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Due to significant tissue loss in teeth requiring pulp treatments, hermetic restoration of the remaining dental tissues is one of the most crucial factors in determining the treatment's success. The adhesion of composite resins to calcium silicate cements (CSCs) is considered challenging. Consequently, it is crucial to identify the optimal method for obtaining optimal adhesion. The aim of the present study is to evaluate the shear bond strength (SBS) values of immediate and delayed restorations with fiber-reinforced composites on powder–liquid, premixed, and resin-containing flowable CSCs. In the present study, the SBS values obtained after immediate (14 min) and delayed (7 days) restorations of three different CSCs (NeoMTA2, NeoPutty, and TheraCal PT) with three different resin composite materials (EverX FlowTM, EverX PosteriorTM, and Filtek Z550) were compared. The fracture types were evaluated using a stereomicroscope and SEM. TheraCal PT had the highest SBS values for both immediate and delayed restorations, and the comparison with other materials showed a statistically significant difference (p = 0.001). In contrast, there was no statistically significant difference between the SBS values of NeoMTA and NeoPutty (p > 0.05). In both immediate and delayed restorations, there was no statistically significant difference between nanohybrid and fiber-reinforced composites (p > 0.05). The simple use and strong bonding ability of TheraCal PT with composite resins may provide support for the idea that it is suitable for pulpal interventions. Nevertheless, due to the in vitro nature of this study, additional in vitro and clinical studies are required to investigate the material's physical, mechanical, and biological properties for use in clinical applications. [ABSTRACT FROM AUTHOR]

Background: Recently several calcium silicate flowable sealers have been introduced as endodontic materials for the root canal. This clinical study tested the use of a new premixed calcium silicate bioceramic sealer in association with the Thermafil warm carrier-based technique (TF). Epoxy-resin-based sealer with the warm carrier-based technique was the control group. Methodology: Healthy consecutive patients (n = 85) requiring 94 root canal treatments were enrolled in this study and assigned to one filling group (Ceraseal-TF n = 47, AH Plus-TF n = 47) in accordance with operator training and best clinical practice. Periapical X-rays were taken preoperatively, after root canal filling and after 6, 12 and 24 months. Two evaluators blindly assessed the periapical index (PAI) and sealer extrusion in the groups (k = 0.90). Healing rate and survival rate were also evaluated. Chi-square tests was used to analyze significant differences between the groups. Multilevel analysis was performed to evaluate the factors associated with healing status. Results: A total of 89 root canal treatments in 82 patients were analyzed at the end-line (24 months). The total drop-out was 3.6% (3 patients; 5 teeth). A total of 91.1% of healed teeth (PAI 1-2) was observed in Ceraseal-TF, with 88.6% in AH Plus-TF. No significant difference was observed on healing outcome and survival among the two filling groups (p > 0.05). Apical extrusion of the sealers occurred in 17 cases (19.0%). Of these, 6 occurred in Ceraseal-TF (13.3%) and 11 in AH Plus-TF (25.0%). Three Ceraseal extrusions were radiographically undetectable after 24 months. All the AH Plus extrusions did not change during the evaluation time. Conclusions: The combined use of the carrier-based technique and premixed CaSi-based bioceramic sealer showed clinical results comparable with carrier-based technique and epoxy-resin-based sealer. The radiographical disappearance of apically extruded Ceraseal is a possible event in the first 24 months. [ABSTRACT FROM AUTHOR]

