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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 82-85

Investigation of the change in color caused by the contact of calcium silicate-based materials with endodontic irrigation solutions


1 Department of Pediatric Dentistry, Faculty of Dentistry, Firat University, Elazig, Turkey
2 Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa, Turkey

Date of Submission30-Sep-2020
Date of Acceptance02-Dec-2020
Date of Web Publication16-Jul-2021

Correspondence Address:
Ahmet Aras
Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa 63300
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_134_20

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  Abstract 


Introduction: Although calcium silicate-based cements are very successful in healing, they cause esthetic problems and dissatisfaction, especially in anterior teeth because they cause discoloration in the teeth. This study aimed to detect the color changes that occur as a result of contact of BIOfactor mineral trioxide aggregate (MTA) and biodentin with three different irrigation agents. Methods: The materials to be tested (G1: BIOfactor MTA and G2: Biodentin) were prepared as per the manufacturer's directions. The prepared materials were placed in cylindrical molds of 8 mm diameter and 3 mm height and kept in a 37°C oven for 24 h to complete their hardening. Subsequently, the samples were immersed in one of three different irrigation solutions (5% sodium hypochlorite, 17% ethylenediaminetetraacetic acid [EDTA] or saline) for 24 h. After drying, spectrophotometer was utilized to quantify color under consistent laboratory light by the same administrator. Results: Significantly, more color changes were observed in the G1 group compared to the G2 group (P = 0.05). Although color changes were detected in all subgroups of G1 and G2 groups as a result of contact with different irrigation materials, it was determined that these changes were not statistically significant (P > 0.05). The irrigation agent that caused the most discoloration was saline (12.33 ± 6.87) in G1 group and EDTA (7.05 ± 3.48) in G2 group. Conclusion: As a result of this study, significantly more color changes were found in BIOfactor MTA than biodentin. It was found that different irrigation agents did not cause statistically significant color changes.

Keywords: Biodentine, calcium silicate, mineral trioxide aggregate, spectrophotometer


How to cite this article:
Atas O, Aras A. Investigation of the change in color caused by the contact of calcium silicate-based materials with endodontic irrigation solutions. J Dent Res Rev 2021;8:82-5

How to cite this URL:
Atas O, Aras A. Investigation of the change in color caused by the contact of calcium silicate-based materials with endodontic irrigation solutions. J Dent Res Rev [serial online] 2021 [cited 2021 Dec 8];8:82-5. Available from: https://www.jdrr.org/text.asp?2021/8/2/82/321523




  Introduction Top


Tooth discoloration caused by materials used in endodontic treatments is a common situation. The reason for this discoloration is mostly blood, necrotic pulp tissue, and materials used in endodontic treatment remaining in dentinal tubules.[1]

Many products with different contents have been developed for the use in endodontic treatments. Tricalcium phosphate, mineral trioxide aggregate (MTA), calcium hydroxide, and tetra calcium phosphate are some of them. However, in recent years, calcium silicate-based materials have become extremely mainstream due to their various clinical applications and advantages.[1],[2]

Compared to other materials, MTA has been shown to cause high sealing and low cytotoxicity in many studies.[3] It is used successfully in many different areas such as vital pulpotomy, direct pulp capping, retrograde filling, perforation repair, and apexification. As MTA becomes widespread, it has been shown in many clinical studies that it shows good biocompatibility has a high marginal sealing ability and provides hard-tissue formation. However, some of its negative aspects still need to be improved. These include setting time, handling property, and tooth discoloration.[4]

While these problems were continuing in MTA, an alternative bioactive material called Biodentin (Septodont, France) was developed with a shorter setting time (12 min) and can be used in similar clinical applications.[5] This material contains zirconium oxide instead of bismuth oxide, which is found in MTA and reported as the source of coloration to provide radiopacity.[5],[6]

Biodentin has also been used successfully in various endodontic treatments such as MTA. However, researchers and manufacturers are still working on products with better properties.[4] More recently, a new type MTA was released as BIOfactor MTA (Imicryl Dental, Turkey) which can be used for pulp capping, pulpotomy, apexification, retrograde filling, apical plug procedures, and root perforation repair.[7] The BIOfactor MTA powder contains ytterbium oxide (as a radiopacifier), tricalcium aluminate, and tricalcium and dicalcium silicate.[8] This new material can be prepared in different fluency according to the treatment type. The manufacturer claims that BIOfactor MTA has a shorter setting time, stronger sealing, easier handling properties, finer powder for faster hydration, and that it does not cause tooth discoloration.[7]

Some of the endodontic filling materials result in crown discoloration, which enhances their interaction with both the substance and the chromogenic materials used in the treatment process. Thus, material selection should not be based exclusively on functional and biological requirements, but rather on esthetic considerations. There has been an increased recognition that more attention needs to be paid to this area.[9],[10]

This study aimed to evaluate the color change caused by the contact of this new MTA product and Biodentin with different irrigation materials with a spectrophotometer.


