19. Moät nghieân cöùu khaùc cho thaáy iRoot SP coù ñoä beàn lieân keát vôùi ngaø chaân R cao hôn AH Plus,
Epiphany®, vaø MTA Fillapex, khoâng phaân bieät ñieàu kieän ñoä aåm.[96] Trong push-out test, thì
töông töï AH Plus vaø lôùn hôn MTA Fillapex.[97]
Khi iRoot SP ñöôïc söû duïng vôùi xi maêng nhöïa töï daùn (self-adhesive), ñoä beàn lieân keát cuûa choát
sôïi khoâng bò aûnh höôûng xaáu.[98]
Ñoä beàn lieân keát cuûa EndoSequence Sealer vaø AH Plus coù giaù trò töông töï nhau vaø ñeàu khoâng
bò aûnh höôûng bôûi vieäc loaïi boû lôùp muøn ngaø.[99] Söï hieän dieän cuûa dung dòch muoái ñeäm
phosphate (phosphate-buffered saline: PBS) beân trong oáng tuûy laøm taêng ñoä beàn lieân keát cuûa
EndoSequence Sealer/gutta percha sau 1 tuaàn, nhöng khoâng coù söï khaùc bieät ôû thôøi ñieåm 2
thaùng.[100] Tuy nhieân, yù nghóa laâm saøng cuûa nhöõng phaùt hieän naøy laø khoâng chaéc chaén.
Khaùng gaõy (Resistance to fracture)
Nghieân cöùu in vitro cho thaáy iRoot SP laøm taêng söï khaùng gaõy cuûa chaân R ñaõ ñöôïc ñieàu trò noäi
nha, ñaëc bieät khi noù ñöôïc söû duïng chung vôùi cone gutta-percha coù phuû söù sinh hoïc.[101] Söï
khaùng gaõy taêng ôû chaân R chöa tröôûng thaønh vôùi iRoot SP,[102] vaø ôû chaân R tröôûng thaønh vôùi
AH Plus, EndoSequence Sealer, vaø MTA Fillapex.[103] Keát quaû töông töï ñöôïc baùo caùo ñoái
vôùi EndoSequence Sealer vaø AH Plus Jet sealer ôû caùc R coái nhoû 1 chaân ñöôïc traùm chaân
R.[93]
Ñoä tan (Solubility)
Söï phoùng thích Ca2+
ôû möùc ñoä cao ñöôïc baùo caùo laø töø söï tan cuûa iRoot SP, MTA Fillapex,
Sealapex, vaø MTA-Angelus, nhöng khoâng coù ôû AH Plus. Söï phoùng thích cuûa ion Ca2+
ñöôïc
cho laø keát quaû cuûa ñoä tan cao hôn vaø nhöõng thay ñoåi beà maët.[104] Tuy nhieân, nghieân cöùu ñaõ
ñaùnh giaù caùc vaät lieäu theo tieâu chuaån ANSI/ADA spec. No. 57, khoâng ñöôïc thieát keá cho vaät
lieäu troän saün (chæ caàn söï hieän dieän cuûa ñoä aåm ñeå ñoâng). Ñieàu naøy coù theå laø lyù do cho söï khaùc
bieät giöõa keát quaû cuûa nghieân cöùu naøy vaø nhöõng quan saùt in vivo.
Khaû naêng ñieàu trò laïi
Khaû naêng loaïi boû EndoSequence Sealer vaø AH Plus laø nhö nhau trong moät nghieân cöùu so
saùnh duïng cuï caàm tay vaø duïng cuï noäi nha laïi ProTaper Universal.[105] Tuy nhieân, khoâng coù
vaät lieäu traùm bít naøo coù theå ñöôïc loaïi boû hoaøn toaøn ra khoûi oáng tuûy.[106] Micro-computed
tomography cho thaáy khoâng coù kyõ thuaät ñieàu trò laïi naøo loaïi boû ñöôïc hoaøn toaøn gutta-
percha/iRootSP sealer ra khoûi oáng tuûy.[107]
pH vaø tính khaùng khuaån
Vaät lieäu söù sinh hoïc coù pH = 12.7 luùc ñang ñoâng, töông töï canxi hydroxide, taïo ra taùc duïng
khaùng khuaån.[13] Sealer söù sinh hoïc coù pH lôùn hôn AH Plus [90] trong moät khoaûng thôøi gian
daøi hôn.[91] pH kieàm giuùp loaïi boû caùc vi khuaån nhö Enterococcus faecalis. EndoSequence
Paste, Putty vaø MTA coù hieäu quaû khaùng khuaån choáng laïi caùc chuûng laâm saøng cuûa E. faecalis
töông töï nhau.[92]
MTA Fillapex coù hieäu quaû khaùng Enterococcus faecalis, Escherichia coli, Streptococcus
mutans vaø Candida albicans cao hôn AH 26 (Madani vaø cs) [67]. Xi maêng MTA vaø Portland
ñaõ ñöôïc chöùng minh laø khoâng coù hoaït ñoäng khaùng khuaån treân E. coli [68].
20. Maëc duø hoaït ñoäng khaùng khuaån laø yeâu caàu quan troïng cuûa moät sealer noäi nha, nhöng haàu heát
chuùng khoâng coù khaû naêng cung caáp söï baûo veä hoaøn toaøn. MTA Dentsply, MTA Angelus vaø xi
maêng Portland öùc cheá söï taêng tröôûng cuûa P. aeruginosa trong khi canxi hydroxide coù hieäu
quaû choáng laïi P. aeruginosa vaø B. fragillis. Trong ñieàu kieän yeám khí, vaät lieäu naøy ñöôïc chöùng
minh laø khoâng hieäu quaû vôùi E. faecalis, vaø E. coli [64].
