Comparative evaluation of calcium ion release of two commercially available pulp capping agents at different time periods: An in vitro study

INTRODUCTION. Vital pulp therapy is a significant approach in restorative dentistry, enabling the preservation of pulp vitality and the stimulation of hard tissue repair. Modern pulp capping materials, particularly silicate-based cements, facilitate dentin bridge formation and promote tissue remineralization.TheraCal LC and ApaCal ART are two commercially available materials with bioactive properties and the ability to release calcium ions, contributing to pulp healing. However, there is limited literature on the bioactivity of ApaCal ART. This in vitro study aims to comparatively evaluate the calcium ion release from TheraCal LC and ApaCal ART using the EDTA titration method. The null hypothesis assumes no statistically significant differences between the tested materials.
AIM. The study aimed to compare and evaluate the calcium ion release of two commercially available pulp capping agents TheraCal LC and ApaCal ART at different time periods
MATERIALS AND METHODS. This in vitro study was conducted following good laboratory practice guidelines and approved by the institutional review board (Approval No. [DYPDCH/DPU/EC/582/142/2023]). Twenty cylindrical specimens (6 mm × 3 mm) were prepared using silicon molds and divided into two groups: TheraCal LC (n = 10) and ApaCal ART (n = 10). A dental floss was incorporated into each mold before filling with the respective material. TheraCal LC was light-cured for 20 seconds, and ApaCal ART for 40 seconds. The specimens were weighed for standardization and incubated in deionized water at 37°C and 100% humidity for 24 hours. Specimens were immersed in 5 mL of distilled water and assessed at 24 hours, 7 days, and 21 days. The solution was refreshed at each time point, and calcium ion concentration was measured using the EDTA titration method. Data were analyzed using IBM SPSS® Statistics 21.0. Intragroup comparisons were performed using repeated measures ANOVA with Tukey’s post-hoc test, and intergroup comparisons with an unpaired t-test (p < 0.05 considered statistically significant).
CONCLUSIONS. The study demonstrated that TheraCal LC and ApaCal ART exhibited a progressive increase in calcium ion release over time, reaching a peak on day 21. TheraCal LC released significantly more calcium ions at all time points and may be preferable for indirect pulp capping due to its enhanced stimulation of hard tissue formation.

1. Marovic D., Tarle Z., Hiller K.A., Müller R., Rosentritt M., Skrtic D., Schmalz G. Reinforcement of experimental composite materials based on amorphous calcium phosphate with inert fillers. Dent Mater. 2014;30(9):1052–1060. https://doi.org/10.1016/j.dental.2014.06.001

2. Kumar N.K., Geervani V.S., Kumar R.S.M., Singh S., Abhishek M., Manimozhi M. Data-driven dentistry: Computational revelations redefining pulp capping. J Conserv Dent Endod. 2024;27(6):649–653. https://doi.org/10.4103/JCDE.JCDE_268_24

3. Nangia U., Mala K., Shetty N., Natarajan S., Shenoy R. Histological analysis of human pulp following direct pulp capping with different materials: An ex vivo study. J Conserv Dent. 2021;24(6):585–588. https://doi.org/10.4103/jcd.jcd_486_21

4. Koutroulis A., Kuehne S.A., Cooper P.R., Camilleri J. The role of calcium ion release on biocompatibility and antimicrobial properties of hydraulic cements. Sci Rep. 2019;9(1):19019. https://doi.org/10.1038/s41598-019-55288-3

5. Nakamura K., Abe S., Minamikawa H., Yawaka Y. Calcium charge and release of conventional glass-ionomer cement containing nanoporous silica. Materials. 2018;11(8):1295. https://doi.org/10.3390/ma11081295

6. AAE position statement on vital pulp therapy. J Endod. 2021;47(9):1340–1344. https://doi.org/10.1016/j.joen.2021.07.015

7. Bostanci B., Gezgin O. The in vitro evaluation of calcium and bioactive glass based pulp capping. J Dent Oral Care Med. 2018;4(3):301.

