, and 90 days, respectively. ResultsThe principal composition of the interfacial dentine layer and incorporation of calcium and silicon into dentine was measured at 1, 7, 30, and 90 days. Statistical analysis was performed by multiple comparisons using post hoc Tukey HSD. ConclusionAll the materials have shown bioactivity, i.e. release of calcium, silicon, and their uptake in the adjacent dentin in the presence of phosphate-buffered saline.

Immature dental pulp, which has a highly cellular structure and a rich vascular nutrition system, is highly resistant to inflammation, In these teeth, determining the treatment option based on clinical and radiographic findings alone may result in the removal of diseased pulp tissue as well as vital pulp tissue. In order to increase the prognosis of these teeth, vital pulp treatments are highly recommended to preserve pulp vitality. By evaluating the condition of the root pulps of young permanent molars separately, it is possible to increase the prognosis of the tooth by combining regenerative endodontic treatment and pulpotomy treatment according to the condition of the pulps. In this case report, regenerative endodontic treatment and pulpotomy treatment were applied to different root canals of the first molar, which became necrotic before completing its maturation due to caries and had an apical lesion, and excellent healing was demonstrated. Key words: Biodentine, immature permanent teeth, periapical lesions, pulpotomy, regenerative endodontic treatment.

Objective: To systematically evaluate and meta-analyze the short-and long-term clinical and radiologic failure rates of Biodentine versus formocresol as pulpotomy medicaments in primary teeth. Data sources: Relevant medical databases were searched until May 2021 for randomized controlled trials that used Biodentine and formocresol as pulpotomy medicaments in primary teeth with deep caries. Primary outcomes included clinical and radiologic failure rates at 12 months. Secondary outcomes were clinical and radiologic failure rates at 3, 6, 9, 13 to 24, and 25 to 48 months. Results: Nine randomized controlled trials (N = 626) with low risk of bias were included. Pooled analysis showed that compared to formocresol, Bioden tine had significantly lower clinical failure rates (relative risk [RR] 0.16; 95% confidence interval (CI) 0.03 to 0.87; six randomized controlled trials; N = 394; GRADE, low) and radiologic failure rates (RR 0.19; 95% CI 0.08 to 0.49; six randomized controlled trials; N = 393; GRADE, low) at 12 months. Radiologic failure rates at 6 and 9 months were significantly lower in the Biodentine group compared to the formocresol group. Conclusion: Compared to formocresol, Biodentine may be a superior medicament when used for pulpotomy in primary teeth. Adequately powered randomized controlled trials are needed to substantiate this evidence. [ABSTRACT FROM AUTHOR]

Background: Biodentine is widely used for endodontic applications; recently, it has been incorporated with triple antibiotic paste (TAP). The effect of endodontic irrigants on the physical characteristics of this new combination needs to be studied. Aims: The aim of the study was to evaluate the surface roughness and microhardness of Biodentine incorporated with TAP subjected to various endodontic irrigants. Materials and Methods: Hundred cylindrical discs (6 mm × 3 mm) were prepared by mixing the Biodentine with TAP (3:1). The specimens were subjected to different irrigating solutions for 5 min in 5 groups (n = 20): Group 1: distilled water (control), Group 2: 2.5% sodium hypochlorite, Group 3: 17% ethylenediaminetetraacetic acid, Group 4: 2% chlorhexidine (CHX), and Group 5: 2% chitosan nanoparticles (CSNs). Half of the specimens in each group were subjected to surface roughness (n = 10) and another half to microhardness (n = 10). Surface roughness was measured using a surface roughness tester, and digital Vickers microhardness testing was performed on each specimen. Statistical Analysis: One-way ANOVA and post hoc Tukey's tests (P = 0.05) were used. Results: The highest microhardness was found with 2% CSN, whereas 2% CSN and 2% CHX had a minimal effect on the surface roughness of Biodentine incorporated with TAP (P = 0.05). Conclusion: The root canal irrigant 2% CSN exhibited the highest microhardness and least surface roughness of modified Biodentine with TAP. [ABSTRACT FROM AUTHOR]