Ñoäc tính teá baøo (Cytotoxicity) vaø töông hôïp sinh hoïc (Biocompatibility)
Moät soá nghieân cöùu in vitro cho thaáy vaät lieäu söù sinh hoïc troän saün coù tính töông hôïp sinh hoïc
vaø ñoäc tính teá baøo töông töï nhö MTA.[14], [70],[71],[80-87) Nhöõng teá baøo caàn cho söï laønh
thöông baùm dính vôùi vaät lieäu söù sinh hoïc vaø taïo ra moâ thay theá.[14]
So vôùi AH Plus® (Dentsply) vaø TubliSealTM
(SybronEndo), Sealer söù sinh hoïc coù ñoäc tính teá
baøo thaáp hôn.[14],[71] Maët khaùc, moät nghieân cöùu keát luaän raèng BC Sealer vaãn coøn ñoäc tính
teá baøo ôû möùc trung bình trong thôøi gian 6 tuaàn [70] vaø caùc teá baøo gioáng taïo coát baøo giaûm hoaït
tính sinh hoïc vaø hoaït tính cuûa alkaline phosphatase so vôùi MTA vaø Geristore® (DenMat).[69]
Hoaït tính sinh hoïc (Bioactivity)
Moät nghieân cöùu in vitro cho thaáy iRoot SP laø moät vaät lieäu thuaän lôïi cho söï töông taùc teá
baøo.[111] Söï tieáp xuùc cuûa MTA vaø EndoSequence Putty vôùi dung dòch muoái ñeäm phosphate
(PBS) daãn ñeán söï keát tuûa taêng theo thôøi gian cuûa caùc caáu truùc tinh theå apatite, cho thaáy raèng
vaät lieäu coù hoaït tính sinh hoïc.[108] Caùc teá baøo tuûy R ngöôøi coù bieåu hieän taêng sinh vaø khoaùng
hoùa toái öu treân beà maët cuûa iRoot BP Plus.[112]
iRoot SP coù ñoäc tính teá baøo thaáp hôn vaø möùc baùm dính teá baøo cao hôn coù yù nghóa so vôùi MTA
Fillapex, moät sealer goác nhöïa salicylate chöùa caùc haït MTA.[109] EndoSequence Sealer coù
pH vaø söï phoùng thích Ca2+
cao hôn AH Plus [90] nhöng phoùng thích Ca2+
ít hôn BioDentine
(Septodont) vaø MTA traéng.[110] Ñaõ coù baùo caùo raèng MTA coù theå cung caáp khaû naêng kích taïo
moâ vaø laéng ñoïng (deposition) moâ cöùng nhieàu hôn iRoot SP.[113] Tuy nhieân, yù nghóa laâm
saøng cuûa nhöõng phaùt hieän naøy laø chöa chaéc chaén.
Che tuûy tröïc tieáp
Vieäc loaïi boû hoaøn toaøn ngaø nhieãm truøng ôû xoang saâu ngaø saâu vaø khoâng coù beänh lyù noäi nha
ñoâi khi coù theå daãn ñeán loä phaàn tuûy khoûe maïnh. Trong nhöõng ñieàu kieän nhaát ñònh, vieäc ñoùng
loå thoâng coù theå ñöôïc thöïc hieän vôùi xi maêng canxi hydroxide ñeå che tuûy tröïc tieáp. Thaønh coâng
cuûa ñieàu trò naøy ñöôïc ñaùnh giaù bôûi thôøi gian soáng cuûa tuûy. Caùc nghieân cöùu theo doõi 10 naêm
cho thaáy tæ leä thaønh coâng laø 30-85% [72,73].
MTA laø moät vaät lieäu coù hoaït tính sinh hoïc, coù theå ñöôïc söû duïng ñeå che tuûy tröïc tieáp [74,75].
Noù khoâng tieâu, coù theå ñoâng trong ñieàu kieän aåm, vaø kích thích söï taïo thaønh cuûa ngaø [76]. Tæ leä
thaønh coâng ñöôïc baùo caùo sau che tuûy tröïc tieáp vôùi MTA cao hôn canxi hydroxide. Trong moät
nghieân cöùu so saùnh, Mente vaø cs baùo caùo tæ leä thaønh coâng laø 80.5% khi che tuûy tröïc tieáp vôùi
MTA vaø 59 % khi söû duïng canxi hydroxide trong khoaûng thôøi gian 24–123 thaùng (trung bình
42 thaùng) [77].
IV. CHÆ ÑÒNH TREÂN LAÂM SAØNG VAØ CAÙC CA CUÏ THEÅ
Che tuûy tröïc tieáp, giaùn tieáp vaø laáy tuûy buoàng
Case 1: che tuûy tröïc tieáp
21. Hình 8: BN nam 20 tuoåi ñöôïc chaån ñoaùn vieâm tuûy coù hoài phuïc R46 (A). Sau khi gaây teâ vaø
loaïi boû phaàn R saâu, ñieåm loä tuûy ñöôïc che tröïc tieáp vôùi BC RRM-Fast Set (B). Sau khi lôùp ñaùy
söù sinh hoïc ñoâng cöùng hoaøn toaøn, R ñöôïc traùm laïi baèng nhöïa composite vaø ñöôïc chuïp X
quang (C). Theo doõi 6 thaùng thì thaáy R khoâng coù trieäu chöùng, test ñoä soáng tuûy (+), X quang
khoâng coù daáu hieäu beänh lyù (D). (Nguoàn: Dr. Mohammed A. Alharbi)
Case 2: laáy tuûy buoàng
Hình 9: R36 ñöôïc chaån ñoaùn vieâm tuûy khoâng hoài phuïc. Ñieàu trò ñöôïc löïa choïn laø laáy tuûy
buoàng (vôùi BC putty) ñeå caûi thieän cô hoäi soáng vaø khoûe maïnh cuûa phaàn tuûy chaân coøn laïi. X
quang tröôùc thuû thuaät cho thaáy loå saâu lôùn vaø daây chaèng nha chu ôû vuøng choùp giaõn nhe (A)ï.
