Effect of Tricalcium Silicate

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Article published online: 2020-09-08

THIEME
Original Article 101

Effect of Tricalcium Silicate on Direct Pulp Capping:


Experimental Study in Rats
Lúcio P.G. Chicarelli1  Mariana B.F. Webber1  João P.A. Amorim1  Ana L.C.A. Rangel1 
Veridiana Camilotti1  Mario A.C. Sinhoreti2  Marcio J. Mendonça1

1 Dental School, State University of Western Paraná, Cascavel, Address for correspondence Marcio J. Mendonça, DDS, MS, PhD,
Paraná, Brazil Department of Prosthodontics, Dental School Rua Universitária,
2 Piracicaba Dental School, University of Campinas, Piracicaba, São 2069–Faculdade, Cascavel-PR, ZIP 85.819-110, Brazil
Paulo, Brazil (e-mail: dr.mendonca@uol.com.br).

 Eur J Dent:2021;5:101–108

Abstract Objectives  Conduct a histological comparison of the pulp response to different


materials, with a focus on the continuity and morphology of the mineralized barrier
after direct pulp capping.
Materials and Methods  One hundred and eight maxillary first molars of 54 Wistar
rats were subject to direct pulp capping and divided into three groups according to
the materials used: calcium hydroxide (CH), mineral trioxide aggregate (MTA), and
Biodentine. All cavities were sealed, and the animals were euthanized at 7, 14, and
21 days. Descriptive histological evaluation of the inflammation and formation of the
mineralized barrier was performed.
Statistical Analysis  Statistical analyses were performed using the Kruskal–Wallis
test, which was complemented by the Dunn test; differences with p < 0.05 were con-
sidered statistically significant.
Keywords Results  The results showed that MTA and Biodentine elicited less intense inflamma-
► Direct pulp capping tory reactions than CH. With respect to the formation and quality of the dentin barrier
► mineral trioxide formed, differences were observed at 21 days between the analyzed groups; the best
aggregate results being obtained following treatment with MTA and Biodentine.
► Biodentine Conclusion  MTA and Biodentine induced formation of a more continuous and uni-
► tricalcium silicate form mineralized barrier with less intense pulp response than CH.

Introduction of a hard tissue barrier with an amorphous pattern.3 This


material presents disadvantages such as porosity in the
Direct pulp capping is a treatment for exposed vital pulp; it dentin bridge produced, poor adherence to the dentin, and
involves the placement of a dental material over the exposed failure to produce good long-term sealing.4
area to facilitate both the formation of a protective barrier In 1993, Torabinejad developed a calcium silicate cement,
and the maintenance of the vital pulp.1,2 From a more precise known as mineral trioxide aggregate (MTA), which was indi-
clinical perspective, direct pulp capping is a clinical technique cated for root perforations and later for pulp caps.5 The chem-
that lies between indirect pulp capping and pulpotomy.2 The ical reaction of this material in direct contact with the pulp
direct pulp capping procedure aims to maintain pulp vital- leads to the formation of calcium crystals, similar to those
ity. This procedure utilizes calcium hydroxide (CH) which, in found in CH.2 The superior nature of MTA in comparison with
contact with the pulp tissue, promotes superficial necroly- CH in terms of sealing capacity, dentin quality6 and biocom-
sis with zones of necrosis and inflammatory response; these patibility7 supports the replacement of CH by this material in
may be attributed to its pH (almost 13.0) and the formation direct pulp capping procedures.8

DOI https://doi.org/ © 2020. European Journal of Dentistry.


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102 Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al.

