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Objective: This study aimed to investigate of bioactive materials with specific properties, particularly highly plastic bioceramic cements. These materials are being studied extensively due to their potential to maintain pulp vitality and promote tissue regeneration. Material and Methods: Tooth discoloration induced by an experimental tricalcium silicate-based cement (EC) was evaluated and compared with that of Biodentine (BD) and white MTA-Angelus (MTA). Cavities were prepared on the lingual surfaces of thirty-two blocks of healthy bovine incisors. The blocks were chemically cleaned and then subjected to an initial color evaluation (CIELab values) using a spectrophotometer and randomly divided into three experimental groups (n=10); two additional blocks served as controls. After manipulation, the cements were placed in the cavities, which were subsequently restored with composite restorations. After another color measurement (baseline), they were immersed in bottles of distilled water; they were stored at 37 °C and 100% humidity for the entire test period. The color change (ΔE) was measured after 14, 30, 120 and 150 days. ANOVA and Tukey tests showed significant differences after 14 days (EC vs. MTA), 30 days (EC vs. BD) and 120/150 days (EC vs. BD/MTA) (p < 0.05). Results: All tested materials induced ΔE changes, with the EC group showing the least change at the end of the experiment (ΔE=4.08). Conclusion: EC induced less color change over a 5-month period and thus showed color stability over the entire period, whereas BD and MTA showed progressive discoloration. (AU)

Objetivo: O objetivo deste estudo foi investigar materiais bioativos com propriedades específicas, particularmente cimentos biocerâmicos altamente plásticos. Esses materiais estão sendo amplamente estudados devido ao seu potencial para manter a vitalidade da polpa e promover a regeneração dos tecidos. Material e Métodos: A descoloração dentária induzida por um cimento experimental à base de silicato tricálcico (CE) foi avaliada e comparada com a do Biodentine (BD) e do MTA-Angelus branco (MTA). Foram preparadas cavidades nas superfícies linguais de trinta e dois blocos de incisivos bovinos saudáveis. Os blocos foram quimicamente limpos e, em seguida, submetidos a uma avaliação inicial de cor (valores CIELab) usando um espectrofotômetro e divididos aleatoriamente em três grupos experimentais (n=10); dois blocos adicionais serviram como controles. Após a manipulação, os cimentos foram colocados nas cavidades, que foram posteriormente restauradas com compósito. Após outra medição de cor (valor de referência), eles foram imersos em frascos de água destilada; oram armazenados a 37 °C e 100% de umidade durante todo o período de teste. A alteração de cor (ΔE) foi medida após 14, 30, 120 e 150 dias. Os testes ANOVA e Tukey mostraram diferenças significativas após 14 dias (CE vs. MTA), 30 dias (CE vs. BD) e 120/150 dias (CE vs. BD/MTA) (p < 0,05). Resultados: Todos os materiais testados induziram alterações de ΔE, sendo que o grupo EC apresentou a menor alteração no final do experimento (ΔE=4,08). Conclusão: O EC induziu menos alterações de cor em um período de 5 meses e, portanto, apresentou estabilidade de cor durante todo o período, enquanto o BD e o MTA apresentaram descoloração progressiva.(AU)

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Objectives: This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis. Materials and Methods: Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). Results: No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001). Conclusions: The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.

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Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen.

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno.

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Abstract A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.

Resumo Uma busca contínua de materiais bioativos com capacidade de substituir o tecido pulpar danificado, com efetiva capacidade de selamento e biocompatibilidade, tem representado a atenção e foco de muitos estudos ao longo das últimas décadas. Este estudo envolve uma revisão narrativa da literatura desenvolvida por meio de pesquisas representativas encontradas no PUBMED/MEDLINE e pesquisas em livros didáticos associadas ao mecanismo de ação de materiais bioativos (hidróxido de cálcio, agregado de trióxido mineral (MTA) e cimentos de silicato de cálcio). A presente análise reflexiva das particularidades dos elementos químicos destes materiais bioativos, considerando o mecanismo de ação tecidual e antibacteriano, possibilita um melhor entendimento das características e similaridades no comportamento tecidual. A pasta de hidróxido de cálcio continua sendo a substância antibacteriana de escolha como medicação intracanal para o tratamento das infecções do sistema de canais radiculares. Este fato se deve a disponibilidade química de íons cálcio e hidroxila do hidróxido de cálcio aos tecidos, e a inibição enzimática bacteriana. Os cimentos de silicato de cálcio, dentre os quais inclui o MTA, apresentam uma resposta biológica favorável ao estímulo à deposição de tecido mineralizado nas áreas seladas e em contato com tecido conjuntivo. Este fato é decorrente da similaridade entre os elementos químicos, em especial devido a dissociação iônica, ao potencial estímulo de enzimas teciduais, e a contribuição com um meio alcalino decorrente do pH destes materiais. O comportamento dos materiais bioativos, em especial o MTA e os novos cimentos de silicato de cálcio na atividade de selamento biológico mostraram efetivos. A endodontia contemporânea atualmente conta com o potencial de materiais bioativos com propriedades análogas capaz de estimular o selamento biológico em perfurações radiculares laterais e de furca, em obturações radiculares, capeamento pulpar, pulpotomia, apicificação e procedimentos endodônticos regenerativos, além de outras condições clínicas.

