Introduction: The aim of the present study was to evaluate and compare the compressive strength (CS) of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement when mixed with propylene glycol (PG). Methods and Materials: Twenty four custom-made split molds with 5 holes in each were prepared. Molds were allocated into eight groups (n=15 holes) as follows: Groups 1,5: CEM and MTA mixed with PG (100%), Groups 2,6: CEM and MTA mixed with PG (20% )+CEM or MTA liquid (80%) respectively, Groups 3,7: CEM and MTA mixed with PG (50% )+CEM or MTA liquid (50% ) respectively, Groups 4,8: CEM and MTA mixed with CEM or MTA liquid respectively as control groups. All specimens were kept in 37°C in an incubator and the compressive strength was evaluated after 7 days. Data were analyzed using the Kruskal Wallis and Dunne tests. The level of significance was set at 0.05. Results: In all concentration of PG, MTA samples showed better results than CEM cement. In CEM samples, adding 20% PG could significantly increase the compressive strength in comparison with control group and 100% PG (P=0.047 and P=0.011, respectively). In MTA samples, adding 100% and 50% PG significantly increased the compressive strength of the cement in comparison with control group (P=0.037 and, P=0.005, respectively). Conclusion: Considering the limitations of the present study, appropriate concentration of PG could improve the CS of MTA and CEM cement.Keywords: Calcium-Enriched Mixture Cement; Compressive Strength; Mineral Trioxide Aggregate; Propylene Glyco

