Incorporation of chlorhexidine gluconate or diacetate into a glass-ionomer cement: porosity, surface roughness, and anti-biofilm activity

To evaluate the porosity, surface roughness and anti-biofilm activity of a glass-ionomer cement (GIC) after incorporation of different concentrations of chlorhexidine (CHX) gluconate or diacetate. Methods: For the porosity and surface roughness tests, 10 test specimens were fabricated of the GIC Ketac Molar Easy Mix (KM) and divided into the following groups: Control, GIC and 0.5% CHX diacetate; GIC and 1.0% CHX diacetate; GIC and 2.0% CHX diacetate; GIC and 0.5% CHX gluconate; GIC and 1.0% CHX gluconate; GIC and 2.0% CHX gluconate. To evaluate porosity, the test specimens were fractured. The fragments were photographed by scanning electron microscopy (SEM), and the images analyzed with the aid of the software program Image J. The surface roughness (Ra) was obtained by the mean value of three readouts performed on the surface of each specimen, always through the center. To analyze the anti-biofilm activity, strains of S. mutans ATCC 35688 were used, and the groups control and GIC +CHX diacetate 1% were divided as follows: GIC (1 day); GIC (7 days), GIC (14 days), GIC (21 days); GIC+CHX (1 day), GIC+CHX (7 days), GIC+CHX (14 days), GIC+CHX (21 days); GIC+ CHX (1 day), GIC+ CHX (7 days), GIC+ CHX (14 days) and GIC+ CHX (21 days) using 10 test specimens per group. For biofilm growth, the specimens were placed in a vertical position in 24-well plates and incubated overnight 10 times. The culture medium was renewed every 24 hours. The suspension was diluted and seeded on BHI agar for quantification of the bacteria present. For evaluation of all the tests the two-way ANOVA was used, and if necessary, the Tukey test was applied, with a level of significance of 5%. Results: Regarding GIC porosity, the ANOVA showed that the presence of CHX increased the porosity (P< 0.001) proportionally to the increase in concentrations (P= 0.001), without however, presenting interaction between material and concentration (P= 0.705). Regarding the number of pores, a significant increase in pores was observed with the increase in CHX concentration (P= 0.003). The surface roughness test demonstrated no statistically significant effect as to increase or reduction in roughness at any of the CHX concentrations used (P> 0.05). Anti-biofilm activity analysis pointed out a significant effect of the factors material (P= 0.006) and time (P< 0.001), with CHX diacetate CHX presenting greater effectiveness in reducing microorganisms.

Repair of Bone Defects Filled with New Calcium Aluminate Cement (EndoBinder)

The aim of this study was to evaluate and compare the repair of bone defects filled with calcium aluminate cement (EndoBinder), mineral trioxide aggregate (MTA), and calcium hydroxide. Methods After mixing, the cements were inserted into bone defects (3.3 mm) mechanically created in the right and left tibias of 30 rats (Rattus norvegicus, Wistar). In the control group, the bone defects were filled with blood clot of the animal itself. After time intervals of 7, 30, and 90 days had elapsed, bone tissue biopsies (n = 5) were surgically obtained and submitted to laboratory processing. The response of bone tissue in contact with the materials was microscopically analyzed. The percentage of neoformed bone tissue in the defect was determined by means of planimetry counting points superimposed on the histologic image. Results Significant increase in the percentage of neoformed bone tissue was observed throughout the experimental periods in all groups (P < .05). For the cements EndoBinder and MTA (30 and 90 days), these percentage values were statistically higher than those of the control group (P < .05); however, they were similar to those of calcium hydroxide (P > .05). Conclusions EndoBinder and MTA allowed complete repair of bone defects created in rat tibias.

Air abrasion before and/or after zirconia sintering: surface characterization, flexural strength, and resin cement bond strength