Sau khi putty ñaõ ñoâng cöùng, tieán haønh traùm keát thuùc vaø chuïp X quang (B). Sau 18 thaùng theo
doõi, R khoâng coù trieäu chöùng (C), X quang sau 24 thaùng cho thaáy söï phaùt trieån cuûa chaân R
ñöôïc tieáp tuïc, moâ quanh choùp khoûe maïnh, vaø quan troïng laø phaàn tuûy coøn laïi khoâng bò canxi
hoùa (ñieàu naøy thöôøng thaáy khi laáy tuûy buoàng vôùi canxi hydroxide) (D). Chuïp X quang R ñoái
22. beân sau 18 thaùng cho thaáy söï phaùt trieån cuûa chaân R laø töông töï nhau (E). (Nguoàn: Dr.
Guillaume Jouanny)
Case 3: Ñieàu trò noäi nha ôû R vónh vieãn cheát tuûy
Hình 10: R46 coù toån thöông quanh choùp (A) caàn ñöôïc ñieàu trò noäi nha 2 laàn heïn: laàn 1 söûa
soaïn oáng tuûy vaø ñaët (Ca(OH)2), laàn 2 sau 3 tuaàn, tieán haønh traùm bít oáng tuûy baèng BC Sealer
vaø gutta-percha vôùi kyõ thuaät moät cone (B). X quang sau 1 naêm theo doõi cho thaáy –moâ quanh
choùp ñaõ laønh thöông (C). (Nguoàn: Dr. Gilberto Debelian).
Case 4: Caét choùp, traùm ngöôïc
Hình 11: R coù trieäu chöùng laâm saøng vaø X quang cuûa nang quanh choùp (A). Ñieàu trò ñöôïc löïa
choïn laø caét choùp. Sau khi caét choùp, oáng tuûy ñöôïc söûa soaïn ngöôïc vôùi ñaàu sieâu aâm ñeán vò trí
choát (B). OÁng tuûy ñöôïc traùm vôùi BC Sealer ñaàu tieân vaø moät nuùt BC RRM-Putty 2 mm ñöôïc
23. nhoài vaøo xoang traùm ngöôïc (C, D). Chuïp X quang ngay sau phaãu thuaät (E). Sau 1 naêm theo
doõi thaáy coù söï laønh thöông cuûa moâ quanh choùp (F). (Nguoàn: Dr. Gilberto Debelian).
Keát luaän
Söù sinh hoïc hieän nay coù raát nhieàu öùng duïng trong noäi nha vaø chöõa raêng. Kieán thöùc caäp nhaät
cho nhöõng vaät lieäu coù hoaït tính sinh hoïc môùi naøy laø raát caàn thieát ñeå ñaûm baûo cho vieäc löïa
choïn vaät lieäu phuø hôïp nhaát trong caùc tình huoáng laâm saøng khaùc nhau.
Taøi lieäu tham khaûo
1. Hench LL. The story of bioglass. J Mater Sci Mater Med. 2006;17: 967–978.
2. Ree M, Schwartz R. Clinical applications of bioceramics materials in endodontics. Endod
Pract 2014;7:32—40.
3. Best SM , Porter AE, Thian ES , Huang J. Bioceramics: Past, present and for the future. J
Eur Ceram Soc. 2008: 1319–1327.
4. Dubok VA. Bioceramics: Yesterday, today and tomorrow. Powder Metallurgy and Metal
Ceramics. 2000;39:381-94.
5. Hench L. Bioceramics: From Concept to Clinic. J. Am. Ceram. Soc. 1991; 74(7):1487-
1510.
6. Cheng L, Ye F, Yang R, Lu X, Shi Y, Li L, et al. Osteoinduction of hydroxyapatite/beta-
tricalcium phosphate bioceramics in mice with a fractured fibula. Acta
Biomater. 2010;6(4):1569–1574. [PubMed]
7. Hermansson L. Nanostructural bioceramics: Advances in Chemically Bonded
Bioceramics. CRC Press; 2014.
8. Tomoaia G, Tomoaia-Cotisel M, Pop LB, Mocanu A, Pop A. Nanopowders of
hydroxyapatite and its substituted derivatives with medical applications and their
fabrication procedure. A20100523. Romanian Patent. 2013 Apr 10.
9. Hickman K. Bioceramics. Internet (Overview) April 1999.
(http://www.csa.com/discoveryguides/archives/bceramics.php)
10. Jefferies S. Bioactive and biomimetic restorative materials: a comprehensive review. Part
I. J Esthet Restor Dent 2014;26: 14—26.
11. Koch K , Brave D. Bioceramic technology — the game changer in endodontics.
Endodontic Practice US. 2009;12:7–11.
12. Nekoofar MH, Stone DF, Dummer PM. The effect of blood contamination on the
compressive strength and surface microstructure of mineral trioxide aggregate. Int Endod J
2010;43:782—91.
13. Zhang H, Shen Y, Ruse ND, Haapasalo M. Antibacterial activity of endodontic sealers by
modified direct contact test against Enterococcus faecalis. J Endod 2009;35:1051—5.
14. Zhang W, Li Z, Peng B. Ex vivo cytotoxicity of a new calcium silicate based canal filling
material. Int Endod J 2010;43: 769—74.
15. Trope M, Debelian G. Bioceramic technology in endodontics. Inside Dent 2014;5:53—60.
16. Richardson IG. The calcium silicate hydrates. Cement and Concrete Research.
2008;38:137–58.
24. 17. Jain P, Ranjan M. The rise of biocramics in endodontics: A review. Int J Pharm Bio Sci
2015;6(1):416-422.
