Physicochemical and biological evaluation of endodontic filling materials for primary teeth

Katerine Jahnecke Pilownic1, Ana Paula Neutzling Gomes1, Zhe Jun Wang2, Luiza Helena Silva Almeida3, Ana Regina Romano1 , Ya Shen2 ,Anelize de Oliveria Campello Felix4, Markus Haapasalo2, Fernanda Geraldo Pappen1

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This study evaluated the pH, radiopacity, antimicrobial effect, cytotoxicity and biocompatibility of endodontic filling materials for deciduous teeth. Zinc oxide eugenol (ZOE, S.S.White, Artigos Dentarios Ltda., Rio de Janeiro, RJ, Brazil), calcium hydroxide paste with iodo form (Vitapex, Neo Dental International Inc., Federal Way, WA, USA) and Calen (S.S.White, Rio de Janeiro, RJ, Brazil) were evaluated in comparison with an experimental material based on MTA - BIO-C Temp (Angelus, Londrina, PR, Brazil).
Clinical implications: A material's antimicrobial capacity is measured by its pH; the higher the pH, the more effective the material is, since bacteria can not survive in alkaline environments. Since the radiopacity of a material is directly related to its biological induction capacity—the higher the radiopacity, the lower the biological induction capacity—it must be noticeable but not exaggerated. Cytotoxicity and biocompatibility are inversely linked in the sense that the greater the material's biocompatibility, the lowerits cytotoxicity.
The pH of the experimental MTA-based endodonticmaterial was similar to that of Calen+ZO during the trial period. After 30 days, the experimental MTA had the highest pH while Vitapex had the lowest pH.

Antibacterial test:
Compared to the other materials, the experimental filling material based on MTA demonstrated a superior antibacterial effect. After four hours of exposure, it eradicated more than99.9% of E. faecalis cells. Following a 24-hour exposure period, all other materials eradicated over 98% of the bacteria.

Cytotoxicity test:
Cells exposed to Vitapex extracts showed higher viabilities at all extract concentrations, while cells exposed to ZOE extracts showed the lowest viabilities (p<0.001). Cells exposed to MTA-based material and those exposed to Calen+ZO showed no statistical difference in viability(p=0.115).

Biocompatibility test:
Representative samples from each group areshown in Figure 1. On day 15, thick fibrous capsule formation and moderate inflammatory reactions were observed with allVitapex and experimental samples of MTA-basedmaterials. In the ZOE and Calen+ZO groups, the intensity of inflammation was moderate to severe (p=0.001) (Table 3). On day 30, a mild inflammatory infiltrate was observed in the MTA-based materials group, while the other materials induced mainly moderate inflammation (p=0.001).

These results showed that the MTA-based material performed satisfactorily in terms of the properties studied. However, additional in vivo studies are required for a more accurate evaluation of the material.