Background: Bioactivity refers to the ability of a material to interact with living organisms or biological systems in a way that elicits a specific response. In the context of materials science and medicine, bioactivity is particularly important because it can determine the suitability of material for various applications. Objective: To evaluate and compare different commercially available calcium silicate-based materials regarding: 1. Morphological and elemental analysis at the dentin/material interface. 2. Calcium and silicon release and uptake by adjacent root canal dentine by evaluating the calcium and silicon incorporation depth in adjacent root canal dentin. Materials and Methods: This study examined four calcium silicate-based cements: Biodentine, MTA Angelus, BioAggregate, and MTA Plus. One hundred extracted human teeth with intact apices and no cavities were selected. Root sections measuring 3 mm in length were created at the mid-root level using low-speed diamond discs. Bioactivity was evaluated at 1, 7, 30, and 90 days, respectively. Results: The principal composition of the interfacial dentine layer and incorporation of calcium and silicon into dentine was measured at 1, 7, 30, and 90 days. Statistical analysis was performed by multiple comparisons using post hoc Tukey HSD. Conclusion: All the materials have shown bioactivity, i.e. release of calcium, silicon, and their uptake in the adjacent dentin in the presence of phosphate-buffered saline. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36 months in school children from the remote village of Kerung, Nepal. Methods: From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33 months, respectively. Results: After 12 months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33 months was 67.6% and 50%, respectively. Radiographically, no pathology was observed. Conclusion: This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1 year and in a substantial number of cases for up to 21 and 33 months. [ABSTRACT FROM AUTHOR]

This study aimed to analyse the effect of root-end resection on the sealing ability of orthograde apical plugs of three root-end filling materials (MTA Repair HP, Biodentine, MTA Plus) using the bacterial leakage method and compare it with the retrograde root-end filling technique. Eighty-four extracted mandibular premolar teeth with single root and single straight canals were selected and randomly divided into two main experimental groups (n = 36) depending on the apical plug placement technique and a control: Group I: orthograde technique, followed by root-end resection; Group II: retrograde root-end filling technique; one control Group III (n = 12): obturation with gutta-percha, followed by root-end resection. Experimental groups were further subdivided into three subgroups A, B, and C (n = 12) depending on the three different root-end filling materials used. An apical plug of 3 mm thickness was obtained in both the experimental groups. The apical sealing ability was evaluated with the dual-chamber bacterial leakage method. Statistical analysis was performed using the Kaplan–Meier survival analysis test. By the end of 30 days, the occurrence of turbidity indicating bacterial leakage was 75% in MTA Repair HP, 83.3% in Biodentine, and 91.7% in MTA Plus samples. This trend of turbidity was similar in both orthograde and retrograde technique. The control group showed turbidity in all the samples (100%). More MTA Repair HP samples (25%) survived the 30 days observation period with no bacterial leakage compared to Biodentine (16.7%) and MTA Plus (8.3%). The sealing ability of already set root-end filling materials placed through the orthograde technique did not deteriorate after root-end resection. Also among three root-end filling materials, MTA Repair HP presented the lowest bacterial microleakage followed by Biodentine and MTA Plus, respectively. [ABSTRACT FROM AUTHOR]

Objectives: A tricalcium silicate-based cement, Biodentine™, has displayed antibiofilm activity when mixed with chitosan powder. This study aimed to assess the effect of chitosan incorporation on the physico-mechanical and biological properties of Biodentine™. Methods: In this study, medium molecular weight chitosan powder was incorporated into Biodentine™ in varying proportions (2.5 wt%, 5 wt%, 10 wt%, and 20 wt%). The setting time was determined using a Vicat apparatus, solubility was assessed by calculating weight variation after water immersion, radiopacity was evaluated and expressed in millimeters of aluminum, the compressive strength was evaluated using an Instron testing machine, and the microhardness was measured with a Vickers microhardness tester. In addition, surface topography of specimens was analyzed using scanning electron microscopy, and the effect of chitosan on the viability of human embryonic kidney (HEK 293) cells was measured by a colorimetric MTT assay. Results: Incorporation of 2.5 wt% and 5 wt% chitosan powder delivered an advantage by speeding up the setting time of Biodentine material. However, the incorporation of chitosan compromised all other material properties and the crystalline structure in a dose-dependent manner. The chitosan-modified material also showed significant decreases in the proliferation of the HEK 293 cells, signifying decreased biocompatibility. Significance: Chitosan incorporation into calcium silicate materials adversely affects the physical and biological properties of the material. Despite the increased antimicrobial activity of the modified material, the diminution in these properties is likely to reduce its clinical value. [ABSTRACT FROM AUTHOR]

Aim: This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period. Materials and Methods: A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC (n = 54) or coronal pulpotomy group (n = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis. Results: There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response (P = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT (P = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks. Conclusion: Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide. [ABSTRACT FROM AUTHOR]

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When "loose" success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2–94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0–95.3%). When "strict" success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of "complete" healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when "incomplete" healings were regarded as successful outcomes. [ABSTRACT FROM AUTHOR]