New tricalcium silicate-based cement Biodentine of polyethylene (43 × 30 × 15 cm), in pairs, under controlled
(Septodont, France) was released in 2011.9 These are com- temperature conditions ranging between 22°C and 25°C,
posed of tricalcium silicate, dicalcium silicate, calcium relative humidity of 55%, and photoperiod of 12 hour (light
carbonate, calcium oxide, and zirconium oxide (radiopac- period from 7:00 am to 7:00 pm). The experimental pro-
ifier) as well as liquid containing water, calcium chloride cedures were in accordance with the Ethical Principles on
(water-soluble polymer, responsible for accelerating the Animal Experimentation adopted by the Brazilian College
setting time of the material), and modified polycarboxylate of Animal Experimentation (COBEA), and they were ana-
(which imparts plasticity to the material).10 Initially, these lyzed and approved by the Committee on Ethics in Animal
cements were developed as substitutes for dentin; however, Experimentation (CEEA) of UNIOESTE, no. 14/18-CEUA.
they presented favorable results in inducing the formation of
mineralized tissue when in direct contact with the pulp.11,12 Experimental Groups
In addition to its biocompatibility,13,14 it also presented The animals were randomly assigned to three treatment
advantages such as viscosity and reduced setting time in groups (CH, MTA, and Biodentine), with 18 animals per
comparison with MTA.15 However, a deeper understanding of group. Each group was subdivided into three time periods
the influence of the constituents of the pulp capping materi- of 7, 14, and 21 days, with six animals per group per period
als on their properties is necessary.16 (►Table 1).
Research on teeth from animal models has been widely
used; according to Dammaschke,17 the Wistar rat molar, Pulp Capping
which is anatomically, biologically, and histologically simi- At 56 days, the animals were anesthetized with a combina-
lar to the human tooth, is considered a miniature molar and tion of 1 mL of ketamine (injectable Dopalen, Ceva Saúde
exhibits a superior repair speed compared with the human Animal, Paulínia, SP, Brazil) and 0.2 mL of xylazine (injectable
tooth. Owing to ease of handling and similar histological Anasedan, Ceva Saúde Animal, Paulínia, SP, Brazil) and diluted
response in direct pulpal capping procedures, the Wistar rat in 3.8 mL of saline, intraperitoneally (0.1 mL of solution/50 g
molar represents a valid model for research.18 of animal body weight).17 After anesthesia, the animals were
In view of the need to better understand the perfor- placed on an appropriate surgical table,20 which allowed the
mance of various materials indicated for the protection opening of the oral cavity, facilitating access to the maxillary
of histologically exposed pulps, the aim of this study was teeth (►Fig. 1).
to conduct a histological comparison of the pulp response On the occlusal side of the maxillary first molars (right
to different materials, with a focus on the continuity and and left), circular cavities were made using an electric motor
morphology of the mineralized barrier after direct pulp (Driller, BLM 600 Plus, Carapicuíba, SP, Brazil) at 3000 rpm
capping. with an ISO 006 LN 28-mm drill bit (D 205 LN; Dentsply,
Maillefer, Ballaigues, Switzerland), and pulp exposures
verified with C+#15 files (Dentsply, Maillefer, Ballaigues,
Materials and Methods
Switzerland).17,21
Sample Size Pulp hemorrhage was controlled, and the cavity was dried
From the data obtained in a pilot test, the sample size was with sterile absorbent paper cones (►Fig. 2A). Capping was
determined using the BioStat 5.3 program (Instituto Mauá, performed on pulp exposures (►Fig.  2B) for the following
Amazonas, Brazil), considering an analysis power of 0.80, groups G1: CH (Calcium Hydroxide P.A., Biodynamic, Ibiporã,
minimum difference between the means of 0.22, and stan- PR, Brazil) in powder form; G2: MTA (White MTA; Angelus,
dard deviation (SD) of the mean error 0.11, which guaranteed Londrina, PR, Brazil), handled according to the manufactur-
a minimum of six sample units per experimental group. er’s guidelines on glass plate; and G3: Biodentine (Septodont;
Saint-Maur-des-Fosses, France), handled on a glass plate. The
Animals materials were applied with the aid of a metallic device, the
A total of 54 male rats weighing approximately 200 g,19 of the MTA Applicator (MTA Applicator; Angelus, Londrina, PR,
56-day-old Wistar variety, were purchased from the Western Brazil), and the cavities were sealed to avoid exposure to
State University of Paraná (UNIOESTE) Central Bioterium. the resin-modified glass ionomer (Vitremer; 3M ESPE do
They were adapted and kept in the Sectoral Bioterium of Brasil Ltda., Sumaré, SP, Brazil) (►Fig. 2C) and photoactivated
the UNIOESTE, Cascavel, Paraná, Brazil, in collective cages for 20 seconds with the Radii-cal device (SDI–Innovative

