Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium‑enriched mixture, and Biodentine® in the presence and absence of blood

Zahrasadat Madani, Shiva Alvandifa, Ali Bizhani


Background: Calcium silicate cements in treatments such as revascularization and apexogenesis
are adjacent to blood and pulp tissues. This study evaluated tooth discoloration after treatment
with mineral trioxide aggregate (MTA), calcium‑enriched mixture (CEM) cement, and Biodentine®
in the presence and absence of blood using spectrophotometric analysis.
Materials and Methods: In this experimental study, A total of 68 extracted permanent anterior
teeth were prepared and randomly divided into two groups as follows: the sponge embedded in access
cavities was saturated with fresh blood or normal saline using insulin syringe, and then each group was
subdivided into the following three cement subgroups: MTA‑Angelus®, CEM cement, and Biodentine;
these materials with a thickness of 3 mm were placed in the access cavity on the sponge. In the control
group, the sponges were saturated in saline and blood in the absence of cements. Discoloration rate
was measured by spectrophotometer within the following four intervals: after preparing the cavity
and 1 day, 1 month, and 6 months after material placement. ANOVA and Tukey’s test were used to
assess the effect of blood and materials and time on discoloration. (P < 0.05).
Results: In general, discoloration rate is significantly higher in blood group than saline
group (P < 0.05) and an increase in Δ E is observed over time for the materials in all groups. In
this study, discoloration rate in the presence and absence of blood in Biodentine group was lower,
and this difference was statistically significant compared to that of MTA group (P < 0.05) but not
significant compared to that of the CEM group.
Conclusion: This study indicated that Biodentine induces the lowest tooth discoloration in the
presence and absence of blood, and its discoloration rate is significantly lower than that of MTA.
Therefore, it can be suggested that Biodentine can be used more confidently for endodontic
treatments with coronal blood contamination such as regeneration and cervical perforation repair
in esthetic zone of teeth.
Key Words: Calcium‑enriched mixture cement, MTA‑Angelus®, tooth discoloration

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