Adl, Alireza

Sadat Shojaee, Nooshin

Sedigh-Shams, Mahdi

Sobh namayan, Fereshte

Zarghami, Elnaz

English

Journals Portal, Shahid Beheshti University of Medical Sciences

 IEJ Iranian Endodontic Journal 2017;12(4): 493-496 Compressive Strength of Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement Mixed with Propylene Glycol Fereshte Sobhnamayan a, Alireza Adl b*, Nooshin Sadat Shojaee a, Mahdi Sedigh-Shams a, Elnaz Zarghami c a Department of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran; b Department of Endodontics, Biomaterials Research Center, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran; c Student Research Committee, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran  ARTICLE INFO  ABSTRACT Article Type: Original Article  Introduction: The aim of the present study was to evaluate and compare the compressive strength (CS) of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement when mixed with propylene glycol (PG). Methods and Materials: Twenty four custom-made split molds with 5 holes in each were prepared. Molds were allocated into eight groups (n=15 holes) as follows: Groups 1,5: CEM and MTA mixed with PG (100%), Groups 2,6: CEM and MTA mixed with PG (20% )+CEM or MTA liquid (80%) respectively, Groups 3,7: CEM and MTA mixed with PG (50% )+CEM or MTA liquid (50% ) respectively, Groups 4,8: CEM and MTA mixed with CEM or MTA liquid respectively as control groups. All specimens were kept in 37°C in an incubator and the compressive strength was evaluated after 7 days. Data were analyzed using the Kruskal Wallis and Dunne tests. The level of significance was set at 0.05. Results: In all concentration of PG, MTA samples showed better results than CEM cement. In CEM samples, adding 20% PG could significantly increase the compressive strength in comparison with control group and 100% PG (P=0.047 and P=0.011, respectively). In MTA samples, adding 100% and 50% PG significantly increased the compressive strength of the cement in comparison with control group (P=0.037 and, P=0.005, respectively). Conclusion: Considering the limitations of the present study, appropriate concentration of PG could improve the CS of MTA and CEM cement. Keywords: Calcium-Enriched Mixture Cement; Compressive Strength; Mineral Trioxide Aggregate; Propylene Glycol Received: 13 Jun 2017 Revised: 26 Aug 2017 Accepted: 10 Sep 2017 Doi: 10.22037/iej.v12i4.17748  *Corresponding author: Alireza Adl, Department of Endodontics, Biomaterials Research Center, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-713 6263193 E-mail: adla@sums.ac.ir      Introduction ineral trioxide aggregate (MTA) is a hydrophilic calcium silicate-based cement with osteogenic, cementogenic and odontogenic potential that can be used for perforation repairs, pulp capping and pulpotomy [1, 2]. Distilled water is normally used for mixing MTA. However this mixture is difficult to manipulate and its setting time is long [3, 4]. In order to alleviate these problems other vehicles have been proposed but, the clinical effects are controversial. Methylcellulose, calcium chloride, calcium lactate gluconate, PG and KY liquid (Johnson & Johnson, Langhorne, PA, USA) are among the vehicles that improve the manageability of this mixture [3, 5-7]. PG is a nontoxic alcoholic viscose vehicle that successfully improved the handling of MTA [6, 8, 9]. It also increase its push-out bond strength [10], sealing ability [8] and results in higher pH and Ca2+ dissociation during the initial post-mixing periods [6, 9]. Different ratios of PG and water has been shown to affect the physical and chemical properties of this cement, as crystal hydration is an important factor for the setting reaction of MTA [11]. The addition of high ratios of PG (≥50%) decreases the M IEJ Iranian Endodontic Journal 2017;12(4): 493-496 494 Sobhnamayan et al. water content in the mixture and causes the changes in physical and chemical characteristics of MTA [9]. Compressive strength (CS) is an indicator of setting reaction and stability of the materials [12, 13]. This entity in hydraulic cements such as MTA is as an indicator of hydration reaction  which is affected by the type of MTA, the mixing liquid, condensing pressure and the techniques used  for mixing the powder and liquid [14-17]. Calcium-enriched mixture (CEM) cement is another hydrophilic cement with clinical applications similar to MTA but a different chemical composition [18-21]. This novel endodontic cement showed favorable results in terms of biocompatibility, antibacterial effect and sealing properties [19, 22-26]. Different studies showed that different mixing methods and vehicles could affect the compressive strength of this material, as well [16, 27]. So far, there have been no published studies on the effect of PG on the CS of CEM cement. Therefore, this in vitro study aimed to evaluate the effect of adding different ratios of PG into MTA liquid and CEM liquid on the CS of these materials