8. Yamamoto S., Han L., Noiri Y., Okiji T. Evaluation of the Ca ion release, pH and surface apatite formation of a prototype tricalcium silicate cement. Int Endod J. 2017;50(Suppl. 2):e73-e82. https://doi.org/10.1111/iej.12737

9. Allam G., Abd El-Geleel O. Evaluating the mechanical properties, and calcium and fluoride release of glassionomer cement modified with chicken eggshell powder. Dent J. 2018;6(3):40. https://doi.org/10.3390/dj6030040

10. Itoh A., Ueno K. Evaluation of 2-hydroxy-1-(2-hydroxy-4-sulpho-1-naphthylazo)-3-naphthoic acid and hydroxynaphthol blue as metallochromic indicators in the EDTA titration of calcium. Analyst. 1970;(1131):583–589. https://doi.org/10.1039/AN9709500583

11. Han L., Kodama S., Okiji T. Evaluation of calcium-releasing and apatite-forming abilities of fast-setting calcium silicate-based endodontic materials. Int Endod J. 2015;48(2):124–130. https://doi.org/10.1111/iej.12290

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

13. Akhlaghi N., Khademi A. Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature. Dent Res J. 2015;12(5):406–417. https://doi.org/10.4103/1735-3327.166187

14. Saghiri M.A., Asatourian A., Garcia-Godoy F., Sheibani N. Effect of biomaterials on angiogenesis during vital pulp therapy. Dent Mater J. 2016;35(5):701–709. https:// doi.org/10.4012/dmj.2015-332

15. Beegum M.S.F., George S., Anandaraj S., Sumi Issac J., Khan S.N., Ali Habibullah M. Comparative evaluation of diffused calcium and hydroxyl ion release from three different Indirect pulp capping agents in permanent teeth – An in vitro study. Saudi Dent J. 2021;33(8):1149–1153. https://doi.org/10.1016/j.sdentj.2021.02.004

16. Arandi N.Z., Rabi T. TheraCal LC: From biochemical and bioactive properties to clinical applications. Int J Dent. 2018;2018:3484653. https://doi.org/10.1155/2018/3484653

17. Gandolfi M.G., 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. 2015;13(1):43–60. https://doi.org/10.5301/jabfm.5000201

18. Estrela C., Holland R. Calcium hydroxide: study based on scientific evidences. J Appl Oral Sci. 2003;11(4):269–282. https://doi.org/10.1590/s1678-77572003000400002

19. Camilleri J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. Dent Mater. 2014;30(7):709–715. https://doi.org/10.1016/j.dental.2014.03.012

20. Savas S., Botsali M.S., 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;33(6):764–769. https://doi.org/10.4012/dmj.2013-274

21. Gandolfi M.G., Siboni F., Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012;45(6):571–579. https://doi.org/10.1111/j.1365-2591.2012.02013.x

22. Bryan T.E., Khechen K., Brackett M.G., Messer R.L., El-Awady A., Primus C.M. et al. In vitro osteogenic potential of an experimental calcium silicate-based root canal sealer. J Endod. 2010;36(7):1163–1169. https://doi.org/10.1016/j.joen.2010.03.034

23. Anthrayose P., Aggarwal A., Yadav S., Nawal R.R., Talwar S. Microscopic and elemental characterization of hydrated dental pulp capping agents. J Conserv Dent. 2021;24(5):496–501. https://doi.org/10.4103/jcd.jcd_460_21

24. Al-Saudi K.W. A paradigm shift from calcium hydroxide to bioceramics in direct pulp capping: A narrative review. J Conserv Dent Endod. 2024;27(1):2–10. https:// doi.org/10.4103/jcd.jcd_241_23

25. Okabe T., Sakamoto M., Takeuchi H., Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod. 2006;32(3):198–201. https://doi.org/10.1016/j.joen.2005.10.041

26. Bjørndal L. Indirect pulp therapy and stepwise excavation. Pediatr Dent. 2008;30(3):225–229.

27. King M. Preserving the vital pulp in operative dentistry. Dent Update. 2003;30(3):159.

28. Iyer J.V., Kanodia S.K., Parmar G.J., Parmar A.P., Asthana G., Dhanak N.R. Comparative evaluation of different direct pulp capping agents in carious tooth: An in vivo study. J Conserv Dent. 2021;24(3):283–287. https://doi.org/10.4103/jcd.jcd_71_21