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ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 121-126  

Effect of biomineralization ability on push-out strength of proroot mineral trioxide aggregate, mineral trioxide aggregate branco, and calcium phosphate cement on dentin: An In vitro evaluation


1 Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Mangalore, Karnataka, India
3 Department of Conservative Dentistry and Endodontics, Kannur Dental College, Kannur, Kerala, India
4 Department of Oral Medicine and Radiology, AJ Shetty Dental College, Mangalore, Karnataka, India

Date of Web Publication27-Nov-2017

Correspondence Address:
Vanita D Revankar
Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_120_17

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   Abstract 

Context: Biomineralization is a process which leads to the formation of an interfacial layer with tag-like structures at the cement-dentin interface. It is due to interaction of mineral trioxide aggregate (MTA) and Portland cement with dentin in phosphate-buffered solution (PBS). This study is aimed to evaluate the effect of influence of biomineralization process on push-out bond strength of ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK, USA), MTA Branco (Angelus Soluc¸o˜es Odontolo´gicas, Londrina, PR, Brazil) and calcium phosphate cement (BioGraft CPC). Aim: The aim of this study was to evaluate the effect of biomineralization process on the push-out strength of ProRoot MTA, MTA Branco, and CPC after mixing with 0.2% chlorhexidine gluconate solution (0.2% CHX) and 2% lidocaine solution (2% LA) on the bond strength of MTA-dentin. Materials and Methods: Dentin discs with uniform cavities were restored with ProRoot MTA, MTA Branco, and calcium phosphate cement after mixing with 0.2% CHX solution and 2% lidocaine solution. The samples were uniformly distributed into two groups. Experimental group being immersed in PBS solution and control group being immersed in saline for 2 months. Instron testing machine (Model 4444; Instron Corp., Canton, MA, USA) was used to determine the bond strength. Statistical Analysis Used: A two-way analysis of variance and post hoc analysis by Bonferroni test. Results: All samples immersed in experimental group displayed a significantly greater resistance to displacement than that observed for the samples in control group (P < 0.05). MTAs displayed a significantly greater resistance to displacement than calcium phosphate cements. Conclusion: The main conclusion of this study was that the push-out bond strength of the cements, mainly the MTA groups, was positively influenced by the biomineralization process.

Keywords: Biomineralization, bond strength, calcium phosphate cement, carbonated apatite, mineral trioxide aggregate


How to cite this article:
Revankar VD, Prathap M S, Shetty K H, Shahul A, Sahana K. Effect of biomineralization ability on push-out strength of proroot mineral trioxide aggregate, mineral trioxide aggregate branco, and calcium phosphate cement on dentin: An In vitro evaluation. J Pharm Bioall Sci 2017;9, Suppl S1:121-6

How to cite this URL:
Revankar VD, Prathap M S, Shetty K H, Shahul A, Sahana K. Effect of biomineralization ability on push-out strength of proroot mineral trioxide aggregate, mineral trioxide aggregate branco, and calcium phosphate cement on dentin: An In vitro evaluation. J Pharm Bioall Sci [serial online] 2017 [cited 2022 Jul 5];9, Suppl S1:121-6. Available from: https://www.jpbsonline.org/text.asp?2017/9/5/121/219262




   Introduction Top


Perforation is the leading cause for endodontic failure.[1] An incidence of perforation in endodontic treatment ranges from 3% to 10%.[2] An ideal perforation repair material should provide an adequate seal and should resist the dislodging forces, such as mechanical loads of occlusion or the condensation of restorative materials over it.[3],[4]

Many materials such as amalgam, super EBA, IRM, Cavit, composite resin and glass Ionomer cements had been used in the past to seal perforation sites. These materials have their own disadvantages such as microleakage, toxicity, and sensitivity to the presence of moisture.[5]

Researches in the field of biomaterials have overcome these barriers and have led to the development of new biomaterials such as CPC, mineral trioxide aggregate (MTA), biodentine, and bioaggregate.

Calcium phosphate cements (CPC) were first reported by Brown and Chow in 1986 as a self-setting, bioactive and biodegradable[6] material which is comprised equimolar amounts of tetracalcium phosphate and dicalcium phosphate anhydrous was shown to be biocompatible[7] and osteoconductive.