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Abstract Cetrimide (CTR) is a cationic surfactant detergent with antimicrobial and antibiofilm activity. The aim of this study was to evaluate setting time, pH, solubility and antibiofilm activity of tricalcium silicate cement (TSC) with zirconium oxide (ZrO2) and its association with 0.2 and 0.4% cetrimide. Initial and final setting times (IST and FST) were assessed based on ISO-6876. pH was evaluated at periods of 1,3,7,14 and 21 days. Solubility was analyzed by weight loss. A modified direct contact test (MDCT) on the biofilm of Enterococcus faecalis formed on bovine root dentin blocks was performed, after 6 hours of manipulation and 15 hours of contact time. The analysis was performed by UFC mL ¯¹ counting. The data were analyzed by ANOVA and Tukey's tests (α=0.05). Higher IST was observed for TSC/ZrO2+CTR in both concentrations than for TSC/ZrO2 and lower FST for TSC/ZrO2+0.4% CTR (p0.05). All materials exhibited increased mass. TSC/ZrO2+CTR 0.4% had lower mass gain than the other materials (p<0.05). The highest antibiofilm activity was observed for TSC/ZrO2+CTR in both concentrations, when compared with the positive control (p<0.05). In conclusion, CTR exhibited potential to promote greater antibiofilm activity to tricalcium silicate cement, without harming its physicochemical properties of setting time, pH and solubility.

Resumen Cetrimida (CTR) es un detergente y surfactante catiónico con actividad antimicrobiana y antibiofilm. El objetivo de este estudio fue evaluar el tiempo de fraguado, pH, solubilidad y actividad antibiofilm del cemento de silicato tricálcico (CST) con óxido de zirconio (ZrO2) y su asociación con CTR a 0.2% y 0.4%. Tiempo de fraguado inicial y final (TFI y TFF) fueron determinados con base en las normas ISO-6876. pH fue evaluado en los períodos de 1,3, 7,14 y 21 días. Solubilidad fue analizada por la pérdida de masa/peso. El test de contacto directo modificado (TCDM) fue realizado sobre biofilm de Enterococcus faecalis formado en dentina radicular bovina, después de 6 horas de manipulación de los cementos y 15 horas de contacto. El análisis fue realizado por la cuantificación de UFC mL¯¹. Los datos fueron analizados usando las pruebas de ANOVA y Tukey (α=0.05). Mayor TFI fue observado para CST/ ZrO2+CTR en las dos concentraciones que para TSC/ZrO2 y menor TFF para TSC/ ZrO2+CTR 0.4% (p0.05). Todos los materiales mostraron aumento de masa. TSC/ZrO2+CTR 0.4% tuvo menor gano de masa que los otros materiales (p<0.05). Mayor actividad antibiofilm fue observado para CST/ZrO2+CTR en las dos concentraciones, cuando comparados con el grupo control positivo (p<0.05). En conclusión, CTR demostró potencial para promover superior actividad antibiofilm al cemento de silicato tricálcico (CST), sin perjudicar sus propiedades físico-químicas de tiempo de fraguado, pH y solubilidad.

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RESUMEN Tradicionalmente, el hidróxido de calcio (HC) era considerado el material de elección para el recubrimiento pulpar directo (RPD); pero esto ha cambiado con los años debido a las distintas desventajas que presenta. Los cementos a base de silicato de calcio (CSC) tienen propiedades ventajosas al compararlos con el HC como: bioactividad, biocompatibilidad, menor tiempo de fraguado, capacidad de sellado y resistencia, por lo que son usados en una variedad de procedimientos endodónticos, entre ellos el RPD. El presente artículo de revisión recopila información a partir de la búsqueda manual de artículos originales de investigación científica y revisiones de literatura de la base de datos de Medline/PubMed. Se describen las variedades de CSC, su mecanismo de acción, desventajas, factores relacionados y tasas de éxito clínico en su aplicación en casos de RPD.

ABSTRACT Traditionally, calcium hydroxide (HC) was considered the material of choice for direct pulp capping (RPD); but this has changed over the years due to the various disadvantages it presents. Calcium silicate-based cements (CSC) have properties that are advantageous to HC such as: bioactivity, biocompatibility, shorter setting time, sealing capacity and resistance, which they are used in a variety of endodontic procedures, including RPD.This review article compiles information from the manual search of original scientific research articles and literature reviews of the Medline / PubMed database. The varieties of CSC, their mechanism of action, disadvantages, related factors and rates of clinical success in their application in cases of RPD are described.

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OBJECTIVES: This study compared the Biodentine, MTA Repair HP, and Bio-C Repair bioceramics in terms of bond strength to dentin, failure mode, and compression. MATERIALS AND METHODS: Fifty-four slices obtained from the cervical third of 18 single-rooted human mandibular premolars were randomly distributed (n = 18). After insertion of the bioceramic materials, the push-out test was performed. The failure mode was analyzed using stereomicroscopy. Another set of cylindrically-shaped bioceramic samples (n = 10) was prepared for compressive strength testing. The normality of data distribution was analyzed using the Shapiro-Wilk test. The Kruskal-Wallis and Friedman tests were used for the push-out test data, while compressive strength was analyzed with analysis of variance and the Tukey test, considering a significance level of 0.05. RESULTS: Biodentine presented a higher median bond strength value (14.79 MPa) than MTA Repair HP (8.84 MPa) and Bio-C Repair (3.48 MPa), with a significant difference only between Biodentine and Bio-C Repair. In the Biodentine group, the most frequent failure mode was mixed (61%), while in the MTA Repair HP and Bio-C Repair groups, it was adhesive (94% and 72%, respectively). Biodentine showed greater resistance to compression (29.59 ± 8.47 MPa) than MTA Repair HP (18.68 ± 7.40 MPa) and Bio-C Repair (19.96 ± 3.96 MPa) (p < 0.05). CONCLUSIONS: Biodentine showed greater compressive strength than MTA Repair HP and Bio-C Repair, and greater bond strength than Bio-C Repair. The most frequent failure mode of Biodentine was mixed, while that of MTA Repair HP and Bio-C Repair was adhesive.

