Browse > Article
http://dx.doi.org/10.5395/rde.2015.40.1.1

Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications  

Utneja, Shivani (Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences)
Nawal, Ruchika Roongta (Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences)
Talwar, Sangeeta (Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences)
Verma, Mahesh (Department of Prosthodontics, Maulana Azad Institute of Dental Sciences)
Publication Information
Restorative Dentistry and Endodontics / v.40, no.1, 2015 , pp. 1-13 More about this Journal
Abstract
Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.
Keywords
Biological and physical properties; Calcium enriched mixture cement; Clinical applications; Composition; Leakage; Mechanism of action;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Yavari HR, Samiei M, Shahi S, Aghazadeh M, Jafari F, Abdolrahimi M, Asgary S. Microleakage comparison of four dental materials as intra-orifice barriers in endodontically treated teeth. Iran Endod J 2012;7:25-30.
2 Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Treatment outcomes of primary molars direct pulp capping after 20 months: a randomized controlled trial. Iran Endod J 2013;8:149-152.
3 Malekafzali B, Shekarchi F, Asgary S. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. Eur J Paediatr Dent 2011;12:189-193.
4 Nosrat A, Asgary S, Eghbal MJ, Ghoddusi J, Bayat-Movahed S. Calcium-enriched mixture cement as artificial apical barrier: a case series. J Conserv Dent 2011;14:427-431.   DOI
5 Bidar M, Disfani R, Asgary S, Forghani M, Gharagozlo S, Rouhani A. Effect of calcium hydroxide premedication on the marginal adaptation of calcium-enriched mixture cement apical plug. Dent Res J (Isfahan) 2012;9:706-709.
6 Asgary S, Eghbal MJ, Ghoddusi J. Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial. Clin Oral Investig 2014;18:635-641.   DOI
7 Asgary S, Eghbal MJ. The effect of pulpotomy using a calcium-enriched mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial. Odontology 2010;98:126-133.   DOI
8 Asgary S, Ahmadyar M. Vital pulp therapy using calcium-enriched mixture: an evidence-based review. J Conserv Dent 2013;16:92-98.   DOI
9 Mehrdad L, Malekafzali B, Shekarchi F, Safi Y, Asgary S. Histological and CBCT evaluation of a pulpotomised primary molar using calcium enriched mixture cement. Eur Arch Paediatr Dent 2013;14:191-194.   DOI
10 Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 2011;37:581-587.   DOI
11 Harandi A, Forghani M, Ghoddusi J. Vital pulp therapy with three different pulpotomy agents in immature molars: a case report. Iran Endod J 2013;8:145-148.
12 Asgary S. Calcium-enriched mixture pulpotomy of a human permanent molar with irreversible pulpitis and condensing apical periodontitis. J Conserv Dent 2011;14:90-93.   DOI
13 Asgary S, Eghbal MJ. Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial. Acta Odontol Scand 2013;71:130-136.   DOI
14 Moradi Majd N, Akhtari F, Araghi S, Homayouni H. Treatment of a vertical root fracture using dualcuring resin cement: a case report. Case Rep Dent 2012;2012:985215. doi: 10.1155/2012/985215. [Epub 2012 Dec 18]   DOI
15 Asgary S, Nosrat A, Seifi A. Management of inflammatory external root resorption by using calcium-enriched mixture cement: a case report. J Endod 2011;37:411-413.   DOI
16 Camp J, Fuks A. Pediatric endodontics: endodontic treatment for the primary and young permanent dentition. In: Cohen S, Hargreaves K, Keiser K, editors. Pathways of the Pulp. 9th ed. St Louis: Mosby Elsevier; 2006. p822-882.
17 Rafter M. Apexification: a review. Dent Traumatol 2005;21:1-8.   DOI
18 Giuliani V, Baccetti T, Pace R, Pagavino G. The use of MTA in teeth with necrotic pulps and open apices. Dent Traumatol 2002;18:217-221.   DOI
19 Hayashi M, Shimizu A, Ebisu S. MTA for obturation of mandibular central incisors with open apices: case report. J Endod 2004;30:120-122.   DOI
20 Gaitonde P, Bishop K. Apexification with mineral trioxide aggregate: an overview of the material and technique. Eur J Prosthodont Restor Dent 2007;15:41-45. Calcium enriched mixture cement: review
21 Hiremath H, Gada N, Kini Y, Kulkarni S, Yakub SS, Metgud S. Single-step apical barrier placement in immature teeth using mineral trioxide aggregate and management of periapical inflammatory lesion using platelet-rich plasma and hydroxyapatite. J Endod 2008;34:1020-1024.   DOI
22 Milani AS, Rahimi S, Borna Z, Jafarabadi MA, Bahari M, Deljavan AS. Fracture resistance of immature teeth filled with mineral trioxide aggregate or calciumenriched mixture cement: an ex vivo study. Dent Res J (Isfahan) 2012;9:299-304.
