UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4305
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Braz Dent Sci 2024 Apr/June;27 (2): e4305
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
Descoloração dentária
ex vivo
induzida por materiais à base de silicato de cálcio: análise de um cimento experimental
Suyane Maria LUNA-CRUZ1,2 , Bernardo Almeida AGUIAR1 , Ana Grasiela LIMOEIRO3 , Marco Antônio Húngaro DUARTE3 ,
Bruno Carvalho de VASCONCELOS1 , Juliano Sartori MENDONÇA1
1 - Universidade Federal do Ceará, Programa de Pós-graduação em Odontologia. Fortaleza, CE, Brazil.
2 - Centro Universitário UniFametro. Fortaleza, CE, Brazil.
3 - Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Dentística, Endodontia e Materiais Odontológicos.
Bauru, SP, Brazil.
How to cite: Luna-Cruz SM, Aguiar BA, Limoeiro AG, Duarte MAH, Vasconcelos BC, Mendonça JS.
Ex vivo
tooth discoloration induced
by calcium silicate-based materials: analysis of an experimental cement. Braz Dent Sci. 2024;27(2):e4305. https://doi.org/10.4322/
bds.2024.e4305
ABSTRACT
Objective: This study aimed to investigate of bioactive materials with specic properties, particularly highly
plastic bioceramic cements. These materials are being studied extensively due to their potential to maintain
pulp vitality and promote tissue regeneration. Material and Methods: Tooth discoloration induced by an
experimental tricalcium silicate-based cement (EC) was evaluated and compared with that of Biodentine (BD)
and white MTA-Angelus (MTA). Cavities were prepared on the lingual surfaces of thirty-two blocks of healthy
bovine incisors. The blocks were chemically cleaned and then subjected to an initial color evaluation (CIELab
values) using a spectrophotometer and randomly divided into three experimental groups (n=10); two additional
blocks served as controls. After manipulation, the cements were placed in the cavities, which were subsequently
restored with composite restorations. After another color measurement (baseline), they were immersed in bottles
of distilled water; they were stored at 37 °C and 100% humidity for the entire test period. The color change
(ΔE) was measured after 14, 30, 120 and 150 days. ANOVA and Tukey tests showed signicant differences
after 14 days (EC vs. MTA), 30 days (EC vs. BD) and 120/150 days (EC vs. BD/MTA) (p < 0.05). Results: All
tested materials induced ΔE changes, with the EC group showing the least change at the end of the experiment
(ΔE=4.08). Conclusion: EC induced less color change over a 5-month period and thus showed color stability
over the entire period, whereas BD and MTA showed progressive discoloration.
KEYWORDS
Dental cements; Dental materials; Endodontics; Silicate cement; Tooth discoloration.
RESUMO
Objetivo: O objetivo deste estudo foi investigar materiais bioativos com propriedades especícas, particularmente
cimentos biocerâmicos altamente plásticos. Esses materiais estão sendo amplamente estudados devido ao seu
potencial para manter a vitalidade da polpa e promover a regeneração dos tecidos. Material e Métodos: A
descoloração dentária induzida por um cimento experimental à base de silicato tricálcico (CE) foi avaliada
e comparada com a do Biodentine (BD) e do MTA-Angelus branco (MTA). Foram preparadas cavidades nas
superfícies linguais de trinta e dois blocos de incisivos bovinos saudáveis. Os blocos foram quimicamente limpos
e, em seguida, submetidos a uma avaliação inicial de cor (valores CIELab) usando um espectrofotômetro e
divididos aleatoriamente em três grupos experimentais (n=10); dois blocos adicionais serviram como controles.
Após a manipulação, os cimentos foram colocados nas cavidades, que foram posteriormente restauradas com
compósito. Após outra medição de cor (valor de referência), eles foram imersos em frascos de água destilada;
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Braz Dent Sci 2024 Apr/June;27 (2): e4305
Luna-Cruz SM et al.
Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
INTRODUCTION
The quest for conservative dental treatments
that preserve pulp vitality and regenerate
biological tissues has prompted research into
bioactive materials with these properties and
the development of highly plastic bioceramic
cement [1-3]. Most studies in the literature are
based on the evaluation of commercially available
calcium silicate cements, which are indicated as
direct and indirect pulp capping and endodontic
repair materials [4-8]. However, some of these
materials have limitations regarding their clinical
indication, such as the increased risk of tooth
discoloration [4,9-12], which becomes more
relevant as these agents can be used at levels up
to the cervical region [9,13].
Biodentine (BD; Septodont, Saint-Maur-des-
Fósses, France) consists of a powder of tricalcium
silicate, zirconium oxide, calcium oxide, calcium
carbonate, red and yellow pigments, and brown
iron oxide; the liquid is composed of water,
calcium chloride and a thickening agent. In turn,
the white MTA-Angelus (MTA; Angelus Ind.
Prod. Odont. S/A, Londrina, PR, Brazil) presents
tricalcium and dicalcium silicates, tricalcium
aluminate (white Portland cement), calcium
oxide and calcium tungstate in its powder and
only distilled water in its liquid. The powder of
the experimental calcium silicate-based cement
(EC), on the other hand, consists of tricalcium
silicate, zirconium oxide, calcium oxide and
calcium phosphate. Its liquid contains water, a
water-soluble polymer, and a setting accelerator
(Table I).
Originally, bismuth oxide was added to
these cements because it was known as
a radiopacier [14]. However, both clinical and
experimental observations showed an increase in
tooth discoloration associated with the presence of
this compound BAHAA [15,16]. This process occurs
due to the interaction between bismuth oxide and
collagen in the absence of oxygen, resulting in a
dark-colored precipitate that causes pigmentation
of the dentin [17-19].
The increasing demand for aesthetics [20],
where conspicuous changes in tooth color could
be considered a treatment failure, has led to the
search for alternative radiopaciers. Compounds
such as zirconium oxide and calcium tungstate
are already available in some commercial
products [4,19,21], and, more recently, niobium
oxide [22] and ytterbium oxide [23] have been
evaluated for the same purpose.
foram armazenados a 37 °C e 100% de umidade durante todo o período de teste. A alteração de cor (ΔE) foi
medida após 14, 30, 120 e 150 dias. Os testes ANOVA e Tukey mostraram diferenças signicativas após 14 dias
(CE vs. MTA), 30 dias (CE vs. BD) e 120/150 dias (CE vs. BD/MTA) (p < 0,05). Resultados: Todos os materiais
testados induziram alterações de ΔE, sendo que o grupo EC apresentou a menor alteração no nal do experimento
(ΔE=4,08). Conclusão: O EC induziu menos alterações de cor em um período de 5 meses e, portanto, apresentou
estabilidade de cor durante todo o período, enquanto o BD e o MTA apresentaram descoloração progressiva.
PALAVRAS-CHAVE
Cimentos odontológicos; Materiais odontológicos; Endodontia; Cimento de silicato; Descoloração dos dentes.
Table I - Chemical composition of the cements used
BD (#B28191) MTA (#101663) EC (Requested Patent)
Powder
Tricalcium silicate Tricalcium silicate Tricalcium silicate
Zirconium oxide Dicalcium silicate Zirconium oxide
Calcium oxide Tricalcium aluminate Calcium oxide
Calcium carbonate Calcium oxide Calcium phosphate
Yellow pigment Calcium tungstate
Red pigment
Brown iron oxide
Liquid
Water Distilled water Ultrapure water
Calcium chlorite dehydrate Water soluble polymers
Areo Setting accelerator
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Braz Dent Sci 2024 Apr/June;27 (2): e4305
Luna-Cruz SM et al.
Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
However, in addition to satisfactory radiopacity
properties, these new materials must also have
compatible physicochemical and biological
properties while preserving the color of the tooth
structures. Considering that any new material
indicated as a capping or repair agent should not
produce a noticeable color change, the present study
compared tooth discoloration by an experimental
calcium silicate-based cement with that of two
commercial cements, Biodentine and white MTA-
Angelus. The null hypothesis was that there would
be no signicant color change between the materials.
