Quantifying Coronal Primary Tooth Discoloration Caused by Different Pulpotomy Materials

Introduction: Bioceramic materials, gray and white mineral trioxide aggregate (GMTA, WMTA), have been shown to have high rates of success in various endodontic applications. A major drawback is their tendency to discolor teeth. Biodentine (BD), a recenlty developed bioceramic material, has been claimed not to discolor teeth. The aim of this study was to compare tooth discoloration after applying different pulpotomy base materials (BD, GMTA and WMTA).

Methods: Forty human fully developed primary incisors teeth were used in this study. Coronal access was achieved by a Tungsten Carbide drill, and the pulp chambers were accessed and chemo-mechanically debrided. Each material was placed in the pulp chamber, up to the cervical sectioning level. All specimens were incubated at 37◦ C and 100% humidity for 14 weeks and have been evaluated before the study and weekly. Color was assessed according to the CIE L*a*b* color space system.

Results: The ∆E (delta E) of all experimental groups (GMTA, WMTA and BD) were significantly different from the control group at all time points. Color changes in the GMTA and WMTA groups showed significantly higher discoloration compared to BD group in the cervical part of the crown, since week 1. WMTA group showed significant discoloration in the cervical part as of week 1, and gradually increased over time. BD group showed no significant discoloration over time. GMTA group showed the most significant discoloration at week 1 and week 14 (P<0.05).

Conclusions: both GMTA and WMTA pulpotomy materials may discolor tooth structure over time in an extracted primary anterior tooth model. When choosing bioceramic pulpotomy material, BD may be preferable, mainly in esthetic area.

Biodentine; Discoloration; Pulputomy; Mineral Trioxide Aggregate; Pro Root

1. Fuks AB. Current concepts in vital primary pulp therapy. Eur J Paediatr Dent. 2002;3(3):115-120. http://www.ncbi.nlm.nih.gov/pubmed/12870999. Accessed September 23, 2018.

2. AMERICAN ACADEMY OF PEDIATRIC DENTISTRY CLINICAL PRACTICE GUIDELINES 245. http://www.aapd.org/media/policies_ guidelines/g_pulp.pdf. Accessed September 23, 2018.

3. Markovic D, Zivojinovic V, Vucetic M. Evaluation of three pulpotomy medicaments in primary teeth. Eur J Paediatr Dent ;6(3):133. 2005.

4. Vargas KG, Fuks AB, Peretz B. Pulpotomy Techniques: Cervical (Traditional) and Partial. In: Pediatric Endodontics. Cham: Springer International Publishing; 2016:51-70. doi:10.1007/978-3-319-27553-6_5

5. Ranly DM. Assessment of the systemic distribution and toxicity of formaldehyde following pulpotomy treatment: Part one. ASDC J Dent Child. 1985;52(6):431-434. http://www.ncbi.nlm.nih.gov/pubmed/3864800. Accessed November 27, 2019.

6. Praveen KN, Rashmi N, Vipin BK, Pujan MP. Pulpotomy Medicaments: Continued Search for New Alternatives- A Review. https://pdfs.semanticscholar.org/4116/5c5c4386eff7dad9b9680d7099d92ddd58e0.pdf. Accessed November 27, 2019.

7. Vargas KG, Packham B. Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation. Pediatr Dent. 27(3):233- 237. http://www.ncbi.nlm.nih.gov/pubmed/16173229. Accessed November 27, 2019.

8. Smaïl-Faugeron V, Courson F, Durieux P, Muller-Bolla M, Glenny A-M, Fron Chabouis H. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2014;(8):CD003220. doi:10.1002/14651858. CD003220.pub2

9. HOLAN, G. Introduction to dental trauma : Managing traumatic injuries in the primary dentition. Pediatr Dent Infancy Through Adolesc. 2005:236- 256. https://ci.nii.ac.jp/naid/10030290004/. Accessed September 23, 2018.

10. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod. 1978;4(8):232-237. doi:10.1016/S0099-2399(78)80153-8

11. 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):942-949. doi:10.1111/j.1365-2591.2012.02053.x

12. van der Burgt TP, Mullaney TP, Plasschaert AJM. Tooth discoloration induced by endodontic sealers. Oral Surgery, Oral Med Oral Pathol. 1986;61(1):84-89. doi:10.1016/0030-4220(86)90208-2

13. Asgary S, Akbari Kamrani F, Taheri S. Evaluation of antimicrobial effect of MTA, calcium hydroxide, and CEM cement. Iran Endod J. 2007;2(3):105- 109. http://www.ncbi.nlm.nih.gov/pubmed/24298290. Accessed July 28, 2018.

14. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod. 1995;21(7):349- 353. doi:10.1016/S0099-2399(06)80967-2

15. Belobrov I, Parashos P. Treatment of Tooth Discoloration after the Use of White Mineral Trioxide Aggregate. J Endod. 2011;37(7):1017-1020. doi:10.1016/J.JOEN.2011.04.003

16. Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. 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

17. Akbari M, Rouhani A, Samiee S, Jafarzadeh H. Effect of dentin bonding agent on the prevention of tooth discoloration produced by mineral trioxide aggregate. Int J Dent. 2012;2012:563203. doi:10.1155/2012/563203

18. Song J-S, Mante FK, Romanow WJ, Kim S. Chemical analysis of powder and set forms of Portland cement, gray ProRoot MTA, white ProRoot MTA, and gray MTA-Angelus. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2006;102(6):809-815. doi:10.1016/j.tripleo.2005.11.034

19. Maroto M, Barberia E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol. 2003;19(3):165-169. doi:10.1034/j.1600-9657.2003.00106.x

20. Watts JD, Holt DM, Beeson TJ, Kirkpatrick TC, Rutledge RE. Effects of pH and Mixing Agents on the Temporal Setting of Tooth-colored and Gray Mineral Trioxide Aggregate. J Endod. 2007;33(8):970-973. doi:10.1016/J. JOEN.2007.01.024

21. Steffen R, van Waes H. Understanding mineral trioxide aggregate/Portlandcement: A review of literature and background factors. Eur Arch Paediatr Dent. 2009;10(2):93-97. doi:10.1007/BF03321608

22. Hwang Y-C, Kim D-H, Hwang I-N, et al. Chemical Constitution, Physical Properties, and Biocompatibility of Experimentally Manufactured Portland Cement. J Endod. 2011;37(1):58-62. doi:10.1016/J.JOEN.2010.09.004

23. Han L, Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials. Int Endod J. 2013;46(9):808-814. doi:10.1111/ iej.12062

24. Shokouhinejad N, Nekoofar MH, Razmi H, et al. Bioactivity of EndoSequence Root Repair Material and Bioaggregate. Int Endod J. 2012;45(12):1127-1134. doi:10.1111/j.1365-2591.2012.02083.x

25. Zhou H, Shen Y, Wang Z, et al. In Vitro Cytotoxicity Evaluation of a Novel Root Repair Material. J Endod. 2013;39(4):478-483. doi:10.1016/j. joen.2012.11.026

26. AlAnezi AZ, Jiang J, Safavi KE, Spangberg LSW, Zhu Q. Cytotoxicity evaluation of endosequence root repair material. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;109(3):e122-e125. doi:10.1016/J.TRIPLEO.2009.11.028

27. Butt N, Bali A, Talwar S, Chaudhry S, Nawal R, Yadav S. Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine. Indian J Dent Res. 2014;25(6):692. doi:10.4103/0970-9290.152163

28. Camilleri J. Investigation of Biodentine as dentine replacement material. J Dent. 2013;41(7):600-610. doi:10.1016/j.jdent.2013.05.003

29. Flores-Mir C, Silva E, Barriga MI, Lagravère MO, Major PW. Lay person’s perception of smile aesthetics in dental and facial views. J Orthod. 2004;31(3):204-209. doi:10.1179/146531204225022416

30. Cortes MI de S, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children. Community Dent Oral Epidemiol. 2002;30(3):193-198. http:// www.ncbi.nlm.nih.gov/pubmed/12000342. Accessed September 23, 2018.