Background: Calcium-silicate-based cements (CSC) have gained an increasing scientific and clinical relevance, enabling more conservative approaches, namely pulp preservation and regeneration therapies. This research aims to study the influence of four clinical variables on the interfaces between CSC and composite adhesive restoration, concerning shear bond strength (SBS) and ultra-morphological patterns. Methods: SBS tests were performed in 320 specimens divided in 16 groups (n = 20) according to: two CSC (NuSmile® NeoMTA, BiodentineTM); two adhesive systems (ClearfilTM SE Bond 2 (CSEB2), ClearfilTM Universal Bond Quick (CUBQ)); optional application of an additional hydrophobic bonding layer (HBL); two restoration times (immediate, seven days). Scanning electron microscopy (SEM) was performed to conduct the ultra-morphology interface analysis in 32 deciduous molars prepared and randomly allocated into the 16 groups. Results: Globally, SBS tests showed higher bond strength of CUBQ compared to CSEB2 (p < 0.001), as with an additional HBL application (p = 0.014) and delayed restoration (p < 0.001). SEM showed the interpenetration between adhesive systems and CSC forming a hybrid layer, whose depth and thickness depended on the restoration time and adhesive strategy. Conclusions: The independent clinical variables adhesive system, application of an additional HBL and restoration time affected the bond performance and ultra-morphological interface between composite adhesive restoration and CSC. [ABSTRACT FROM AUTHOR]

The implementation of hydraulic calcium silicate-based endodontic cements (HCSCs) in biologically based endodontic procedures for the primary dentition has been recently investigated, focusing on the biological response of stem cells from human exfoliated deciduous teeth (SHEDs) towards them. The present systematic review aimed to present a qualitative synthesis of the available literature consisting of in vitro assays, which assessed the cytocompatibility and bioactive properties of HCSCs in direct contact with SHEDs. Following the PRISMA statement, an electronic database search was carried out in Medline, Scopus, Embase, Web of Science, and SciELO on March 31st and updated on November 16th, 2020. In vitro studies evaluating the biological response of SHEDs to the treatment with HCSCs were eligible. Within the term biological response, assays assessing the cytocompatibility (i.e., cell viability, migration, proliferation), cell plasticity or differentiation (i.e., osteo/odontogenic marker expression), and bioactivity or biomineralization (i.e., mineralized nodule formation) were included. A total of seven studies were included after the selection process. The study sample comprised an extensive range of cell viability, migration, proliferation, adhesion, and bioactivity assays regarding the biological response of SHEDs towards five different commercially available HCSCs (MTA, ProRoot MTA, Biodentine, iRoot BP Plus, and Theracal LC). Biodentine, MTA, and iRoot BP Plus showed significant positive results in cytocompatibility and bioactivity assays when cultured with SHEDs. The results from in vitro assays assessing the cytocompatibility and bioactivity of the HCSCs MTA, Biodentine, and iRoot BP Plus towards SHEDs support their use in vital pulp treatment for the primary dentition. [ABSTRACT FROM AUTHOR]

Background and Objectives : Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods : The PRISMA guidelines were followed. The search strategy included PubMed ® , EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. Results : The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions : The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

This beagle pulpotomy study compared the inflammatory response and mineralization-inducing potential of three calcium silicate cements: ProRoot mineral trioxide aggregate (MTA) (Dentsply, Tulsa, OK, USA), OrthoMTA (BioMTA, Seoul, Korea), and Endocem MTA (Maruchi, Wonju, Korea). Exposed pulp tissues were capped with ProRoot MTA, OrthoMTA, or Endocem MTA. After 8 weeks, we extracted the teeth, then performed hematoxylin-eosin and immunohistochemical staining with osteocalcin and dentin sialoprotein. Histological evaluation comprised a scoring system with eight broad categories and analysis of calcific barrier areas. We evaluated 44 teeth capped with ProRoot MTA (n = 15), OrthoMTA (n = 18), or Endocem MTA (n = 11). Most ProRoot MTA specimens formed continuous calcific barriers; these pulps contained inflammation-free palisading patterns in the odontoblastic layer. Areas of the newly formed calcific barrier were greater with ProRoot MTA than with Endocem MTA (p = 0.006). Although dentin sialoprotein was highly expressed in all three groups, the osteocalcin expression was reduced in the OrthoMTA and Endocem MTA groups. ProRoot MTA was superior to OrthoMTA and Endocem MTA in all histological analyses. ProRoot MTA and OrthoMTA resulted in reduced pulpal inflammation and more complete calcific barrier formation, whereas Endocem MTA caused a lower level of calcific barrier continuity with tunnel defects. [ABSTRACT FROM AUTHOR]