Influence of blood contamination on the bond strength and biointeractivity of Biodentine used as root-end filling

Abstract

Aim To evaluate the influence of blood contamination on the bond strength and apatite forming ability of Biodentine used as root-end filling material. Methodology Eighty (n = 80) extracted single-rooted, sound human maxillary anterior teeth were prepared and obturated. Then, the roots were resected, retrograde cavities were prepared and Biodentine was inserted as the root-end filling material. Teeth were then randomly divided into 2 equal groups (n = 40) according to the setting environment of Biodentine i.e., group A where setting took place in human blood and group B where setting took place in deionized water (control group). Teeth were incubated at 37 °C for 45 min to ensure complete setting. Root discs with the filling material in their core were prepared. Push-out bond strength test was performed using a universal testing machine and failure mode was examined. Both groups were aged in HBSS for 30 days. Apatite nucleation was evaluated at one-day, 7-days, and 30-days interval using SEM for morphological analysis and EDX for elemental analysis. Calculation of the Ca/P ratios was performed in addition to XRD for crystal phase analysis. Results Blood contamination (group A) resulted in significant reduction of bond strength values. It also affected the amount of apatite deposition on the material surface and interfacial spaces with higher Ca/P ratios than that of the normal stoichiometric hydroxyapatite. Conclusions Blood contamination during setting of Biodentine had a detrimental effect on the bond strength and reduced the nucleation of apatite in comparison to non-contaminated group.

Push‐out bond strength of the calcium silicate‐based endodontic cements in the presence of blood: A systematic review and meta‐analysis of in vitro studies

“…Furcation perforation in molars was the most evaluated area due to the high prevalence of perforation in this region during root canal treatments or post‐space preparation (Arens & Torabinejad, 1996 ). Apical root slices were filled with CSCs as root‐end filling material in two studies to stimulate apicoectomy clinical situations in the blood presentation (Akcay et al, 2016 ; Shalabi et al, 2019 ).…”

“…None of the evaluated studies demonstrate sample size calculations clearly. The evaluated dentin slices in each group ranged between five (Ratih & Putri, 2017 ) and forty (Shalabi et al, 2019 ).…”

“…Nine studies evaluated the bond strength of Biodentine to the dentinal wall after blood exposure. In three studies, bond strength was notably increased after blood contamination (Shalabi et al, 2019 ; Singla et al, 2018 ; Yazdi et al, 2017 ); while four studies did not report any significant differences before and after blood exposure (Aggarwal et al, 2013 ; Bhagya et al, 2018 ; Marquezan et al, 2018 ; Üstün et al, 2015 ). In spite of these manuscripts, two studies reported the adverse effects of blood contamination on the bond strength of Biodentine (Adl et al, 2019 ; Akcay et al, 2016 ).…”

“…Nine studies determined the failure modes among 13 reviewed articles. Only four studies reported failure modes before and after blood contamination (Adl et al, 2019 ; Marquezan et al, 2018 ; Shalabi et al, 2019 ; Üstün et al, 2015 ). The differences in failure mode pattern before and after blood exposure were only reported in two studies for Biodentine (Marquezan et al, 2018 ; Shalabi et al, 2019 ).…”

“…The risk of bias assessment was performed based on previous modified tools to adapt to the in vitro nature of this systematic review (AlShwaimi et al, 2016 ; Neelakantan et al, 2018 ; Shalabi et al, 2019 ; Samiei et al 2019 ). The quality assessment of studies was based on the following parameters: sample size calculation, standardization of specimens, randomization, blinding to experimental protocols, standardization of preparation protocol, and data reporting.…”