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Introdução: A perfuração radicular é um acidente técnico-operatório que resulta em comunicação da cavidade pulpar com os tecidos periodontais. Esse tipo de acidente pode apresentar prognóstico desfavorável, por afetar significativamente o soalho da câmara coronária ou os terços cervical, médio e apical do canal radicular. Entre os fatores que interferem no prognóstico das perfurações radiculares, destacam-se: localização, extensão, presença ou ausência de bolsa periodontal; tempo decorrido entre a perfuração e o tratamento; e tipo de material obturador. Nesse contexto, os cimentos obturadores de canais denominados biocerâmicos surgiram como uma proposta inovadora para tratamento de perfurações antes consideradas de prognóstico desfavorável. Objetivo: O presente trabalho teve por objetivo relatar o tratamento de uma perfuração radicular em molar inferior com o cimento biocerâmico EndoSequence BC Sealer, com três anos de acompanhamento. Resultados: As imagens radiográficas e os dados clínicos do paciente evidenciaram o sucesso no tratamento da perfuração, com reparo da lesão perirradicular. Conclusão: O cimento endodôntico biocerâmico EndoSequence BC Sealer associado com a retomada do trajeto original do conduto e sua instrumentação favoreceram o reparo dos tecidos perirradiculares, sugerindo propriedades biológicas promissoras de compatibilidade e bioativida (AU).

Introduction: Root perforation is a technical-surgical accident that results in communication of the pulp cavity with periodontal tissues. This type of accident may have an unfavorable prognosis because it significantly affects the floor of the coronary chamber or the cervical, middle and apical thirds of the root canal. Factors that interfere with the prognosis of root perforations include location, extension, presence or absence of periodontal pocket, time elapsed between perforation and treatment, and type of obturator material. In this context, bioceramic canal sealers have emerged as an innovative proposal for treatment of perforations previously considered to have an unfavorable prognosis. Objective: The aim of this study was to report the treatment of a lower molar root perforation with the EndoSequence BC Sealer bioceramic sealer after a 3-year follow up. Results: Radiographic images and patient clinical data showed success in the treatment of perforation with repair of the periradicular lesion. Conclusion: Endo-Sequence BC Sealer bioceramic endodontic sealer associated with the resumption of the original conduit path and its instrumentation favored the repair of periradicular tissues, suggesting promising biological properties of compatibility and bioactivity (AU).

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Introduction: This study aims to analyze the influence of particles size of sol-gel derived calcium silicate particles in the setting reaction of bioactive endodontic cements. Materials and Methods: Sol-gel derived calcium silicate particles were synthesized and sieved to separate the particles in different sizes: CS400, CS200, and CS100. A commercial MTA (Control) was used as control. The particle size and the specific surface area were assessed by laser diffraction and nitrogen adsorption. The cements were prepared with water as the liquid for the reaction. The setting time was conducted according to ISO 6876, and the setting kinetics was analyzed by Fourier trans-formed infrared spectroscopy (FTIR) at different time points between 120s to 72h. Results: The particle size varied from 9.45µm (CS400 ) to 31.01 (Control). The higher specific surface area valuer reached 15.14g/cm2 in the CS400. The smallest particle sizes, the higher specific surface area, and the lowest setting time were found for CS400 (p < 0.05). Control presented the highest setting time (p < 0.05). The FTIR analyses showed the differences in materials structure over time, with faster hydration and crystallization for CS400. The setting kinetics was slower for Control even when compared to a sol-gel derived group with similar particle size. Conclusion:The route of synthesis and the particle size influences the setting reaction of calcium silicate-based cements. The reduction of particle size for sol-gel derived calcium silicates lead to the acceleration of the setting reaction of the produced bioactive endodontic cement.

Introdução: Este estudo tem como objetivo analisar a influência do tamanho de partículas de silicato de cálcio derivadas de sol-gel na reação de presa de cimentos endodônticos bioativos. Materiais e Métodos: Partículas de silicato de cálcio derivadas de sol-gel foram sintetizadas e peneiradas para separar as partículas em diferentes tamanhos: CS400, CS200 e CS100. Um MTA comercial (Controle) foi usado como controle. O tamanho das partículas e a área superficial específica foram avaliados por difração a laser e adsorção de nitrogênio. Os cimentos foram preparados com água como líquido para a reação. O tempo de presa foi conduzido de acordo com a ISO 6876, e a cinética de presa foi analisada por espectroscopia de infravermelho transformada de Fourier (FTIR) em diferentes pontos de tempo entre 120s a 72h. Resultados: O tamanho de partícula variou entre 9,45µm (CS400) e 31,01 (Controle). A maior área de superfície foi encontrada nas partículas do grupo CS400 (15.14g/cm2). Os menores tamanhos de partícula, a maior área de superfície específica e o menor tempo de presa foram encontrados para CS400 (p < 0,05). O Control apresentou o maior tempo de presa (p < 0,05). As análises de FTIR mostraram as diferenças na estrutura dos materiais ao longo do tempo, com hidratação e cristalização mais rápidas para CS400. A cinética de presa foi mais lenta para Control mesmo quando comparado a um grupo derivado de sol-gel com tamanho de partícula semelhante. Conclusão: A rota de síntese e o tamanho das partículas influenciam a reação de endurecimento dos cimentos à base de silicato de cálcio. A redução do tamanho de partícula para silicatos de cálcio derivados de sol-gel leva à aceleração da reação de pega do cimento endodôntico bioativo produzido.