23 Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004;30:196-200.   DOI
24 Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod 2009;35:745-749.   DOI
25 Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod 2010;36:536-541.   DOI
26 Swarup S, Rao A. Bioceramics in pediatric endodontics. 1st ed. Trivandrum: Lambert Academic Publishing; 2013. p53-68.
27 Nasseh A. The rise of bioceramics. Endodontic Practice 2009;2:17-22.
28 Koch K, Brave D. A new day has dawned: the increased use of bioceramics in endodontics. Dentaltown 2009;10(4):39-43.
29 Best SM, Porter AE, Thian ES, Huang J, Bioceramics: past, present and for the future. J Eur Ceram Soc 2008;28:1319-1327.   DOI
30 Jean A, Kerebel B, Kerebel LM, Legeros RZ, Hamel H. Effects of various calcium phosphate biomaterials on reparative dentin bridge formation. J Endod 1988;14:83-87.   DOI
31 Pissiotis E, Spangberg LS. Biological evaluation of collagen gels containing calcium hydroxide and hydroxyapatite. J Endod 1990;16:468-473.   DOI
32 Liu C, Wang W, Shen W, Chen T, Hu L, Chen Z. Evaluation of the biocompatibility of a nonceramic hydroxyapatite. J Endod 1997;23:490-493.   DOI
33 Dhingra A, Chopra V, Raj S. Challenges of bioengineering and endodontics. J Dev Biol Tissue Eng 2011;3:80-84.
34 Harbert H. Generic tricalcium phosphate plugs: an adjunct in endodontics. J Endod 1991;17:131-134.   DOI
35 Boone ME 2nd, Kafrawy AH. Pulp reaction to a tricalcium phosphate ceramic capping agent. Oral Surg Oral Med Oral Pathol 1979;47:369-371.   DOI
36 Oguntebi B, Clark A, Wilson J. Pulp capping with Bioglass and autologous demineralised dentin in miniature swine. J Dent Res 1993;72:484-489.   DOI
37 Coviello J, Brilliant JD. A preliminary clinical study on the use of tricalcium phosphate as an apical barrier. J Endod 1979;5:6-13.   DOI
38 Metsger DS, Driskell TD, Paulsrud JR. Tricalcium phosphate ceramic-a resorbable bone implant: review and current status. J Am Dent Assoc 1982;105:1035-1038.   DOI
39 Bae WJ, Chang SW, Lee SI, Kum KY, Bae KS, Kim EC. Human periodontal ligament cell response to a newly developed calcium phosphate-based root canal sealer. J Endod 2010;36:1658-1663.   DOI
40 Abu Zeid ST, Ezzat KM, Kamal SM. Reparative activity of bioglass and tricalcium phosphate to induce apical closure compared to normal apexogensis (histological and histochemical study). Available from: http://www.kau.edu.sa/Files/0052394/Researches/28671_Reparative%20Activity%20Of%20Bioglass%20And%20Tricalcium%20Phosphate.pdf(updated 2014 Mar 30).
41 Friedman S. Application of glass-ionomer in endodontics. In: Davidson CL, Mjor IA, editors. Advances in glassionomer cements. Chicago: Quintessence Books; 1999. p183-200.
42 Naoum HJ, Chandler NP. Temporization for endodontics. Int Endod J 2002;35:964-978.   DOI
43 Chong BS, Pitt Ford TR, Watson TF. The adaptation and sealing ability of light-cured glass ionomer retrograde root fillings. Int Endod J 1991;24:223-232.   DOI
44 Pameijer CH. A review of luting agents. Int J Dent 2012;2012:752861. doi: 10.1155/2012/752861. Epub 2012 Feb 22.   DOI
45 Hilton TJ. Keys to Clinical Success with pulp capping: a review of the literature. Oper Dent 2009;34:615-625.   DOI
46 Asgary S, Eghbal MJ, Parirokh M, Torabzadeh H. Sealing ability of three commercial mineral trioxide aggregate and an experimental root-end filling material. Iran Endod J 2006;1:101-105.
47 Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part III: clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-413.   DOI
48 Gomes-Filho JE, Watanabe S, Bernabe PF, de Moraes Costa MT. A mineral trioxide aggregate sealer stimulated mineralization. J Endod 2009;35:256-260.   DOI
49 Tyagi S, Mishra P, Tyagi P. Evolution of root canal sealers: an insight story. Eur J Gen Dent 2013;2:199-218.   DOI
50 Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod 2008;34:990-993.   DOI
51 Asgary S, Eghbal MJ, Parirokh M, Ghoddusi J. Effect of two storage solutions on surface topography of two root-end fillings. Aust Endod J 2009;35:147-152.   DOI
52 Asgary S, Eghbal MJ, Ehsani S. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. J Endod 2010;36:837-841.   DOI
53 Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod 2011;37:562-567.   DOI
54 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;87:706-709.
