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      CYTOTOXICITY AND BIOCOMPATIBILITY OF DIRECT AND INDIRECT PULP CAPPING MATERIALS

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          Abstract

          There are several studies about the cytotoxic effects of dental materials in contact with the pulp tissue, such as calcium hydroxide (CH), adhesive systems, resin composite and glass ionomer cements. The aim of this review article was to summarize and discuss the cytotoxicity and biocompatibility of materials used for protection of the dentin-pulp complex, some components of resin composites and adhesive systems when placed in direct or indirect contact with the pulp tissue. A large number of dental materials present cytotoxic effects when applied close or directly to the pulp, and the only material that seems to stimulate early pulp repair and dentin hard tissue barrier formation is CH.

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          Most cited references165

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          Mineral trioxide aggregate material use in endodontic treatment: a review of the literature.

          The purpose of this paper was to review the composition, properties, biocompatibility, and the clinical results involving the use of mineral trioxide aggregate (MTA) materials in endodontic treatment. Electronic search of scientific papers from January 1990 to August 2006 was accomplished using PubMed and Scopus search engines (search terms: MTA, GMTA, WMTA, mineral AND trioxide AND aggregate). Selected exclusion criteria resulted in 156 citations from the scientific, peer-reviewed dental literature. MTA materials are derived from a Portland cement parent compound and have been demonstrated to be biocompatible endodontic repair materials, with its biocompatible nature strongly suggested by its ability to form hydroxyappatite when exposed to physiologic solutions. With some exceptions, MTA materials provide better microleakage protection than traditional endodontic repair materials using dye, fluid filtration, and bacterial penetration leakage models. In both animal and human studies, MTA materials have been shown to have excellent potential as pulp-capping and pulpotomy medicaments but studies with long-term follow-up are limited. Preliminary studies suggested a favorable MTA material use as apical and furcation restorative materials as well as medicaments for apexogenesis and apexification treatments; however, long-term clinical studies are needed in these areas. MTA materials have been shown to have a biocompatible nature and have excellent potential in endodontic use. MTA materials are a refined Portland cement material and the substitution of Portland cement for MTA products is presently discouraged. Existing human studies involving MTA materials are very promising, however, insufficient randomized, double-blind clinical studies of sufficient duration exist involving MTA for all of its clinical indications. Further clinical studies are needed in these areas.
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            Comparison of the physical and mechanical properties of MTA and portland cement.

            This study evaluated and compared the pH, radiopacity, setting time, solubility, dimensional change, and compressive strength of ProRoot MTA (PMTA), ProRoot MTA (tooth colored formula) (WMTA), white Portland cement (WP), and ordinary Portland cement (OP). The results showed that PMTA and Portland cement have very similar physical properties. However, the radiopacity of Portland cement is much lower than that of PMTA. The compressive strength of PMTA was greater than Portland cement at 28 days. The major constituent of PMTA is Portland cement. Given the low cost of Portland cement and similar properties when compared to PMTA, it is reasonable to consider Portland cement as a possible substitute for PMTA in endodontic applications. However, industrially manufactured Portland cement is not approved currently for use in the United States and therefore no clinical recommendation can be made for its use in the human body. Further in vitro and in vivo tests, especially with regards its biocompatibility, should be conducted to ascertain if it meets the FDA requirements for use as a medical device.
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              Mechanical properties and microstructures of glass-ionomer cements.

              The objective of this study was to determine the flexural strength (FS), compressive strength (CS), diametral tensile strength (DTS), Knoop hardness (KHN) and wear resistance of ten commercial glass-ionomer cements (GICs). The fracture surfaces of these cements were examined using scanning electron microscopic (SEM) techniques to ascertain relationships between the mechanical properties and microstructures of these cements. Specimens were fabricated according to the instructions from each manufacturer. The FS, CS, DTS, KHN and wear rate were measured after conditioning the specimens for 7 d in distilled water at 37 degrees C. One-way analysis of variance with the post hoc Tukey-Kramer multiple range test was used to determine which specimen groups were significantly different for each test. The fracture surface of one representative specimen of each GIC from the FS tests was examined using a scanning electron microscope. The resin-modified GICs (RM GICs) exhibited much higher FS and DTS, not generally higher CS, often lower Knoop hardness and generally lower wear resistance, compared to the conventional GICs (C GICs). Vitremer (3M) had the highest values of FS and DTS; Fuji II LC (GC International) and Ketac-Molar (ESPE) had the highest CS; Ketac-Fil (ESPE) had the highest KHN. Ketac-Bond (ESPE) had the lowest FS; alpha-Silver (DMG-Hamburg) had the lowest CS. Four GICs (alpha-Fil (DMG-Hamburg), alpha-Silver, Ketac-Bond and Fuji II) had the lowest values of DTS, which were not significantly different from each other; alpha-Silver and Ketac-Silver had the lowest values of KHN. The highest wear resistance was exhibited by alpha-Silver and Ketac-Fil; F2LC had the lowest wear resistance. The C GICs exhibited brittle behavior, whereas the RM GICs underwent substantial plastic deformation in compression. The more integrated the microstructure, the higher were the FS and DTS. Higher CS was correlated with smaller glass particles, and higher KHN was found where there was a combination of smaller glass particles and lower porosity. Larger glass particle sizes and a more integrated microstructure contributed to a higher wear resistance. The mechanical properties of GICs were closely related to their microstructures. Factors such as the integrity of the interface between the glass particles and the polymer matrix, the particle size, and the number and size of voids have important roles in determining the mechanical properties.
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                Author and article information

                Journal
                J Appl Oral Sci
                J Appl Oral Sci
                Journal of Applied Oral Science
                Faculdade de Odontologia de Bauru da Universidade de São Paulo (Bauru )
                1678-7757
                1678-7765
                December 2009
                December 2009
                : 17
                : 6
                : 544-554
                Affiliations
                [1 ]DDS, Graduate student, Department of Operative Dentistry, Endodontics and Dental Materials, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
                [2 ]DDS, MSc, PhD, Associate Professor, Department of Operative Dentistry, Endodontics and Dental Materials, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
                [3 ]DDS, MSc, PhD, Associate Professor, Department of Physiology and Pathology, State University of São Paulo, Araraquara Dental School, Araraquara, SP, Brazil
                [4 ]DDS, MSc, PhD, Associate Professor, Department of Orthodontics and Pediatric Dentistry, State University of São Paulo, Araraquara Dental School, Araraquara, SP, Brazil
                [5 ]DDS, MSc, Graduate student, Department of Biological Sciences, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
                [6 ]DDS, MSc, PhD, Full Professor, Department of Operative Dentistry, Endodontics and Dental Materials, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
                [7 ]DDS, MSc, PhD Associate Professor, Department of Biological Sciences, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
                Author notes
                Corresponding address: Maria Teresa Atta, Disciplina de Dentística - Alameda Dr. Octávio Pinheiro Brizolla, 9-75 - 17012-901 - Vila Cidade Universitária - Bauru, SP - Brazil - Fone: +55-14-3235-8358 - Fax: +55-14-3235-8523 - E-mail: tereatta@ 123456usp.br
                Article
                S1678-77572009000600002
                10.1590/S1678-77572009000600002
                4327511
                20027424
                d7799311-7299-4ca3-909d-05165e0d521e

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 7, Tables: 0, Equations: 0, References: 86, Pages: 11
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