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Abstract This study assessed the fracture resistance of simulated immature teeth reinforced with calcium aluminate cement (CAC) or mineral trioxide aggregate (MTA) containing calcium carbonate nanoparticles (nano-CaCO3). The microstructural arrangement of the cements and their chemical constitution were also evaluated. Forty-eight canines simulating immature teeth were distributed into 6 groups (n=8): Negative control - no apical plug or root canal filling; CAC - apical plug with CAC; CAC/nano-CaCO3 - apical plug with CAC+5% nano-CaCO3; MTA - apical plug with MTA; MTA/nano-CaCO3 - apical plug with MTA+5% nano-CaCO3; and Positive control - root canal filling with MTA. The fracture resistance was evaluated in a universal testing machine. Samples of the cements were analyzed under Scanning Electron Microscope (SEM) to determine their microstructural arrangement. Chemical analysis of the cements was performed by Energy Dispersive X-ray Spectroscopy (EDS). The fracture resistance of CAC/nano-CaCO3 was significantly higher than the negative control (p<0.05). There was no significant difference among the other groups (p>0.05). Both cements had a more regular microstructure with the addition of nano-CaCO3. MTA samples had more calcium available in soluble forms than CAC. The addition of nano-CaCO3 to CAC increased the fracture resistance of teeth in comparison with the non-reinforced teeth. The microstructure of both cements containing nano-CaCO3 was similar, with a more homogeneous distribution of lamellar- and prismatic-shaped crystals. MTA had more calcium available in soluble forms than CAC.

Resumo Este estudo avaliou a resistência à fratura de dentes imaturos simulados reforçados com cimento de aluminato de cálcio (CAC) ou trióxido agregado mineral (MTA) contendo nanopartículas de carbonato de cálcio (nano-CaCO3). O arranjo microestrutural dos cimentos e sua constituição química também foram avaliados. Quarenta e oito caninos simulando dentes imaturos foram distribuídos em 6 grupos (n=8): Controle negativo - sem plug apical ou obturação do canal radicular; CAC - plug apical com CAC; CAC/nano-CaCO3 - plug apical com CAC + 5% nano-CaCO3; MTA - plug apical com MTA; MTA/nano-CaCO3 - plug apical com MTA + 5% nano-CaCO3; e Controle positivo - obturação dos canais radiculares com MTA. A resistência à fratura foi avaliada em máquina universal de ensaios. Amostras dos cimentos foram analisadas em Microscópio Eletrônico de Varredura (MEV) para determinar seu arranjo microestrutural. A análise química dos cimentos foi realizada por Espectroscopia de Energia Dispersiva de Raio-X (EDS). A resistência à fratura de CAC/nano-CaCO3 foi significativamente maior do que o controle negativo (p<0,05). Não houve diferença significativa entre os outros grupos (p>0,05). Ambos os cimentos apresentaram microestrutura mais regular com a adição de nano-CaCO3. As amostras de MTA apresentaram mais cálcio disponível em formas solúveis do que CAC. A adição de nano-CaCO3 ao CAC aumentou a resistência à fratura dos dentes em comparação aos dentes não reforçados. A microestrutura de ambos os cimentos contendo nano-CaCO3 foi semelhante, com uma distribuição mais homogênea de cristais de formato lamelar e prismático. MTA apresentou mais cálcio disponível nas formas solúveis do que CAC.

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OBJECTIVES: To evaluate a new material containing tantalum oxide as an alternative radiopacifier, and a water-based gel for hydration, in comparison with two calcium silicate-based cement: ProRoot MTA and Biodentine. MATERIALS AND METHODS: ProRoot MTA (Dentsply), Biodentine (Septodont), and a new hydraulic calcium silicate cement White-MTAFlow (Ultradent) (in 'thin' consistency) were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive spectroscopy (EDS). The interaction with dentin was also assessed using SEM and EDS. Physical and chemical properties radiopacity, setting time, linear flow, volumetric central filling, and lateral flow, pH, and volume change were investigated together with the color luminosity (L) and color change (ΔE). The agar diffusion and direct contact antimicrobial activity, and methylthiazolyldiphenyl-tetrazolium-bromide (MTT) cytotoxicity using human fibroblast cells were also evaluated. Data were statistically analyzed at a 5% significance level. RESULTS: All materials were composed of tricalcium and dicalcium silicate but had different radiopacifiers, and calcium hydroxide (portlandite) deposition was detected in XRD analysis. White-MTAFlow exhibited radiopacity values in accordance with ISO standard, and the longest setting time. The water-based gel provided the highest linear flow, a comparable cavity central filling, and the highest groove-lateral flow in the volumetric flow analysis. White-MTAFlow exhibited an alkalinity reduction, and Biodentine, a progressive increase of pH values after 28 days. However, similar volume loss for White-MTAFlow was assessed in comparison to Biodentine after the 28-day immersion. White-MTAFlow showed the highest L value (91.5), and ProRoot MTA the lowest (78.1) due to dentin staining caused by bismuth migration. None of the materials exhibited inhibition halos against the tested bacteria, and similar turbidity values were obtained after 48 h in direct contact with E. faecalis, indicating an upregulation to bacterial growth. White-MTAFlow showed MTT cytocompatibility similarly to the control group. CONCLUSIONS: White-MTAFlow in 'thin' consistency presents comparable physicochemical, biological, and antimicrobial properties to ProRoot MTA and Biodentine, and does not cause color alteration in dentin. CLINICAL RELEVANCE: White-MTAFlow is a suitable material for use as reparative endodontic cement. Further studies considering its biocompatibility are necessary.

