Calcium enriched mixture (CEM) cement has been recently invented by the last author. It is composed of calcium oxide, calcium phosphate, calcium silicate and calcium sulphate; however, it has a different chemical composition to mineral trioxide aggregate (MTA). The purpose of this ex vivo study was to investigate the cytotoxicity of CEM cement, and compare it with intermediate restorative material (IRM) and MTA. The materials were tested in fresh and set states on L929 fibroblasts to assess their cytotoxicity. The cell viability responses were evaluated with methyl-tetrazolium bromide assay and Elisa reader at 1, 24 and 168 h (7 days). The tested materials were eluted with L929 culture medium according to international standard organisation 109935 standard. Distilled water and culture medium served as positive and negative controls, respectively. Differences in cytotoxicity were evaluated by one-way anova and t-tests. The cytotoxicity of the materials was statistically different at the three time intervals (P < 0.01). The lowest cytotoxic values recorded were expressed by MTA subgroups followed by CEM cement; IRM subgroups were the most cytotoxic root-end/dental material (P < 0.001). CEM cement and MTA are reasonable alternatives to IRM because of lower cytotoxicity. CEM cement also has good biocompatibility as well as lower estimated cost to MTA and seems to be a promising dental material.

When compared to placebo, preemptive oral analgesics are superior in achieving anesthetic success in inflamed pulp.

Color stability of WMTA was inferior to CEM samples after exposure to different duration of irradiation and media over time.

Although periapical inflammatory lesions are usually resulted by infection in the root canal system, this rare case showed that a periapical lesion related to an infected tooth may cause pulpal necrosis in adjacent intact tooth, with no history or clinical signs of caries, disease, trauma or developmental anomaly. This case also suggests that the periapical lesion can be treated conservatively, without surgical intervention. Furthermore, this case highlights the importance of prompt treatment of apical periodontitis before the lesion becomes extensive as well as follows up of large lesions. (Restor Dent Endod 2013;38(2):90-92)

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