31. Holan G, Needleman HL. Premature loss of primary anterior teeth due to trauma–potential short- and long-term sequelae. Dent Traumatol. 2014;30(2):100-106. doi:10.1111/edt.12081

32. Gherunpong S, Tsakos G, Sheiham A. The prevalence and severity of oral impacts on daily performances in Thai primary school children. Health Qual Life Outcomes. 2004;2(1):57. doi:10.1186/1477-7525-2-57

33. Karamouzos A, Athanasiou AE, Papadopoulos MA, Kolokithas G. Toothcolor assessment after orthodontic treatment: A prospective clinical trial. Am J Orthod Dentofac Orthop. 2010;138(5):537.e1-537.e8. doi:10.1016/J. AJODO.2010.03.026

34. Karamouzos A, Papadopoulos MA, Kolokithas G, Athanasiou AE. Precision of in vivo spectrophotometric colour evaluation of natural teeth. J Oral Rehabil. 2007;34(8):613-621. doi:10.1111/j.1365-2842.2007.01744.x

35. Nickerson D. Munsell Color System, Company, and Foundation.; 1976. https://munsell.com/wp-content/uploads/2011/03/munsell-color-history-dorothy-nickerson.pdf. Accessed September 23, 2018.

36. Chu SJ. Use of a reflectance spectrophotometer in evaluating shade change resulting from tooth-whitening products. J Esthet Restor Dent. 2003;15 Suppl 1:S42-8. http://www.ncbi.nlm.nih.gov/pubmed/15000904. Accessed September 23, 2018.

37. Russell MD, Gulfraz M, Moss BW. In vivo measurement of colour changes in natural teeth. J Oral Rehabil. 2000;27(9):786-792. http://www.ncbi.nlm.nih.gov/pubmed/11012854. Accessed September 23, 2018.

38. Davis MC, Walton RE, Rivera EM. Sealer Distribution in Coronal Dentin. J Endod. 2002;28(6):464-466. doi:10.1097/00004770-200206000-00012

39. Camilleri J. Color Stability of White Mineral Trioxide Aggregate in Contact with Hypochlorite Solution. J Endod. 2014;40(3):436-440. doi:10.1016/j. joen.2013.09.040

40. Seghi RR, Hewlett ER, Kim J. Visual and Instrumental Colorimetric Assessments of Small Color Differences on Translucent Dental Porcelain. J Dent Res. 1989;68(12):1760-1764. doi:10.1177/00220345890680120801

41. 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):243-250. doi:10.1016/j.joen.2008.10.026

42. 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

43. Karabucak B, Li D, Lim J, Iqbal M. Vital pulp therapy with mineral trioxide aggregate. Dent Traumatol. 2005;21(4):240-243. doi:10.1111/j.1600-9657.2005.00306.x

44. Jang J-H, Kang M, Ahn S, et al. Tooth Discoloration after the Use of New Pozzolan Cement (Endocem) and Mineral Trioxide Aggregate and the Effects of Internal Bleaching. J Endod. 2013;39(12):1598-1602. doi:10.1016/J.JOEN.2013.08.035

45. Freccia WF, Peters DD. A technique for staining extracted teeth: a research and teaching aid for bleaching. J Endod. 1982;8(2):67-69. doi:10.1016/ S0099-2399(82)80260-4

46. Marin PD, Bartold PM, Heithersay GS. Tooth discoloration by blood: an in vitro histochemical study. Dent Traumatol. 1997;13(3):132-138. doi:10.1111/j.1600-9657.1997.tb00026.x