18. Prati C, Gandolfi MG. Calcium silicate bioactive cements: Biological perspectives and
clinical applications. Dent Mater 2015;31(4):351-370.
19. Viola NV, Tanomaru Filho M, Cerri PS. MTA versus portland cement: Review of literature.
Rev Sul-bras Odontol 2011;8(4):446-452.
20. Parirokh M, Torabinejad M. Calcium silicate–based cements in mineral trioxide aggregate:
Properties and clinical applications. Hoboken, NJ, USA: John Wiley & Sons, 2014.
21. Parirokh M, Torabinejad M. Mineral trioxide aggregate: A comprehensive literature
review—part I: Chemical, physical, and antibacterial properties. J Endod 2010;36(1):16-27.
22. Borges AH, Pedro FL, Miranda CE, Semenoff-Segundo A, Pecora JD, Filho AM.
Comparative study of physico-chemical properties of mta-based and portland cements. Acta
Odontol Latinoam 2010;23(3):175-181.
23. Dreger LA, Felippe WT, Reyes-Carmona JF, Felippe GS, Bortoluzzi EA, Felippe MC.
Mineral trioxide aggregate and portland cement promote biomineralization in vivo. J Endod
2012;38(3):324-329.
24. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a
new rootend filling material. J Endod 1995;21(7):349-353.
25. Zapf AM, Chedella SC, Berzins DW. Effect of additives on mineral trioxide aggregate
setting reaction product formation. J Endod 2015;41(1):88-91.
26. Islam I, Chng HK, Yap AU. Comparison of the physical and mechanical properties of mta
and portland cement. J Endod 2006;32(3):193-197.
27. Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in
endodontic treatment: A review of the literature. Dent Mater 2008;24(2):149-164.
28. De-Deus G, Reis C, Brandao C, Fidel S, Fidel RA. The ability of portland cement, MAT, and
mta bio to prevent through-and-through fluid movement in repaired furcal perforations. J
Endod 2007;33(11):1374-1377.
29. Malhotra N, Agarwal A, Mala K. Mineral trioxide aggregate: A review of physical
properties. Compend Contin Educ Dent 2013;34(2):25-32.
30. Aggarwal V, Singla M, Miglani S, Kohli S. Comparative evaluation of push-out bond
strength of proroot mta, biodentine, and mta plus in furcation perforation repair. J Conserv
Dent 2013;16(5):462-465.
31. Walker MP, Diliberto A, Lee C. Effect of setting conditions on mineral trioxide aggregate
flexural strength. J Endod 2006;32(4):334-336.
32. Torabinejad M, Parirokh M. Mineral trioxide aggregate: A comprehensive literature
review—part II: Leakage and biocompatibility investigations. J Endod 2010;36(2):190-202.
33. Makkar S, Vashisht R, Kalsi A, Gupta P. The effect of altered ph on push-out bond strength
of biodentin, glass ionomer cement, mineral trioxide aggregate and theracal. Serb Dent J
2015;62(1):7-13.
34. Macwan C, Deshpande A. Mineral trioxide aggregate (mta) in dentistry: A review of
literature. J Oral Res Rev 2014;6:71-74.
35. Malkondu O, Karapinar Kazandag M, Kazazoglu E. A review on biodentine, a contemporary
dentine replacement and repair material. Biomed Res Int 2014;2014:160951.
36. Arora V, Nikhil V, Sharma N, Arora P. Bioactive dentin replacement. J Dent Med Sci
2013;12:51-57.
25. 37. Ranjan M. Review on biodentine-a bioactive dentin substitute. J Dent Med Sci
2014;13(1):13-17.
38. Singh H, Kaur M, Markan S, Kapoor P. Biodentine: A promising dentin substitute. J
Interdiscipl Med Dent Sci 2014;2:140.
39. LeGeros RZ. Calcium phosphate materials in restorative dentistry: A review. Adv Dent Res
1988;2(1):164-180.
40. Hench LL. Bioceramics: From concept to clinic. J Am Ceram Soc 1991;74(7):1487-1510.
41. Skrtic D, Antonucci JM, Eanes ED, Eichmiller FC, Schumacher GE. Physicochemical
evaluation of bioactive polymeric composites based on hybrid amorphous calcium
phosphates. J Biomed Mater Res 2000;53(4):381-391.
42. Camilleri J, Sorrentino F, Damidot D. Characterization of un-hydrated and hydrated
bioaggregate and mta angelus. Clin Oral Investig 2015;19(3):689-698.
43. Tuloglu N, Bayrak S. Comparative evaluation of mineral trioxide aggregate and bioaggregate
as apical barrier material in traumatized nonvital, immature teeth: A clinical pilot study.
Niger J Clin Pract 2016;19(1):52-57.
44. Leal F, De-Deus G, Brandao C, Luna AS, Fidel SR, Souza EM. Comparison of the root-end
seal provided by bioceramic repair cements and white mta. Int Endod J 2011;44(7):662-668.
45. Ghoddusi J. Material modifications and related materials. Berlin Heidelberg: Springer, 2014.
46. Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic
material. J Endod 2008;34(8):990-993.
47. Ayatollahi F, Tabrizizadeh M, Zare Bidoki F, Ayatollahi R, Hazeri Baqdad Abad M.
Comparison of marginal adaptation of mta and cem cement apical plugs in three different
media. Iran Endod J 2016;11(4):332-335.
48. Asgary S, Akbari Kamrani F, Taheri S. Evaluation of antimicrobial effect of mta, calcium
hydroxide, and cem cement. Iran Endod J 2007;2(3):105-109.
49. Asgary S, Parirokh M, Eghbal MJ, Ghoddusi J. Sem evaluation of pulp reaction to different
pulp capping materials in dog’s teeth. Iran Endod J 2006;1(4):117-123.