The purpose of this in vitro study was to evaluate the effect of air-abrasion/zirconia sintering order on the yttria partially stabilized tetragonal zirconia polycrystal (Y-TZP) surface characterization (roughness, morphology, and phase transformation), flexural strength (FS), and shear bond strength (SBS) to a resin cement. Y-TZP specimens were air abraded with 50-μm Al2O3 particles after (AS), before (BS), or before and after zirconia sintering (BAS). For roughness (Ra), 30 block specimens (12×12×3.0 mm; n=10) had their surfaces analyzed by a profilometer. Next, on the air-abraded surfaces of these specimens, composite resin discs (n=30) were bonded with RelyX ARC. The bonded specimens were stored for 24 hours in distilled water at 37°C before shear testing. Failure mode was determined with a stereomicroscope (20×). The surface morphology (n=2) was evaluated by SEM (500×). For the four-point flexural strength test (EMIC DL2000), 39 bar-shaped specimens (20×4.0×1.2 mm; n=13) were air abraded according to the three conditions proposed, and an additional group (nonabraded) was evaluated (n=13). The quantitative analysis of phase transformation (n=1) was completed with Rietveld refinement with X-ray diffraction data. Ra (μm) and SBS (MPa) data were analyzed by one-way analysis of variance (ANOVA) and the Tukey test (α=0.05). Pearson correlation analysis was used to determine if there was a correlation between roughness and SBS. For FS (MPa) data, one-way ANOVA and the Dunnett C-test (α=0.05) were used. The air-abrasion/zirconia sintering order influenced significantly (p<0.001) Ra, SBS, and FS. The BS and AS groups presented the highest (1.3 μm) and the lowest (0.7 μm) Ra. The highest SBS (7.0 MPa) was exhibited by the BAS group, followed by the AS group (5.4 MPa) and finally by the BS group (2.6 MPa). All groups presented 100% adhesive failure. A weak correlation (r=−0.45, p<0.05) was found between roughness and SBS. The air-abrasion/zirconia sintering order provided differences in the surface morphology. The nonabraded (926.8 MPa) and BS (816.3 MPa) groups exhibited statistically similar FS values but lower values than the AS (1249.1 MPa) and BAS (1181.4 MPa) groups, with no significant difference between them. The nonabraded, AS, BS, and BAS groups exhibited, respectively, percentages of monoclinic phase of 0.0 wt%, 12.2 wt%, 0.0 wt%, and 8.6 wt%. The rougher surface provided by the air-abrasion before zirconia sintering may have impaired the bonding with the resin cement. The morphological patterns were consistent with the surface roughness. Considering the short-term SBS and FS, the BAS group exhibited the best performance. Air abrasion, regardless of its performance order, provides tetragonal to monoclinic transformation, while sintering tends to zero the monoclinic phase content.

Interference of the assessment method in pH values of an epoxy-based cement

Introduction: Alkalinization potential is a fundamental property of endodontic epoxy-based cements containing calcium hydroxide. Studies have shown discrepant pH results for same materials at different evaluation periods. A possible reason accounting for these differences may be the assessment procedures. Objective: To evaluate the pH value of an epoxy-based cement (Sealer 26) in different periods of analysis, using two assessment methods. Material and methods: Sealer 26 was manipulated and immediately placed into polyethylene tubes (n=10, each group) and immersed in distilled water. In G1, the tubes were kept in the same water during all experiment; and in G2, the tubes were removed and placed into another flask with an equal amount of water after the pH evaluation. The pH of these solutions was measured at 24 hours, 7, 14 and 28 days. Analysis were made within the same group according to the experimental periods and between groups in each experimental period. Data were submitted to ANOVA (α = 5%) and t test, respectively. Results: For G1 and G2, all periods showed different pH values (p < 0.05), except between 14 and 28 days (p > 0.05) and between 7 and 14 days (p > 0.05), respectively. In each period, no significant differences were observed between the groups. Conclusion: The method to obtain the pH values in different experimental periods no interfered in the final results. However, difference was observed when the results were analyzed at same group.

Evaluation of the physicochemical properties and push-out bond strength of mta-based root canal cement

Aim: This study investigated the flowability, setting time, pH, calcium release and bond strength of a MTA-based cement (MTA Fillapex®) compared to AH Plus and Sealapex. Materials and methods: For the flowability test, the ISO 6876:2001 specification was utilized and for the setting time test, the ASTM C266-03 specification was utilized. For the pH and calcium release measurements, 10 samples were prepared for each group and analyzed for several different periods. For the push-out test, dentin disks were distributed into three groups, according to the cement utilized and into three subgroups, according to the root third (n = 10). After obturation, the specimens underwent push-out testing. The data were compared statistically using a significance level of 5%. Results: The flowability of all materials was found to be similar (p > 0.05). The setting times were different among the groups tested (MTA Fillapex < Sealapex < AH Plus) (p < 0.05). At days 7 and 28, the MTA Fillapex presented the higher pH values (p < 0.05). At 24 hours and at 14 days, the calcium release of the MTA Fillapex was similar to that of Sealapex (p > 0.05). AH Plus presented the lowest pH and calcium release values (p < 0.05). In all root thirds, the adhesion to the dentin of the MTA Fillapex and Sealapex were significantly lower than that of AH Plus (p < 0.05). Conclusion: MTA Fillapex and Sealapex presented several similar properties and both were found to be different than AH Plus. Clinical significance: This study evaluated the physicochemical and mechanical properties of new MTA-based root canal cement, in order to use this scaler in root canal fillings. MTA Fillapex showed satisfactory properties for clinical use.