  Methods Top


This study was conducted at the department of pediatric dentistry of XXX University. The minimum sample size was calculated according the previous studies that have resemble to our study.[1],[9],[11] A total of 48 samples (24 in Biodentin group and 24 in BIOfactor MTA group) were necessary with accepting α = 0.05, β = 0.20, (1−β) = 0.80.

The samples tested in this study were divided into two main groups and three subgroups in each main group. Groups are as follows:

  • G1: Group of BIOfactor MTA (n = 24)
  • G1a: Group of BIOfactor MTA immersed in 5% sodium hypochlorite (NaOCl) (n = 8)
  • G1b: Group of BIOfactor MTA immersed in 17% ethylenediaminetetraacetic acid (EDTA) (n = 8)
  • G1c: Group of BIOfactor MTA immersed in saline (n = 8)
  • G2: Group of Biodentin (n = 24)
  • G2a: Group of Biodentin immersed in 5% sodium hypochlorite (NaOCl) (n = 8)
  • G2b: Group of Biodentin immersed 17% EDTA (n = 8)
  • G2c: Group of Biodentin immersed in saline (n = 8).


The materials to be tested (BIOfactor MTA and Biodentin) were prepared as per the manufacturer's directions. The prepared materials were placed in cylindrical molds of 8 mm diameter and 3 mm height and kept in a 37°C oven for 24 h to complete their hardening. Subsequently, the samples were immersed in one of three different irrigation solutions (5% NaOCl, 17% EDTA or saline) for 24 h. All samples were then left to dry. After drying, spectrophotometer (VITA Easyshade Compact; VITA Zahnfabrik, Bad S€ackingen, Germany) was utilized to quantify color under consistent laboratory light by the same administrator. Before and after immersing, pictures of the samples were taken with a digital camera, and their color values were measured.

The color evaluation was accounted with utilizing the L*a*b* system. The evaluations were performed in three times for each sample, and mean values were calculated. Then, the discoloration (ΔE) was calculated according to the equation of ΔE = (ΔL2 + Δa2 + Δb2) 1/2. ΔL, Δa and Δb represent the change in brightness, red-green axis, and the yellow-blue axis, respectively.

Statistical analysis

Statistical analyses were performed with IBM SPSS version 23 (Chicago, IL, USA). For the determination of the sample size of the method, a statistical power test (G* Power software) was performed. Statistical significance was defined as P ≤ 0.05. Mean and standard deviation of variables were calculated for descriptive statistics. The data were evaluated with the two-way analysis of variance.


  Results Top


After the measurements made with the spectrophotometer, the mean initial L*, a*, and b* values for G1 were (36.8 ± 3.33), (3.38 ± 0.77), and (6.79 ± 0.63), respectively. The mean baseline L*, a*, and b* values for G2 were measured as (29.49 ± 4.64), (6.77 ± 1.1), and (14.95 ± 0.6). Significantly more color changes were observed in the G1 group compared to the G2 group (P = 0.05). Although color changes were detected in all subgroups of G1 and G2 groups as a result of contact with different irrigation materials, it was determined that these changes were not statistically significant (P > 0.05). The irrigation agent that caused the most discoloration was saline (12.33 ± 6.87) in the G1 group and EDTA (7.05 ± 3.48) in the G2 group. Detailed data about the color change of all groups and subgroups are shown in [Table 1] and [Figure 1].
Table 1: Comparison of spectrophotometric values of the groups

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Figure 1: The mean and standard deviation of ΔE values of the groups

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  Discussion Top


This study was planned to detect the color changes caused by the contact of a new type of MTA-BIOfactor MTA and Biodentin, with different irrigation agents. Although similar studies[1],[9],[11] have been conducted on different MTA types and Biodentin in previous studies, this is the first study conducted with the BIOfactor MTA as far as we know.