The activity of biomaterials used during endodontic treatment can be affected by various factors. One of them is the chemical action of the irrigant that they are exposed to. The aim of this multimethod ex vivo study was to evaluate the influence of ethylenediaminetetraacetic acid (EDTA) on the surface appearance and chemical composition of Biodentine used in perforation repair. Twenty material specimens were prepared according to manufacturers' recommendations and divided into two setting-time-based groups, tested after 45 min (group A) and 24 h (group B) of setting. Material was irrigated with 17% EDTA solution with or without simultaneous ultrasonic activation. The surface characteristics and the chemical composition analysis of the Biodentine specimens were performed with the aid of a scanning electron microscope (SEM) and an energy dispersive spectroscopy (EDS) method, respectively. The volumetric loss of material was measured by dedicated digital software in an optical microscope. Statistical analysis was performed. The EDS study confirmed that after the rinsing protocol, the percentage content of elements differed between the groups. The EDTA rinse, whether ultrasonically activated or not, visibly affected the surface appearance and chemical composition of Biodentine. The specimens' surface subjected to irrigation was more irregular under SEM than in a control group. The US activation of the liquid amplified its impact on the tested material. The average volume loss in group A after 5 min irrigation was 3.98 µm3 for each µm2 of the chosen area and it increased up to 7.74 µm3/μm2 after the ultrasonic activation. In group B, indicated volume loss values were 6.30 and 11.70 µm3/μm2 for 5 min irrigation without and with US activation, respectively. Using a 20 min irrigation time and ultrasonic activation increased it up to 32.71 µm3/µm2. Each rinsing protocol involving irrigation with ethylenediaminetetraacetic acid modified the surface features and the chemical composition of the evaluated hydraulic tricalcium silicate cement. Further research is needed to indicate the possible impact of the observed changes on its long-term clinical performance. [ABSTRACT FROM AUTHOR]

Background: The discoloration potential of dental materials and applications such as vital pulp therapy also cause discoloration due to the presence of blood. Dentin tubule sealing methods could be used for the prevention of discoloration. Aim: The purpose of this study was to evaluate the effect of sealing pulp chamber walls with Nd:YAG laser against discoloration caused by tricalcium silicate‐based materials in the presence and absence of blood contamination. Design: Eighty‐one extracted human maxillary incisors were prepared and randomly divided into nine groups according to the Nd:YAG laser application, the cement to be used (NeoMTA Plus/Biodentine), and the presence or absence of blood. The color measurements were obtained with a spectrophotometer at baseline and then at the sixth (T1) and 12th (T2) months thereafter. Results: Sealing with Nd:YAG laser and placing NeoMTA Plus or Biodentine on human blood significantly increased discoloration at T1 and T2 (p <.05). Similarly, without sealing the cavity and placing NeoMTA Plus or Biodentine on human blood significantly increased discoloration at T1 and T2 (p <.05). Conclusion: Regardless of sealing the dentin tubules with Nd:YAG laser, NeoMTA Plus and Biodentine caused more discoloration in the presence of blood contamination. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the sealing ability of different biomaterials as intra-orifice barriers in the internal bleaching of discolored teeth with the walking bleaching technique. The release of hydroxyl ions from the bleaching materials can cause cervical root resorption, making it necessary to use intra-orifice barrier materials to prevent this issue. Materials and methods: In the current study, the high-performance liquid chromatography (HPLC) method was used to measure the released hydroxyl ions. The study included 90 single-rooted and single-canal premolars, which were divided into four groups based on the intra-orifice barrier materials used (mineral trioxide aggregate [MTA], calcium-enriched mixture [CEM], Biodentine, and MTA+PG) and the type of bleaching material (sodium perborate + water or sodium perborate + hydrogen peroxide 30%). Two control groups were also considered in this study: a positive control group, where sodium perborate and hydrogen peroxide were placed inside the pulp chamber without any intra-orifice barriers; and a negative control group, where no bleaching agent or surgical obstruction was used, and the root surface was covered with wax up to the cemento-enamel junction (CEJ) level. Results: The results showed that there was a significant difference in the concentration of hydroxyl ions released among the studied groups. The amount of hydroxyl ion released was highest in the positive control group and lowest in the CEM group. Among the intra-orifice barrier materials used, CEM cement was found to be the most appropriate material for use in the step-by-step internal bleaching method. Conclusions: The study highlights the importance of using appropriate intra-orifice barrier materials to prevent root cervical resorption in internal bleaching procedures.