MATERIAL AND METHODS
For the study, the sample size calculation
was based on the results of a previous study [24]
(means of 1.96 to 4.91), considering an alpha
error of 5%, a power of 80%, and an allocation
ratio of N2/N1= 1, resulting in a sample size of
10 specimens per group (
n
= 10).
Thirty-two sound bovine incisors were
therefore collected and enamel/dentin blocks
measuring 10 x 10 x 3.5 mm (height x width x
thickness) were prepared. Circular cavities with a
diameter of 5.0 mm and a depth of 1.5 mm were
then prepared on the lingual surfaces using high-
speed diamond burs (#4054, KG Sorensen, Cotia,
Brazil) with copious irrigation. Blocks with residual
enamel/dentin less than 2.0 mm were replaced.
After completion of the cavities, the blocks
were placed in an ultrasonic bath where they
were successively bathed with a 2.5% sodium
hypochlorite solution (Biodinamica, Ibiporã,
PR, Brazil) and 17% ethylenediaminetetraacetic
acid (Biodinamica) [17]. The samples were
then washed with saline and carefully dried
with sterile gauze. At this stage, the initial color
of the blocks was measured using a clinical
spectrophotometer (Vita EasyShade V, VITA
Zahnfabrik, Bad Sackingen, Germany) under
controlled light to verify the initial values and
ensure homogeneity of the samples in the groups.
The measurements were based on the CIELab
(International Commission on Illumination) color
space values, represented by L*a*b*, where “L”
stands for luminosity, “a” for measurements on
the red-green axis and “b” for measurements
on the yellow-blue axis [17]. Samples whose
“L” values deviated by more than 10% from the
overall mean value were also replaced.
The initial color parameters of the samples
allowed random grouping according to the
cements used. All tested materials contain
calcium silicates as active ingredients, with some
variations nowadays.
The margins of the cavities were etched
with 37% phosphoric acid (Condac 37;
FGM Dental Group, Joinvile, SC, Brazil) for
30 seconds, followed by extensive washing for
30 seconds [15,17]. Two layers of dentin adhesive
(Single Bond 2, 3M ESPE, Sumaré, Brazil) were
then applied to the same cavity margins. After
applying the second layer (Optilight LD Max,
Gnatus, Ribeirão Preto, Brazil), a gentle blow-
out and photopolymerisation for 20 s were
performed.
The commercial cements BD and MTA
were mixed according to the manufacturer’s
instructions. For the BD cement, after opening
the capsule, 5 drops of liquid were trickled on
the material powder. Sequentially, the closed
capsule was stirred up for 30 s in an amalgamator
(Amalga Mix II, Gnatus, Ribeirão Preto, Brazil).
For MTA and EC a powder/liquid ratio of
1:0.33 (g/g) was used; the liquid was gently
mixed with the powder previously positioned on
a glass plate and, with the help of a #24 spatula,
they were mixed until a uniform mass was
formed (approximately 30 s). Immediately after
manipulation, the materials were placed in the
wells and left at 37 ºC and 100% humidity during
the setting time of the material. The lingual
surfaces of the samples were then sealed with
composite (A2 Opallis Flow, FGM Dental Group,
Joinvile, Brazil) and light-cured for 60 seconds.
Two additional specimens were prepared and
restored with composite only to serve as a control.
After restoration, the specimens were
immersed in asks containing 10 mL of distilled
water and placed in an oven at 37 ºC, where they
remained throughout the experiment. Before
immersion, the parameters “L”, “a” and “b” were
recorded again (D0 - baseline) to determine the
color change (ΔE) during the entire immersion
time [15]. The blocks were evaluated after 14,
30, 120 and 150 days by measuring the color
parameters as previously described. Additional
care was taken for color measurements: The
operator was previously intensely calibrated
and blinded to the group under analysis; the
analyzes were carried out in an environment with
controlled and standardized lighting throughout
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Luna-Cruz SM et al.
Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
the experiment; the use of a padronized silicone
matrix to standardize the measurement position.
The ΔE values were calculated using the
following formula [17]:
1/ 2
222
( 0) ( 0) ( 0)E Ln L an a bn b
∆= − + − + −
(1)
At the end of the test period, a representative
specimen from each group was embedded in
acrylic resin, analyzed in cross-section, and
photographed.
Statistical analysis
The ΔE values were recorded and each
assessment period was compared with the D0
values (baseline). These data were tabulated and
analyzed using the Shapiro-Wilk test to determine
the normality of the data. Once their parametric
nature was confirmed, they were analysed
using the ANOVA and Tukey test for individual
comparisons, with the signicance level set at 5%
in each case. In addition, the variation in brightness
between the initial and nal measurements of the
experiment (ΔL, 150 days) was measured and the
data were treated as described above.
RESULTS
The initial color parameters analysis was
carried out after the distribution of the samples
among the groups. It conrmed their statistical
similarity (p = 0.91) and the homogeneity of
the sample. The Control group specimens do not
present any signicant color variation during the
analyzed period (p = 0.88), attesting the method
security.
The ΔE changes induced by the commercial
cements (BD and MTA) and the EC are shown
in Table II. All tested materials induced tooth
discoloration to an extent that is considered
clinically conspicuous [ΔE > 3.7] [15,25]. The
White MTA-Angelus exhibited the most signicant
color change at 14 days, with its color change
being statistically greater than that of BD and
EC. At 30 days, Biodentine showed the highest
values, surpassing both MTA and EC. At 120
and 150 days, the EC samples displayed lower
values compared to BD and MTA. Considering the
analysis of the behavior of the materials between
the analyzed periods, signicant differences were
observed in both BD and EC (p < 0.05). In EC,
despite presenting higher values at 30 days, there
was a reduction in them to the point of reaching
120/150 with the patterns observed at 14 days.
BD, on the other hand, also showed an increase
in darkening values at 30, however, even showing
some reduction at 120/150 days, the values at
the end. The MTA do not presented variation
between the periods (p > 0.05).
Table II shows the mean and standard deviation
of the luminosity of the specimens in each group.
In this evaluation, the EC specimens showed the
lowest deviation (ΔL = 2.7), which was statistically
different from that of the commercial materials (p <
0.05). In the samples from the control group, which
were only restored with composite, the ΔE values
remained within the clinically perceptible limits.
Figure 1 shows a picture of representative samples
from the test groups.
DISCUSSION
In restorative procedures, various efforts
are made to preserve dentin and pulp tissue.
Regenerative procedures have been extensively
studied to develop clear and safe protocols
for situations where preservation of these
structures is critical to pulp vitality. These
procedures require the use of a material with
good physicochemical properties in combination
Table II - Values (
Mean
and
sd
) of tooth discoloration (ΔE) and luminosity (L) and its variation caused by the cements evaluated during the
experimental period
Material
ΔE L
14 d 30 d 120 d 150 d Immediately 150 d Variation
Mean sd Mean sd Mean sd Mean sd Mean sd Mean sd Mean sd
Biodentine 4.52a,A 2.27 14.49b,C 1.61 7.65b,B 1.06 7.93b,B 2.68 96.9 2.52 88.8 3.9 8.1b2.9
White MTA-Angelus 8.35b,A 1.33 8.37a,A 3.03 8.45b,A 2.34 9.34b,A 2.98 99,0 0.76 88.1 0.91 9.9b1.6
Experimental cement 4.69a,A 2.91 7.05a,B 3.2 3.8a,A 2.64 4.08a,A 1.8 91.3 4.53 88.7 4.16 2.7a3.3
a,bDifferent lower-case superscript letters represent significant differences between the experimental groups in the periods evaluated
according to the ANOVA and Tukey tests, both with p < 0.05. A,BDifferent upper-case superscript letters represent significant differences
between the analysed periods in each group according to the ANOVA and Tukey tests, both with p < 0.05.