The reason we prefer this product is the manufacturer's claim that it will not cause discoloration on the teeth. As it is known, calcium silicate-based cements products, which are frequently used in endodontic treatments, are very successful in healing, but they cause esthetic problems and dissatisfaction especially in anterior teeth because they cause discoloration in the teeth. Researchers and manufacturers constantly carry out new studies and produce different products to solve this coloration problem.[12]

Each new product produced is contacted with different irrigation agents, and the resulting interaction and color changes are observed. In this study, we immersed BioFactor MTA, which is a novel material, and Biodentine, which is reported to cause less coloration compared to white MTA (wMTA) in studies, in the most commonly used irrigation agents in endodontic treatments (5% NaOCl, 17% EDTA or saline).

Changes in tooth color can be observed visually or with special devices. Using a spectrophotometer in color detection was preferred because it provides a higher stability and magnificent repeatability without being affected by ambient and light.[10]

The CIE system is an arrangement for international standardization on color issues and is accepted by the ISO.[13] The CIE L*a*b* system is a sensitive methodology that also analyzes the slight changes in color. The ΔE, acquired from the values of L*, a*, and b*, indicates the discrepancy between the final and the initial color. ΔE ≥ 3.3 is a clinically noticeable discoloration;[12] as per this description, all materials in this experiment demonstrated noticeable discoloration.

Many mechanisms related to the coloration caused by MTA on teeth have been proposed. However, the exact cause is not yet known. In recent studies, it has been emphasized that the bismuth oxide contained by MTA may be the main cause of this coloration.[14],[15] In two different studies, it was reported that MTA products containing bismuth oxide got a darker color due to the oxide disappearing and turning into bismuth metal as a result of contact with NaOCl.[15],[16] For this reason, different radiopaque substances are preferred instead of bismuth oxide in newly developed products. In our study, BioFactor MTA containing ytterbium oxide and Biodentin containing zirconium oxide were used.

The common conclusion reached in many studies comparing the color change of MTA and Biodentine is that MTA causes statistically significant more color change than Biodentine.[6],[17],[18],[19] In our study, although the manufacturer claims that it does not cause color change, it was determined that Biofactor MTA caused significantly more color change compared to Biodentine (P = 0.05).

Marciano et al. reported that contact of collagen with calcium tungstate and zirconium oxide demonstrated no discoloration; however, bismuth oxide showed an evident discoloration.[14] Color stability of Biodentine can be clarified by this result as also mentioned in another article.[20]

In their studies, Shah and Banga reported that calcium silicate-based cements (Biodentine and wMTA) cause a meaningful color change when in contact with frequently used irrigation agents (sodium hypochlorite and chlorhexidine).[1] In our study, when we compared Biofactor MTA and Biodentine, it was observed that different irrigation agents caused the color change. However, the analysis did not confirm any significant differences between the irrigation agents.

Madani et al. found the highest color change in saline contact with wMTA in their study.[19] In our study, parallel to the studies of Madani et al., the highest color change was determined in the G1a group (Biofactor MTA-Saline).

The highest rate of discoloration in the G2 group was observed in the G2b group (Biodentine with EDTA), but this was not statistically significant. Sobhnamayan et al. in their study,[9] it was reported that when they brought into contact with Biodentine and EDTA, two samples had erosions. However, we think that the highest color change seen in EDTA in this group may be related to this situation.

One of the limitations of this study is the absence of wMTA as a control group in the study. Another limitation is that the total number of participants (n = 48) was a small sample size.


  Conclusion Top


As a result of this study, significantly more color changes were found in BioFactor MTA than Biodentine. It was determined that different irrigation agents did not cause statistically significant color changes. Further studies with a large sample size that also include wMTA and are needed to support these findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shah T, Banga KS. Effect of commonly used irrigants on the colour stabilities of two calcium-silicate based material. Eur Oral Res 2019;53:141-5.  Back to cited text no. 1
    
2.
Ma J, Shen Y, Stojicic S, Haapasalo M. Biocompatibility of two novel root repair materials. J Endod 2011;37:793-8.  Back to cited text no. 2
    
3.
Voveraityte V, Gleizniene S, Lodiene G, Grabliauskiene Z, Machiulskiene V. Spectrophotometric analysis of tooth discolouration induced by mineral trioxide aggregate after final irrigation with sodium hypochlorite: An in vitro study. Aust Endod J 2017;43:11-5.  Back to cited text no. 3
    