50. Hirschberg CS, Patel NS, Patel LM, Kadouri DE, Hartwell GR. Comparison of sealing
ability of mta and endosequence bioceramic root repair material: A bacterial leakage study.
Quintessence Int 2013;44(5):e157-162.
51. Martinez-Cortes M T-MC, Rosales C, Uribe-Querol E. Cytotoxicity assessment of 3
endodontic sealing cements used in periapical surgery. Revista Odontologica Mexicana
2017;21(1):e40-e48.
52. Saxena P, Gupta SK, Newaskar V. Biocompatibility of root-end filling materials: Recent
update. Restor Dent Endod 2013;38(3):119-127.
53. Koch K, Brave D. Ten tips for using bioceramics in endodontics. Dentaltown. 2010;10:94-
96.
54. Zhejun Wang. Bioceramic materials in endodontics. Endodontic Topics 2015, 32, 3–30.
55. Oliveira MG, Xavier CB, Demarco FF, Pinheiro AL, Costa AT, Pozza DH. Comparative
chemical study of MTA and Portland cements. Braz Dent J. 2007;18(1):3–7. [PubMed]
56. Scheerer SQ, Steiman HR, Cohen J. A comparative evaluation of three root-end filling
materials: an in vitro leakage study using Prevotella nigrescens. J Endod. 2001;27:40–
42. [PubMed]
57. Camilleri J, Montesin FE, Papaioannou S, McDonald F, Pitt Ford TR. Biocompatibility of
two commercial forms of mineral trioxide aggregate. Int Endod J. 2004;37:699–
704. [PubMed]
26. 58. Porter ML, Bertó A, Primus CM, Watanabe I. Physical and chemical properties of new-
generation endodontic materials. J Endod. 2010;36(3):524–528. [PubMed]
59. Emine ST, Tuba UA. White mineral trioxide aggregate pulpotomies: Two case reports with
longterm follow-up. Contemp Clin Dent 2011;2(4):381- 384.
60. Camilleri J. Mineral Trioxide Aggregate in Dentistry. Springer; 2014. [PubMed]
61. Kossev D, Stefanov V. Ceramic-based sealers as new alternative to currently used
endodontic sealers. Available from:
http://www.endoexperience.com/documents/Ceramicbasedsealers.PDF.
62. Koch K, Brave D, Ali Nasseh A. A review of bioceramic technology in
endodontics. Available from:
http://www.dentaltribune.com/htdocs/uploads/printarchive/editions/60f01a2ff396414f681553
0033a55bf8_6-12.pdf.
63. Zhu L, Yang J, Zhang J, Peng B. A comparative study of BioAggregate and ProRoot MTA
on adhesion, migration, and attachment of human dental pulp cells. J
Endod. 2014;40(8):1118–1123. [PubMed]
64. Ribeiro CS, Kuteken FA, Hirata R, Junior, Scelza MF. Comparative evaluation of
antimicrobial action of MTA, calcium hydroxide and Portland cement. J Appl Oral
Sci. 2006;14:330–333. [PMC free article][PubMed]
65. Ehsani M, Dehghani A, Abesi F, Khafri S, Ghadiri Dehkordi S. Evaluation of Apical Micro-
leakage of Different Endodontic Sealers in the Presence and Absence of Moisture. J Dent
Res Dent Clin Dent Prospects. 2014;8(3):125–129. [PMC free article] [PubMed]
66. Topçuoğlu HS, Arslan H, Akçay M, Saygili G, Cakici F, Topçuoğlu G. The effect of
medicaments used in endodontic regeneration technique on the dislocation resistance of
mineral trioxide aggregate to root canal dentin. J Endod. 2014;40(12):2041–2044. [PubMed]
67. Madani ZS, Sefidgar SA, Rashed Mohasel A, Zabihi E, Mesgarani A, Bijani A, et al.
Comparative evaluation of antimicrobial activity of two root canal sealers: MTA Fillapex and
AH 26. Minerva Stomatol. 2014;63(7–8):267–272. [PubMed]
68. Sipert CR, Hussne RP, Nishiyama CK, Torres SA. In vitro antimicrobial activity of Fill
Canal, Sealapex, Mineral Trioxide Aggregate, Portland cement and EndoRez. Int Endod
J. 2005;38(8):539–543.[PubMed]
69. Modareszadeh MR, Di Fiore PM, Tipton DA, Salamat N. Cytotoxi-city and alkaline
phosphatase activity evaluation of EndoSe-quence root repair material. J Endod
2012;38:1101—5.
70. Willershausen I, Wolf T, Kasaj A, Weyer V, Willershausen B, Marroquin BB. Influence
of a bioceramic root end material and mineral trioxide aggregates on fibroblasts and
osteoblasts. Arch Oral Biol 2013;58:1232—7.
71. Alanezi AZ, Jiang J, Safavi KE, Spangberg LS, Zhu Q. Cytotoxicity evaluation of
EndoSequence root repair material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2010;109:122—5.
72. Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct
pulp-capping procedures performed by dental students: a retrospective study. J Am Dent
Assoc. 2006;137(12):1699–1705. [PubMed]
73. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. Pulp capping of carious exposures:
treatment outcome after 5 and 10 years: a retrospective study. J Endod. 2000;26(9):525–
528. [PubMed]
27. 74. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and
biological properties of the material. Int Endod J. 2006;39(10):747–754. [PubMed]
75. Junn DJ. Quantitative assessment of dentin bridge formation following pulp-capping with
mineral trioxide aggregate (master’s thesis) Loma Linda, Calif: Loma Linda University;
2000.
76. Moghaddame-Jafari S, Mantellini MG, Botero TM, McDonald NJ, Nör JE. Effect of ProRoot
MTA on pulp cell apoptosis and proliferation in vitro. J Endod. 2005;31(5):387–
391. [PubMed]
77. Mente J, Hufnagel S, Leo M, Michel A, Gehrig H, Panagidis D, et al. Treatment outcome of
mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. J
Endod. 2014;40(11):1746–1751. [PubMed]
78. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a com-prehensive literature review:
Part III. Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400—
13.