during seven days post mixing. Materials and Methods Twenty four custom-made two-part split Plexiglass molds were used in this experimental in vitro study. Each mold had five holes with internal diameter of 4±0.1 mm and height of 6±0.1 mm. The molds were randomly allocated into eight groups (3 molds/15 holes in each group). The groups comprised groups 1 and 5; CEM and MTA mixed with PG (100%), groups 2 and 6; CEM and MTA mixed with PG (20%)+CEM or MTA liquid (80%), respectively, groups 3 and 7; CEM and MTA mixed with PG (50%)+CEM or MTA liquid (50%), respectively, and groups 4 and 8; CEM and MTA mixed with CEM or MTA liquid, respectively as control groups (Table 1). The CEM or MTA liquid /PG ratios were determined by volume. The powder/liquid ratio was 1 g powder to 0.4 mL liquid for MTA based on a previous study and 1 g powder to 0.54 mL liquid for CEM cement based on a pilot study. CEM (BioniqueDent, Tehran, Iran) and MTA (Angelus; Londrina, Parana, Brazil) were prepared as above and then homogenized and immediately positioned incrementally into the molds by amalgam carrier. After gentle packing and compacting with condensers, excess material was removed with wet cotton pellets. The molds were then wrapped into wet pieces of gauze saturated with PBS and kept in an incubator at 37°C for seven days. After 7 days, the samples were removed from the incubator and the molds were split. The set CEM and MTA blocks were removed carefully by applying light force, taking care not to damage the samples. After removal, the samples were evaluated for voids or cracks. To test the compressive strength, the samples were placed lengthwise between the platens of a universal testing machine (Z050; Zwick/Roell Group, Ulm, Germany). Cross head of the device applied force at a speed of 1 mm/min in the direction parallel to the longitudinal axis of the molds until the materials were crushed. This force was recorded based on Newton’s (N) and was converted into MPa using the following formula: CS=4p/μd2 where p is the maximum force applied in Newton's, and d is the mean diameter of the specimen in mm. Data were analyzed using the Kruskal Wallis and Dunne test. Software (SPSS version 18.0, SPSS, Chicago, IL, USA) was used for the analysis of data. The level of statistical significance was defined at 0.05. Results Table 1 shows the mean (median) and standard deviation (SD) of compressive strength in eight experimental groups. In all concentrations of PG, MTA exhibited higher compressive strength compared to CEM cement. In CEM samples the results showed that adding 20% PG to CEM liquid could significantly increase the compressive strength of the samples in comparison with control group and group mixed with 100% PG.(P=0.047, and P=0.011 respectively). Group mixed with 50% PG also showed a significantly better result than 100% PG (P=0.028). In MTA samples, adding 100% PG and 50% PG significantly increase the compressive strength of CEM cement in comparison with control group (P=0.037 and P=0.005, respectively). However, this difference was not significant for group mixed with 20% PG (P=0.084). It has also been shown that there was not a significant difference between the samples mixed with different ratio of PG (100%, 20% and 50%). Table 1. Mean (SD) of compressive strength in different groups (Similar lower case and upper case letters indicate no statistically significant differences (P<0.05) in the same row and column, respectively) Groups/vehicle 100% PG 20% PG 50% PG 100% CEM/MTA liquid MTA 20 (20)±4.56  Aa 18 (19.9)±6.31 Aab 22 (22.3)±2.52 Aa 10 (11)±3.20 Ab CEM 0.72 (0.72)±0.15 Bc 1.83 (1.93)±0.44 Ba 1.63 (1.56)±0.41 Bab 0.84 (0.97)±0.37 Bbc   IEJ Iranian Endodontic Journal 2017;12(4): 493-496 495 Compressive strength of MTA and CEM with PG  Discussion Since the introduction of MTA and CEM cement, various methods or vehicles have been used to improve their characteristics [13, 28-32]. For instance, by removing gypsum at the final stage of the manufacturing process and adding polycarboxylate super plasticizers, the setting time of MTA decreased and its flowability increased [13] or by adding 10% calcium chloride to CEM cement, solubility, pH and setting time of this cement improved [32]. Other researchers studied the influence of different vehicles on physical and chemical properties of MTA [3, 6, 7, 28]. As stated before, PG was added to MTA to improve its handling. It has also been shown that this vehicle could increase its bond strength [10]. The results of the present study showed that all concentrations of PG increased the compressive strength of MTA. This increase was statistically significant for concentrations of 100% and 50%. On the other hand, Ghasemi et al. [33] showed that Mixing MTA with 20% PG significantly reduced the CS. This difference may be attributed to the different experimental set ups that have been used in two studies. Ghasemi et al. [33] used paraffin to grease the internal surfaces of their steel molds before material placement.  