Effect of calcium silicate-based repair sealers on bone healing in rat skull defects: histological and histomorphometric study

AIM. This study investigated the impact of calcium silicate sealers on bone healing in rat calvaria defects.

MATERIALS AND METHODS. Twenty-six rats were divided into 3 groups. Calvaria defects were prepared and treated in 3 different ways: CG (n = 6): Filling with clot; ES (n = 10): Filling with Endosequence BC RRM Putty repair sealer and BC (n = 10): Filling with Bio C repair sealer.

RESULTS. After 15 and 30 days, histological evaluations revealed varied levels of bone regeneration and inflammation. The group treated with a blood clot showed more bone regeneration without inflammation at 15 days. However, after 30 days, complete closure of the defect with immature tissue was observed in this group, while limited new bone formation occurred in the other groups, accompanied by mild inflammation.

CONCLUSIONS. Overall, the study suggests that calcium silicate-based sealers can induce new bone formation, but they do not offer superior bone repair compared to natural healing with a blood clot alone.

1. Rodríguez-Lozano F.J., López-García S., García-Bernal D., Pecci-Lloret M.R., Guerrero-Gironés J., Pecci-Lloret M.P. et al. In vitro effect of putty calcium silicate materials on human periodontal ligament stem cells. Appl. Sci. 2020;10(1):325. https://doi.org/10.3390/app10010325

2. Hoshino R.A., Delfino M.M., Silva G.F., Guerreiro-Tanomaru J.M., Tanomaru-Filho M., Sasso-Cerri E., Cerri P.S. Biocompatibility and bioactive potential of the NeoMTA Plus endodontic bioceramic-based sealer. Restor Dent Endod. 2020;46(1):e4. https://doi.org/10.5395/rde.2021.46.e4

3. López-García S., Lozano A., García-Bernal D., Forner L., Llena C., Guerrero-Gironés J. et al. Biological effects of new hydraulic materials on human periodontal ligament stem cells. J Clin Med. 2019;8(8):1216. https://doi.org/10.3390/jcm8081216

4. Bilge K., Ataş O., Yildiz Ş., Çalik I., Dündar S., Gezer Ataş A. Histological evaluation of tissue reaction and new bone formation of different calcium silicate-based cements in rats. Aust Dent J. 2024;69(1):18–28. https://doi.org/10.1111/adj.12980

5. Jitaru S., Hodisan I., Timis L., Lucian A., Bud M. The use of bioceramics in endodontics – literature review. Clujul Med. 2016;89(4):470–473. https://doi.org/10.15386/cjmed-612

6. Klein-Junior C.A., Zimmer R., Dobler T., Oliveira V., Marinowic D.R., Özkömür A., Reston E.G. Cytotoxicity assessment of Bio-C Repair Íon+: A new calcium silicate-based cement. J Dent Res Dent Clin Dent Prospects. 2021;15(3):152–156. https://doi.org/10.34172/joddd.2021.026

7. Wang Z., Shen Y., Haapasalo M. Antimicrobial and antibiofilm properties of bioceramic materials in endodontics. Materials. 2021;14(24):7594. https://doi.org/10.3390/ma14247594

8. Dawood A.E., Parashos P., Wong R.H.K., Reynolds E.C., Manton D.J. Calcium silicate-based cements: composition, properties, and clinical applications. J Investig Clin Dent. 2017;8(2):e12195. https://doi.org/10.1111/jicd.12195

9. Benetti F., Queiroz Í.O.A., Cosme-Silva L., Conti L.C., Oliveira S.H.P., Cintra L.T.A. Cytotoxicity, biocompatibility and biomineralization of a new ready-for-use bioceramic repair material. Braz Dent J. 2019;30(4):325–332. https://doi.org/10.1590/0103-6440201902457

10. Delfino M.M., de Abreu Jampani J.L., Lopes C.S., Guerreiro-Tanomaru J.M., Tanomaru-Filho M., Sasso-Cerri E., Cerri P.S. Comparison of Bio-C Pulpo and MTA Repair HP with White MTA: effect on liver parameters and evaluation of biocompatibility and bioactivity in rats. Int Endod J. 2021;54(9):1597–1613. https://doi.org/10.1111/iej.13567