79. Belobrov I, Parashos P. Treatment of tooth discoloration after the use of white mineral
trioxide aggregate. J Endod 2011;37: 1017—20.
80. Zoufan K, Jiang J, Komabayashi T, Wang YH, Safavi KE, Zhu Q. Cytotoxicity evaluation of
gutta flow and endo sequence BC Sealers. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2011;112:657—61.
81. Ma J, Shen Y, Stojicic S, Haapasalo M. Biocompatibility of two novel root repair materials. J
Endod 2011;37:793—8.
82. Ciasca M, Aminoshariae A, Jin G, Montagnese T, Mickel A. A comparison of the
cytotoxicity and proinflammatory cytokine production of EndoSequence root repair material
and ProRoot mineral trioxide aggregate in human osteoblast cell culture using reverse-
transcriptase polymerase chain reaction. J Endod 2012;38:486—9.
83. Hirschman WR, Wheater MA, Bringas JS, Hoen NM. Cytotoxicity comparison of three
current direct pulp-capping agents with a new bioceramic root repair putty. J Endod
2012;38:385—8.
84. Willershausen I, Callaway A, Briseno B, Willershausen B. In vitro analysis of the
cytotoxicity and the antimicrobial effect of four endodontic sealers. Head Face Med
2011;7:15.
85. Damas BA, Wheater MA, Bringas JS, Hoen MM. Cytotoxicity comparison of mineral
trioxide aggregates and EndoSequence bioceramic root repair materials. J Endod
2011;37:372—5.
86. Mukhtar-Fayyad D. Cytocompatibility of new bioceramic-based materials on human
fibroblast cells (MRC-5). Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2011;112:137—42.
87. De-Deus G, Canabarro A, Alves GG, Marins JR, Linhares AB, Granjeiro JM.
Cytocompatibility of the ready-to-use bioceramic putty repair cement iRoot BP Plus with
primary human osteo-blasts. Int Endod J 2012;45:508—13.
88. Loushine BA, Bryan TE, Looney SW, Gillen BM, Loushine RJ, Weller RN, et al. Setting
properties and cytotoxicity evaluation of a premixed bioceramic root canal sealer. J Endod
2011;37: 673—7.
89. Gandolfi MG, Iacono F, Agee K, Siboni F, Tay F, Pashley DH, et al. Setting time and
expansion in different soaking media of experi-mental accelerated calcium-silicate cements
and ProRoot MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108: 39—45.
28. 90. Candeiro GT, Correia FC, Duarte MA, Ribeiro-Siqueira DC, Gavini G. Evaluation of
radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J Endod
2012;38:842—5.
91. Zhou HM, Shen Y, Zheng W, Li L, Zheng YF, Haapasalo M. Physical properties of 5 root
canal sealers. J Endod 2013;39:1281—6.
92. Lovato KF, Sedgley CM. Antibacterial activity of EndoSequence root repair material and
ProRoot MTA against clinical isolates of Enterococcus faecalis. J Endod 2011;37:1542—6.
93. Zhang W, Li Z, Peng B. Assessment of a new root canal sealer’s apical sealing ability. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:79—82.
94. Antunes HS, Gominho LF, Andrade-Junior CV, Dessaune-Neto N, Alves FRF, Rocas IN, et
al. Sealing ability of two root-end filling materials in a bacterial nutrient leakage model. Int
End J 2015;12:30—7.
95. Ersahan S, Aydin C. Dislocation resistance of iRoot SP, a calcium silicate based sealer, from
radicular dentine. J Endod 2010;36:2000—2.
96. Nagas E, Uyanik MO, Eymirli A, Cehreli ZC, Vallittu PK, Lassila LV, et al. Dentin moisture
conditions affect the adhesion of root canal sealers. J Endod 2012;38:240—4.
97. Sagsen B, Ustun Y, Demirbuga S, Pala K. Push-out bond strength of two new calcium
silicate-based endodontic sealers to root canal dentine. Int Endod J 2011;44:1088—91.
98. Ozcan E, C¸apar I˙D, C¸etin AR, Tunc¸demir AR, Aydınbelge HA. The effect of calcium
silicate-based sealer on the push-out bond strength of fibre posts. Aust Dent J 2012;57:166—
70.
99. Shokouhinejad N, Gorjestani H, Nasseh AA, Hoseini A, Moham-madi M, Shamshiri AR.
Push-out bond strength of gutta-percha with a new bioceramic sealer in the presence or
absence of smear layer. Aust Endod J 2013;39:102—6.
100. Shokouhinejad N, Hoseini A, Gorjestani H, Raoof M, Assadian H, Shamshiri AR. Effect of
phosphate-buffered saline on push-out bond strength of a new bioceramic sealer to root canal
dentin. Dent Res J (Isfahan) 2012;9:595—959.
101. Ghoneim AG, Lutfy RA, Sabet NE, Fayyad DM. Resistance to fracture of roots obturated
with novel canal-filling systems. J Endod 2011;37:1590—2.
102. Ulusoy OI, Nayır Y, Darendeliler-Yaman S. Effect of different root canal sealers on fracture
strength of simulated immature roots. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2011;112: 544—7.
103. Topcuoglu HS, Tuncay O, Karatas E, Arslan H, Yeter K. In vitro fracture resistance of roots
obturated with epoxy resin-based, mineral trioxide aggregate-based, and bioceramic root
canal sealers. J Endod 2013;39:1630—3.
104. Borges RP, Sousa-Neto MD, Versiani MA, Rached-Junior FA, De- Deus G, Miranda CE, et
al. Changes in the surface of four calcium silicate-containing endodontic materials and an
epoxy resin-based sealer after a solubility test. Int Endod J 2012;45:419—42.