Table 1  Groups of experimental animals with details of periods of euthanasia and material used in each group
Description of group Animals Euthanasia
7 days 14 days 21 days
CH 18 6 6 6
MTA 18 6 6 6
Biodentine 18 6 6 6

European Journal of Dentistry Vol. 15 No. 1/2021 © 2020. European Journal of Dentistry.
Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al. 103

Fig. 1  Operating table for immobilization and maintenance of the oral cavity opening of the animal.

Fig. 2  (A) Hemorrhage control with paper cones; (B) rounded cavities; site of exposure; (C) sealing with Vitremer glass ionomer (3M-ESPE);
(D) photopolymerization for 20 seconds.

Dental Products, Australia), with a power of 1200 mW/cm2 a decalcifying acid solution (hydrogen chloride; UN 1789,
(►Fig.  2D). At the end of the experimental period of 7, 14, Allkimia, Campinas, SP, Brazil) for 24 hours at room tem-
and 21 days after pulp capping, the animals were euthanized perature and evaluated to verify the degree of decalcification
by guillotine decapitation. achieved.
After decalcification, the samples were again washed in tap
Histological Processing water for 1 hour for automatic histological processing, which
The jaws were removed, dissected, identified, and fixed in lasted approximately 12 hours (Automatic Tissue Processor;
10% formalin solution for 48 hours, washed in running water, Leica Microsystems® TP1020, Nussloch, Germany), with
and stored in 70% alcohol. After this period, the samples paraffin blocks (Purified Paraffin; Vetec Química Fina, Rio de
were washed in running water for 1 hour and immersed in Janeiro, RJ, Brazil). Cuts of 5-μm thickness were obtained using

European Journal of Dentistry Vol. 15 No. 1/2021 © 2020. European Journal of Dentistry.
104 Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al.

a semiautomatic microtome (Hestion; ERM3000, Daintree presented amorphous formation of mineralized tissue at the
Scientific, St. Helens, Australia), and histological sections were site of exposure and in contact with the material used, both
stained with Harris hematoxylin and eosin (HE). in evolution and continuity with dentin (►Fig.  4). Analysis
of the mineralized barrier revealed statistical differences
Histological Analysis in continuity, with those capped with CH differing from
The histological analyses were performed by a blinded cal- those of the MTA group (►Table  3). Differences in terms of
ibrated observer, in which the on-site aspects of the pulp morphology were also observed: the morphology of those
exposure were evaluated using an optical microscope with capped with CH was different from those capped with either
40x- and 100x-objective lenses (Leica Microsystems ICC50 the MTA and Biodentine. However, between CH and MTA, no
HD; Nussloch, Germany) and an image capture system statistically significant differences were found (►Table 4).
(Las Ez–Leica, version 2.10, 2012). The following parameters At 21 days, higher amounts with discrete inflammatory
were analyzed: inflammatory response, continuity and mor- infiltrate of pulp and formation of hard tissue were present
phology of the dentine barrier formed. The results were classi- in all cases; however, in the MTA and Biodentine groups,
fied according to the scores described in ►Table 2. The results the barrier formed obliterated, on occasion, the entire root
were evaluated by scores using the image capture system.22 canal, with a formation aspect similar to that of pulpal cal-
culus (atubular dentin) (►Fig. 5). No statistically significant
Statistical Analysis differences were found in the morphology of the mineralized
Statistical analyses were performed using the BioStat 5.3 pro- barrier (►Table  3), However, between CH and Biodentine,
gram (Instituto Mauá; Amazonas, Brazil), using the Kruskal– statistically significant differences were found for continuity
Wallis test and complemented by the Dunn test; differences of the mineralized barrier (►Table 4).
with p<0.05 were considered statistically significant.