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Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
with excellent biological properties [26-28].
Therefore, these materials should be able to
induce remineralization in procedures such as
pulp capping or revascularization of blood clots.
Furthermore, these materials should not
induce tooth discoloration [25]. The aim of the
present study was therefore to evaluate the color
changes induced by an experimental tricalcium
silicate-based material in comparison to those
induced by commercially available cements (BD
and MTA). The results of this study indicate that
all materials caused some degree of color change.
However, the EC group caused less discoloration
compared to the other cements and remained close
to clinically perceptible values (> 3.7). Therefore,
the null hypothesis of this study was rejected.
The methods used in this study followed
the pattern of previous studies [4,9,24], which
were based on an earlier classic study [17].
Bovine teeth were also used in these studies.
The use of bovine teeth and human teeth has
been investigated previously and showed similar
results with both substrates [24]; therefore,
the use of bovine teeth is justified for this
purpose. The assessment of tooth discoloration
using spectrophotometry is another point
of convergence between the listed studies,
although the assessment time in each study was
highly individual. Furthermore, regarding the
systematic analysis of color data, two models
are most common, CIELab and CIEDE2000. The
latter has been attributed greater sensitivity [29]
however, studies that used both did not identify
discrepancies in results [30-32]; endodontic
literature usually uses CIELab [9,19,24], which
is why, in the name of comparing results, this
model was chosen. The analysis of the change in
lightness (“L”) was added because it could allow
a better assessment of tooth darkening.
In general, the values found here
are compatible with those available in the
literature [9,11,19,24]. An interesting nding
concerns their variation, independent of cement,
over time. In the present study, the three
cements experienced variations in their darkening
values, with a peak at 30 days, followed by a
reduction. This fact has been attributed to an
initial concentration of staining, followed by
a kind of spreading, generally softening the
measured color parameters [9,19,24].
The color change analysis revealed that the
samples from the EC group had significantly
lower ΔE values compared to the two commercial
cements at 150 days follow-up (p < 0.05).
Although the values were above the threshold
of clinical perceptibility (< 3.7), they were very
close to this target (4.08). Considering the periods
evaluated, the EC presents, at the end, values
similar to those initially presented (p > 0.05).
In addition, the EC group also showed the least
variation in brightness (P < 0.05). This behavior
was somewhat expected as zirconium oxide is
used as a radiopacier, which is considered safe
in terms of tooth discoloration [24].
In contrast, the BD cement caused (150 days) a
signicant color change despite the use of zirconium
oxide as radiopacifier (7.93). As for behavior
throughout the evaluation period, it ultimately
showed a signicant difference compared to the
parameters observed at 14 days (p < 0.05). In
addition, a brightness variation of about 10% was
observed in the BD group (8.1). This observation
is not new in the literature, as systematic reviews
Figure 1 - Representative image of specimens from the groups evaluated after 150 days (A- BD; B- MTA; C- EC; D- Control).
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Luna-Cruz SM et al.
Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
also report the observation of color changes after
the use of BD [33]. This occurrence could be due to
the presence of yellow and red pigments in addition
to brown iron oxide in the composition specied by
the manufacturer [21].
Clinically noticeable color changes also
occurred in the MTA group, with values peaking
after 150 days [4,25]. Over time, no signicant
variation was observed (p > 0.05). This group also
showed the greatest variation in luminosity in this
study (9,9). The composition of this material was
recently changed, replacing bismuth oxide with
calcium tungstate [4]. So, it is difcult to compare
the results of the present study with those
available in the literature. However, a previous
study had already indicated the occurrence of
tooth discoloration in materials with calcium
tungstate as radiopacier [34]. Although the new
formulation shows color changes, the values are
much lower than those of the original formulation
using bismuth oxide [19].
In summary, although the EC cements showed
lower color changes compared to the commercial
cements, the in vitro nature of this study limits
the extrapolation of the results. Therefore, future
studies are needed to evaluate the performance of
this new material under conditions more like oral
uids and in the presence of blood clots, as well
as in vivo experiments.
