Top

Clinical Oral Investigations

Published in:

01-06-2021 | Cytokines | Original Article

Tailored 70S30C Bioactive glass induces severe inflammation as pulpotomy agent in primary teeth: an interim analysis of a randomised controlled trial

Authors: Yasmine Elhamouly, Rania M. El Backly, Dalia M. Talaat, Samia S. Omar, Maha El Tantawi, Karin M. L. Dowidar

Published in: Clinical Oral Investigations | Issue 6/2021

Abstract

Objectives

This study compared clinical, histologic, and inflammatory outcomes of Biodentine and Bioactive glass (70S30C-BAG) as pulpotomy agents in primary teeth.

Methods

A randomised, clinical trial was performed recruiting 70 children, 5–9 years old, having ≥ 1 tooth indicated for vital pulpotomy. Participants were randomised to Biodentine or 70S30C-BAG groups. Clinical evaluation was scheduled at 1, 3, 6, 9, and 12 months. Additional 16 teeth were extracted after 6 weeks to assess histologic and inflammatory response (IL-8/IL-10 ratio) using ELISA. Fisher exact, Mann Whitney U test, and t test were used to compare clinical, histologic outcomes and IL-8/IL-10 ratio.

Results

After 3 months, 10 teeth treated with Biodentine were clinically successful, while 9 teeth treated with 70S30C-BAG failed (P < 0.001) necessitating trial termination. Causes of failure were analysed by assessing the pH and ionic release of 70S30C-BAG. Biodentine-treated teeth showed minor inflammation, normal pulp, and hard tissue formation.70S30C-BAG-treated teeth showed severe inflammation, abscesses, root resorption without hard tissue formation. There was a significantly greater percent reduction of IL-8/IL-10 ratio in Biodentine than 70S30C-BAG (mean ± SD = 66.39 ± 18.56 and 40.66 ± 0.86, P = 0.02).

Conclusions

Biodentine showed favourable clinical, histologic, and anti-inflammatory outcomes, promoting pulp healing and regeneration. 70S30C-BAG resulted in pulp necrosis—through persistent inflammation—causing clinical failure.

Clinical relevance

Biodentine is a promising pulpotomy agent in primary teeth; it promoted healing and regeneration of the dentine-pulp complex. In its current form, 70S30C-BAG is not a suitable pulpotomy agent; it induced persistent inflammation, negating the pulp ability to heal and regenerate. TRN: NCT03786302, 12/19/2018.

Available only for authorised users

Stringhini JE, Dos Santos MGC, Oliveira LB, Mercadé M (2019) MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials. Clin Oral Investig 23:1967–1976. https://doi.org/10.1007/s00784-018-2616-6CrossRef

Arora V, Nikhil V, Namrata S, Arora P (2013) Bioactive dentin replacement. IOSR J Dent Med Sci 12:51–57. https://doi.org/10.9790/0853-1245157CrossRef

Laurent P, Camps J, About I (2012) BiodentineTM induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J 45:439–448. https://doi.org/10.1111/j.1365-2591.2011.01995.xCrossRefPubMed

Cuadros-Fernández C, Lorente Rodríguez AI, Sáez-Martínez S, García-Binimelis J, About I, Mercadé M (2016) Short-term treatment outcome of pulpotomies in primary molars using mineral trioxide aggregate and Biodentine: a randomized clinical trial. Clin Oral Investig 20:1639–1645. https://doi.org/10.1007/s00784-015-1656-4CrossRefPubMed

Rajasekharan S, Martens LC, Vandenbulcke J, Jacquet W, Bottenberg P, Cauwels RGEC (2017) Efficacy of three different pulpotomy agents in primary molars: a randomized control trial. Int Endod J 50:215–228. https://doi.org/10.1111/iej.12619CrossRefPubMed