Paraffin and PG may have a chemical interaction which could adversely affect the compressive strength of MTA. Salem Milani et al. [10] showed that mixing MTA with 100% and 20% PG increased its push-out bond strength to dentin but the most suitable ratio was 80% DW-20% PG which is partly in accordance with the present study although these two studies are  not directly comparable. Based on the results of the present study, adding PG to the CEM cement in the concentration of 20% could significantly increase the compressive strength of the samples in comparison to the control group. Adding 100% PG to this cement not only didn’t increase but also caused a non-significant decrease in the compressive strength value. As the CS of hydraulic cements is an indicator of hydration reaction, this finding may be attributed to the change in the hydration process of powder particles when CEM cement mixed with 100% PG.  There are no published data available on the CS of CEM cement when PG was used as a vehicle; thus direct comparison with other studies is impossible. Another finding of this study was that in all concentration of PG, MTA samples showed better results than CEM cement. This finding is not in agreement with Shahi et al. [17] who reported that irrespective of the differences in mixing techniques, the CS of CEM cement is similar to MTA after 21 days. This difference could be attributed to different experimental set-ups, different time intervals and different mixing methods used in these studies. Adl et al. [34] reported that CEM cement showed significantly lower bond strength to the dentinal wall compared to MTA which is partly in agreement with the present study. However, as compressive strength and posh-out bond strength tests have different entities, direct comparison of the two studies is not reasonable and further studies on the effect of PG on the bond strength of CEM cement are recommended.  Conclusion Under the limitations of this study, where the compressive strength is important, the use of PG in concentrations of 50% and 100% for MTA and 20% for CEM cement is cautiously recommended. Acknowledgment The authors thank the Vice-Chancellery of Shiraz University of Medical Sciences for supporting this research (Grant no. 94-01-03-9882). The authors also thank Dr. M. Vosoughi of the Dental Research Center of the School of Dentistry for statistical analysis. Conflict of Interest: ‘None declared’. References 1. Main C, Mirzayan N, Shabahang S, Torabinejad M. Repair of root perforations using mineral trioxide aggregate: a long-term study. J Endod. 2004;30(2):80-3. 2. Torabinejad M, Hong C-U, Ford TRP, Kariyawasam SP. Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report. J Endod. 1995;21(11):569-71. 3. Ber BS, Hatton JF, Stewart GP. Chemical modification of ProRoot MTA to improve handling characteristics and decrease setting time. J Endod. 2007;33(10):1231-4. 4. Pelliccioni GA, Vellani CP, Gatto MRA, Gandolfi MG, Marchetti C, Prati C. Proroot mineral trioxide aggregate cement used as a retrograde filling without addition of water: an in vitro evaluation of its microleakage. J Endod. 2007;33(9):1082-5. 5. AlAnezi AZ, Zhu Q, Wang Y-H, Safavi KE, Jiang J. Effect of selected accelerants on setting time and biocompatibility of mineral trioxide aggregate (MTA). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(1):122-7. 6. Holland R, Mazuqueli L, de Souza V, Murata SS, Júnior ED, Suzuki P. Influence of the type of vehicle and limit of obturation on apical and periapical tissue response in dogs’ teeth after root canal filling with mineral trioxide aggregate. J Endod. 2007;33(6):693-7.  IEJ Iranian Endodontic Journal 2017;12(4): 493-496 496 Intracanal medicaments and microleakage of MTA plugs 7. Hsieh S-C, Teng N-C, Lin Y-C, Lee P-Y, Ji D-Y, Chen C-C, Ke E-S, Lee S-Y, Yang J-C. A novel accelerator for improving the handling properties of dental filling materials. J Endod. 2009;35(9):1292-5. 8. Brito-Júnior M, Viana F, Pereira R, Nobre S, Soares J, Camilo C, Faria-e-Silva A. Sealing ability of MTA-Angelus with propyleneglycol in furcal perforations. Acta Odontol Latinoam. 2009;23(2):124-8. 9. Duarte M, Alves de Aguiar K, Zeferino M, Vivan R, Ordinola‐Zapata R, Tanomaru‐Filho M, Weckwerth P, Kuga MC. Evaluation of the propylene glycol association on some physical and chemical properties of mineral trioxide aggregate. Int Endod J. 2012;45(6):565-70. 10. Milani AS, Froughreyhani M, Aghdam SC, Pournaghiazar F, Jafarabadi MA. Mixing with propylene glycol enhances the bond strength of mineral trioxide aggregate to dentin. J Endod. 2013;39(11):1452-5. 11. Camilleri J. Hydration mechanisms of mineral trioxide aggregate. Int Endod J. 2007;40(6):462-70. 12. Nekoofar M, Adusei G, Sheykhrezae M, Hayes S, Bryant S, Dummer P. The effect of condensation pressure on selected physical properties of mineral trioxide aggregate. Int Endod J. 2007;40(6):453-61. 