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VOLUME 11 , ISSUE 1 ( January-February, 2020 ) > List of Articles


Coronal Discoloration Related to Bioceramic and Mineral Trioxide Aggregate Coronal Barrier in Non-vital Mature Teeth Undergoing Regenerative Endodontic Procedures

Mohammad Yaman Seirawan, Kinda Layous, Mohammad Kinan Seirawan, Mazen Doumani

Keywords : Bioceramic, Discoloration, Mineral trioxide aggregate, Regenerative endodontic procedures

Citation Information : Seirawan MY, Layous K, Seirawan MK, Doumani M. Coronal Discoloration Related to Bioceramic and Mineral Trioxide Aggregate Coronal Barrier in Non-vital Mature Teeth Undergoing Regenerative Endodontic Procedures. World J Dent 2020; 11 (1):52-60.

DOI: 10.5005/jp-journals-10015-1698

License: CC BY-NC 4.0

Published Online: 01-02-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objectives: This study aimed to compare the coronal discoloration related to the application of two coronal sealing materials: Bioceramic (BC) root repair material (RRM) putty and mineral trioxide aggregate (MTA). Materials and methods: A total of 16 patients (divided into two subgroups, each one included 8 patients) had undergone regenerative endodontic procedures (REPs). Disinfecting the canals was achieved by the application of the double-antibiotic paste (DAP) “metronidazole and ciprofloxacin” to exclude minocycline discoloration effect; after 3 weeks, the medicament was removed, apical bleeding was induced till the formation of blood clot in the root canal, and then a coronal sealing was created. Bioceramic RRM putty was used in eight patients, while gold standard “MTA” was used in another eight patients. Finally, resin modified glass ionomer (RMGI) was applied followed with resin composite matching the shade of the treated teeth. Shades were measured immediately after procedures and through organized follow-up (3, 6, 9, and 12 months). Data were collected according to Commission International de I’Eclairage (CIE-LAB) and then ΔE values were calculated. A two-way statistical analysis of variance was performed depending on Student’s t and Chi-square tests at 95% (p = 0.05). Results: Coronal discoloration accompanied with MTA was clinically perceptible (ΔE > 3.3) through all periods. Coronal discoloration was slightly recognized in the BC group. However, there was no significant difference between the used two materials through studied periods (p > 0.05). There was incrementally increasing of discoloration through sequential organized follow-up periods. Conclusion: As a result of this study, BC RRM putty could be a good alternative material to MTA through REPs. Clinical significance: Pulp REPs are predictable therapies, but discoloration is still considered as a one of the most unfavorable complications; so, this study highlights on this outcome to obviate it.