55 Asgary S, Eghbal MJ, Parirokh M, Ghanavati F, Rahimi H. A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:609-614.   DOI
56 Asgary S, Kamrani FA. Antibacterial effects of five different root canal sealing materials. J Oral Sci 2008;50:469-474.   DOI
57 Samiee M, Eghbal MJ, Parirokh M, Abbas FM, Asgary S. Repair of furcal perforation using a new endodontic cement. Clin Oral Investig 2010;14:653-658.   DOI
58 Asgary S, Ehsani S. Permanent molar pulpotomy with a new endodontic cement: a case series. J Conserv Dent 2009;12:31-36.   DOI
59 Asgary S, Ahmadyar M. One-visit endodontic retreatment of combined external/internal root resorption using a calcium-enriched mixture. Gen Dent 2012;60:e244-248.
60 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;35:243-250.   DOI
61 Amini Ghazvini S, Abdo Tabrizi M, Kobarfard F, Akbarzadeh Baghban A, Asgary S. Ion release and pH of a new endodontic cement, MTA and Portland cement. Iran Endod J 2009;4:74-78.
62 Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011;44:697-730.   DOI
63 Estrela C, Bammann LL, Estrela CR, Silva RS, Pecora JD. Antimicrobial and chemical study of MTA, Portland cement, calcium hydroxide paste, Sealapex and Dycal. Braz Dent J 2000;11:3-9.
64 Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial effects of some root end filling materials. J Endod 1995;21:403-406.   DOI
65 Asgary S, Akbari Kamrani F, Taheri S. Evaluation of antimicrobial effect of MTA, calcium hydroxide, and CEM cement. Iran Endod J 2007;2:105-109.
66 Murray PE, Garcia Godoy C, Garcia Godoy F. How is the biocompatibilty of dental biomaterials evaluated? Med Oral Patol Oral Cir Bucal 2007;12:e258-266.
67 Hasan Zarrabi M, Javidi M, Naderinasab M, Gharechahi M. Comparative evaluation of antimicrobial activity of three cements: new endodontic cement (NEC), mineral trioxide aggregate (MTA) and Portland. J Oral Sci 2009;51:437-442.   DOI
68 Kangarlou A, Sofiabadi S, Yadegari Z, Asgary S. Antifungal effect of calcium enriched mixture cement against Candida albicans. Iran Endod J 2009;4:101-105.
69 Razmi H, Aminsobhani M, Bolhari B, Shamshirgar F, Shahsavan S, Shamshiri AR. Calcium enriched mixture and mineral trioxide aggregate activities against Enterococcus Faecalis in presence of dentin. Iran Endod J 2013;8:191-196.
70 Ghoddusi J, Tavakkol Afshari J, Donyavi Z, Brook A, Disfani R, Esmaeelzadeh M. Cytotoxic effects of new endodontic cement and mineral trioxide aggregate on L929 line culture. Iran Endod J 2008;3:17-23.
71 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;38:70-75.   DOI
72 Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J 2006;39:747-754.   DOI
73 Asgary S, Moosavi SH, Yadegari Z, Shahriari S. Cytotoxic effect of MTA and CEM cement in human gingival fibroblast cells. Scanning electronic microscope evaluation. N Y State Dent J 2012;78:51-54.
74 Tabarsi B, Pourghasem M, Moghaddamnia A, Shokravi M, Ehsani M, Ahmadyar M, Asgary S. Comparison of skin test reactivity of two endodontic biomaterials in rabbits. Pak J Biol Sci 2012;15:250-254.   DOI
75 Asgary S, Parirokh M, Eghbal MJ, Ghoddusi J. SEM evaluation of pulp reaction to different pulp capping materials in dog’s teeth. Iran Endod J 2006;1:117-123.
76 Parirokh M, Mirsoltani B, Raoof M, Tabrizchi H, Haghdoost AA. Comparative study of subcutaneous tissue responses to a novel root-end filling material and white and grey mineral trioxide aggregate. Int Endod J 2011;44:283-289.   DOI
77 Rahimi S, Mokhtari H, Shahi S, Kazemi A, Asgary S, Eghbal MJ, Mesgariabbasi M, Mohajeri D. Osseous reaction to implantation of two endodontic cements: mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM). Med Oral Patol Oral Cir Bucal 2012;17:e907-911.