105. Hess D, Solomon E, Spears R, He J. Retreatability of a bioceramic root canal sealing
material. J Endod 2011;37:1547—50.
106. Ersev H, Yilmaz B, Dincol ME, Daglaroglu R. The efficacy of ProTaper University rotary
retreatment instrumentation to remove single gutta-percha cones cemented with several endo-
dontic sealers. Int Endod J 2012;45:756—62.
107. Ma J, Al-Ashaw AJ, Shen Y, Gao Y, Yang Y, Zhang C, et al. Efficacy of ProTaper
universal rotary retreatment system for gutta-percha removal from oval root canals: a micro-
computed tomo-graphy study. J Endod 2012;38:1516—20.
29. 108. Shokouhinejad N, Nekoofar MH, Razmi H, Sajadi S, Davies TE, Saghiri MA, et al.
Bioactivity of EndoSequence root repair material and bioaggregate. Int Endod J
2012;45:1127—34.
109. Guven EP, Yalvac¸ ME, Kayahan MB, Sunay H, S¸ahın F, Bayirli G. Human tooth germ
stem cell response to calcium-silicate based endodontic cements. J Appl Oral Sci
2013;21:351—7.
110. Han L, Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials.
Int Endod J 2013;46:808—14.
111. Zhang W, Li Z, Peng B. Effects of iRoot SP on mineralization-related genes expression in
MG63 cells. J Endod. 2010;36(12):1978-1982.
112. Zhang S, Yang X, Fan M. BioAggregate and iRoot BP Plus optimize the proliferation and
mineralization ability of human dental pulp cells. Int Endod J. 2013;46(10):923-929.
113. Güven EP, Taşlı PN, Yalvac ME, Sofiev N, Kayahan MB, Sahin F. In vitro comparison of
induction capacity and biomineralization ability of mineral trioxide aggregate and a
bioceramic root canal sealer. Int Endod J. 2013;46(12):1173-1182.
114. Poggio C, Lombardini M, Alessandro C, Simonetta R. Solubility of root-end-filling
materials: a comparative study. J Endod 2007: 33: 1094–1097.
115. Danesh G, Dammaschke T, Gerth HU, Zandbiglari T, Schafer E. A comparative study of
selected properties of ProRoot mineral trioxide aggregate and two Portland cements. Int
Endod J 2006: 39: 213–219.
116. Shie MY, Huang TH, Kao CT, Huang CH, Ding SJ. The effect of a physiologic solution pH
on properties of white mineral trioxide aggregate. J Endod 2009: 35: 98–101.
117. Basturk FB, Nekoofar MH, Gunday M, Dummer PM. The effect of various mixing and
placement techniques on the compressive strength of mineral trioxide aggregate. J Endod
2013: 39: 111–114.
118. Formosa LM, Mallia B, Camilleri J. Mineral trioxide aggregate with anti-washout gel—
properties and microstructure. Dent Mater 2013: 29: 294–306.
119. Nekoofar MH, Adusei G, Sheykhrezae MS, Hayes SJ, Bryant ST, Dummer PM. The effect
of condensation pressure on selected physical properties of mineral trioxide aggregate. Int
Endod J 2007: 40: 453–461.
120. Kayahan MB, Nekoofar MH, Kazandag M, Canpolat C, Malkondu O, Kaptan F, et al.
Effect of acid-etching procedure on selected physical properties of mineral trioxide
aggregate. Int Endod J 2009: 42:1004–1014.
121. Formosa LM, Mallia B, Camilleri J. The effect of curing conditions on the physical
properties of tricalcium silicate cement for use as a dental biomaterial. Int Endod J 2012: 45:
326–336.
122. Namazikhah MS, Nekoofar MH, Sheykhrezae MS, Salariyeh S, Hayes SJ, Bryant ST, et al.
The effect of pH on surface hardness and microstructure of mineral trioxide aggregate. Int
Endod J 2008: 41: 108–116.
123. Zhou H, Shen Y, Wang Z, Li L, Zheng Y, Hakkinen L, et al. In vitro cytotoxicity evaluation
of a novel root repair material. J Endod 2013: 39: 478–483.
124. Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial effects of some root
end filling materials. J Endod 1995: 21: 403–406.
125. Duarte MA, Demarchi AC, Yamashita JC, Kuga MC, Fraga Sde C. pH and calcium ion
release of 2 root-end filling materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2003: 95: 345–347.
30. 126. Song JS, Mante FK, Romanow WJ, Kim S. Chemical analysis of powder and set forms of
Portland cement, gray ProRoot MTA, white ProRoot MTA, and gray MTA-Angelus. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2006: 102: 809–815.
127. Chng HK, Islam I, Yap AU, Tong YW, Koh ET. Properties of a new root-end filling
material. J Endod 2005: 31: 665–668.
128. Santos AD, Araujo EB, Yukimitu K, Barbosa JC, Moraes JC. Setting time and thermal
expansion of two endodontic cements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2008,106:77–79.
129. 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: 731–736.
130. Hwang YC, Lee SH, Hwang IN, Kang IC, Kim MS, Kim SH, et al. Chemical composition,
radiopacity, and biocompatibility of Portland cement with bismuth oxide. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2009,107: 96–102.
131. Tanomaru JM, Tanomaru-Filho M, Hotta J, Watanabe E, Ito IY. Antimicrobial activity of
endodontic sealers based on calcium hydroxide and MTA. Acta Odontol Latinoam 2008: 21:
147–151.
132. Luczaj-Cepowicz E, Pawinska M, Marczuk-Kolada G, Leszczynska K, Waszkiel D.
Antibacterial activity of two mineral trioxide aggregate materials in vitro evaluation. Ann
Acad Med Stetin 2008: 54: 147–150.
