Bioactive cements: from biological properties to clinical applications

Aim: Calcium silicate-based cements represent safe and predictable materials widely used in different fields of endodontics. They can be applied as pulp dressing agents during vital pulp therapy (VPT) of carious-affected deciduous or permanent teeth with immature roots as well as endodontic cements in case of root perforation or regenerative endodontic procedures. Therefore, it's crucial to demonstrate biocompatible and antibiofilm properties of bioactive cements (i.e. MTA and Biodentine) in order to support their successful use in the clinical field. Materials and Methods: Biocompatibility of ProRootMTA and Biodentine specimens was assessed through cell culture of Saos-2 cells and both cement extracts by viability assay, oxidative stress analysis and immunofluorescence evaluation; on the other hand, antibiofilm efficacy was assessed by evaluating the biofilm forming ability of Streptococcus mutans onProRootMTA and Biodentine disks using Crystal Violet assay. Results: Cells exposed to ProRootMTA and Biodentine showed a good cell viability, slightly better in presence of the first; moreover, cells seeded on ProRootMTA presented a higher degree of biocompatibility compared to Biodentine. Accordingly, Biodentine demonstrated lightly fewer promising outcomes in terms of oxidative stress and focal adhesions of cells than ProRoot MTA, although the differences were not statistically significant. Inhibition of superficial colonization as well as biofilm forming ability of S. mutants were successfully obtained with both evaluated cements, even though ProRootMTA demonstrated a more efficient time-dependent antibiofilm effect than Biodentine. Conclusion: Bioactive cements proved to be biocompatible and to possess antibiofilm properties. When compared, MTA would seem to perform slightly better and could be considered as the gold standard material in the endodontic procedures.