Fast-Setting Calcium Silicate-Based Pulp Capping Cements—Integrated Antibacterial, Irritation and Cytocompatibility Assessment

Abstract

Calcium silicate-based cements (CSCs) are endodontic materials widely used in vital pulp-capping approaches. Concerning the clinical application, the reduced set time and pre-mixed formulations are relevant characteristics during the operative management of pulpal exposure, aiming to optimise the work time and improve cross-infection/asepsis control. Additionally, clinical success seems to be greatly dependent on the biological performance of the materials that directly contact the living pulp. As such, this work approaches an integrative biological characterisation (i.e., antibacterial, irritation, and cytocompatibility assays) of three fast-setting CSCs—BiodentineTM, TotalFill® BC RRM™ Fast Putty, and Theracal LC®. These cements, after setting for 24 h, presented the expected topography and elemental composition (assessed by scanning electron microscopy, coupled with EDS analysis), in accordance with the information of the manufacturer. The set cements displayed a significant and similar antibiofilm activity against S. mutans, in a direct contact assay. Twenty-four-hour eluates were not irritant in the standardised CAM assay, but elicited distinct dose- and time-dependent cytotoxicity profiles on fibroblastic cells—i.e., Biodentine was devoid of toxicity, TotalFill presented a slight dose-dependent initial toxicity that was easily overcome, and Theracal LC was deleterious at high concentrations. When compared to long-setting ProRoot MTA cement, which highlighted the pursued integrative approach, Biodentine presented a similar profile, but TotalFill and Theracal LC displayed a poorer performance regarding antibiofilm activity/cytocompatibility features, and Theracal LC suggested eventual safety concerns.

Antibacterial Activity of Root Repair Cements in Contact with Dentin—An Ex Vivo Study

“…Therefore, the buffering capacity of dentin had a greater impact on the commercial materials, probably due to the earlier completion of diffusion of the hydroxyl ions. The antibacterial characteristics of Biodentine and TotalFill formulations have been found to be similar when tested against cariogenic bacteria with the rationale to use these as pulp capping agents [55,56]. The zinc oxide eugenol-based IRM showed an overall steadier yet inferior antibacterial potential in our experiments.…”

Ex Vivo Osteogenesis Induced by Calcium Silicate-Based Cement Extracts

“…The present work compared the osteogenic/bone formation potential of two fast-setting cements, Biodentine TM and TotalFill ® , with the gold standard and long-setting ProRoot ® MTA, using the 3D organotypic embryonic chick femur development model. This study aimed to take a step forward on the functionality of these cements compared with previous work, showing that the formulations were not cytotoxic to human fibroblasts in an indirect contact assay as established by ISO 0993-1:2018 guidelines and were also devoid of irritation potential in the in vivo chorioallantoic membrane (CAM) assay [ 43 ]. Further, performing this ex vivo translational approach allowed us to explore the suitability of this model as an alternative research framework, intended to advance the 3R’s policy [ 33 , 34 ].…”

Antibacterial behavior of calcium fluoride-modified tricalcium silicate cement against different oral bacterial strains

“…It is independent of the diffusivity and solubility of the cement, which is an advantage that can be used to overcome certain limitations associated with the agar diffusion method. 9 The in-vitro evaluation of antimicrobial activity should be customized to simulate different clinical situations. This study aimed to assess the effect of the fresh mix on the bacteria, simulating the clinical situation.…”

“…8 Biodentine has antibacterial potential, attributed to the release of calcium hydroxide due to the hydration reaction, which aids in the disinfection of dentin and the inhibition of various microorganisms' growth. 9 The anti-cariogenic effects of fluoride are well-documented and rely on various mechanisms, such as reducing demineralization, enhancing remineralization, plaque formation interference, and bacterial growth and metabolism inhibition. All these mechanisms are assumed to possess the anticariogenic effect of the fluoride-releasing restorative materials.…”