4.
Hosoya N, Takigawa T, Horie T, Maeda H, Yamamoto Y, Momoi Y, et al. A review of the literature on the efficacy of mineral trioxide aggregate in conservative dentistry. Dent Mater J 2019;38:693-700.  Back to cited text no. 4
    
5.
Palma PJ, Marques JA, Falacho RI, Correia E, Vinagre A, Santos JM, et al. Six-month color stability assessment of two calcium silicate-based cements used in regenerative endodontic procedures. J Funct Biomater 2019;10:14.  Back to cited text no. 5
    
6.
Ramos JC, Palma PJ, Nascimento R, Caramelo F, Messias A, Vinagre A, et al. 1-year in vitro evaluation of tooth discoloration induced by 2 calcium silicate–based cements. J Endod 2016;42:1403-7.  Back to cited text no. 6
    
7.
Oznurhan F, Kayabasi M, Keskus B. Evaluation of long-term results of two different calcium silicate based materials in primary molar teeth vital pulpotomies: An in vivo study. Cumhur Dent J 2020;23:45-51.  Back to cited text no. 7
    
8.
Akbulut MB, Bozkurt DA, Terlemez A, Akman M. The push-out bond strength of BIOfactor mineral trioxide aggregate, a novel root repair material. Restor Dent Endod 2019;44:e5.  Back to cited text no. 8
    
9.
Sobhnamayan F, Adl A, Ghanbaran S. Effect of different irrigation solutions on the colour stability of three calcium silicate-based materials. J Dent Biomater 2017;4:373-8.  Back to cited text no. 9
    
10.
Francis G, Acharya SR, Kini S. To determine tooth discolouration after treatment with various endodontic materials using spectrophotometric analysis – An in vitro study. J Clin Diagnostic Res 2019;13:7-12.  Back to cited text no. 10
    
11.
Keskin C, Demiryurek EO, Ozyurek T. Color stabilities of calcium silicate-based materials in contact with different irrigation solutions. J Endod 2015;41:409-11.  Back to cited text no. 11
    
12.
Możyńska J, Metlerski M, Lipski M, Nowicka A. Tooth discoloration induced by different calcium silicate-based cements: A systematic review of in vitro studies. J Endod 2017;43:1593-601.  Back to cited text no. 12
    
13.
Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. Spectrophotometric analysis of coronal discolouration induced by grey and white MTA. Int Endod J 2013;46:137-44.  Back to cited text no. 13
    
14.
Marciano MA, Costa RM, Camilleri J, Mondelli RF, Guimarães BM, Duarte MA. Assessment of color stability of white mineral trioxide aggregate angelus and bismuth oxide in contact with tooth structure. J Endod 2014;40:1235-40.  Back to cited text no. 14
    
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Camilleri J. Color stability of white mineral trioxide aggregate in contact with hypochlorite solution. J Endod 2014;40:436-40.  Back to cited text no. 15
    
16.
Bhavya B, Sadique M, Simon EP, Ravi SV, Lal S. Spectrophotometric analysis of coronal discoloration induced by white mineral trioxide aggregate and Biodentine: An in vitro study. J Conserv Dent 2017;20:237-40.  Back to cited text no. 16
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17.
Jamshidifar A, Madani Z. Comparison of teeth discolorations induced by mineral trioxide aggregate, calcium-enriched mixture and biodentine using spectrophotometric analysis. Casp J Dent Res 2019;8:37-42.  Back to cited text no. 17
    
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Yoldaş SE, Bani M, Atabek D, Bodur H. Comparison of the potential discoloration effect of bioaggregate, biodentine, and white mineral trioxide aggregate on bovine teeth: In vitro research. J Endod 2016;42:1815-8.  Back to cited text no. 18
    
19.
Madani Z, Alvandifar S, Bizhani A. Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium-enriched mixture, and Biodentine(®) in the presence and absence of blood. Dent Res J (Isfahan) 2019;16:377-83.  Back to cited text no. 19
    
20.
Vallés M, Roig M, Duran-Sindreu F, Martínez S, Mercadé M. Color stability of teeth restored with biodentine: A 6-month in vitro study. J Endod 2015;41:1157-60.  Back to cited text no. 20
    


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