خلفية البحث وهدفه: تعد إزالة المواد الحاشية عاملاً مهماً جداً في سياق إعادة المعالجة اللبية، لذلك فقد كان الهدف من هذا البحث هو إجراء دراسة مخبرية مقارِنة لتقييم إمكانية إزالة مادتي خماسي الأكاسيد المعدنية (5(MO، و(Biodentine)من الأقنية الجذرية المستقيمة في سياق إعادة المعالجة اللبية، مع قياس الزمن اللازم لذلك، باستخدام تقنية الأمواج فوق الصوتية (US)، ومعرفة فعاليتها في هذا المجال. مواد البحث وطرائقه: تألفت عينة الدراسة من 24 سناً بشريةً دائمةً، علويةً وسفليةً، وحيدة ومستقيمة القناة، مقلوعة حديثاً، حُضِّرت الأقنية الجذرية باستخدام تقنيَّة (Crown-Down). قُسِّمت العينة عشوائياً إلى مجموعتين متساويتين، بحيث تكون كل منهما مؤلفة من 12 سناً، وذلك تبعاً لمادة الحشو القنوي الجذري المستخدمة: ]م1: مادة 5MO، م2: مادة [Biodentine. بعد الحشو القنوي الجذري، طبقت مادة الترميم التاجي (الاسمنت الزجاجي الشاردي) (GIC)، وحفظت الأسنان في (درجة حرارة 37 درجة مئوية – ورطوبة 100%) لمدة 7 أيام، ثم أزيلت كل من المادتين الحاشيتين باستخدام تقنية الأمواج فوق الصوتية (US)، مع قياس الزمن اللازم لذلك. أُخضِعت البيانات إلى الاختبار الإحصائي ANCOVA، وحُسِبت قيم معامل الارتباط Person، مع قيمة لمستوى الدلالة ( P≤ 0,05). النتائج: بينت النتائج أن مادة 5MO هي المادة الأسهل في الإزالة من مادة Biodentine في الأقنية الجذرية المستقيمة باستخدام تقنية الأمواج فوق الصوتية (US) في سياق إعادة المعالجة اللبية، حيث استغرقت زمناً أقصرَ لإزالتها بالمقارنة مع مادةBiodentine، مع وجود تأثير دال إحصائياً (P ˃ 0,05). الاستنتاجات: يمكن إزالة كل من مادتي 5MO، و Biodentine من الأقنية الجذرية المستقيمة، باستخدام تقنية الأمواج فوق الصوتية (US)، لذلك يمكن اعتبار تقنية الأمواج فوق الصوتية (US) تقنية فعالة في إزالة هاتين المادتين في سياق إعادة المعالجة اللبية.

Aim: The aim of this study was to assess the outcome of biodentine apexification for the management of traumatized immature teeth with necrotic pulp over a period of 12 months. Methods: Eighty-five human maxillary incisors with traumatized immature necrotic pulp in patients aged 10–50 years were selected for this study. Root canal treatment was initiated and the biodentine apexification procedure was performed in a single appointment for all teeth. Intraoral preoperative and postoperative periapical radiographs were used to assess periapical (PA) changes, changes in root length (RL), and radiographic root area (RRA). Preoperative and postoperative cone-beam computed tomography (CBCT) images were used to assess the three-dimensional (3D) volumetric changes. Patients were recalled at 12 months posttreatment for the evaluation of clinical symptom, percussion, and palpation examination. Descriptive statistics was computed for preoperative demographic, patient-centric data, and treatment success. Paired t-test was used to compare the preoperative and 12-month postoperative changes in RRA, RL, and 3D volumetric changes of the parameters. Results: Forty-eight out of the 49 teeth that completed the study were asymptomatic and functional. Comparing the preoperative and the 12-month review radiographs using the periapical index scores based on the size of the lesion, completely healed lesions were 79.16% while lesions in the process of healing were 20.83%. There was a significant (P < 0.05) increase in RL (14.17%), RRA (40.87%), and dentin volume (26.63%). Conclusion: 3D volumetric analysis suggests that biodentine apexification has the ability to deposit hard tissue 3-dimensionally, and it is an effective alternative to the conventional apexification materials.

Abstract Objectives Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth. Materials and Methods Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible. An electronic search of four databases and two clinical trial registries was carried out up to February 28, 2021 using a search strategy properly adapted to the PICO framework. Screening, data extraction, and risk of bias (RoB) assessment of primary studies were performed in duplicate and independently. The primary outcome was clinical and radiological success; secondary outcomes included continued root formation, tooth discoloration, and dentin bridge formation. Results 21 RCTs were included in the study. The RoB assessment indicated a moderate risk among the studies. Due to significant clinical and statistical heterogeneity among the studies, performing network meta‐analysis (NMA) was not possible. An ad hoc subgroup analysis revealed strong evidence of a higher success of DPC with Mineral Trioxide Aggregate (MTA) compared to calcium hydroxide (CH) (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.66−5.79). MTA performed better than CH in pulp capping (both DPC and pulpotomy) of mature compared to immature teeth (OR = 3.34, 95% CI: 1.81−6.17). The GRADE assessment revealed moderate strength of evidence for DPC and mature teeth, and low to very low strength of evidence for the remaining subgroups. Conclusions Considerable clinical and statistical heterogeneity among the trials did not allow NMA. The ad hoc subgroup analysis indicated that the clinical and radiographic success of MTA was higher than that of CH but only in mature teeth and DPC cases where the strength of evidence was moderate. PROSPERO Registration: number CRD42020127239.