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Introdução: Acidentes e complicações podem acontecer em qualquer fase do tratamento endodôntico. Podem ocorrer devido a diversos fatores, como falhas dos instrumentos, dificuldades anatômicas e limitações do profissional, o que, muitas vezes, pode alterar o prognóstico de um caso. Objetivo: O presente relato de caso aborda uma situação em que uma paciente se apresentava com dois instrumentos fraturados e uma perfuração radicular em um dente molar inferior com periodontite apical. Relato do caso: Os fragmentos foram removidos por meio de técnica mecanizada e ultrassônica padronizada, e a perfuração foi tratada e selada com material à base de silicato de cálcio. Conclusão: O emprego de recursos tecnológicos atuais favoreceu a resolução do caso, melhorando seu prognóstico. O restabelecimento da condição de normalidade do dente e tecidos adjacentes foi confirmado por exames radiográficos e tomográficos (AU).

Introduction: Accidents and complications may happen at any endodontic treatment stage. These are likely to change the prognosis of treatment and can be due to factors related to instrumental failure, anatomic difficulties and the professional's limitations. Objective: This case report addresses a case where a patient presenting two separated instruments and a root perforation in a lower molar with apical periodontitis. Case report: The separated instruments have been removed by mechanical and ultrasonic standardized method and the perforation was treated and sealed by silicate cement-based material. Conclusion: The use of technological resources favored the resolution of the case, increasing its predictability. The reestablishment of the normal condition of the tooth and surrounding tissues was confirmed by radiograph and computed tomography exams (AU).

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RESUMEN Los cementos a base de silicato de calcio son materiales bioactivos, que poseen la capacidad de liberar mayor cantidad de iones de calcio e hidroxilo, brindando ciertas ventajas como mayor capacidad antimicrobiana y de remineralización, incrementando la longevidad de los tratamientos pulpares. Theracal LC es un cemento a base de silicato de calcio el cual tiene como ventaja su presentación de fácil aplicación a comparación de otros cementos bioactivos. En el presente reporte de caso, Theracal LC fue utilizado como forro cavitario. Al examen clínico el paciente presentó las piezas 36 y 35 con el diagnóstico dental: caries dental con lesión con cavidad y caries dental con lesión profunda adyacente a restauración, respectivamente y como diagnóstico pulpar: Pulpa sana, en ambas piezas. Se realizaron restauraciones directas con resina compuesta en las piezas 36 y 35, considerando los siguientes pasos: grabado selectivo, sistema adhesivo autocondicionante, cemento protector a base de silicato de calcio y resina compuesta para técnica Bulk.

SUMMARY Calcium silicate-based cements are bioactive materials, which have the capacity to release a greater number of calcium and hydroxyl ions, providing some advantages like an increased antimicrobial and remineralise activity, increasing the pulp treatments longevity. Theracal LC is a calcium silicate-based cement that has as an advantage its easy application, comparing to others bioactive cements. In this case report, Theralcal LC was used as a cavity liner. At clinical examination teeth 36 and 35 exhibited diagnosis of Dental caries; 36 with a cavitated lesion and 35 with a lesion adjacent to a previous restoration; and pulp diagnosis, Sound Pulp, for both tooth pieces. Direct restorations were made with composite resin in tooth pieces 36 and 35, considering the following steps: selective etching, self-etch adhesive system, calcium silicate-based cement and Bulk-fill resin composite.

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Abstract The purpose of this study was to investigate and to compare the physical-mechanical properties of a resin-modified calcium silicate material (TheraCal LC), used for pulp-capping, to MTA (Angelus) and a calcium hydroxide cement (Dycal). Specimens of each material (n=12) were prepared in Teflon molds (3.58 mm x 3 mm) and measured before and after immersion in distilled water for 24 h and 30 days to evaluate the dimensional change. The same specimens were submitted to compressive strength test on a Universal Testing Machine (Instron) (1 mm/min). Root canals were filled with the cements (n=8), and after 24 h, the bond strength (push-out test) to dentin was also assessed on a Universal Testing Machine (1 mm/min). Eight additional specimens of TheraCal LC were prepared to evaluate the bond strength immediately after light curing. Data were analyzed using One-Way ANOVA, and Tukey or Bonferroni post hoc tests (p<0.05). Percentage expansion of TheraCal LC was above the Specification No. 57 of ANSI/ADA, in both periods. The dimensional change for TheraCal LC was higher than MTA in 24 h and 30 days; and Dycal in 30 days (p<0.05). TheraCal LC had higher compressive and bond strength to dentin in comparison with MTA and Dycal (p<0.05). Although TheraCal LC expanded more than the ANSI/ADA recommendation, its compressive and push-out bond strength to dentin were satisfactory and superior to MTA and Dycal.