133. Grech L, Mallia B, Camilleri J. Investigation of the physical properties of tricalcium silicate
cement-based root-end filling materials. Dent Mater 2013: 29: 20–28.
134. Grech L, Mallia B, Camilleri J. Characterization of set Intermediate Restorative Material,
Biodentine, BioAggregate and a prototype calcium silicate cement for use as root-end filling
materials. Int Endod J 2013: 46: 632–641.
135. Wang Z, Ma J, Shen Y, Haapasalo M. Acidic pH weakens the microhardness and
microstructure of three tricalcium silicate materials. Int Endod J 2015: 48: 323–332.
136. Cavenago BC, Pereira TC, Duarte MA, Ordinola-Zapata R, Marciano MA, Bramante CM,
et al. Influence of powder-to-water ratio on radiopacity, setting time, pH, calcium ion release
and a micro-CT volumetric solubility of white mineral trioxide aggregate. Int Endod J 2014:
47: 120–126.
137. Vivan RR, Zapata RO, Zeferino MA, Bramante CM, Bernardineli N, Garcia RB, et al.
Evaluation of the physical and chemical properties of two commercial and three experimental
root-end filling materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010: 110:
250–256.
138. Hansen SW, Marshall JG, Sedgley CM. Comparison of intracanal EndoSequence Root
Repair Material and ProRoot MTA to induce pH changes in simulated root resorption defects
over 4 weeks in matched pairs of human teeth. J Endod 2011: 37: 502–506.
139. Faria-Junior NB, Tanomaru-Filho M, Berbert FL, Guerreiro-Tanomaru JM. Antibiofilm
activity, pH and solubility of endodontic sealers. Int Endod J 2013: 46: 755–762.
140. Morgental RD, Vier-Pelisser FV, Oliveira SD, Antunes FC, Cogo DM, Kopper PM.
Antibacterial activity of two MTA-based root canal sealers. Int Endod J 2011: 44: 1128–
1133.
141. Eid AA, Gosier JL, Primus CM, Hammond BD, Susin LF, Pashley DH, et al. In vitro
biocompatibility and oxidative stress profiles of different hydraulic calcium silicate cements.
J Endod 2014: 40: 255–260.
31. 142. Silva EJ, Rosa TP, Herrera DR, Jacinto RC, Gomes BP, Zaia AA. Evaluation of
cytotoxicity and physicochemical properties of calcium silicate-based endodontic sealer
MTA Fillapex. J Endod 2013: 39: 274–277.
143. Biodentine scientific file. Active Biosilicate Technology TM, Septodont. Saint-Maur-des-
Fosses Cedex, France: R&D Department. 2010: www.septodont.fr.
144. Fridland M, Rosado R. Mineral trioxide aggregate (MTA) solubility and porosity with
different waterto-powder ratios. J Endod 2003: 29: 814–817.
145. Bin CV, Valera MC, Camargo SE, Rabelo SB, Silva GO, Balducci I, et al. Cytotoxicity and
genotoxicity of root canal sealers based on mineral trioxide aggregate. J Endod 2012: 38:
495–500.
146. Walsh RM, Woodmansey KF, Glickman GN, He J. Evaluation of compressive strength of
hydraulic silicate-based root-end filling materials. J Endod 2014: 40: 969–972.
147. Oliveira IR, Pandolfelli VC, Jacobovitz M. Chemical, physical and mechanical properties of
a novel calcium aluminate endodontic cement. Int Endod J 2010: 43: 1069–1076.
148. Nekoofar MH, Aseeley Z, Dummer PM. The effect of various mixing techniques on the
surface microhardness of mineral trioxide aggregate. Int Endod J 2010: 43: 312–320.
149. Lee YL, Lee BS, Lin FH, Yun Lin A, Lan WH, Lin CP. Effects of physiological
environments on the hydration behavior of mineral trioxide aggregate. Biomaterials 2004:
25: 787–793.
150. EL-Ma’aita AM, Qualtrougha AJ, Watts DC. The effect of smear layer on the push-out
bond strength of root canal calcium silicate cements. Dent Mater 2013: 29: 797–803.
151. Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-
out bond strength of Biodentine and conventional root perforation repair materials. J Endod
2013: 39: 380–384.
152. Shokouhinejad N, Nekoofar MH, Iravani A, Kharrazifard MJ, Dummer PM. Effect of acidic
environment on the push-out bond strength of mineral trioxide aggregate. J Endod 2010: 36:
871–874.
153. Saghiri MA, Shokouhinejad N, Lotfi M, Aminsobhani M, Saghiri AM. Push-out bond
strength of mineral trioxide aggregate in the presence of alkaline pH. J Endod 2010: 36:
1856–1859.
154. Reyes-Carmona JF, Felippe MS, Felippe WT. The biomineralization ability of mineral
trioxide aggregate and Portland cement on dentin enhances the push-out strength. J Endod
2010: 36: 286–291.
155. Amin SA, Seyam RS, El-Samman MA. The effect of prior calcium hydroxide intracanal
placement on the bond strength of two calcium silicate-based and an epoxy resin-based
endodontic sealer. J Endod 2012: 38: 696–699.
156. DeLong C, He J, Woodmansey KF. The effect of obturation technique on the push-out bond
strength of calcium silicate sealers. J Endod 2015: 41: 385–388.
157. Assmann E, Scarparo RK, Bottcher DE, Grecca FS. Dentin bond strength of two mineral
trioxide aggregate-based and one epoxy resin-based sealers. J Endod2012: 38: 219–221.
158. Koulaouzidou EA, Economides N, Beltes P, Geromichalos G, Papazisis K. In vitro
evaluation of the cytotoxicity of ProRoot MTA and MTA Angelus. J Oral Sci 2008: 50: 397–
402.