CONCLUSION
Under the conditions of this study, the
experimental tricalcium silicate cement showed
less color change compared to the commercially
available cements Biodentine and white MTA-
Angelus over a 5-month period, suggesting potential
applicability for clinical use in aesthetic areas.
Author’s Contributions
SMLC, JSM, BCV, MAHD: Conceptualization.
SMLC, BAA, AGL: Data curation. JSM, MAHD:
Formal Analysis. BCV, JSM: Funding Acquisition.
JSM, BCV: Supervision. SMLC, AGL, BCV, JSM
Writing – Original Draft Preparation, JSM, BCV,
MAHDWriting – Review & Editing.
Conict of Interest
The authors have no conicts of interest to
declare.
Funding
This study was partially supported by
CAPES, Brazilian agency and FUNCAP -
Ceará Foundation to Support Scientific and
Technological Development.
Regulatory Statement
This study does not require ethics approval.
REFERENCES
1. Duarte MAH, Marciano MA, Vivan RR, Tanomaru M Fo,
Tanomaru JMG, Camilleri J. Tricalcium silicate-based cements:
properties and modifications. Braz Oral Res. 2018;32(Suppl
1):e70. http://doi.org/10.1590/1807-3107bor-2018.vol32.0070.
PMid:30365611.
2. Eskandari F, Razavian A, Hamidi R, Yousefi K, Borzou S. An
updated review on properties and indications of calcium
silicate-based cements in endodontic therapy. Int J Dent.
2022;2022:6858088. http://doi.org/10.1155/2022/6858088.
PMid:36349079.
3. Ballal NV, Rao S, Yoo J, Ginjupalli K, Toledano M, Al-Haj Husain
N, et al. Fracture resistance of teeth obturated with two
different types of Mineral Trioxide Aggregate Cements. Braz
Dent Sci. 2020;23(3):1-9. http://doi.org/10.14295/bds.2020.
v23i3.2000.
4. Pelepenko LE, Saavedra F, Antunes TBM, Bombarda GF, Gomes
BPFA, Zaia AA, et al. Investigation of a modified hydraulic
calcium silicate-based material - Bio-C Pulpo. Braz Oral Res.
2021;35:e077. http://doi.org/10.1590/1807-3107bor-2021.
vol35.0077. PMid:34161414.
5. Asgary S, Eghbal MJ, Shahravan A, Saberi E, Baghban AA,
Parhizkar A. Outcomes of root canal therapy or full pulpotomy
using two endodontic biomaterials in mature permanent
teeth: a randomized controlled trial. Clin Oral Investig.
2022;26(3):3287-97. http://doi.org/10.1007/s00784-021-
04310-y. PMid:34854987.
6. Bahaa NM, El-Korashy DI, Sherief DI. The effect of adding
ytterbium trifluoride on the radiopacity, compressive strength,
setting time and bioactivity of biodentine: an in vitro study. Braz
Dent Sci. 2022;25(3):e3360. http://doi.org/10.4322/bds.2022.
e3360.
7. Bahadr HS, Türkyilmaz A, Bayraktar Y, Çelik Ç. Effect of
laser-assisted retrograde cavity preparation on push-out-
bond-strength of mineral trioxide aggregate and calcium-
enriched-mixture-cement. Braz Dent Sci. 2022;25(1):e2736.
http://doi.org/10.4322/bds.2022.e2736.
8. Nassar MAM, Abdelgawad LM, Khallaf ME, El Rouby DH, Sabry
D, Radwan MM. Experimental nano calcium aluminate/tri calcium
silicate root repair: Synthesis, physical and mechanical properties
compared to mineral trioxide aggregate and Biodentine. Braz Dent
Sci. 2022;25(4):e3368. http://doi.org/10.4322/bds.2022.e3368.
9. Aguiar BA, Frota LMA, Taguatinga DT, Vivan RR, Camilleri J,
Duarte MAH,et al. Influence of ultrasonic agitation on bond
strength, marginal adaptation, and tooth discoloration provided
by three coronary barrier endodontic materials. Clin Oral
Investig. 2019;23(11):4113-22. http://doi.org/10.1007/s00784-
019-02850-y. PMid:30788695.