Grewal N, Salhan R, Kaur N, Patel H (2016) Comparative evaluation of calcium silicate-based dentin substitute (Biodentine ® ) and calcium hydroxide (pulpdent) in the formation of reactive dentin bridge in regenerative pulpotomy of vital primary teeth: triple blind, randomized clinical trial. Contemp Clin Dent 7:457. https://doi.org/10.4103/0976-237X.194116CrossRefPubMedPubMedCentral

Galler KM, D’Souza RN, Hartgerink JD, Schmalz G (2011) Scaffolds for dental pulp tissue engineering. Adv Dent Res 23:333–339. https://doi.org/10.1177/0022034511405326CrossRefPubMed

Jones JR, Ehrenfried LM, Hench LL (2006) Optimising bioactive glass scaffolds for bone tissue engineering. Biomaterials 27:964–973. https://doi.org/10.1016/j.biomaterials.2005.07.017CrossRefPubMed

Haghgoo R, Ahmadvand M (2016) Evaluation of pulpal response of deciduous teeth after direct pulp capping with bioactive glass and mineral trioxide aggregate. Contemp Clin Dent 7:332–335. https://doi.org/10.4103/0976-237x.188552CrossRefPubMedPubMedCentral

10.

Long Y, Liu S, Zhu L, Liang Q, Chen X, Dong Y (2017) Evaluation of pulp response to novel bioactive glass pulp capping materials. J Endod 43:1647–1650. https://doi.org/10.1016/j.joen.2017.03.011CrossRefPubMed

11.

Abdel Naby SM (2007) A comparative study of the pulpal response to mineral trioxide aggregate versus bioactive glass as pulpotomy agents in primary teeth. Dissertation, University of Alexandria

12.

Midha S, Kim TB, Van Den Bergh W, Lee PD, Jones JR, Mitchell CA (2013) Preconditioned 70S30C bioactive glass foams promote osteogenesis in vivo. Acta Biomater 9:9169–9182. https://doi.org/10.1016/j.actbio.2013.07.014CrossRefPubMed

13.

Wang S, Kowal TJ, Marei MK, Falk MM, Jain H (2013) Nanoporosity significantly enhances the biological performance of engineered glass tissue scaffolds. Tissue Eng A 19:1632–1640. https://doi.org/10.1089/ten.tea.2012.0585CrossRef

14.

El Shazley N, Hamdy A, El-Eneen HA, El Backly RM, Saad MM, Essam W, Moussa H, El Tantawi M, Jain H, Marei MK (2016) Bioglass in alveolar bone regeneration in orthodontic patients. JDR Clin Transl Res 1:244–255. https://doi.org/10.1177/2380084416660672CrossRef

15.

Wang S, Gao X, Gong W, Zhang Z, Chen X, Dong Y (2014) Odontogenic differentiation and dentin formation of dental pulp cells under nanobioactive glass induction. Acta Biomater 10:2792–2803. https://doi.org/10.1016/j.actbio.2014.02.013CrossRefPubMed

16.

Jun SK, Lee JH, Lee HH (2017) The biomineralization of a bioactive glass-incorporated light-curable pulp capping material using human dental pulp stem cells. Biomed Res Int 2017:1–9. https://doi.org/10.1155/2017/2495282CrossRef

17.

Alsenan J, Chou L (2017) Effect of silicon and calcium on human dental pulp cell cultures. Int J Mater Sci Appl 6:290. https://doi.org/10.11648/j.ijmsa.20170606.14CrossRef

18.

Lopez TCC, Diniz IMA, Ferreira LS, Marchi J, Borges R, de Cara SPHM, D’Almeida-Couto R, Marques MM (2017) Bioactive glass plus laser phototherapy as promise candidates for dentine hypersensitivity treatment. J Biomed Mater Res B Appl Biomater 105:107–116. https://doi.org/10.1002/jbm.b.33532CrossRefPubMed

19.

Wu C, Luo Y, Cuniberti G, Xiao Y, Gelinsky M (2011) Three-dimensional printing of hierarchical and tough mesoporous bioactive glass scaffolds with a controllable pore architecture, excellent mechanical strength and mineralization ability. Acta Biomater 7:2644–2650. https://doi.org/10.1016/j.actbio.2011.03.009CrossRefPubMed

20.