Discussion
Results
In this study, an experimental animal model (Wistar rat) was
Pulp response presented severe hyperemia at 7 days (►Fig. 3) used, owing to the ease of experimental handling, coupled
in all experimental groups, irrespective of the material used.
The analysis of the acute inflammatory infiltrate demon-
strated varying extensions: the group treated with CH exhib- Table 2  Scores used for histological analysis
ited the greatest extension of the inflammatory processes, Mineralized barrier
followed by the MTA and Biodentine groups, respectively. Scores Continuity
Necrotic remains and dentinal scrapings were present in all 1 Complete
animals of the various groups. 2 Partially present
At 14 days, 70% of the samples capped with CH showed 3 Absent
necrosis and microabscess areas in the root canals, with Scores Morphology
single-cell chronic inflammatory infiltrate in the periapical 1 Tubular dentin
region. The other samples exhibited initiation of amorphous 2 Irregular deposition of hard tissue or dentin
formation of mineralized material in the middle of cellular 3 Only small layer of hard tissue deposition
4 Absence of hard tissue deposition
tissue. Further, the pulps, capped with MTA and Biodentine,

Fig. 3  Photomicrograph of the pulps of the euthanized animals at 7 days after pulp exposure in the various experimental groups, according to
the material used: (a) CH; (b) MTA; and (c) Biodentine. Severe pulp hyperemia in all samples (circle) with higher intensity for CH, followed by
MTA and Biodentine; p = pulp; d = dentin; rd = dentin scrapings; CH = calcium hydroxide; MTA = MTA; Bd = Biodentine. Hematoxylin and eosin
staining. Magnification: 40x.

European Journal of Dentistry Vol. 15 No. 1/2021 © 2020. European Journal of Dentistry.
Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al. 105

Fig. 4  Photomicrograph of the pulps of the euthanized animals at 14 days after pulp exposure in the various experimental groups, according to the mate-
rial used (a) CH; (b) MTA; and (c) Bd. Analysis of the dentin barrier formed (a) CH = calcium hydroxide–the circled region highlights the transition zone of
necrosis (top of the circle) and microabscess (bottom of the circle) induced by CH and the beginning of amorphous formation of mineralized tissue (*);
(b) MTA = amorphous formation of mineralized tissue (*) and pulpar microabscess area (p); (c) Bd = Biodentine–amorphous formation of mineralized tissue
(*); p = pulp; d = dentin; * = dentin bridge; rd = dentinal scrapings. Staining of hematoxylin and eosin. Magnification: 40x.

Table 3  Histological analysis of the tooth pulp for mineralized barrier–continuity in experimental animals according to time
Continuity 7 days 14 days 21 days
CH 3.00 (± 0.00) Aa 2.90 (± 0.32) Aa 2.67 (± 0.50) Aa
MTA 3.00 (± 0.00) Aa 2.00 (± 0.00) Ba 1.91 (± 0.94) Aba
Biodentine 3.00 (± 0.00) Aa 2.10 (0.48) ABa 1.70 (± 0.48) Bb
Abbreviations: CH, calcium hydroxide; MTA, mineral trioxide aggregate.
Values expressed as mean ± standard deviation; Kruskal–Wallis test, complemented by the Dunn test. Lower-case letters (line) and different capital
letters (column) mean statistically significant differences = p < 0.05.