10. Jesus LS, Volpato CAM, Bortoluzzi EA, Teixeira CS, Rossetto
HL, Pires-de-Souza FCP,etal. Tooth discoloration induced by
the different phases of a calcium aluminate cement: one-year
7
Braz Dent Sci 2024 Apr/June;27 (2): e4305
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo tooth discoloration induced by calcium silicate-based materials: analysis of an experimental cement
Luna-Cruz SM et al.
Ex vivo
tooth discoloration induced by calcium silicate-based
materials: analysis of an experimental cement
assessment. J Esthet Restor Dent. 2021;33(7):999-1009. http://
doi.org/10.1111/jerd.12739. PMid:33929073.
11. Taha NA, Hamdan AM, Al-Hiyasat AS. Coronal discoloration
induced by calcium silicate-based cements used in full
pulpotomy in mature permanent molars: a randomized clinical
trial. Clin Oral Investig. 2022;27(4):1723-30. http://doi.
org/10.1007/s00784-022-04799-x. PMid:36445467.
12. Correia A, Matos F, Huhtala MF, Bresciani E, Caneppele T. Clinical
performance of whitening on devitalized teeth: a retrospective
observational study. Braz Dent Sci. 2020;23(1):1-7. http://doi.
org/10.14295/bds.2020.v23i1.1809.
13. Diogenes A, Ruparel NB. Regenerative endodontic procedures:
clinical outcomes. Dent Clin North Am. 2017;61(1):111-25. http://
doi.org/10.1016/j.cden.2016.08.004. PMid:27912813.
14. Berger T, Baratz AZ, Gutmann JL. In vitro investigations into
the etiology of mineral trioxide tooth staining. J Conserv Dent.
2014;17(6):526-30. http://doi.org/10.4103/0972-0707.144584.
PMid:25506138.
15. Jacobovitz M, de Pontes Lima RK. The use of calcium hydroxide
and mineral trioxide aggregate on apexification of a replanted
tooth: a case report. Dent Traumatol. 2009;25(3):e32-6. http://
doi.org/10.1111/j.1600-9657.2008.00745.x. PMid:19239484.
16. Belobrov I, Parashos P. Treatment of tooth discoloration
after the use of white mineral trioxide aggregate. J Endod.
2011;37(7):1017-20. http://doi.org/10.1016/j.joen.2011.04.003.
PMid:21689563.
17. Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth
discoloration induced by endodontic materials: a laboratory
study. Int Endod J. 2012;45(10):942-9. http://doi.org/10.1111/
j.1365-2591.2012.02053.x. PMid:22506849.
18. Camilleri J. Color stability of white mineral trioxide aggregate in
contact with hypochlorite solution. J Endod. 2014;40(3):436-40.
http://doi.org/10.1016/j.joen.2013.09.040. PMid:24565667.
19. Marciano MA, Costa RM, Camilleri J, Mondelli RFL, Guimarães
BM, Duarte MAH. Assessment of color stability of white mineral
trioxide aggregate Angelus and bismuth oxide in contact with
tooth structure. J Endod. 2014;40(8):1235-40. http://doi.
org/10.1016/j.joen.2014.01.044. PMid:25069940.
20. Gomes GH, Corbellini AO, Rotta WG, Martos J, Boeira
GF. Interdisciplinary esthetic approach in clinical dental
rehabilitation. J Conserv Dent. 2021;24(5):519-23. http://doi.
org/10.4103/jcd.jcd_441_21. PMid:35399760.
21. Active Biosilicate Technology™. Biodentine [scientific file].
Lancaster, PA: Septodont; 2010.
22. Bosso-Martelo R, Guerreiro-Tanomaru JM, Viapiana R, Berbert
FLC, Duarte MAH, Tanomaru-Filho M. Physicochemical properties
of calcium silicate cements associated with microparticulate
and nanoparticulate radiopacifiers. Clin Oral Investig.
