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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 34  |  Issue : 2  |  Page : 127-130

Evaluation of shear bond strength of e-mineral trioxide aggregate and biodentine with glass ionomer cement: An in vitro study


Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital, Indore, Madhya Pradesh, India

Date of Submission23-Jan-2022
Date of Decision08-Mar-2022
Date of Acceptance12-Mar-2022
Date of Web Publication01-Jul-2022

Correspondence Address:
Dr. Shivangi Trivedi
F12, Jhoomer Ghat, Near Hotel Mashal, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/endo.endo_17_22

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  Abstract 


Aim: The aim of this study was to evaluate the shear bond strength of glass ionomer cement (GIC) with e-mineral trioxide aggregate (MTA) and Biodentine when placed immediately and after initial set.
Materials and Methodology: Forty acrylic blocks with 2-mm height and 5-mm diameter central holes were prepared and randomly divided into two equal groups (n = 20). Group A (n = 20) and Group B (n = 20) were filled with E-MTA and Biodentine, respectively. These groups (n = 20) were further divided into two subgroups each; subgroup A1 (n = 10) and A2 (n = 10) were the placement of GIC immediately over freshly mixed e-MTA and after initial set e-MTA, respectively, subgroup B1 (n = 10) and B2 (n = 10) were the placement of GIC immediately over freshly mixed Biodentine and after initial set Biodentine, respectively. All the samples were later subjected to UTM for shear bond strength test.
Results: The highest shear bond strength was recorded with subgroup B1 were the placement of GIC immediately over freshly mixed Biodentine, i. e., (18.72 MPa) and lowest with subgroup A2 placement of GIC after initial set MTA (5.96MPa). The shear bond strength of GIC condensed over freshly mixed e-MTA (subgroup A1) shows higher mean value then after initial set MTA (subgroup A2); however, SBS was highest in the placement of GIC immediately over freshly mixed Biodentine (subgroup B1).
Conclusion: Within the limitation of this in vitro study, it can be concluded that freshly mixed Biodentine can be restored immediately with GIC.

Keywords: Biodentine, conventional glass ionomer cement, e-mineral trioxide aggregate, shear bond strength


How to cite this article:
Hiremath H, Solanki AS, Trivedi S, Verma D. Evaluation of shear bond strength of e-mineral trioxide aggregate and biodentine with glass ionomer cement: An in vitro study. Endodontology 2022;34:127-30

How to cite this URL:
Hiremath H, Solanki AS, Trivedi S, Verma D. Evaluation of shear bond strength of e-mineral trioxide aggregate and biodentine with glass ionomer cement: An in vitro study. Endodontology [serial online] 2022 [cited 2022 Aug 8];34:127-30. Available from: https://www.endodontologyonweb.org/text.asp?2022/34/2/127/349576




  Introduction Top


Pulp exposure during tooth decay, restorative procedures, and traumatic injuries affect pulp vitality. For long-term survival of such tooth, maintenance of pulp vitality is essential, which can be achieved by various methods such as indirect pulp capping in which carious dentin close to the pulp is preserved to avoid pulp exposure and is covered with the biocompatible material, direct pulp capping (DPC) in which mechanical or traumatic vital pulp exposure sealed with biomaterial in direct contact with the exposed pulp and pulpotomy in which coronal pulp tissue is removed and then sealed through biomaterial.[1],[2] The biomaterial which is used in all these procedures is a dental repair restorative material that will trigger the biological response of tissue/cells. Some of the commercially available biomaterials are mineral trioxide aggregate (MTA), MTA flow™, Biodentine™, and e-MTA. MTA was introduced by Torabinejad in 1993 as a retrograde filling material of choice in DPC, perforation repair, apexification, and root-end filling material. Despite its uses in various clinical scenarios, it has several shortcomings which hinder its clinical use such as long setting time, difficulty in manipulation and delivery, the potential for discoloration, and high solubility during setting.[3]