MTA promotes biomineralization in the presence of phosphate-buffered solution (PBS).[8] It forms apatite at cement-PBS system which gets accumulated inside collagen fibrils, stimulates controlled mineral nucleation on dentin, and induces the organization of an interfacial film with tag-like structures at the cement-dentin interface.[9] Refinement in the marginal seal of MTA apical plugs after immersion in PBS over time could be attributed to biomineralization process.[10]

MTA exhibits very good biocompatibility and superior sealing ability.[11] The resistance to displacement raises over a period and may get affected in the presence of blood contamination.[12] To overcome this drawback, CPC was experimented.

Conventionally, distilled water had been used to mix these cements. An acidic pH in the environment impedes MTA and CPC setting and reduces its strength and hardness.[13] To improve the efficacy of MTA and CPC, CHX and 2% lidocaine solution had been used in this study.

Chlorhexidine (CHX) is a dicationic bisguanide cholorophenyl ring that was initially used as a general disinfectant because of its broad antibacterial action.[14] It is also used as an irrigant to sterilize the root canal system.[15],[16] It has been shown that mixing of MTA with CHX increases the antibacterial efficacy of MTA.[17] Lidocaine 2% containing 1:50,000 epinephrine (Astra pharmaceutical products) was used to enhance hemostasis in the surgical sites. There are inconsistent results in the literature regarding effect of CHX and LA on the physical properties of MTA and CPC.

The objective of this study was to compare and evaluate the effect of 0.2% CHX and 2% LA on the bond strength of PROROOT-MTA, MTA Branco, and CPC dentin ex vivo.


   Materials and Methods Top


One hundred and twenty sound human premolars extracted for orthodontic purposes were used in the present study.

The crowns were removed [Figure 1] and midroot dentin was horizontally sectioned into 2.00 mm thick slices with a water-cooled low-speed carborundum disc [Figure 2]. With a spherical diamond bur, the space of the canal was enlarged and two complete passes of a #5 Gates-Glidden bur was done to obtain 1.3 mm diameter standardized cavities. The sections were initially immersed in 17% EDTA for 3 min followed by 1% sodium hypochlorite for 3 min. They were then washed in distilled water and dried.
Figure 1: Decoronated specimens

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Figure 2: Tooth being sectioned

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One hundred and twenty sectioned teeth samples were divided into two groups equally, one being control Group A (saline solution) and the other being experimental Group B [Figure 3], i.e., phosphate-buffered solution (PBS). Each group was further divided into 6 subgroups.
Figure 3: Sectioned specimens

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MTA Branco, CPC, and ProRoot MTA powder was mixed with 0.2% CHX solution and 2% LA on a glass slab with a cement spatula following the manufacturer's recommendations. When the mixture showed putty consistency, with the help of a Dovgan carrier (G. Hartzell and Son, Concord, CA, USA) placed in root canals and compacted with pluggers (Dentsply Tulsa Dental). All specimens were examined using a microscope at 16 × magnification. Specimens with cracks, defects, or gaps between the material and dentin walls were excluded from the study.

Immediately after filling, samples from the control group (A) were placed in a saline solution of 15 ml (PH = 7.2) for 2 months at 37° centigrade [Figure 4] and experimental group (B) were placed in PBS of 15 ml for 2 months at 37° centigrade [Figure 5]. The solution was replaced once in every 5 days.
Figure 4: Specimens in saline solutions

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Figure 5: Specimens in phosphate-buffered solution

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Push-out test

After experimental periods, samples were placed in a steel holder which was tightened to an aligning apparatus that held it centered beneath a steel piece with a cylindrical punch. Using an MTS testing machine, the bond strengths were measured [Figure 6].
Figure 6: Specimens subjected for universal testing machinea

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The barrel-shaped end of a 2/4 hand blogger with 1 mm diameter was used as a force probe mounted on the moving head of the MTS. The force probe travelling at a speed of 0.2 mm/min, applied pressure to the surfaces of MTA in each specimen until the substance was dislodged. The ultimate force utilized to MTA before dislodgement occurred was recorded as N force.

All measurements investigated by means of SPSS 16.0 system for windows. (SPSS Inc, US). A two-way analysis of variance (ANOVA) compared with the 5% significance level was performed to compare the differences in dislodgement force among the twelve subgroups.