13. Wongkornchaowalit N, Lertchirakarn V. Setting time and flowability of accelerated Portland cement mixed with polycarboxylate superplasticizer. J Endod. 2011;37(3):387-9. 14. Basturk FB, Nekoofar MH, Gunday M, Dummer PM. Effect of varying water-to-powder ratios and ultrasonic placement on the compressive strength of mineral trioxide aggregate. J Endod. 2015;41(4):531-4. 15. Bidar M, Eslami N, Naghavi N, Fasihi Z, Mashhadi NA. The effect of different concentrations of chlorhexidine gluconate on the compressive strength of mineral trioxide aggregate. J Dent Res Dent Clin Dent Prospects. 2015;9(1):1. 16. Sahebi S, Sadatshojaee N, Jafari Z. Effect of different mixing and placement methods on the compressive strength of calcium-enriched mixture. Iran Endod J. 2015;10(2):104. 17. Shahi S, Ghasemi N, Rahimi S, Yavari HR, Samiei M, Janani M, Bahari M, Moheb S. The effect of different mixing methods on the flow rate and compressive strength of mineral trioxide aggregate and calcium-enriched mixture. Iran Endod J. 2015;10(1):55. 18. Asgary S, Eghbal MJ, Parirokh M, Ghoddusi J, Kheirieh S, Brink F. Comparison of mineral trioxide aggregate's composition with Portland cements and a new endodontic cement. J Endod. 2009;35(2):243-50. 19. Mozayeni MA, Milani AS, Marvasti LA, Asgary S. Cytotoxicity of calcium enriched mixture cement compared with mineral trioxide aggregate and intermediate restorative material. Aust Endod J. 2012;38(2):70-5. 20. Shokouhinejad N, Razmi H, Fekrazad R, Asgary S, Neshati A, Assadian H, Kheirieh S. Push‐out bond strength of two root‐end filling materials in root‐end cavities prepared by Er, Cr: YSGG laser or ultrasonic technique. Aust Endod J. 2012;38(3):113-7. 21. Zarrabi MH, Javidi M, Jafarian AH, Joushan B. Histologic assessment of human pulp response to capping with mineral trioxide aggregate and a novel endodontic cement. J Endod. 2010;36(11):1778-81. 22. Asgary S, Eghbal MJ, Parirokh M. Sealing ability of a novel endodontic cement as a root‐end filling material. J Biomed Mater Res A. 2008;87(3):706-9. 23. Asgary S, Kamrani FA, Taheri S. Evaluation of antimicrobial effect of MTA, calcium hydroxide, and CEM cement. Iran Endod J. 2007;2(3):105. 24. Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod. 2008;34(8):990-3. 25. Mirhadi H, Moazzami F, Safarzdeh S. The Effect of Acidic pH on Microleakage of Mineral Trioxide Aggregate and Calcium-Enriched Mixture Apical Plugs. Iran Endod J. 2014;9(4):257-60. 26. Tabrizizadeh M, Asadi Y, Sooratgar A, Moradi S, Sooratgar H, Ayatolahi F. Sealing ability of mineral trioxide aggregate and calcium-enriched mixture cement as apical barriers with different obturation techniques. Iran Endod J. 2014;9(4):261-5. 27. Sobhnamayan F, Adl A, Farzaneh Z, Shojaee NS. Effect of pH and Lidocaine on the Compressive Strength of Calcium Enriched Mixture Cement. Journal of Dental Biomaterials. 2015;2(4):118-23. 28. Appelbaum KS, Stewart JT, Hartwell GR. Effect of sodium fluorosilicate on the properties of Portland cement. J Endod. 2012;38(7):1001-3. 29. Hwang Y-C, Kim D-H, Hwang I-N, Song S-J, Park Y-J, Koh J-T, Son H-H, Oh W-M. Chemical constitution, physical properties, and biocompatibility of experimentally manufactured Portland cement. J Endod. 2011;37(1):58-62. 30. Lee B-N, Hwang Y-C, Jang J-H, Chang H-S, Hwang I-N, Yang S-Y, Park Y-J, Son H-H, Oh W-M. Improvement of the properties of mineral trioxide aggregate by mixing with hydration accelerators. J Endod. 2011;37(10):1433-6. 31. Massi S, Tanomaru-Filho M, Silva GF, Duarte MAH, Grizzo LT, Buzalaf MAR, Guerreiro-Tanomaru JM. pH, Calcium Ion Release, and Setting Time of an experimental Mineral Trioxide Aggregate–based root canal sealer. J Endod. 2011;37(6):844-6. 32. Abbaszadegan A, Sedigh Shams M, Jamshidi Y, Parashos P, Bagheri R. Effect of calcium chloride on physical properties of calcium‐enriched mixture cement. Aust Endod J. 2015;41(3):117-21. 33. Ghasemi N, Rahimi S, Shahi S, Milani AS, Rezaei Y, Nobakht M. Compressive Strength of Mineral Trioxide Aggregate with Propylene Glycol. Iran Endod J. 2016;11(4):325. 34. Adl A, Sobhnamayan F, Kazemi O. Comparison of push-out bond strength of mineral trioxide aggregate and calcium enriched mixture cement as root end filling materials. Dent Res J 2014;11(5):564.  Please cite this paper as: Sobhnamayan F, Adl A, Sadat Shojaee N, Sedigh-Shams M, Zarghami E. Compressive Strength of Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement Mixed with Propylene Glycol. Iran Endod J. 2017;12(4):493-6.                         Doi: 10.22037/iej.v12i4.17748.  

Compressive Strength of Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement Mixed with Propylene Glycol

https://journals.sbmu.ac.ir/iej/article/download/17748/13802

Compressive Strength of Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement Mixed with Propylene Glycol

Abstract

Similar works

Full text

Available Versions

Journals Portal, Shahid Beheshti University of Medical Sciences