Biodentine is a new bioactive material that was introduced to overcome the shortcoming of MTA. It acts as a “bioactive dentin substitute” which has a short setting time and superior biological and mechanical properties as compared to MTA. It needs less water than MTA due to the presence of water-reducing agent.[2],[4] These properties make it more stable than MTA. E-MTA is another biomaterial that was recently introduced into the market. It is tricalcium silicate-based bioceramic cement that triggers the healing process. It consists of ultrafine-grained powder due to which it forms a smooth consistency after mixing and its handling properties are superior. However, to achieve long-term success, a protective material must be placed over this biomaterial so that microleakage can be prevented. The number of studies has been conducted to assess the protective material that can be placed in direct contact with these calcium silicate-based cement. Although the American Association of Endodontics recommends the placement of 3–4 mm layer of glass ionomer over the biomaterial, still it's adequate bonding with biomaterial is atopic of concern.[5],[6]

Thus, this in vitro study aimed to evaluate the shear bond strengths of glass ionomer cement (GIC) with e-MTA and Biodentine when placed immediately and after the initial set using universal testing machine.


  Materials and Methodology Top


In this in vitro study, forty acrylic blocks of 3-cm height and 1.5-cm diameter were made in which a central hole of 2-mm height and 5-mm diameter was prepared with the help of putty. 1-mm thick gel foam moistened with saline was placed in each block to simulate the oral environment. These blocks were then randomly divided into two equal groups (n = 20) according to the type of biomaterial used, i.e., Group A: MTA and Group B: Biodentine. Biodentine and e-MTA were mixed according to the manufacturer's instructions to a thick putty-like consistency and filled into the acrylic block of their respective group. The filled material was condensed with the help of a condenser.

Then, the samples of both the groups were further subdivided into two subgroups each, according to the time duration considered for placement of a protective layer of GIC over e-MTA or Biodentine. GIC was placed at the center of Biodentine and MTA into cylindrically blocks with the help of a plastic instrument.

  • Group A (n = 20)
  • Subgroup A1(n = 10).


GIC was mixed according to manufacture instructions and condensed over freshly mixed e-MTA in subgroupA1 (n = 10) and over initial set e-MTA after 15 mins in subgroup A2 (n = 10) cylindrical tube with the plastic instrument. GIC was protected with petroleum jelly.

  • Subgroup A2 (n = 10).


GIC was mixed according to manufacture instructions and condensed over an initial set (15 min) e-MTA in a cylindrical tube with the plastic instrument. GIC was protected with petroleum jelly.

  • Group B (n = 20)
  • Subgroup B1 (n = 10).


Placement of GIC immediately over freshly mixed Biodentine in a cylindrical plastic tube with the plastic instrument. GIC was protected with petroleum jelly.

  • Subgroup B2 (n = 10).


Placement of GIC over initial set (12 min) Biodentine in a cylindrical plastic tube with the plastic instraument. GIC was protected with petroleum jelly.

After the placement of GIC, it was allowed to set for 10 mins in each specimen. Then, all specimens were stored in 100% humidity at 37o for 24 h. Later, the specimens were subjected to a universal testing machine for shear bond strength test; a chisel-edged plunger was mounted onto the movable crosshead of the testing machine and positioned so that the leading edge was aimed at the Biodentine or the MTA base interface to GIC. The force required to remove the restorative material was measured in Newtons (N) (1 MPa = 1 N/mm2), SBS was then calculated by dividing the peak load values by the restorative material base area (3.14 mm2).

Statistical analysis

The collected data were analyzed using SPSS software (version 20.0) (IBM, IBM SPSS Statistics, Chicago (USA)). The intergroup (A1, A2; B1, B2) and intragroup (group A and B) comparison of shear bond strength were done using Mann–Whitney test. The level of significance (P Value) was set at 0.05.