2016;20(1):83-90. http://doi.org/10.1007/s00784-015-1483-7.
PMid:25952552.
23. Queiroz MB, Torres FFE, Rodrigues EM, Viola KS, Bosso-Martelo
R, Chavez-Andrade GM, et al. Physicochemical, biological,
and antibacterial evaluation of tricalcium silicate-based
reparative cements with different radiopacifiers. Dent Mater.
2021;37(2):311-20. http://doi.org/10.1016/j.dental.2020.11.014.
PMid:33323301.
24. Marciano MA, Camilleri J, Costa RM, Matsumoto MA, Guimarães
BM, Duarte MAH. Zinc oxide inhibits dental discoloration
caused by white mineral trioxide aggregate Angelus. J Endod.
2017;43(6):1001-7. http://doi.org/10.1016/j.joen.2017.01.029.
PMid:28416317.
25. Athanassiadis B, Abbott PV, Walsh LJ. A critical analysis of
research methods and experimental models to study tooth
discolouration from endodontic materials. Int Endod J.
2022;55(Suppl 2):370-83. http://doi.org/10.1111/iej.13708.
PMid:35165907.
26. Abbaszadegan A, Adl A, Javanmardi S. Assessment of tooth
discoloration induced by biodentine and white mineral
trioxide aggregate in the presence of blood. J Conserv Dent.
2019;22(2):164-8. http://doi.org/10.4103/JCD.JCD_466_18.
PMid:31142987.
27. 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(4):237-40. http://doi.org/10.4103/0972-
0707.219203. PMid:29259359.
28. Thomas MS, Sharma A, Shetty N, Srikant N. Evaluation of indirect
pulp capping using pozzolan-based cement (ENDOCEM-Zr®)
and mineral trioxide aggregate: a randomized controlled trial. J
Conserv Dent. 2020;23(2):152-7. http://doi.org/10.4103/JCD.
JCD_367_19. PMid:33384487.
29. Pecho OE, Ghinea R, Alessandretti R, Pérez MM, Della Bona
A. Visual and instrumental shade matching using CIELAB and
CIEDE2000 color difference formulas. Dent Mater. 2016;32(1):82-
92. http://doi.org/10.1016/j.dental.2015.10.015. PMid:26631341.
30. Abdulla R, Cowan K. Smoke and mirrors - does smoking cause
discolouration of composite restorations? Evid Based Dent.
2023;24(4):157-8. http://doi.org/10.1038/s41432-023-00955-8.
PMid:37993688.
31. Costa MP, Jacomine JC, Mosquim V, Santin DC, Zabeu GS,
Agulhari MAS,etal. Analysis of color stability and degree of
conversion of different types of resin composites. Braz Oral
Res. 2024;38:e003. http://doi.org/10.1590/1807-3107bor-2024.
vol38.0003. PMid:38198303.
32. Arslan E, Avukat EN, Akay C. The effect of aging on artificial saliva
at different pH values on the color stability of new generation
denture base materials. Cureus. 2024;16(3):e55804. http://doi.
org/10.7759/cureus.55804. PMid:38586635.
33. Slaboseviciute M, Vasiliauskaite N, Drukteinis S, Martens
L, Rajasekharan S. Discoloration potential of biodentine: a
systematic review. Materials. 2021;14(22):6861. http://doi.
org/10.3390/ma14226861. PMid:34832263.
34. Marques RB Jr, Baroudi K, Santos AFC, Pontes D, Amaral M. Tooth
discoloration using calcium silicate-based cements for simulated
revascularization in vitro. Braz Dent J. 2021;32(1):53-8. http://
doi.org/10.1590/0103-6440202103700. PMid:33914003.
Bruno Carvalho de Vasconcelos
(Corresponding address)
Universidade Federal do Ceará, Programa de Pós-graduação em Odontologia,
Fortaleza, CE, Brazil.
Email: bcv@ufc.br
Date submitted: 2024 Mar 17
Accept submission: 2024 July 02
