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References

Camilleri J, Laurent P, About I. Hydration of Biodentine, Theracal LC, and a prototype tricalcium silicate-based dentin replacement material after pulp capping in entire tooth cultures. J Endod. 2014; https://doi.org/10.1016/j.joen.2014.06.018
Camilleri J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. Dent Mater. 2014; 30:709-715
Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012; 45:571-579
Gandolfi MG, Siboni F, Botero T, Bossù M, Riccitiello F, Prati C. Calcium silicate and calcium hydroxide materials for pulp capping: biointeractivity, porosity, solubility and bioactivity of current formulations. J Appl Biomater Funct Mater. 2014; https://doi.org/10.5301/jabfm.5000201
Poggio C, Arciola CR, Beltrami R, Monaco A, Dagna A, Lombardini M, Visai L. Cytocompatibility and antibacterial properties of capping materials. Scient Wld J 2014. 2014; https://doi.org/10.1155/2014/181945
Hebling J, Lessa FC, Nogueira I, Carvalho RM, Costa CA. Cytotoxicity of resin-based light-cured liners. Am J Dent. 2009; 22:137-142
Savas S, Botsali MS, Kucukyilmaz E, Sari T. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances. Dent Mater J. 2014;
Gandolfi MG, Taddei P, Siboni F Development of the foremost light curable calcium-silicate MTA cement as root-end in oral surgery: chemical-physical properties, bioactivity and biological behavior. Dent Mater. 2011; 27:e134-e157
Gandolf MG, Taddei P, Siboni F Biomimetic remineralization of human dentin using promising innovative calcium-silicate hybrid “smart” materials. Dent Mater. 2011; 27:1055-1069
Profeta AC, Mannocci F, Foxton R Experimental etch-and-rinse adhesives doped with bioactive calcium silicate-based micro-fillers to generate therapeutic resin-dentin interfaces. Dent Mater. 2013; 29:729-741
Sauro R, Osorio R, Osorio E Novel light-curable materials containing experimental bioactive micro-fillers remineralise mineral-depleted bonded-dentine interfaces. J Biomater Sci Polym Ed. 2013; 24:940-956
Camilleri J. Tricalcium silicate cements with resins and alternative radiopacifiers. J Endod. 2014; https://doi.org/10.1016/j.joen.2014.08.016

Authors' response

From Volume 41, Issue 10, December 2014 | Pages 931-932

Authors

Arindam Dutta

BDS, MDS, MFDS RCPS(Glasg)

Edinburgh Dental Institute

Articles by Arindam Dutta

WP Saunders

Dundee Dental School

Articles by WP Saunders

Article

We thank Mr Cann for his letter and interest in our article.

The purpose of our review was to make the reader aware of the development and availability of a multitude of materials from the calcium silicate family. To that end, it is indisputable that a class of resin-based hybrid calcium silicate materials has indeed been developed in the recent past and we have highlighted some of these developments up until the point of submission of this article. It is important to note that we qualify TheraCal as a ‘Hybrid’ cement, implying a component other than traditional calcium silicate. Camilleri has recognized TheraCal as a calcium silicate-based material,1,2 as have other authors.3,4 There is general consensus on this aspect in peer reviewed literature and our review has not made new assumptions. Analysis of TheraCal has revealed that its main cementitious phase is a Portland cement, which includes tricalcium aluminate together with tricalcium and dicalcium silicate phases.2 The approach to improve setting and handling properties has driven the development of calcium silicate materials, both in academia and industry, and our paper recognizes the hybrid calcium silicate-resin material. As this approach has been distinct from previously developed methods, it merits inclusion, though under a different generation of the calcium silicate family. The review does not focus on MTA-like materials alone and it is important to acknowledge the existence of a wider calcium silicate material family.

We believe that material properties between commercial brands and formulations within a class/type of material (in this instance calcium silicate materials) will vary. Properties of TheraCal have been investigated.1,2,3,4,5,6,7 Light-cured resins with calcium silicate materials have been reported previously.8,9,10,11,12 Studies have demonstrated formation of hydroxyapatite on the surface of such materials,8,9 as well as dentine remineralization.9,10,11 Some reaction rims were demonstrated around cement particles in hydrated TheraCal, though these are less extensive as compared with Biodentine.2 Secondary electron micrographs of calcium silicate/Bis GMA-TEGDMA (used as a vehicle) material immersed in water and HBSS for 28 days showed calcium silicate hydrate, but to a lesser extent than calcium silicate cements mixed with water or epoxy resins.12 Calcium hydroxide leaching was demonstrated in this study. A light-cured MTA product has also allowed Saos-2 cell viability and growth without toxicity.8 TheraCal has demonstrated calcium ion release in laboratory studies. Owing to differences in methodologies, some studies have demonstrated calcium ion release to be higher,3 or similar to,4 ProRoot MTA, while others have demonstrated this to be lower than Biodentine.2 TheraCal, ProRoot MTA and Biodentine and several other materials have been compared in a single paper which has shown cumulative calcium ion release from Biodentine to be significantly higher than TheraCal and ProRoot MTA.4 No difference was noted between ProRoot MTA and TheraCal.

The argument for biological applications for such hybrid materials in endodontics is therefore still valid, but at a nascent stage. The purpose of this review paper was neither to berate, nor promote a commercial product. It rather highlights the approaches that have been utilized to evolve material properties that are based on calcium silicates. The formation of a surface crystalline layer when in contact with body fluids (or equivalent) and potential for bioactivity is a general feature for these materials and common with preceding generations of calcium silicate materials. It is impossible to perceive fundamental homogeneity on all aspects of a particular class of materials and we have, therefore, in no way attempted to confuse or mislead the readers of Dental Update. Several experimental calcium silicate materials have been reported in the past, but their development has been discarded because of inherently deficient results. In an era of evidence-based dentistry, clinical decisions should be based, on balance, between desirable material features and outcomes of treatment. Randomized clinical trials and high quality clinical evidence for new calcium silicate cements are surprisingly lacking, and require further research.