   Results Top


Two-way ANOVA analysis showed that the mean values demonstrated a statistically significant variance in the mean expulsion force among the CPC and all other subgroups [Table 1].
Table 1: Demonstrates the comparison between the mean bond strength of each subgroup

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The mean dislodgement force of MTA-dentin decreased in the control group. The highest degree of mean dislodgment force was shown by MTA subgroups.

Bonferroni test was used to do a comparison between individual groups.

The results show that compared to the samples immersed in the control group (P > 0.05), samples immersed in experimental group displayed a significantly greater resistance to displacement as shown in [Table 2].
Table 2: Comparison of saline (control) with other groups

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Bond strength was significantly greater in subgroup 1B, 2B, 5B, and 6B than in the others (P > 0.05).

No statistically significant difference in the mean dislodgment force between the 0.2% CHX solution and 2% LA subgroups was documented. Subgroups 3B and w4B showed significantly least amounts of bond strengths than other subgroups shown in [Graph 1].




   Discussion Top


A MTA was developed at Loma Linda University for the sealing between the tooth and the external surfaces of tooth.[18] MTA has been used in both surgical and nonsurgical utilization, along with root-end fillings,[19],[20],[21] direct pulp cappings,[22],[23] perforation repairs in roots or furcation and apexification.[24] Root perforations can be repaired using other materials such as calcium phosphate cement (CPC). They possess the property of biocompatibility and moldability.[25] The above cements can be mixed using saline, CHX, and 2% lidocaine solution. However, the question as to whether these medications would potentially initiate chemical reactions to degrade MTA and CPC or interfere its bond to dentin has not been well addressed in the previous literatures.

Saline and 2% lidocaine solutions are often used because they are easier to use and more convenient alternatives to sterile water in clinical routine.[12] PBS is a buffer solution containing sodium chloride, sodium phosphate, and (in some formulations) potassium chloride and potassium phosphate. It helps maintain a constant pH. The osmolarity and ion concentrations of the solution usually match those of the human body.

The mean values of push-out bond strength of all the experimental groups are in agreement with the findings of previous studies.[12]

Our results showed that compared to the control group, all samples immersed in experimental group showed a significantly greater resistance to dislodgement and showed a significant difference in the mean dislodgment force between the MTA and CPC subgroups. No significant difference was observed among 2% LA and 0.12% CHX groups.

MTA stimulates the precipitation of carbonated apatite, promoting a controlled mineral nucleation on dentin as the formation of an interfacial layer with tag-like structures.[9] Although all cement forms tag-like structures when immersed in PBS, it is important to note that the samples of ProRoot MTA and MTA Branco exhibited significantly superior resistance to displacement than the CPC.

Poor mechanical properties of CPC are the main disadvantage of this material. Since the material is weak under tensile forces.[26] On the other hand, the superior performances of ProRoot MTA and MTA Branco produced the overall highest amount of precipitates and thus, positively influenced the formation of an interfacial layer with tag-like structure.[9] This effect could be responsible for the superior bond strength of the MTAs when compared with the CPC. CPC groups showed significantly least amount of resistance to displacement than the MTA groups.

Our results show that all PBS-immersed samples displayed a significantly greater resistance to dislodgement than that observed for control group.

Based on this ex vivo study, it may be possible to improve the retention of MTA apical plugs to dentin using PBS as an intracanal dressing or as a final rinse in prepared root canals as suggested by Martin et al.[10] In view of this finding, further research is needed to establish a new protocol to encourage the precipitation of carbonated apatite and subsequently the formation of an interfacial layer with tag-like structures.


   Conclusion Top


The main conclusion of this study was that the PBS solution showed higher resistance to dislodgement than compared to saline solution. Biomineralization process showed positive influence on the resistance to dislodgement from dentin of all cement tested. More than CPC, MTA cement, however, benefited more from the process. Lidocaine 2% and 0.12% CHX did not significantly alter the physical properties of the cements. MTA Branco and ProRoot MTA both showed no significant difference in push-out bond strength.