Resumo O objetivo deste estudo foi investigar e comparar as propriedades físico-mecânicas de um material à base de silicato de cálcio modificado por resina (TheraCal LC) ao MTA (Angelus) e um cimento de hidróxido de cálcio (Dycal). Espécimes de cada material (n=12) foram fabricados em moldes de Teflon (3,58 mm x 3 mm) e medidos antes e após imersão em água destilada por 24 h e 30 dias para avaliar a alteração dimensional. Os mesmos espécimes foram submetidos ao teste de resistência à compressão em uma Máquina Universal de Testes (Instron) (1 mm/min). Canais radiculares foram preenchidos com os cimentos (n=8), e após 24 h, a resistência de união (teste de push-out) também foi avaliada em uma Máquina Universal de Testes (1 mm/min). Oito amostras adicionais de TheraCal LC foram preparadas para avaliar a resistência de união imediatamente após a fotoativação. Os dados foram analisados utilizando os testes ANOVA de 1-fator e Tukey; ou Bonferroni (p<0,05). A expansão percentual do TheraCal LC ficou acima da Especificação No. 57 do ANSI/ADA, em ambos os períodos. Os valores de alteração dimensional para TheraCal LC foram maiores que MTA em 24 h e 30 dias; e Dycal em 30 dias (p<0,05). TheraCal LC apresentou maior resistência à compressão e união à dentina em comparação ao MTA e Dycal (p<0,05). Embora TheraCal LC tenha expandido mais que a recomendação da ANSI/ADA, sua resistência à compressão e de união à dentina foram satisfatórias e superiores ao MTA e Dycal.

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Abstract This study evaluated the impact of using biomimetic analogs (poly-acrylic acid and sodium tri-meta-phosphate) on dentin remineralization using two cement materials, the first is calcium silicate based and the second is calcium hydroxide based materials. Two standardized occlusal cavities (mesial and distal) were prepared within dentin after removal of occlusal enamel. Artificial demineralized dentin was induced through pH cycling (8 h in demineralizing and 16 h in remineralizing solutions). Demineralized cavities were divided into four groups; two groups received cement materials. The other groups were first treated with biomimetic analogs then restored with pulp cement materials. Teeth were sectioned buccolingually into two halves. Treated cavities with analogs were stored in simulated body fluid containing poly-acrylic acid. Untreated cavities were stored in simulated body fluid only. Ground unstained sections of demineralized dentin were examined using light microscope. Specimens were examined after 1, 6 and 12 weeks of storage using energy dispersive X-ray Spectroscopy (EDX) and Vickers microhardness was evaluated. Two-way ANOVA was used to analyze data statistically. Calcium silicate-based cement group with biomimetic analogs showed the highest statistically significant calcium and phosphorous wt% in addition to highest surface hardness values after 12 weeks of storage. Demineralized dentin ground sections showed increase in light zones after total period of storage. Calcium silicate-based cement showed the best ability to enrich the artificial carious dentin with ions for remineralization. Using biomimetic analogs had a significant impact on demineralized dentin surface hardness improvement.

Resumo Este estudo avaliou o impacto do uso de análogos biomiméticos (ácido poli-acrílico e tri-meta-fosfato de sódio) na remineralização da dentina usando dois materiais de cimento, o primeiro à base de silicato de cálcio e o segundo à base de hidróxido de cálcio. Duas cavidades oclusais padronizadas (mesial e distal) foram preparadas na dentina após a remoção do esmalte oclusal. A dentina desmineralizada artificial foi induzida por ciclagem de pH (8 h em soluções desmineralizantes e 16 h em soluções remineralizantes). Cavidades desmineralizadas foram divididas em quatro grupos; dois grupos receberam materiais de cimento. Os outros grupos foram tratados primeiro com análogos biomiméticos e depois restaurados com materiais de cimento de celulose. Os dentes foram seccionados bucolingualmente em duas metades. As cavidades tratadas com análogos foram armazenadas em fluido corporal simulado contendo ácido poli-acrílico. As cavidades não tratadas foram armazenadas apenas em fluido corporal simulado. Secções não coradas de dentina desmineralizada foram examinadas usando microscópio óptico. As amostras foram examinadas após 1, 6 e 12 semanas de armazenamento usando Espectroscopia de Raios-X dispersiva por energia (EDX) e microdureza Vickers. ANOVA a dois fatores foi usada para analisar os dados estatisticamente. O grupo de cimento à base de silicato de cálcio com análogos biomiméticos apresentou os maiores percentagens em peso estatisticamente significantes de cálcio e fósforo, além dos maiores valores de dureza superficial após 12 semanas de armazenamento. Seções desmineralizadas de dentina mostraram aumento nas zonas de luz após o período total de armazenamento. O cimento à base de silicato de cálcio mostrou a melhor capacidade de enriquecer a dentina cariada artificial com íons para remineralização. O uso de análogos biomiméticos teve um impacto significativo na melhoria da dureza superficial da dentina desmineralizada.