Table 4  Histological analysis of the tooth pulp for mineralized barrier–morphology in experimental animals according to time
Morphology 7 days 14 days 21 days
CH 4.00 (± 0.00) Aa 3.70 (± 0.48) Aa 3.22 (± 0.97) Aa
MTA 3.63 (± 0.52) Aa 2.50 (± 0.55) Ba 2.82 (± 0.98) Aa
Biodentine 3.90 (± 0.32) Aa 2.70 (± 0.67) Ba 2.20 (± 0.42) Ab
Abbreviations: CH, calcium hydroxide; MTA, mineral trioxide aggregate.
Values expressed as mean ± standard deviation; Kruskal–Wallis test, complemented by the Dunn test. Lower-case letters (line) and different capital
letters (column) mean statistically significant differences = p < 0.05.

Fig. 5 Photomicrograph of the pulps of the euthanized animals at 21 days after pulp exposure in the various experimental groups. Analysis
of the formed dentin barrier. (a) CH = calcium hydroxide–formation of the dentin barrier (*); (b) MTA = formation of the dentin barrier (*); (c)
Bd = Biodentine–formation of the dentin barrier (*); p = pulp; d = dentin; * = dentin bridge; rd = dentinal scrapings. Staining of hematoxylin and
eosin. Magnification: 40x.

European Journal of Dentistry Vol. 15 No. 1/2021 © 2020. European Journal of Dentistry.
106 Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al.