  Results Top


Considering the type of material used, a significant difference was observed between Group A (e-MTA) and Group B (Biodentine) when GIC was placed immediately over freshly mixed e-MTA or Biodentine (P < 0.001), whereas no difference was observed when GIC was placed over initially set e-MTA or Biodentine (P < 0.762) [Table 1].
Table 1: Intragroup comparison between Group A and Group B

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Regarding two time intervals, GIC placed over freshly mixed Biodentine (subgroup B1) showed maximum shear bond strength value (18.72) compared to the group (subgroup B2) in which GIC was placed over initially set Biodentine (6.37). No differences were reported regarding e-MTA performance during intergroup comparison [Table 2].
Table 2: Inter group comparison between group A1 and A2 and B1 and B2

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  Discussion Top


During the restoration of the tooth with pulp exposure, prediction of prognosis has always been a challenging task before the clinician. Thus, an effort to preserve the vitality of pulp using biocompatible materials such as calcium silicate-based cement which provides a strong barrier against microleakage should always be considered.[7] Biodentine is a newer calcium silicate-based material with a fast setting (due to its increased particle size and the presence of calcium chloride) and improved mechanical properties when compared to MTA.[8] On the other hand, e-MTA is a recently introduced calcium silicate-based material that contains ultrafine-grained particles. Unlike MTA, e-MTA sets quickly and has regenerative potential along with antimicrobial properties.

After the pulp capping procedure, the treated tooth would require a proper final restoration and for this, GIC or composite are commonly used.[7] However, several studies reported that the etching of dentin replacement material cause destruction of its microstructure which leads to microleakage.[9] Furthermore, due to the setting contraction of composite or resin-modified GIC, adhesive separation or gap formation was observed with these materials. According to Patil et al., conventional GIC can safely be placed over calcium silicate-based materials.[10]

In such type of restorative procedure, the bond between the pulp capping material and the final restorative material plays a crucial role as it provides an adequate seal.[7] Bond strength is the interfacial adhesion between the substrate and bonded material with the help of an adhesive layer. However, in clinical practice, fracture may take place either in the bonded material or substrate or both. Therefore, clinically bond strength is measured as the force required to fracture the bond formed between pulp capping material and the final restorative material.[11] It was found that the optimal shear bond strength required to produce gap-free restorative margins is 17–20 MPa.[3]

Another important issue regarding bond strength is the timing of placement of final restoration over the dentin replacement material. As there are no specific guidelines that mention the restoration of the teeth undergoing a regenerative endodontic procedure or vital pulp therapy,[2] this study was designed to evaluate the shear bond strength and effective timing of GIC restoration over newer calcium silicate-based materials (Biodentine and e-MTA).

The results of this study suggest that restorative procedure performed immediately after placement of Biodentine has higher bond strength than the delayed time frame (after the initial set). In the present study, the Biodentine group exhibited optimal shear bond strength with a mean of 18.72 MPa [Table 1] which would suggest that the Biodentine can effectively prevent microleakage. For this reason, Biodentine can be the material of choice for an immediate restoration. Similar findings were reported by Palma et al., where they assessed the proper restoration time after placement of Biodentine and ProRoot MTA.[12] While comparing both the calcium silicate-based materials (Biodentine and e-MTA), higher bond strength was observed with Biodentine.

The results of this study coincide with the results of Meraji and Camilleri.,[9] and Camilleri,[12] where they compared the bond strength between GIC and Biodentine or MTA. As there is a lack of literature regarding the properties of e-MTA and its adhesion with restorative materials, the probable reasons of its low bond strength than Biodentine may be due to interference of its setting with GIC. Just like MTA, the mixture of e-MTA and GIC may decrease the setting time and increase its solubility through water sorption from e-MTA. This may further lead to higher porosities and incomplete hydration of e-MTA.

The chemical composition of materials also plays important role in bond strength. Biodentine powder is mainly composed of tricalcium silicate, dicalcium silicate, calcium oxide while liquid contains water, calcium chloride which has a significant role in the faster setting of Biodentine (within 12 min), and carboxylate-based hydrosoluble polymer which acts as a water-reducing agent that decreases the amount of water without affecting the workability (i.e., the flow of material), thus improve the strength of the cement.[13] Powder of e-MTA consists of calcium oxide, silicon dioxide, aluminum oxide, magnesium oxide, ferrous oxide, and zirconium oxide while liquid consists of 100% distilled water (just like MTA). Thus, due to the presence of water, e-MTA may not set as quickly as Biodentine. However, the manufacturer claims that this material requires only 15 min to set. Another reason for the weak shear bond strength of e-MTA is its large particle size (3–30 μ) as compared to Biodentine (1–10 μ).[14] Thus, Biodentine forms tag-like structure after penetrating the dentinal tubules. This results in micromechanical retention of Biodentine.