Goldberg M, Njeh A, Uzunoglu E (2015) Is pulp inflammation a prerequisite for pulp healing and regeneration? Mediat Inflamm 2015:347649–347611. https://doi.org/10.1155/2015/347649CrossRef

21.

ElSalhy M, Azizieh F, Raghupathy R (2013) Cytokines as diagnostic markers of pulpal inflammation. Int Endod J 46:573–580. https://doi.org/10.1111/iej.12030CrossRefPubMed

22.

Magloire H, Romeas A, Melin M, Couble ML, Bleicher F, Farges JC (2001) Molecular regulation of odontoblast activity under dentin injury. Adv Dent Res 15:46–50. https://doi.org/10.1177/08959374010150011201CrossRefPubMed

23.

Salako N, Joseph B, Ritwik P, Salonen J, John P, Junaid TA (2003) Comparison of bioactive glass, mineral trioxide aggregate, ferric sulfate, and formocresol as pulpotomy agents in rat molar. Dent Traumatol 19:314–320. https://doi.org/10.1046/j.1600-9657.2003.00204.xCrossRefPubMed

24.

Haghgoo R, Naderi NJ (2007) Comparison of calcium hydroxide and bioactive glass after direct pulp capping in primary teeth. J Front Dent 4:155–159

25.

Wang S, Falk MM, Rashad A, Saad MM, Marques AC, Almeida RM, Marei MK, Jain H (2011) Evaluation of 3D nano–macro porous bioactive glass scaffold for hard tissue engineering. J Mater Sci Mater Med 22:1195–1203. https://doi.org/10.1007/s10856-011-4297-4CrossRefPubMed

26.

Althunian TA, De Boer A, Groenwold RHH, Klungel OH (2017) Defining the noninferiority margin and analysing noninferiority: an overview. Br J Clin Pharmacol 83:1636–1642. https://doi.org/10.1111/bcp.13280CrossRefPubMedPubMedCentral

27.

Kusum B, Rakesh K, Richa K (2015) Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restor Dent Endod 40:276–285. https://doi.org/10.5395/rde.2015.40.4.276CrossRefPubMedPubMedCentral

28.

El Meligy OA, Allazzam S, Alamoudi NM (2016) Comparison between biodentine and formocresol for pulpotomy of primary teeth: a randomized clinical trial. Quintessence Int (Berl) 47:571–580. https://doi.org/10.3290/j.qi.a36095CrossRef

29.

American Academy of Pediatric Dentistry (2014) Pulp therapy for primary and immature permanent teeth. Reference Manual 39:325–333

30.

Agamy HA, Bakry NS, Mounir MMF, Avery DR (2004) Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent 26:302–309PubMed

31.

Saghaei M (2004) Random allocation software for parallel group randomized trials. BMC Med Res Methodol 4:26. https://doi.org/10.1186/1471-2288-4-26CrossRefPubMedPubMedCentral

32.

Huth KC, Paschos E, Hajek-Al-Khatar N, Hollweck R, Crispin A, Hickel R, Folwaczny M (2005) Effectiveness of 4 pulpotomy techniques—randomized controlled trial. J Dent Res 84:1144–1148. https://doi.org/10.1177/154405910508401210CrossRefPubMed

33.

McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med. https://doi.org/10.11613/bm.2012.031

34.

Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8:18. https://doi.org/10.1186/1741-7015-8-18CrossRefPubMedPubMedCentral

35.

Shayegan A, Jurysta C, Atash R, Petein M, Vanden AA (2012) Biodentine used as a pulp-capping agent in primary pig teeth. Pediatr Dent 34:202E–208E

36.

Ozdemir Y, Kutukculer N, Topaloglu-Ak A, Kose T, Eronat C (2015) Comparative evaluation of pro-inflammatory cytokine levels in pulpotomized primary molars. J Oral Sci 57:145–150. https://doi.org/10.2334/josnusd.57.145CrossRefPubMed

37.