with the fact that the pulp response and recovery after direct In our study, histological analysis of samples from the
pulp capping of rodent teeth are histologically comparable 7-day period demonstrated the capacity of the pulp to
with that in humans.17,19,21 respond to damage, which manifested during this period as
Dentin barrier formation occurs in response to various inflammation of the pulp tissue. According to Goldberg,40 cell
injuries, and this can be characterized as reactional dentin repair begins after inflammation control, with replacement
(primary odontoblasts) or reparative dentin, composed of of the injured or necrotic region by undifferentiated cells.
neo-odontoblasts originating from dental pulp stem cells After transformation, these cells give rise to tissue similar to
(DPSCs), cells with multiple differentiation potentials and the previous undamaged tissue, with three successive phases
capacity for tertiary dentinogenesis.23-25 For the mineralized of cell renewal: slight inflammation associated with cell
barrier formation, the DPSCs migrate, proliferate, and dif- recruitment, cell proliferation filling the lesion site, and cell
ferentiate into neo-odontoblasts, which then synthesize a differentiation in the pulp, creating neo-odontoblasts for the
matrix to form the tertiary dentin at the injury sites.26 production of reparative dentin. These findings were similar
There are several types of stem cells of dental origin to our results.
(DSCs), for example, DPSCs,23 stem cells from human exfo- Our results indicate an outcome characterized by initial
liated deciduous tooth,27 periodontal ligament stem cells,28 pulp inflammation and a zone of necrosis, similar to that
alveolar bone derived mesenchymal stem cells,29 dental described in other studies, thereby corroborating previous
follicle progenitor cells,30 stem cells from the apical part of research.41-43 Analysis of dentin bridge formation at 7 days
the dental papilla,31 teeth germ progenitor cells (Ikeda et al, did not reveal statistically significant differences between
2008), and gingival mesenchymal stem cells.31,32 DPSCs are the three materials tested, similar to Dammaschke et al,18
the first type of DSCs to be isolated; they exhibit pluripo- with similar immunohistochemical analysis results for CH
tency and a typical fibroblast-like morphology.23 and MTA in the first week after direct pulp capping.
DPSCs were isolated and their differentiation potential Although the use of CH in the pure form was recom-
was demonstrated in various media, such as dentinogenic, mended in a previous study,25 this material promoted a more
neurogenic, osteogenic, chondrogenic, adipogenic, and myo- intense inflammatory reaction41,44 compared with MTA and
genic media.33 In dentistry, DSCs can be used in the repair Biodentine, which demonstrated similar results. Previous
of damaged dentin, pulp regeneration and revascularization, studies have shown that CH elicits the generation of zones
osseointegration, and periodontal disorders.34,35 of necrosis when in contact with pulp tissues, which may be
In this study, we used the three materials as direct pulping attributed to its initial caustic effect.45
protect materials: CH, MTA, and Biodentine. CH cement was Therefore, the intense inflammatory response elicited
one of the first materials used in the treatment of live pulps.36 by CH, in comparison with that generated by MTA and
CH releases a large amount of relatively short time. The fac- Biodentine, may influence the formation of a mineralized
tors influencing the alkaline environment required for pulp barrier. This finding coincides with the difference revealed at
healing, to promote immediate selection, the stimulation of 14 days by the analysis of the continuity of the mineralized
hydroxyapatite, and the formation of tertiary dentin in the barrier formation, where the CH presented an inferior result
affected tissues were determined. In addition, the hydroxyls compared with MTA. All samples capped with MTA showed
of this material neutralize the effects of osteoclasts, bond with partial dentin bridge formation. In addition, morphological
hydrogen and form the H2O molecule, and maintain the opti- analysis at 14 days showed that CH presented statistically
mum pH for auxiliary pyrophosphate and remineralization lower values than MTA and Biodentine, whose results were
activity.37 However, CH may possibly wound the primary tooth similar to each other.
pulp to permit internal resorption or dystrophic calcification. The barriers formed using CH were porous, and there-
MTA and Biodentine have a very similar chemical reac- fore not ideal for a proper bacterial sealing, as described by
tion: first, the solid–liquid interface is formed on the surface Paranjpe et al.46 The CH presented a porous barrier as from the
of the particles with immediate dissolution of ions, such as second week, as also reported by Tran et al,43 who concluded
Ca+ that migrate to the solution forming CaOH2; second, that CH used in direct pulp capping produces porous barriers
CaOH2 is attracted by the hydroxyl groups, resulting in the at 14 days in rat pulps compared with Biodentine. In contrast,
formation of calcium silicate hydrate. This gelatinous layer denser and more extensive formations were observed when
has a negative character and can act as a nucleation site to MTA or Biodentine were used, in which the mineralization
form hydroxyapatite. In the third phase, the hydrated cal- formed appeared as an atubular dentin, similar to pulp calci-
cium silicate provides significant and continuous amounts of fication and different from the reactional dentin.47
CH during the first hours of the setting reaction, leading to an In our study, morphological analysis of the mineralized
increase in pH and the concentration of calcium ions in the barrier formed indicated superior irregular deposition of
adjacent areas. Compared with CH and MTA, Biodentine has hard tissue for MTA and Biodentine when compared with
more ions. It consists of tricalcium silicate, dicalcium silicate CH, which presented small depositions of hard tissue at
as a second core material, calcium carbonate, oxide as filler, 14 days. According to Laurent et al,10 Biodentine exhibits a
iron oxide shade, and zirconium oxide as a radio-opacifier. 12-minute setting time and increased sealing capacity. All
The liquid, on the contrary, contains calcium chloride as a materials promote alkalinization of the medium, owing to
setting accelerator and a water-reducing agent.38,39 the pH of around 12.5, which confers antibacterial power

European Journal of Dentistry Vol. 15 No. 1/2021 © 2020. European Journal of Dentistry.
Effect of Tricalcium Silicate on Direct Pulp Capping  Chicarelli et al. 107

