Restor Dent Endod.  2023 May;48(2):e21. 10.5395/rde.2023.48.e21.

Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis

• Souza GLd
• Freitas GAN
• Ribeiro MTH
• Alvarado Lemus NX
• Soares CJ
• Gomes Moura CC

• KMID: 2548224
• DOI: http://doi.org/10.5395/rde.2023.48.e21

Abstract

Objectives
This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis.
Materials and Methods
Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey’s test (α = 0.05).
Results
No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001).
Conclusions
The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.

Keyword

Fracture strength; Non-vital tooth; Osteoclastogenesis; Root resorption; Silicate cement

Figure

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  Figure 1 Classification of the fracture modes – (I) enamel fracture; (II) one-third cervical root fracture; (III) one-third middle root fracture; (IV) vertical root fracture.

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  Figure 2 The number of mean peak load and standard deviations required to cause root fractures in each experimental group.PL: normal periodontal ligament; RRR: replacement root resorption; MTA plug: apical plug with MTA and root canal filling with Bio-C sealer and gutta-percha; BCR: Bio-C repair root canal filling; BD: Biodentine root canal filling.

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  Figure 3 Fracture modes of the specimens after load tests.BD: Biodentine; BCR: Bio-C Repair; MTA: mineral trioxide aggregate; RRR: replacement root resorption; PL: periodontal ligament.

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  Figure 4 Cell viability percentage (%) of RAW 264.7 cells after exposure to extracts. Capital letters indicate comparisons between different material’s dilutions and the control group for each material. Lowercase letters indicate comparisons between materials and dilutions. Groups identified by the same letter are not significantly different (p > 0.05). Two-way analysis of variance and Tukey’s test (p < 0.05).BCR: Bio-C Repair; BD: Biodentine; MTA: mineral trioxide aggregate.

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  Figure 5 TRAP staining. (A) Positive control (RANKL); (B) Negative control (α-minimal essential medium); (C) Cells treated with Bio-C repair extract; (D) Cells treated with Biodentine extract; (E) Cells treated with MTA extract. TRAP-positive multinucleated cells (arrow); 10× magnification. (F) TRAP activity: capital letters indicate comparisons among the materials tested. Groups identified by the same letter are not significantly different (p > 0.05).BCR: Bio-C Repair; BD: Biodentine; MTA, mineral trioxide aggregate; TRAP: tartrate-resistant acid phosphatase; RANKL, receptor activator of nuclear factor-kappa B ligand.

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