Dental discoloration caused by Grey-MTAFlow cement: analysis of its physicochemical, biological and antimicrobial properties

PELEPENKO, Lauter Eston; SAAVEDRA, Flávia; BOMBARDA, Gabriela Fernanda; GOMES, Brenda Paula Figueiredo de Almeida; DE-JESUS-SOARES, Adriana; ZAIA, Alexandre Augusto; DUARTE, Marco Antonio Hungaro; TANOMARU-FILHO, Mario; MARCIANO, Marina Angélica

doi:10.1590/1678-7757-2020-0269

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Brasil

Journal of Applied Oral Science

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Brasil

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Sumário

Original Article • J. Appl. Oral Sci. 28 • 2020 • https://doi.org/10.1590/1678-7757-2020-0269 copy

Dental discoloration caused by Grey-MTAFlow cement: analysis of its physicochemical, biological and antimicrobial properties

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Tricalcium silicate-based cement are materials used in reparative and regenerative procedures in endodontics. A recently proposed formulation aimed to enhance handling during clinical use with a versatile material applicable by syringe. Although, the use of bismuth oxide as radiopacifier and grey raw powder are drawbacks considering aesthetics.

Objectives

Evaluate physicochemical, biological, and antimicrobial properties of Grey-MTAFlow (Ultradent) and assess whether the addition of zinc oxide (ZnO) prevents dentinal discoloration caused by bismuth oxide.

Methodology

Grey-MTAFlow was manipulated in 'thin' consistency for all tests. Luminosity, color change, ion migration to dentine, radiopacity, setting time, ISO 6876:2012 linear flow, volumetric lateral flow and central filling of simulated grooves scanned using micro-computed tomography (μCT), pH, calcium release, volumetric change using μCT, chemical characterisation, cytotoxicity, and antimicrobial activity were assessed. Addition of 5% ZnO to Grey-MTAFlow and a bismuth-containing experimental composition were comparatively tested. Statistical analyses used Shapiro-Wilk, T-test, ANOVA, and Kolmogorov-Smirnov (p<0.05).

Results

The addition of ZnO to Grey-MTAFlow prevented dentine darkening after 90 days due to bismuth migration reduction, although no statistical difference was found (p=0.863). ZnO addition significantly enhanced Grey-MTAFlow radiopacity without differences in initial setting time. Grey-MTAFlow presented an ISO linear flow of 10.9 mm and a balanced volumetric lateral flow with central filling in μCT evaluation. All compositions presented an alkaline pH after immersion. Grey-MTAFlow had a significantly higher calcium ion release after 28 days in comparison to 24 hours (p=0.011) and volumetric expansion of 0.4±1.8% after immersion. ZnO addition altered the hydrated cement matrix once calcium hydroxide (portlandite) could not be detected in characterisation. Neither of the materials produced inhibition halos nor reduced bacterial turbidity, but all presented cytocompatibility above 100%.

Conclusion

Grey-MTAFlow expanded after immersion and exhibited higher luminosity values after the evaluation period when ZnO was added, but chemical modifications after this addition occurred.

Tooth discoloration; Dental materials; Bismuth; Zinc oxide

Composition	Colour change	Luminosity
	(ΔE)	24 hours	28 days	90 days
Negative control	6.3 ± 0.8^a	92.4 ± 0.7^a	90.0 ± 1.7^a	90.7 ± 1.3^a
Grey-MTAFlow cement	67.4 ± 1.7^bc	85.1 ± 1.7^ab	76.5 ± 0.5^abc	67.8 ± 1.7^b
Grey-MTAFlow + 5% ZnO	152.3 ± 6.2^c	84.0 ± 0.4^bc	73.1 ± 0.7^bcd	74.2 ± 0.5^ab
Experimental cement	48.5 ± 12.9^b	94.0 ± 1.8^a	78.3 ± 0.2^ad	85.1 ± 4.0^a
Positive control	1520.0 ± 28.4^d	63.2 ± 13.0^bc	44.5 ± 2.3^b	30.1 ± 14.6^c

Composition	Radiopacity (mm Al)	Setting time (min)		Flow
		Initial	Final	ISO 6876 (mm)	Linear lateral (mm)	Volumetric lateral (mm³) (max. 4 mm³)	Volumetric central cavity (mm³) (max. 2 mm³)
Grey-MTAFlow cement	4.94 ± 0.25^a	8.12 ± 0.37^a	49.00 ± 1.00^a	10.90 ± 0.20^a	6.70 ± 1.40^a	2.40 ± 0.40^a	1.10 ± 0.30^a
Grey-MTAFlow + 5% ZnO	6.87 ± 0.16^b	8.87 ± 0.12^a	52.25 ± 0.25^b	11.40 ± 0.20^b	6.30 ± 0.60^a	2.40 ± 0.20^a	0.90 ± 0.20^a
Experimental cement	6.00 ± 0.36^ab	19.17 ± 0.76^b	100.00 ± 2.00^c	16.60 ± 0.60^b	6.80 ± 0.90^a	1.70 ± 0.40^a	0.30 ± 0.20^b

Composition	pH			Calcium ion release (mg/L)			Volume change*	Cytotoxicity
	3 hoursA	24 hoursA	28 daysA	3 hoursA	24 hoursA	28 daysB	(% after 28 days)	(%)
Grey-MTAFlow cement	8.06 ± 0.14^a	8.02 ± 0.09^a	8.07 ± 0.26^a	4.77 ± 0.76^a	4.35 ± 0.89^a	12.35 ± 1.76^a	+ 0.40 ± 1.80^a	106.94 ± 13.24^a
Grey-MTAFlow + 5% ZnO	8.12 ± 0.11^a	8.14 ± 0.07^b	8.20 ± 0.20^a	1.50 ± 0.39^b	5.78 ± 0.98^b	9.80 ± 1.09^a	- 0.50 ± 2.10^a	109.00 ± 10.37^a
Experimental cement	7.82 ± 0.17^b	8.28 ± 0.10^c	8.60 ± 0.37^b	3.93 ± 0.70^a	3.87 ± 0.54^a	27.24 ± 3.18^b	- 4.60 ± 1.30^b	133.75 ± 12.71^a

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E-mail: jaos@usp.br

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[1] Corresponding address: Lauter Eston Pelepenko. Departamento de Odontologia Restauradora - Universidade de Campinas - FOP - Unicamp - Av. Limeira, 901 - Areião - 13414-903 - Piracicaba - São Paulo - Brasil. Phone: +55 54 99156-5523. e-mail: lauterpelepenko@hotmail.com