to the materials. In routine clinical settings, the Biodentine 7 Zhao W, Wang J, Zhai W, Wang Z, Chang J. The self-setting
material deserves special attention because it induces the properties and in vitro bioactivity of tricalcium silicate.
Biomaterials 2005;26(31):6113–6121
formation of a mineralized barrier, similar to that induced by
8 Paranjpe A, Smoot T, Zhang H, Johnson JD. Direct contact with
MTA, and a reduced setting time, thereby allowing definitive mineral trioxide aggregate activates and differentiates human
restorations to be made after direct pulp capping. This cir- dental pulp cells. J Endod 2011;37(12):1691–1695
cumvents the need for additional clinical sessions, thereby 9 Kunert M, Lukomska-Szymanska M. Bio-Inductive Materials in
eliminating the risk of new pulp exposure and secondary Direct and Indirect Pulp Capping-A Review Article. Materials
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10 Laurent P, Camps J, About I. Biodentine(TM) induces TGF-1
of treatment.
release from human pulp cells and early dental pulp mineral-
At 21 days, morphological analysis of the mineralized bar- ization. Int Endod J 2012;45(5):439–448
rier formed in the various groups revealed superior results for 11 Gandolfi MG, Siboni F, Polimeni A, et al. In vitro screening of
Biodentine relative to CH. It is known that the availability of the apatite-formation ability, biointeractivity and physical
calcium ions stimulates the formation of the calcium carbon- proprieties of a tricalcium silicate material for Endodontics
ate precipitate, which contributes to mineralization. It seems and restorative dentistry. Dent J 2013;1:41–60
12 Tziafa C, Koliniotou-Koumpia E, Papadimitriou S, Tziafas D.
clear that the form and time for the release of calcium and
Dentinogenic responses after direct pulp capping of miniature
hydroxyl ions interfere with the formed mineralized barrier. swine teeth with Biodentine. J Endod 2014;40(12):1967–1971
In CH, the release of the calcium ions occurs rapidly, which 13 Mori GG, Teixeira LM, de Oliveira DL, Jacomini LM, da Silva SR.
acts as an irritant to the tissues and generates a caustic sur- Biocompatibility evaluation of biodentine in subcutaneous tis-
face effect.29 Calcium silicate materials exhibit a slower and sue of rats. J Endod 2014;40(9):1485–1488
14 Bossù M, Iaculli F, Di Giorgio G, Salucci A, Polimeni A,
more gradual release, and disperse larger amounts of calcium
Di Carlo S. Different pulp dressing materials for the pulpotomy
ions compared with CH-based cements. Biodentine, however, of primary teeth: A systematic review of the literature. J Clin
exhibits greater calcium release and extended alkaline activ- Med 2020;9(3):E838
ity, as well as better mechanical properties than MTA.11,48 15 Pérard M, Le Clerc J, Watrin T, et al. Spheroid model study com-
Our results demonstrate the superiority of the new paring the biocompatibility of Biodentine and MTA. J Mater Sci
materials, MTA and Biodentine over CH, when used for Mater Med 2013;24(6):1527–1534
16 Saghiri MA, Orangi J, Asatourian A, et al. Calcium silicate-based
direct capping of live pulps. The use of new materials
cements and functional impacts of various constituents. Dent
based on calcium silicate presents a viable alternative, Mater J 2017;36(1):8–18
with favorable histological characteristics relative to CH, 17 Dammaschke T. Rat molar teeth as a study model for direct
which was previously considered the gold standard for this pulp capping research in dentistry. Lab Anim 2010;44(1):1–6
treatment. 18 Dammaschke T, Stratmann U, Wolff P, Sagheri D,
Schäfer E. Direct pulp capping with mineral trioxide aggre-
Conflict of Interest gate: an immunohistologic comparison with calcium hydrox-
None declared. ide in rodents. J Endod 2010;36(5):814–819
19 Bowen WH. Rodent model in caries research. Odontology
Acknowledgment 2013;101(1):9–14
We thank Coordenadoria de Aperfeiçoamento de Pessoal 20 Kirschneck C, Proff P, Fanghaenel J, Behr M, Wahlmann U,
de Nível Superior (CAPES; Brasília, Brazil) for providing Roemer P. Differentiated analysis of orthodontic tooth move-
ment in rats with an improved rat model and three-dimen-
financial support.
sional imaging. Ann Anat 2013;195(6):539–553
21 Simon S, Cooper P, Smith A, Picard B, Ifi CN, Berdal A. Evaluation
of a new laboratory model for pulp healing: Preliminary study.
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