Indirect resin onlay cemented with self-adhesive resin cement: a comprehensive clinical overview

Advances in adhesive technology and esthetic dental materials have permitted clinicians to perform conservative preparation of the dentition for onlay restorations. Indirect resin onlays are a great alternative to dental crowns for reestablishment the function and esthetic in teeth with great destruction.

Influence of addition of calcium oxide on physicochemical properties of Portland cement with zirconium or niobium oxide

Context: Calcium oxide (CaO) may be added to mineral trioxide aggregate (MTA) or Portland cement (PC) to improve physicochemical and biological properties. Aims: To evaluate the physicochemical properties of PC associated with radiopacifiers and CaO. Materials and Methods: MTA Angelus, PC + 30% zirconium oxide (Zr), or 30% niobium oxide (Nb) associated with 10 or 20% of CaO were evaluated. Gilmore needles were used to evaluate initial and final setting time. Compressive strength was evaluated after the periods of 24 hours and 21 days. pH was analyzed after 3, 12, 24 hours, 7, 14, 21 days. Solubility and flow tests were performed based on the ISO 6876. The data obtained were submitted to analysis of variance and Tukey tests (P ≤ 0.05). Results: The associations with 10% CaO showed greater strength that the associations with 20% CaO. The shortest initial setting time was observed for the association PC + Zr + 20% CaO and MTA. All the cements presented alkaline pH. The flow of all cements was similar. The highest solubility was found in the associations with 20% CaO. Conclusion: The addition of CaO to PC favored the alkaline property and the PC + Zr + 20% CaO presented setting time similar to MTA.

The association of chlorhexidine digluconate and calcium chloride to use as vehicle of a silicate calcium-based cement

Objective: The purpose of this study was to evaluate the influence of the addition of 2% chlorhexidine digluconate (CHX) associated with 5% calcium chloride (CaCl2 ) on antimicrobial activity, setting time, pH and calcium release of gray mineral trioxide aggregate (GMTA). Materials and Methods: GMTA powder was mixed with water, 2% CHX alone or 2% CHX combined with 5% CaCl2 . Antimicrobial activity was determined against Enterococcus faecalis (ATCC 29212) strains by agar diffusion test. Data obtained were submitted to kruskal wallis tests. Analysis of the setting time was evaluated by American society for testing and materials C266-03 requirements. The pH and calcium release analysis were evaluated, in 24 h, 7, 14 and 28 days using pH meter equipment and atomic absorption spectrophotometer, respectively. Data obtained were analyzed by ANOVA, in 5% significance level. Results: Significant differences were seen (P < 0.01) among the zones of bacterial growth inhibition produced by 5% CaCl2 + 2% CHX combination against E. faecalis when compared with water (P < 0.05). Regarding the setting time, that combination had the shortest setting time (P < 0.05). All associations were alkaline and released calcium. No statistical difference was observed between the experimental groups at the different periods of analysis (P > 0.05). Conclusion: Combination of 5% CaCl2 + 2% CHX reduced the setting time and enhanced the antimicrobial activity of GMTA without changing the pH and calcium release.

MTA versus Portland cement: review of literature

Introduction: Both Mineral Trioxide Aggregate (MTA) and Portland cement (PC) have been highlighted because of their favorable biological properties, with extensive applications in Endodontics, including the possibility of using into root canal filling. Objective: This article reviews literature related to MTA and PC comparing their physical, chemical and biological properties, as well as their indications. Literature review: Literature reports studies revealing the similarities between these materials’ properties, including both biocompatibility and bone repair induction. Moreover, there is the need for the development of a root canal sealer based on these materials (MTA and PC). Conclusion: MTA and CP show promissory perspective both in Dentistry and Endodontics.