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  1. Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. J Endod 2013;39(3 Suppl):30–43. DOI: 10.1016/j.joen.2012.11.025.
  2. Diogenes A, Ruparel NB, Shiloah Y, et al. Regenerative endodontics: a way forward. J Am Dent Assoc 2016;147(5):372–380. DOI: 10.1016/j.adaj.2016.01.009.
  3. Wigler R, Kaufman AY, Lin S, et al. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod 2013;39(3):319–326. DOI: 10.1016/j.joen. 2012.11.014.
  4. Shah N, Logani A. SealBio: a novel, non-obturation endodontic treatment based on concept of regeneration. J Conserv Dent 2012;15(4):328–332. DOI: 10.4103/0972-0707.101889.
  5. Saoud TM, Martin G, Chen Y-HM, et al. Treatment of mature permanent teeth with necrotic pulps and apical periodontitis using regenerative endodontic procedures: a case series. J Endod 2016;42(1):57–65. DOI: 10.1016/j.joen.2015.09.015.
  6. Kahler B, Rossi-Fedele G. A review of tooth discoloration after regenerative endodontic therapy. J Endod 2016;42(4):563–569. DOI: 10.1016/j.joen.2015.12.022.
  7. Torabinejad M, Nosrat A, Verma P, et al. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod 2017;43(11):1806–1820. DOI: 10.1016/j.joen. 2017.06.029.
  8. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J 2009;42(1):84–92. DOI: 10.1111/j.1365-2591.2008.01467.x.
  9. Lenherr P, Allgayer N, Weiger R, et al. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J 2012;45(10): 942–949. DOI: 10.1111/j.1365-2591.2012.02053.x.
  10. Akcay M, Arslan H, Yasa B, et al. Spectrophotometric analysis of crown discoloration induced by various antibiotic pastes used in revascularization. J Endod 2014;40(6):845–848. DOI: 10.1016/j.joen.2013.09.019.
  11. Asgary S, Parirokh M, Eghbal MJ, et al. Chemical differences between white and gray mineral trioxide aggregate. J Endod 2005;31(2): 101–103. DOI: 10.1097/01.don.0000133156.85164.b2.
  12. Kontakiotis EG, Filippatos CG, Tzanetakis GN, et al. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod 2015;41(2):146–154. DOI: 10.1016/j.joen.2014.08.003.
  13. Asgary S, Fazlyab M. A successful endodontic outcome with nonobturated canals. Iran Endod J 2015;10(3):208–210. DOI: 10.7508/iej.2015.03.013.
  14. Mozynska J, Metlerski M, Lipski M, et al. Tooth discoloration induced by different calcium silicate-based cements: a systematic review of in vitro studies. J Endod 2017;43(10):1593–1601. DOI: 10.1016/j.joen.2017.04.002.
  15. American Association of Endodontists. AAE Clinical Considerations for a Regenerative Procedure. Availableonline: (accessed on 1 April 2018).
  16. Marin PD, Bartold PM, Heithersay GS. Tooth discoloration by blood: an in vitro histochemical study. Endod Dent Traumatol 1997;13(3): 132–138. DOI: 10.1111/j.1600-9657.1997.tb00026.x.
  17. Shokouhinejad N, Nekoofar MH, Pirmoazen S, et al. Evaluation and comparison of occurrence of tooth discoloration after the application of various calcium silicate-based cements: an ex vivo study. J Endod 2016;42(1):140–144. DOI: 10.1016/j.joen.2015.08.034.
  18. Akbari M, Rouhani A, Samiee S, et al. Effect of dentin bonding agent on the prevention of tooth discoloration produced by mineral trioxide aggregate. Int J Dent 2012. 563203. DOI: 10.1155/2012/563203.
  19. Shokouhinejad N, Khoshkhounejad M, Alikhasi M, et al. Prevention of coronal discoloration induced by regenerative endodontic treatment in an ex vivo model. Clin Oral Investig 2018;22(4):1725–1731. DOI: 10.1007/s00784-017-2266-0.
  20. Hargreaves KM, Berman LH. Cohen’s pathways of the pulp. 11th ed., St. Louis: Mosby Elsevier; 2016. pp. 447–473.
  21. Sakaguchi RL, Powers JM. Craig’s Restorative dental materials. 13th ed., St Louis: Elsevier Mosby; 2012. pp. 55–57.
  22. Marconyak LJJr, Kirkpatrick TC, Roberts HW, et al. A comparison of coronal tooth discoloration elicited by various endodontic reparative materials. J Endod 2016;42(3):470–473. DOI: 10.1016/j.joen.2015.10.013.
  23. Marin PD, Heithersay GS, Bridges TE. A quantitative comparison of traditional and non-peroxide bleaching agents. Endod Dent Traumatol 1998;14(2):64–67. DOI: 10.1111/j.1600-9657.1998.tb00811.x.
  24. Felman D, Parashos P. Coronal tooth discoloration and white mineral trioxide aggregate. J Endod 2013;39(4):484–487. DOI: 10.1016/j.joen.2012.11.053.
  25. Shokouhinejad N, Razmi H, Farbod M, et al. Coronal tooth discoloration induced by regenerative endodontic treatment using different scaffolds and intracanal coronal barriers: a 6-month ex vivo study. Restor Dent Endod 2019;44(3):e25. DOI: 10.5395/rde.2019.44. e25.
  26. Guimarães BM, Tartari T, Marciano MA, et al. Color stability, radiopacity, and chemical characteristics of white mineral trioxide aggregate associated with 2 different vehicles in contact with blood. J Endod 2015;41(6):947–952. DOI: 10.1016/j.joen.2015.02.008.
  27. Shokouhinejad N, Razmi H, Nekoofar M, et al. Push-out bond strength of bioceramic materials in a synthetic tissue fluid. J Dent 2013;10:540–547.
  28. Wang Z. Bioceramic materials in endodontics. Endod Topics 2015;32(1):3–30. DOI: 10.1111/etp.12075.
  29. Chen MYH, Chen KL, Chen CA, et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J 2012;45(3):294–305. DOI: 10.1111/j.1365-2591.2011.01978.x.
  30. Ioannidis K, Mistakidis I, Beltes P, et al. Spectrophotometric analysis of coronal discolouration induced by grey and white MTA. Int Endod J 2013;46(2):137–144. DOI: 10.1111/j.1365-2591.2012.02098.x.
  31. Kohli MR, Yamaguchi M, Setzer FC, et al. Spectrophotometric analysis of coronal tooth discoloration induced by various bioceramic cements and other endodontic materials. J Endod 2015;41(11): 1862–1866. DOI: 10.1016/j.joen.2015.07.003.
  32. Camilleri J. Characterization of hydration products of mineral trioxide aggregate. Int Endod J 2008;41(5):408–417. DOI: 10.1111/j.1365- 2591.2007.01370.x.
  33. Kang SH, Shin YS, Lee HS, et al. Color changes of teeth after treatment with various mineral trioxide aggregate-based materials: an ex vivo study. J Endod 2015;41(5):737–741. DOI: 10.1016/j.joen.2015. 01.019.
  34. Marciano MA, Costa RM, Camilleri J, et al. Assessment of color stability of white mineral trioxide aggregate angelus and bismuth oxide in contact with tooth structure. J Endod 2014;40(8):1235–1240. DOI: 10.1016/j.joen.2014.01.044.
  35. Marciano MA, Duarte MA, Camilleri J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clin Oral Investig 2015;19(9):2201–2209. DOI: 10.1007/s00784-015-1466-8.
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