Pezelj-Ribaric S, Anic I, Brekalo I, Miletic I, Hasan M, Simunovic-Soskic M (2002) Detection of tumor necrosis factor α in Normal and inflamed human dental pulps. Arch Med Res 33:482–484. https://doi.org/10.1016/S0188-4409(02)00396-XCrossRefPubMed

38.

Gholami S, Labbaf S, Houreh AB, Ting HK, Jones JR, Esfahani MHN (2017) Long term effects of bioactive glass particulates on dental pulp stem cells in vitro. Biomed Glas 3:96–103. https://doi.org/10.1515/bglass-2017-0009CrossRef

39.

Uzunoğlu E, Yılmaz Z, Evren Ülker A, Kalaycı S, Karahan S (2011) Determination of pH and calcium ion realease provided by different calcium hyroxide pastes. Clin Dent Res 35:38–42

40.

Fouad WA, Youssef R, Yossef R (2013) Clinical and radiographic assessment of vital pulpotomy in primary molars using mineral trioxide aggregate and a novel bioactive cement. Egypt Dent J 59:1–7

41.

Kim J, Song YS, Min KS, Kim SH, Koh JT, Lee BN, Chang HS, Hwang IN, Oh WM, Hwang YC (2016) Evaluation of reparative dentin formation of ProRoot MTA, biodentine and BioAggregate using micro-CT and immunohistochemistry. Restor Dent Endod 41:29–36. https://doi.org/10.5395/rde.2016.41.1.29CrossRefPubMedPubMedCentral

42.

Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L (2017) Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr Dent 39:16–123PubMed

43.

Sepulveda P, Jones JR, Hench LL (2001) Characterization of melt-derived 45S5 and sol-gel-derived 58S bioactive glasses. J Biomed Mater Res 58:734–740. https://doi.org/10.1002/jbm.10026CrossRefPubMed

44.

Sepulveda P, Jones JR, Hench LL (2002) In vitro dissolution of melt-derived 45S5 and sol-gel derived 58S bioactive glasses. J Biomed Mater Res 61:301–311. https://doi.org/10.1002/jbm.10207CrossRefPubMed

45.

Ciraldo FE, Boccardi E, Melli V, Westhauser F, Boccaccini AR (2018) Tackling bioactive glass excessive in vitro bioreactivity: preconditioning approaches for cell culture tests. Acta Biomater 75:3–10. https://doi.org/10.1016/j.actbio.2018.05.019CrossRefPubMed

46.

Cui CY, Wang SN, Ren HH, Li AL, Qiu D, Gan YH, Dong YM (2017) Regeneration of dental-pulp complex-like tissue using phytic acid derived bioactive glasses. RSC Adv 7:22063–22070. https://doi.org/10.1039/c7ra01480eCrossRef

47.

Ting H, Page SJ, Poologasundarampillai G, Chen S, Yu B, Hanna JV, Jones JR (2017) Phosphate content affects structure and bioactivity of sol-gel silicate bioactive glasses. Int J Appl Glas Sci 8:372–382. https://doi.org/10.1111/ijag.12322CrossRef

48.

Houreh AB, Labbaf S, Ting HK, Ejeian F, Jones JR, Esfahani MHN (2017) Influence of calcium and phosphorus release from bioactive glasses on viability and differentiation of dental pulp stem cells. J Mater Sci 52:8928–8941. https://doi.org/10.1007/s10853-017-0946-4CrossRef

49.

Gong W, Huang Z, Dong Y, Gan Y, Li S, Gao X, Chen X (2014) Ionic extraction of a novel nano-sized bioactive glass enhances differentiation and mineralization of human dental pulp cells. J Endod 40:83–88. https://doi.org/10.1016/j.joen.2013.08.018CrossRefPubMed

50.

Zhou HM, Shen Y, Wang ZJ, Li L, Zheng YF, Häkkinen L, Haapasalo M (2013) In vitro cytotoxicity evaluation of a novel root repair material. J Endod 39:478–483. https://doi.org/10.1016/j.joen.2012.11.026CrossRefPubMed

51.