11. Rencher B., Chang A.M., Fong H., Johnson J.D., Paranjpe A. Comparison of the sealing ability of various bioceramic materials for endodontic surgery. Restor Dent Endod. 2021;46(3):e35. https://doi.org/10.5395/rde.2021.46.e35

12. Yazdanian M., Rahmani A., Tahmasebi E., Tebyanian H., Yazdanian A., Mosaddad S.A. Current and advanced nanomaterials in dentistry as regeneration agents: An update. Mini Rev Med Chem. 2021;21(7):899–918. https://doi.org/10.2174/1389557520666201124143449

13. Silva E.C.A., Pradelli J.A., da Silva G.F., Cerri P.S., Tanomaru-Filho M., Guerreiro-Tanomaru J.M. Biocompatibility and bioactive potential of NeoPUTTY calcium silicate-based cement: An in vivo study in rats. Int Endod J. 2024;57(6):713–726. https://doi.org/10.1111/iej.14054

14. Janini A.C.P., Pelepenko L.E., Moraes B.F., Santos V.A.B., Barros-Costa M., Dos Santos I.A.M. et al. Chemical and in vivo analyses of calcium silicate-based materials in bone and connective tissues. Int Endod J. 2025;58(3):484–503. https://doi.org/10.1111/iej.14191

15. Toubes K.S., Tonelli S.Q., Girelli C.F.M., Azevedo C.G.S., Thompson A.C.T., Nunes E., Silveira F.F. Bio-C Repair – A new bioceramic material for root perforation management: Two case reports. Braz Dent J. 2021;32(1):104–110. https://doi.org/10.1590/0103-6440202103568

16. Chisnoiu R., Moldovan M., Chisnoiu A., Hrab D., Rotaru D., Păstrav O., Delean A. Comparative apical sealing evaluation of two bioceramic endodontic sealers. Med Pharm Rep. 2019;92(Suppl. 3):S55–S60. https://doi.org/10.15386/mpr-1516

17. Damas B.A., Wheater M.A., Bringas J.S., Hoen M.M. Cytotoxicity comparison of mineral trioxide aggregates and EndoSequence bioceramic root repair materials. J Endod. 2011;37(3):372–375. https://doi.org/10.1016/j.joen.2010.11.027

18. Giacomino C.M., Wealleans J.A., Kuhn N., Diogenes A. Comparative biocompatibility and osteogenic potential of two bioceramic sealers. J Endod. 2019;45(1):51–56. https://doi.org/10.1016/j.joen.2018.08.007

19. Moinzadeh A.T., Aznar Portoles C., Schembri Wismayer P., Camilleri J. Bioactivity potential of EndoSequence BC RRM putty. J Endod. 2016;42(4):615–621. https://doi.org/10.1016/j.joen.2015.12.004

20. Shinbori N., Grama A.M., Patel Y., Woodmansey K., He J. Clinical outcome of endodontic microsurgery that uses EndoSequence BC root repair material as the root-end filling material. J Endod. 2015;41(5):607–612. https://doi.org/10.1016/j.joen.2014.12.028

21. Bohning B.P., Davenport W.D., Jeansonne B.G. The effect of guided tissue regeneration on the healing of osseous defects in rat calvaria. J Endod. 1999;25(2):81–84. https://doi.org/10.1016/S0099-2399(99)80001-6

22. Ozdemir H., Toker H., Balcı H., Ozer H. Effect of ozone therapy on autogenous bone graft healing in calvarial defects: a histologic and histometric study in rats. J Periodontal Res. 2013;48(6):722–726. https://doi.org/10.1111/jre.12060

23. Silva G.F., Coelho L.A.S., Costa V.A.S., Conti L.C., Lima A.C.A., Sodré G.C.S. et al. Laboratory study of tissue repair of resin-based endodontic sealers in critical surgical defects. J Appl Oral Sci. 2022;30:e20220108. https://doi.org/10.1590/1678-7757-2022-0108

24. Kui A.G., Berar A., Lascu L., Bolfa P., Bosca B., Mihu C. et al. The influence of root-end filling materials on bone healing – An experimental study. Clujul Med. 2014;87(4):263–268. https://doi.org/10.15386/cjmed-354

25. Farhad A.R., Hasheminia S., Razavi S., Feizi M. Histopathologic evaluation of subcutaneous tissue response to three endodontic sealers in rats. J Oral Sci. 2011;53(1):15–21. https://doi.org/10.2334/josnusd.53.15