Tooth Discoloration Induced by Different Calcium Silicate-based Cements: A Systematic Review Of In Vitro Studies

Introduction: On the basis of many clinical observations, some calcium silicate-based cements have a high potential for staining tooth tissue. This feature greatly limits the use of those cements, particularly for anterior teeth. This review aimed to provide a systematic evaluation of published in vitro studies to determine the effect of different calcium silicate-based cements on dental tissue discoloration.

Methods: This literature review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The literature search was based on all publications without a year limit. The last search was performed on October 22, 2016. An electronic search was performed on MEDLINE (PubMed), Cochrane, and Scopus. The articles were selected to address the following research question: Which materials based on calcium silicate-based cements have hard tissue staining potential? The necessary information was extracted by 2 authors independently using a standardized form.

Results: The search resulted in 390 titles from all databases. Twenty-three studies met the inclusion criteria. Most of the studies exhibited a moderate risk of bias. The results indicated that some materials showed a strong potential for staining, including gray and white MTA Angelus (Londrina, PR, Brazil), gray and white ProRoot MTA (Dentsply, Tulsa, OK), and Ortho MTA (BioMTA, Seoul, Korea). Individual study results showed that Biodentine (Septodont, Saint Maur des Fosses, France), Retro MTA (BioMTA), Portland cement, EndoSequence Root Repair Material (Brasseler USA, Savannah, GA), Odontocem (Australian Dental Manufacturing, Brisbane, Australia), MM-MTA (Micro Mega, Besancon Cedex, France), and MTA Ledermix (Riemser Pharma GmbH, Greiswald-Insel Riems, Germany) were materials with the smallest staining potential.

Conclusions: This review clearly showed that some calcium silicate-based cements have a high potential for staining hard tissue. On the other hand, some showed only a small change in color, which was nearly invisible to the human eye (ΔE <3.3). However, more long-term clinical studies are needed.