Hassan ST, Alothmani OS, Yousef MK (2015) Biodentine and mineral trioxide aggregate: an analysis of solubility, pH changes and leaching elements. Life Sci J. https://doi.org/10.4103/JCD.JCD_45_17

52.

Nakamura Y, Hammarström L, Lundberg E, Ekdahl H, Matsumoto K, Gestrelius S, Lyngstadaas SP (2001) Enamel matrix derivative promotes reparative processes in the dental pulp. Adv Dent Res 15:105–107. https://doi.org/10.1177/08959374010150010201CrossRefPubMed

53.

Ravi GR, Subramanyam RV (2012) Calcium hydroxide-induced resorption of deciduous teeth: a possible explanation. Dent Hypotheses 3:90. https://doi.org/10.4103/2155-8213.103910CrossRef

54.

Yildirim S, Yapar M, Sermet U, Sener K, Kubar A (2008) The role of dental pulp cells in resorption of deciduous teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:113–120. https://doi.org/10.1016/j.tripleo.2007.06.026CrossRefPubMed

55.

Santos RL, Moura MFL, Carvalho FG, Guênes GMT, Alves PM, Pithon MM (2014) Histological analysis of biocompatibility of ionomer cements with an acid-base reaction. Braz Oral Res 28:1–7. https://doi.org/10.1590/S1806-83242014.50000003CrossRef

56.

Giraud T, Jeanneau C, Rombouts C, Bakhtiar H, Laurent P, About I (2019) Pulp capping materials modulate the balance between inflammation and regeneration. Dent Mater 35:24–35. https://doi.org/10.1016/j.dental.2018.09.008CrossRefPubMed

57.

Silva ACO, Faria MR, Fontes A, Campos MS, Cavalcanti BN (2009) Interleukin-1 beta and interleukin-8 in healthy and inflamed dental pulps. J Appl Oral Sci 17:527–532. https://doi.org/10.1590/S1678-77572009000500031CrossRefPubMedPubMedCentral

58.

Hahn C-L, Best AM, Tew JG (2000) Cytokine induction by Streptococcus mutans and pulpal pathogenesis. Infect Immun 68:6785–6789. https://doi.org/10.1128/IAI.68.12.6785-6789.2000CrossRefPubMedPubMedCentral

59.

Mazhari F, Shabzendedar M, Mohtasham N, Nik E, Noorollahian H (2016) Success evaluation of pulpotomy in primary molars with enamel matrix derivative: a pilot study. J Dent Mater Tech 5:94–98. https://doi.org/10.22038/jdmt.2016.6620CrossRef

Title: Tailored 70S30C Bioactive glass induces severe inflammation as pulpotomy agent in primary teeth: an interim analysis of a randomised controlled trial
Authors: Yasmine Elhamouly
Rania M. El Backly
Dalia M. Talaat
Samia S. Omar
Maha El Tantawi
Karin M. L. Dowidar
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keyword: Cytokines
Published in: Clinical Oral Investigations / Issue 6/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03707-5

At a glance: The STEP trials

Springer Medicine

Tailored 70S30C Bioactive glass induces severe inflammation as pulpotomy agent in primary teeth: an interim analysis of a randomised controlled trial

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 6/2021

The influence of the SARS-CoV-2 pandemic on oral and maxillofacial surgery: a nationwide survey among 54 hospitals and 240 private practices in Germany

Is it possible for a simultaneous biomodification during acid etching on naturally caries-affected dentin bonding?

Alteration of the oral microbiota may be a responsible factor, along with estrogen deficiency, by the development of larger periapical lesions

Significance of implant design on the efficacy of different peri-implantitis decontamination protocols

Association between caries and periodontal diseases in a sample of employed adults in Spain: a cross-sectional study

Correction to: Diagnostic accuracy of clinical visualization and light-based tests in precancerous and cancerous lesions of the oral cavity and oropharynx: a systematic review and meta-analysis