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AIM: The aim of this study is to evaluate the effect of different doses of the ionizing radiation (0 Gy, 10 Gy, 30 Gy, and 60 Gy) on the physical properties of dental materials. METHODOLOGY: Disc-shaped samples from each material (Ketac Molar Easymix, Vitro Molar, Vitremer, Vitro Fil Lc, Filtek Z 250 and Filtek Z 350) were made for water solubility, sorption analysis (n = 20), microhardness (n = 20), and surface roughness analysis (n = 24). Specimens were divided into four groups, according to radiation dose: control group (0 Gy), 10 Gy, 30 Gy, and 60 Gy. For water solubility and sorption analysis, the specimens were irradiated and were stored for 21 days to calculate the water solubility and sorption values. Microhardness analysis was carried out before and after irradiation doses. For surface roughness analysis, the specimens were submitted to brushing test, and after 24 h, initial surface roughness analysis was made in a rugosimeter. Subsequently, the samples were irradiated and final surface roughness analysis was made. The original water solubility and sorption, surface roughness, and microhardness values were subjected to ANOVA two-way statistical analysis and Paired t-test and Tukey post hoc test (α = 0.05), respectively. RESULTS: Water solubility and sorption values, and surface roughness values presented statistical difference between groups (0, 10, 30 e 60 Gy) for all materials. CONCLUSIONS: High doses of ionizing radiation (30 Gy and 60 Gy) increased the surface roughness, sorption, and solubility for the most materials.

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Abstract The aim of this study was to evaluate physical properties of endodontic sealers (AH Plus, MTA Fillapex and Endofill), by conventional and micro-CT tests. Dimensional stability was evaluated after immersion of materials in distilled water for 30 days. Solubility and volumetric change were evaluated after 7 and 30 days of immersion in distilled water. Solubility was evaluated by means of mass loss and volumetric change was assessed by micro-CT. Porosity was evaluated under a microscope after 7 days of immersion in distilled water, and by using micro-CT after setting and immersion in distilled water for 7 and 30 days. Statistical analysis was performed by ANOVA and Tukey's test with 5% significance level. MTA Fillapex presented the highest solubility (p<0.05), showing values above the ISO/ADA recommendations. MTA Fillapex presented higher volumetric and dimensional changes, followed by Endofill and AH Plus (p<0.05). Dimensional stability of the MTA Fillapex and AH Plus did not follow ISO/ADA standards. The highest total porosity was observed for MTA Fillapex (p<0.05). Endofill had higher total porosity than AH Plus according to microscope evaluation (p<0,05), and both sealers were similar in micro-CT assessment (p>0,05). In conclusion, MTA Fillapex presented higher solubility, dimensional and volumetric change besides porosity compared to the other evaluated sealers. The assessed physical properties of sealers are related, and the different tests provided complementary data. Micro-CT is a valuable method for assessment of physical properties of endodontic materials.

Resumo O objetivo deste estudo foi avaliar propriedades físicas de cimentos endodônticos (AH Plus, MTA Fillapex e Endofill), por meio de testes convencionais e micro-CT. A estabilidade dimensional foi avaliada após imersão dos materiais em água destilada por 30 dias. A solubilidade e a alteração volumétrica dos materiais foram avaliadas após 7 e 30 dias de imersão em água destilada. A solubilidade foi avaliada por meio de perda de massa e a alteração volumétrica foi avaliada por micro-CT. A porosidade foi avaliada por microscopia após 7 dias de imersão em água destilada e por micro-CT após a presa e imersão em água destilada por 7 e 30 dias. A análise estatística foi realizada por meio dos testes ANOVA e Tukey, com nível de significância de 5%. MTA Fillapex apresentou a maior solubilidade (p<0,05), com valores acima das recomendações ISO/ADA. As alterações volumétricas e dimensionais foram maiores para MTA Fillapex, seguido por Endofill e AH Plus (p<0,05). MTA Fillapex e AH Plus não cumpriram os padrões ISO/ADA em relação à estabilidade dimensional. Uma maior porosidade total foi observada para MTA Fillapex (p <0,05). Endofill apresentou maior porosidade total que o AH Plus pela avaliação em microscopia (p<0,05), e ambos os cimentos foram semelhantes na avaliação por micro-CT (p>0,05). Em conclusão, MTA Fillapex apresentou maior solubilidade, alteração dimensional e volumétrica, além de maior porosidade em relação aos demais cimentos avaliados. As propriedades físicas avaliadas estão relacionadas, e os diferentes testes forneceram dados complementares. Micro-CT é um método valioso para avaliação das propriedades físicas dos materiais endodônticos.

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OBJECTIVES: The effect of ultrasonic agitation (UA) on bond strength and adaptation of cervical plugs prepared with MTA Angelus (MTA), MTA Repair HP (MTAHP), and Biodentine (BIO) was evaluated. Dentin discoloration caused by the materials/treatment was also assessed. MATERIALS AND METHODS: Seventy-two single rooted teeth were divided into six groups depending on the materials/treatment. After cervical plug preparation, dentin discs were excised for the push-out test; additional discs were analyzed under the confocal microscope to determine adaptation (gaps occurrence). For dentin discoloration analysis (ΔE), blocks of bovine incisors had cavities prepared and filled with the materials/treatment (from 7 to 180 days). RESULTS: Both bond strength and adaptation were positively influenced by UA (P < 0.05). Comparison between materials showed an advantage for BIO when compared to MTAHP (P < 0.05). The best and worst results were provided by BIO/UA (12.66 MPa and 1.87%) and MTAHP (2.54 MPa and 28.58%), respectively. For ΔE, significant differences were observed throughout the periods. Just the MTA without UA exhibited noticeable discoloration at 180 days (P < 0.05). CONCLUSIONS: UA favored a better adaptation of the materials to the dentin root, resulting in higher bond strength and adaptation of the materials to the root canal walls. Moreover, UA reduced MTA discoloration, keeping it imperceptible over the period evaluated. CLINICAL RELEVANCE: The better adaptation and higher bond strength provided by UA can be considered clinically relevant due to the importance of maintaining blood clot integrity and the possible esthetic compromise provided by reparative materials when used as coronary barrier in regenerative procedures.

