Portland Cement: An Overview as a Root Repair Material

Portland cement (PC) is used in challenging endodontic situations in which preserving the health and functionality of pulp tissue is of considerable importance. PC forms the main component of mineral trioxide aggregate (MTA) and demonstrates similar desirable properties as an orthograde or retrograde filling material. PC is able to protect pulp against bacterial infiltration, induce reparative dentinogenesis, and form dentin bridge during the pulp healing process. The biocompatibility, bioactivity, and physical properties of PC have been investigated in vitro and in animal models, as well as in some limited clinical trials. This paper reviews Portland cement’s structure and its characteristics and reaction in various environments and eventually accentuates the present concerns with this material. This bioactive endodontic cement has shown promising success rates compared to MTA; however, considerable modifications are required in order to improve its characteristics and expand its application scope as a root repair material. Hence, the extensive chemical modifications incorporated into PC composition to facilitate preparation and handling procedures are discussed. It is still important to further address the applicability, reliability, and cost-effectiveness of PC before transferring into day-to-day clinical practice.

Comparison of Root End Sealing Ability of Three Retrograde Filling Materials in Teeth with Root Apices Resected at 90° using Dye Penetration Method under Fluorescent Microscope: An In-vitro Study

Background: Inadequate seal at the apex is the substantial cause for surgical endodontic dissatisfaction. The retrograde filling material which is used should prevent the egress of potential contaminants into periradicular tissue. Objectives: To evaluate the ability of MTA Angelus, Zirconomer and Bioactive bone cement to seal the root end as retrograde filling material; and to compare root end sealing ability of these three different retrograde filling materials with apices resected at 900 angles using dye penetration method under fluorescent microscope. Methodology: Thirty six extracted upper anterior teeth are to be cut horizontally at the CEJ. After following the standard protocols of, “cleaning, shaping and obturation” with gutta percha and “AH Plus sealer”, the samples will be resected 3mm at the apical end at 90 degree angle along the long axis of the tooth with the help of diamond disc. A root end cavity of depth 3mm will be made with Diamond coated ultrasonic surgical tip S12 90 ND. The teeth will be randomly categorized in 3 groups: Group 1: MTA angelus; Group 2: Zirconomer; Group 3: Bioactive Bone Cement. Following which the roots to be coated with nail varnish except the tip. Each material will be compressed in the root end cavity with the help of small pluggers. All the samples which are retrofilled will be kept in acrydine orange for a duration of 24 hours, following which cleaning & bucco-lingual sectioning(vertical) will be done. Fluorescent microscope will be used for observation of sectioned root samples. Expected Results: Bioactive bone cement is expected to have better sealing ability of the retrograde cavity preparation with minimal or no microleakage followed by MTA Angelus and then Zirconomer. Conclusion: If this study proves correct, this would be helpful for the clinicians to choose better and the most efficient retrograde filling material with best sealing ability and minimal microleakage in a retrograde preparation which will aid in success of the root canal treatment further resolving the infection.

Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.

Biocompatibility and Osteogenic Potential of Calcium Silicate-Based Cement Combined with Enamel Matrix Derivative: Effects on Human Bone Marrow-Derived Stem Cells

The characteristics of retrograde filling material are important factors that can affect the long-term success of apical microsurgery. Various calcium silicate-based cements (CSC) were introduced to overcome drawbacks of mineral trioxide aggregate (MTA), while Emdogain is known to be effective in the regeneration of periodontal tissues. The aim of this study is to evaluate the biocompatibility and osteogenic potential of various CSCs combined with Emdogain on human bone marrow-derived mesenchymal stem cells. Experimental groups were classified into eight groups depending on the material and the presence of Emdogain. In the cell-counting kit test, all experimental groups combined with Emdogain showed higher cell viability compared with those without Emdogain at days 1 and 2. In the wound-healing assay, cell migration increased significantly over time, with or without Emdogain. In the alkaline phosphatase assay, all groups treated with Emdogain showed higher activity compared with those without Emdogain at day 3 (p < 0.05). Using alizarin red S staining, all groups treated with Emdogain showed greater calcium nodule formation compared with those without Emdogain at days 7 and 14 (p < 0.05). In conclusion, using CSCs as retrograde filling materials and the application of additional Emdogain will increase bone regeneration and improve the prognosis of apical microsurgery.

In Vitro Comparison of MTA and BC RRM-Fast Set Putty as Retrograde Filling Materials

Background: To compare, in vitro, the bioceramic materials (MTA and BC RRM-fast set putty) capacity to prevent microleakage of Enterococcus faecalis over time. Methods: An experimental design was made with forty extracted human teeth, coronally cut, and prepared to be placed in a leakage system under sterile conditions. They were randomly divided into an experimental group: thirty teeth (fifteen for retrograde filling material MTA and BC RRM-fast set putty, respectively) and a control group: ten teeth (five positive control, five negative control). The 3 mm root-ends were submerged in a brain-heart infusion broth with a red phenol indicator. The coronal access of each sample was inoculated with E. faecalis every seven days to maintain bacterial viability. The lower chamber was evaluated daily for 30 days to observe the turbidity of the culture medium and establish the presence and day of the filtration. Calculation of the colony-forming units (CFU) was performed for each leaked sample. Results: Of the total samples prepared for each type of bioceramic material, leaked 60.0% (9/15) of the MTA group and 40.0% (6/15) of the BC RRM-fast set putty group. All positive controls filtered on the first day of evaluation, while 20% (1/5) of the negative control leaked in the second week. There was no significant difference in leakage between the bioceramic material types, nor concerning the bacterial count and the type of cement used (p = 0.101). Conclusions: This study suggests that BC RRM-fast set putty and MTA have a similar sealing capacity when used as a retrograde filling material in vitro.

Sealing Efficiency of MTA, Accelerated MTA, Biodentine and RMGIC as Retrograde Filling Materials

Summary Background/Aim: This in-vitro study evaluated the apical-sealing ability of MTA, MTA+10% CaCl2, Biodentine™ and RMGIC when used as retrograde material. Material and Methods: A total of 80 single-rooted bovine incisors were decoronated, instrumented, and divided into 4 groups according to retrograde material, as follows: Group 1: MTA (ProRoot MTA, Dentsply); Group 2: MTA (ProRoot MTA, Dentsply) + 10% CaCl2; Group 3: Biodentine (Biodentine®, Septodont); Group 4: RMGIC (Nova Glass -LC, Imicryl). Root surfaces were isolated with nail polish, and teeth were immersed in 2% methylene blue dye at 37°C for 48 h. The extent of dye penetration (mm) was measured under a stereomicroscope. Results: RMGIC had the highest mean-rank dye penetration score (MP=49.05), followed by MTA (MP=43.65), Biodentine (35.95) and MTA+CaCl2 (MP=33.35). The results of paired comparison tests found the mean microleakage value of MTA+10% CaCl2 and Biodentine (Group 3) to be significantly lower than that of RMGIC (respectively; p=0,020, p=0,019). No significant difference was found in the other group comparisons (p> 0.05). Conclusions: These results suggest that the addition of an accelerator to MTA may reduce microleakage following endodontic surgery. Biodentine can be used as an alternative to MTA on retrograde obturation.

Intentional replantation: case report

Intentional reimplantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. We present the case of a 50-year-old male patient who came to the consultation due to incrustation detachment in tooth #37, when performing the radiographic study an extensive apical lesion was observed in tooth #36 with a sinuous path and the presence of purulent exudate. The tooth #36 was extracted, apicoectomy, retro preparation and retrograde filling were carried out for later reimplantation, showing bone regeneration after one year of evolution.