78 Abbasipour F, Akheshteh V, Rastqar A, Khalilkhani H, Asgary S, Janahmadi M. Comparing the effects of mineral trioxide aggregate and calcium enriched mixture on neuronal cells using an electrophysiological approach. Iran Endod J 2012;7:79-87.
79 Asgary S. Furcal perforation repair using calcium enriched mixture cement. J Conserv Dent 2010;13:156-158.   DOI
80 Asgary S, Ehsani S. Periradicular surgery of human permanent teeth with calcium-enriched mixture cement. Iran Endod J 2013;8:140-144.
81 Tabarsi B, Parirokh M, Eghbal MJ, Haghdoost AA, Torabzadeh H, Asgary S. A comparative study of dental pulp response to several pulpotomy agents. Int Endod J 2010;43:565-571.   DOI
82 Nosrat A, Asgary S. Apexogenesis treatment with a new endodontic cement: a case report. J Endod 2010;36:912-914.   DOI
83 Nosrat A, Asgary S. Apexogenesis of a symptomatic molar with calcium enriched mixture. Int Endod J 2010;43:940-944.   DOI
84 Zarrabi MH, Javidi M, Jafarian AH, Joushan B. Immunohistochemical expression of fibronectin and tenascin in human tooth pulp capped with mineral trioxide aggregate and a novel endodontic cement. J Endod 2011;37:1613-1618.   DOI
85 Nosrat A, Seifi A, Asgary S. Pulpotomy in cariesexposed immature permanent molars using calciumenriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Int J Paediatr Dent 2013;23:56-63.   DOI
86 Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Direct pulp-capping with calcium enriched mixture in primary molar teeth: a randomized clinical trial. Iran Endod J 2010;5:27-30.
87 Asgary S, Nosrat A, Homayounfar N. Periapical healing after direct pulp capping with calcium-enriched mixture cement: a case report. Oper Dent 2012;37:571-575.   DOI
88 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;36:1778-1781.   DOI
89 Torabzadeh H, Asgary S. Indirect pulp therapy in a symptomatic mature molar using calcium enriched mixture cement. J Conserv Dent 2013;16:83-86.   DOI
90 Torabinejad M, Eby WC, Naidorf IJ. Inflammatory and immunological aspects of the pathogenesis of human periapical lesions. J Endod 1985;11:479-488.   DOI
91 Pommel L, Camps J. Effects of pressure and measurement time on the fluid filtration method in endodontics. J Endod 2001;27:256-258.   DOI
92 Verissimo DM, do Vale MS. Methodologies for assessment of apical and coronal leakage of endodontic filling materials: a critical review. J Oral Sci 2006;48:93-98.   DOI
93 Milani AS, Shakouie S, Borna Z, Sighari Deljavan A, Asghari Jafarabadi M, Pournaghi Azar F. Evaluating the effect of resection on the sealing ability of MTA and CEM Cement. Iran Endod J 2012;7:134-138.
94 Xavier CB, Weismann R, de Oliveira MG, Demarco FF, Pozza DH. Root-end filling materials: apical microleakage and marginal adaptation. J Endod 2005;31:539-542.   DOI
95 De Bruyne MA, De Bruyne RJ, De Moor RJ. Long-term assessment of the seal provided by root-end filling materials in large cavities through capillary flow porometry. Int Endod J 2006;39:493-501.   DOI
96 Hasheminia M, Loriaei Nejad S, Asgary S. Sealing ability of MTA and CEM cement as root-end fillings of human teeth in dry, saliva or blood-contaminated conditions. Iran Endod J 2010;5:151-156.
97 Kazem M, Mahjour F, Dianat O, Fallahi S, Jahankhah M. Root-end filling with cement-based materials: an in vitro analysis of bacterial and dye microleakage. Dent Res J (Isfahan) 2013;10:46-51.
98 Soheilipour E, Kheirieh S, Madani M, Akbarzadeh Baghban A, Asgary S. Particle size of a new endodontic cement compared to Root MTA and calcium hydroxide. Iran Endod J 2009;4:112-116.
99 Moradi S, Disfani R, Ghazvini K, Lomee M. Sealing ability of orthograde MTA and CEM cement in apically resected roots using bacterial leakage method. Iran Endod J 2013;8:109-113.
100 Ghorbani Z, Kheirieh S, Shadman B, Eghbal MJ, Asgary S. Microleakage of CEM cement in two different media. Iran Endod J 2009;4:87-90.
101 Haghgoo R, Arfa S, Asgary S. Microleakage of CEM cement and ProRoot MTA as furcal perforation repair materials in primary teeth. Iran Endod J 2013;8:187-190.