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OBJECTIVES: Evaluate the tissue reaction of periodontium subjacent to furcation perforations in rat molars sealed with Biodentine or mineral trioxide aggregate (MTA). MATERIALS AND METHODS: The pulp chamber floor of right upper first molars of 60 rats was perforated and filled with Biodentine, MTA, or cotton pellet (sham); the left first molars were used as control. After 7, 15, 30, and 60 days, maxillary fragments were processed for paraffin-embedding. The periodontal space (PS), volume density of inflammatory cells (VvIC) and fibroblasts (VvFb), number of osteoclasts, and collagen content were obtained. Interleukin-6 (IL-6) and osterix (osteoblast marker) were detected by immunohistochemistry. The data were submitted to ANOVA and Tukey's test (p ≤ 0.05). RESULTS: At 7 days, high values in VvIC, IL-6-immunolabeled cells, and osteoclasts were accompanied by reduced collagen content in enlarged PS of experimental groups. At all periods, VvIC, number of osteoclasts and IL-6, and PS were higher in sham than in Biodentine and MTA (p < 0.0001). From 7 to 60 days, significant reduction in VvIC, IL-6 immunoexpression, and osteoclasts was accompanied by significant increase in VvFb, osteoblasts, and collagen in Biodentine and MTA groups. At 60 days, significant differences in VvIC, PS, IL-6, osteoclasts, and osteoblasts were not found between Biodentine and MTA. Significant differences in the osteoclast number were not observed among Biodentine, MTA, and control groups while osteoblasts number was higher in Biodentine and MTA groups. CONCLUSIONS: Despite the initial inflammatory reaction and bone resorption, the sealing of furcation perforations with Biodentine and MTA favors the repair of periodontal tissues. CLINICAL RELEVANCE: Biodentine and MTA exhibit potential as repair material in the treatment of furcation perforations.

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ABSTRACT: The aim of the study was to evaluate the chemical composition and radiopacity of new calcium-silicatebased cements. Discs of 10 mm x 1 ± 0.1mm were prepared of BiodentineTM, TheraCal, Dycal and GC Fuji IX (n=5). The samples were radiographed directly on an PSP occlusal plate adjacent to an aluminium step wedge. The radiopacity of each specimen was determined according to ISO 9917/2007. Statistical analyses were carried out using ANOVA and Tukey's test at a significance level of 5 %. The chemical constitution of materials was determined by scanning electron microscopy (SEM) and energy dispersive x-ray element mapping. The radiopacities of the materials in decreasing order were: GC Fuji IX (3.45 ± 0.16 mm), Dycal (3.18 ± 0.17), BiodentineTM (2.79 ± 0.22), and TheraCal (2.17 ± 0.17). TheraCal showed the lowest radiopacity compared to the other materials, followed by BiodentineTM. Dycal and GC Fuji IX radiopacity values did not present significant statistical differences. Scanning electron microscopy and energy dispersive X-ray analysis revealed the presence of zirconium in BiodentineTM; and strontium, barium and zirconium in TheraCal as radiopacifying elements. The new calcium silicate cements present distinctive chemical composition. BiodentineTM contains zirconium as a radiopacifying element and has higher radiopacity values than TheraCal, which contains barium and strontium as radiopacifiers.

RESUMEN: El objetivo de este estudio fue evaluar la composición química y la radiopacidad de nuevos cementos en base a silicato de calcio. Discos de 10 mm x 1 ± 0,1 mm fueron preparados con BiodentineTM, TheraCal, Dycal y GC Fuji IX (n=5). Las muestras fueron radiografiadas directamente en una película PSP oclusal adyacente a una cuña escalonada de aluminio. La radiopacidad de cada espécimen fue determinada de acuerdo a la norma ISO 9917/ 2007. Se realizaron los análisis estadísticos con las pruebas ANOVA y test de Tukey con un nivel de significancia de 5 %. La constitución química de los materiales fue determinada con microscopía electrónica de barrido y con mapeo por análisis con dispersión de energía de rayos X. La radiopacidad de los materiales en orden decreciente fue: GC Fuji IX (3,45 ± 0,16 mm), Dycal (3,18 ± 0,7 mm), BiodentineTM (2,79 ± 0,22 mm), y TheraCal (2,17 ± 0,17 mm). TheraCal mostró la menor radiopacidad comparada con los otros materiales, seguido de BiodentineTM. Los valores de radiopacidad de Dycal y GC Fuji IX no presentaron diferencias estadísticas significativas. Los análisis de microscopía electrónica de barrido y mapeo por análisis con dispersión de energía de rayos X revelaron la presencia de zirconio en BiodentineTM; y de estroncio, bario y zirconio en TheraCal, como elementos radiopacos. Los nuevos cementos en base a silicato de calcio presentan una composición química distintiva. BiodentineTM contienen zirconio como elemento que provee radiopacidad y tiene mayor valor de radiopacidad que TheraCal, el cual contiene bario y estroncio como agente radiopaco.

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