  Conclusion Top


Within the limitations of this study, the new pure tricalcium-based pulp capping, repair, and endodontic material showed clinically acceptable and higher shear bond scores compared to e-MTA when restored immediately with conventional GIC. Therefore, the use of Biodentine can be a better material of choice for immediate restoration when compared with e-MTA. However, further research is needed for the clinical performance of e-MTA and its adhesion with the GIC.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Altunsoy M, Tanrıver M, Ok E, Kucukyilmaz E. Shear bond strength of a self-adhering flowable composite and a flowable base composite to mineral trioxide aggregate, calcium-enriched mixture cement, and biodentine. J Endod 2015;41:1691-5.  Back to cited text no. 1
    
2.
Palma PJ, Marques JA, Falacho RI, Vinagre A, Santos JM, Ramos JC. Does delayed restoration improve shear bond strength of different restorative protocols to calcium silicate-based cements? Materials (Basel) 2018;11:2216.  Back to cited text no. 2
    
3.
Cantekin K, Avci S. Evaluation of shear bond strength of two resin-based composites and glass ionomer cement to pure tricalcium silicate-based cement (Biodentine®). J Appl Oral Sci 2014;22:302-6.  Back to cited text no. 3
    
4.
Bodanezi A, Carvalho N, Silva D, Bernardineli N, Bramante CM, Garcia RB, et al. Immediate and delayed solubility of mineral trioxide aggregate and Portland cement. J Appl Oral Sci 2008;16:127-31.  Back to cited text no. 4
    
5.
Kogan P, He J, Glickman GN, Watanabe I. The effects of various additives on setting properties of MTA. J Endod 2006;32:569-72.  Back to cited text no. 5
    
6.
Dawood AE, Manton DJ, Parashos P, Wong R, Palamara J, Stanton DP, et al. The physical properties and ion release of CPP-ACP-modified calcium silicate-based cements. Aust Dent J 2015;60:434-44.  Back to cited text no. 6
    
7.
Meharwade P, Parameshwarappa P, Kenchappa M, Nagaveni NB, Kashetty B. Evaluation of the shear bond strength of methacrylate-based composite, resin-modified glass ionomer cement, and Fuji IX glass ionomer cement with biodentine as a base. CODS J Dent 2019;11:40-43.  Back to cited text no. 7
    
8.
Nekoofar MH, Motevasselian F, Mirzaei M, Yassini E, Pouyanfar H, Dummer PM. The micro-shear bond strength of various resinous restorative materials to aged biodentine. Iran Endod J 2018;13:356-61.  Back to cited text no. 8
    
9.
Meraji N, Camilleri J. Bonding over dentin replacement materials. J Endod 2017;43:1343-9.  Back to cited text no. 9
    
10.
Patil A, Aggarwal S, Kumar T, Bhargava K, Rai V. The evaluation of interfaces between MTA and two types of GIC (conventional and resin modified) under an SEM: An in vitro study. J Conserv Dent 2016;19:254-8.  Back to cited text no. 10
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11.
Kaup M, Dammann CH, Schäfer E, Dammaschke T. Shear bond strength of Biodentine, ProRoot MTA, glass ionomer cement and composite resin on human dentine ex vivo. Head Face Med 2015;11:14.  Back to cited text no. 11
    
12.
Camilleri J. Scanning electron microscopic evaluation of the material interface of adjacent layers of dental materials. Dent Mater 2011;27:870-8.  Back to cited text no. 12
    
13.
Kim J, Song YS, Min KS, Kim SH, Koh JT, Lee BN, et al. Evaluation of reparative dentin formation of ProRoot MTA, Biodentine and BioAggregate using micro-CT and immunohistochemistry. Restor Dent Endod 2016;41:29-36.  Back to cited text no. 13
    
14.
Jung Y, Yoon JY, Dev Patel K, Ma L, Lee HH, Kim J, et al. Biological effects of tricalcium silicate nanoparticle-containing cement on stem cells from human exfoliated deciduous teeth. Nanomaterials (Basel) 2020;10:1373.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]



 

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