However, further studies are recommended before this mixture can safely be used in clinical situations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kvinnsland I, Oswald RJ, Halse A, Grønningsaeter AG. A clinical and roentgenological study of 55 cases of root perforation. Int Endod J 1989;22:75-84.  Back to cited text no. 1
    
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Alhadainy HA. Root perforations. A review of literature. Oral Surg Oral Med Oral Pathol 1994;78:368-74.  Back to cited text no. 2
    
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Gancedo-Caravia L, Garcia-Barbero E. Influence of humidity and setting time on the push-out strength of mineral trioxide aggregate obturations. J Endod 2006;32:894-6.  Back to cited text no. 3
    
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Kogan P, He J, Glickman GN, Watanabe I. The effects of various additives on setting properties of MTA. J Endod 2006;32:569-72.  Back to cited text no. 4
    
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Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.  Back to cited text no. 5
    
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Brown WE, Chow LC. A new calcium phosphate water setting cement. In: Brown PW, editor. Cements Research Progress. Westerville, OH: American Ceramic Society; 1986. p. 352-79.  Back to cited text no. 6
    
7.
Hong YC, Wang JT, Hong CY, Brown WE, Chow LC. The periapical tissue reactions to a calcium phosphate cement in the teeth of monkeys. J Biomed Mater Res 1991;25:485-98.  Back to cited text no. 7
    
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Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I. Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 2005;31:97-100.  Back to cited text no. 8
    
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Reyes-Carmona JF, Felippe MS, Felippe WT. Biomineralization ability and interaction of mineral trioxide aggregate and White Portland cement with dentin in a phosphate-containing fluid. J Endod 2009;35:731-6.  Back to cited text no. 9
    
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Martin RL, Monticelli F, Brackett WW, Loushine RJ, Rockman RA, Ferrari M, et al. Sealing properties of mineral trioxide aggregate orthograde apical plugs and root fillings in an in vitro apexification model. J Endod 2007;33:272-5.  Back to cited text no. 10
    
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Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. Am Assoc Endod 1999;25:197-205.  Back to cited text no. 11
    
12.
Vanderweele RA, Schwartz SA, Beeson TJ. Effect of blood contamination on retention characteristics of MTA when mixed with different liquids. J Endod 2006;32:421-4.  Back to cited text no. 12
    
13.
Taylor HF. Cement Chemistry. 2nd ed. London: Thomas Telford Ltd.; 1997.  Back to cited text no. 13
    
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Hirst RC. Chlorhexidine: A review of the literature. Periodontal Abstr 1972;20:52-8.  Back to cited text no. 14
    
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Karale R, Thakore A, Shetty V. An evaluation of antibacterial efficacy of 3% sodium hypochlorite, high-frequency alternating current and 2% chlorhexidine on Enterococcus faecalis: An in vitro study. J Conserv Dent 2011;14:2-5.  Back to cited text no. 15
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16.
Alves FR, Almeida BM, Neves MA, Moreno JO, Rôças IN, Siqueira JF Jr., et al. Disinfecting oval-shaped root canals: Effectiveness of different supplementary approaches. J Endod 2011;37:496-501.  Back to cited text no. 16
    
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Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge RE. The anti-microbial effect against Enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. J Endod 2007;33:844-7.  Back to cited text no. 17
    
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Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. J Endod 1993;19:541-4.  Back to cited text no. 18
    
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Torabinejad M, Hong CU, Pitt Ford TR, Kaiyawasam SP. Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: A preliminary report. J Endod 1995;21:569-71.  Back to cited text no. 19
    
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Torabinejad M, Ford TR, Abedi HR, Kariyawasam SP, Tang HM. Tissue reaction to implanted root-end filling materials in the tibia and mandible of guinea pigs. J Endod 1998;24:468-71.  Back to cited text no. 20
    
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Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR. Investigation of mineral trioxide aggregate for root-end filling in dogs. J Endod 1995;21:603-8.  Back to cited text no. 21
    
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Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR, Miller DA, Kariyawasam SP, et al. Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys. J Endod 1997;23:225-8.  Back to cited text no. 22
    
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Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 1996;127:1491-4.  Back to cited text no. 23
    
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Shabahang S, Boyne PJ, Abedi HR, McMillan P, Torabinejad M. Apexification in immature dog teeth using osteogenic protein-1, mineral trioxide aggregate, and calcium hydroxide (abstract). J Endod 1997;23:265.  Back to cited text no. 24
    
25.
Hong YC, Wang JT, Hong CY, Brown WE, Chow LC. The periapical tissue reactions to a calcium phosphate cement in the teeth of monkeys. J Biomed Mater Res 1991;25:485–98.  Back to cited text no. 25
    
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Ambard AJ, Mueninghoff L. Calcium phosphate cement: Review of mechanical and biological properties. J Prosthodont 2006;15:321-8.  Back to cited text no. 26
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]


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