Compressive strength and setting time of MTA and portland cement associated with different radiopacifying agents

The aim of this study was to evaluate the compressive strength and setting time of MTA and Portland cement (PC) associated with bismuth oxide (BO), zirconium oxide (ZO), calcium tungstate (CT), and strontium carbonate (SC). Methods. For the compressive strength test, specimens were evaluated in an EMIC DL 2000 apparatus at 0.5 mm/min speed. For evaluation of setting time, each material was analyzed using Gilmore-type needles. The statistical analysis was performed with ANOVA and the Tukey tests, at 5% significance. Results. After 24 hours, the highest values were found for PC and PC + ZO. At 21 days, PC + BO showed the lowest compressive strength among all the groups. The initial setting time was greater for PC. The final setting time was greater for PC and PC + CT, and MTA had the lowest among the evaluated materials (< 0.05). Conclusion. The results showed that all radiopacifying agents tested may potentially be used in association with PC to replace BO.

Ph and antimicrobial activity of portland cement associated with different radiopacifying agents

The aim of this study was to evaluate the antimicrobial activity and pH changes induced by Portland cement (PC) alone and in association with radiopacifiers. Methods. The materials tested were pure PC, PC + bismuth oxide, PC + zirconium oxide, PC + calcium tungstate, and zinc oxide and eugenol cement (ZOE). Antimicrobial activity was evaluated by agar diffusion test using the following strains: Micrococcus luteus, Streptococcus mutans, Enterococcus faecalis, Pseudomonas aeruginosa, and Candida albicans. After 24 hours of incubation at 37°C, inhibition of bacterial growth was observed and measured. For pH analysis, material samples (n=10) were placed in polyethylene tubes and immersed in 10 mL of distilled water. After 12, 24, 48, and 72 hours, the pH of the solutions was determined using a pH meter. Results. All microbial species were inhibited by the cements evaluated. All materials composed of PC with radiopacifying agents promoted pH increase similar to pure Portland cement. ZOE had the lowest pH values throughout all experimental periods. Conclusions. All Portland cement-based materials with the addition of different radiopacifiers (bismuth oxide, calcium tungstate, and zirconium oxide) presented antimicrobial activity and pH similar to pure Portland cement.

Portland cement use in dental root perforations: a long term followup

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

Chemical characterization and bioactivity of epoxy resin and Portland cement-based sealers with niobium and zirconium oxide radiopacifiers

The purpose of this study was to characterize and to evaluate the bioactivity potential of experimental root canal sealers (ES) based on Portland cement, epoxy resin with nano- and micro-particles of niobium or zirconium oxide used as radiopacifiers in comparison to AH Plus and MTA Fillapex. Methods Specimens of the sealers (10 mm in diameter × 1 mm thick) were prepared and the radiopacity was evaluated according to ISO 6876 (2012) specifications. Characterization of the sealers was performed under the scanning electron microscope (SEM) immediately after setting and after immersion for 28 days in Hank's balanced salt solution (HBSS). In addition X-ray energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and Fourier transform infrared (FT-IR) spectroscopy were also performed. The pH and calcium ion release were measured after 1, 7, 14, 21 and 28 days after completion of seating using a digital pH meter and an atomic absorption spectrophotometer, respectively. Results The experimental sealers exhibited an average radiopacity of 2.5 mm thickness of aluminum, which was similar to MTA Fillapex (P > 0.05) and inferior to AH Plus (P < 0.05). AH Plus did not show bioactivity. Although the experimental sealers did not exhibit the formation of hydration product, they encouraged the deposition of crystalline spherical structures of calcium deficient phosphate. The highest pH and calcium release values were observed with the experimental sealers (P < 0.01). ES-Nb-micro was the only sealer to present hexagonal shaped crystal deposition. Significance Novel root canal sealers based on a mixture of Portland cement, epoxy resin and radiopacifier exhibited a degree of bioactivity although no evidence of cement hydration was demonstrated on material characterization. The radiopacifier particle size had limited effect on the sealer microstructure and chemical properties.

Effect of chlorhexidine gluconate on porosity and compressive strength of a glass ionomer cement

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Influence of the addition of chlorhexidine diacetate on bond strength of a high-viscosity glass ionomer cement to sound and artificial caries-affected dentin

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)