Elkateb, Walid M; Young, Anne; Nguyen, Linh Tb; (2023) Novel Bioactive Calcium Phosphate based endodontic cements with added Hydroxyapatite nanoparticles and antibacterial agent ε-Polylysine. Presented at: TERMIS-EU Chapter 2023, Manchester, UK.

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Abstract

INTRODUCTION: Vital Pulp therapy and Revascularization are endodontic therapeutic techniques that rely on the regenerative capacity of human dental pulp stem cells (hDPSCs). An Ideal material for these techniques should provide antibacterial action, encourage cell proliferation and release essential ions for remineralisation. Other requirements include suitable handling, setting and mechanical properties. Unfortunately, current commercial materials, fall short of fulfilling some of these requirements. Calcium phosphate compounds have inherent biocompatibility, bio-interactivity and bioactivity (apatite-forming capacity). Nevertheless, their application in Endodontics have not been fully explored. Aim is to improve the bioactivity of a Brushite forming novel calcium phosphate cement, by addition of Hydroxyapatite (HA) nanoparticles in the presence of ɛ polylysine (PLS) as an antibacterial agent and comparing it to Mineral Trioxide Aggregate (MTA), Biodentine and Dycal. METHODS: Brushite cement was prepared using equimolar Mono and β-Tricalcium phosphate (TCP) with 800mM citric acid at a powder to liquid ratio of 4:1. This was then modified through TCP substitution by HA (25 or 50 wt%). Additionally, PLS (20 or 40 wt%) was added to the citric acid solution. Setting and dissolution kinetics were determined using FTIR and gravimetrically (n=3). Flexural strength after setting for 24 hours was determined (n=6). hDPSCs viability and adherence on disc surfaces was assessed with SEM and Live /dead (L/D) stain (n=3). Cellular proliferation rate in the presence of different extract dilutions for up to 7 days was assessed using MTT assay (n=6). RESULTS: Combined FTIR and mechanical studies, showed Brushite formulations set within 30 minutes. Conversely MTA and Biodentine had much slower and different setting chemistries. Flexural strength for the Brushite formulations decreased upon PLS addition (25±2 to 12.14± 1 MPa). Strengths of MTA (6.4±0.5 MPa), Biodentine (13.4±1 MPA) and Dycal (3.4±0.5 MPa) were significantly lower (p <<0.05). Increase in PLS concentration, accelerated the early Brushite dissolution (first 30 minutes), but this was reduced 50% by HA addition. Commercial cements initially increased in mass before dissolution. L/D assay showed a high ratio of live cells in the HA added groups, this ratio decreased clearly in the HA free formulations, with fewer live cells on the MTA and Biodentine, and none on the Dycal. MTT assay showed cells exposed to extracts from formulations with HA had a higher proliferation rate than control and commercial formulations. DISCUSSION & CONCLUSIONS: Brushite forming cements with antibacterial agent ɛ polylysine may be a useful candidate as an endodontic cement. Addition of Hydroxyapatite nanoparticles improved the bioactivity.

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