# Patent

## Title
Dental cement

## Abstract

Compositions containing Montmorillonite and Portland cement for tooth filling are disclosed; such compositions have shown good biocompatibility, excellent marginal adaptation to dentinal walls, short setting time, and improved viscosity.

## Background
TECHNICAL FIELD
The present invention relates to a composition for use in dentistry, a method of producing and uses of such a composition. The present invention further relates to a method of tooth filling by means of the mentioned composition.
BACKGROUND ART
In most dental, in particular endodontic, procedures the achievement of a good seal between the tooth and the filling composition is essential in order to prevent bacterial recontamination of the root canal and ensure long-term clinical success (1, 2). The presence of marginal gaps between the interfaces of retrofilling compositions and root dentin are sites of possible microleakage (3, 4) and penetration of microorganisms and their toxins (5, 6).
Mineral trioxide aggregate (MTA) (ProRoot Dentsply-Maillefer, Baillagues, Switzerland) has been recently introduced for root perforations sealing and as a retrograde filling composition (7,8).
The principal compounds present in MTA are tricalcium silicate, tricalcium aluminate, tricalcium oxide and silicate oxide (7).
Some difficulties are reported by clinicians when using MTA including poor handling characteristic and lengthy setting time. It would be useful to improve those characteristics (9, 10, and 11). Furthermore, a recent study conducted by using a fluid conductive device and by capillary flow porometry reported that root-end fillings performed using MTA presented microleakage (12).
The fluid filtration method was found to be a valid technique to evaluate the sealing ability of root-end filling compositions (13, 14).
DISCLOSURE OF INVENTION
It is an object of the present invention to provide a composition for use in dentistry, a method of producing and uses of such a composition, all of which provide for at least partly eliminating the drawbacks of the prior art, while at the same time being cheap and easy to implement.
According to the present invention, there are provided a composition for use in dentistry, a method of producing and uses of such a composition as claimed in the accompanying independent Claims or in any one of the Claims depending directly or indirectly on the independent Claims.



BRIEF DESCRIPTION OF THE DRAWINGS
A number of non-limiting embodiments of the present invention will be described by way of example with reference to the accompanying figures, in which:
FIG. 1 shows XRD patterns of compositions in accordance with the present inventions [compositions TC-1 (TC-1%) and TC-2 (TC-2%)], and reference material (white-MTA and Portland cement) indicating the presence of the same main constituents; on the y axis counts/seconds are reported; on the x axis 2° Θ is reported;
FIG. 2 shows SEM-replica photomicrograph (200×) of a composition in accordance of the present invention, (composition TC-1%) showing a good marginal adaptation at the dentine/cement interface (D=dentine);
FIG. 3 shows SEM-replica image (200×) of a composition in accordance of the present invention (composition TC-2%) (no gap is visible; a valid and homogeneous interfacial adaptation of the composition (C) to the dentin margins (D) is evident);
FIG. 4 shows SEM-replica photomicrograph (200×) of the interfacial region between white-MTA (C) and dentinal tissue (D) (a closed gap at the interfacial region is visible);
FIG. 5 shows the viability of Saos 2 treated with cements extracts for 72 h: mean±standard error;
FIG. 6 shows the viability of Saos 2 on solid cements at 72 h: mean±standard error;
FIG. 7 shows ALP release at 72 h: mean±standard error; and
FIG. 8 shows SEM-replica photomicrograph (500×) of cements surfaces.



BEST MODE FOR CARRYING OUT THE INVENTION
In accordance with a first aspect of the present invention, there is provided a composition comprising a phyllosilicate.
Phyllosilicates indicate silicates, which naturally occur as sheets (from Greek φ{acute over (υ)}λλov phyllon, leaf). Usually, in nature, phyllosilicates form parallel sheets of silicate tetrahedra with Si2O5 in a 2:5 ratio.
As far as the present invention is concerned, the phyllosilicates belonging to the Clay mineral group is of particular interest. Advantageously, the phyllosilicate comprises (in particular, consists of) Montmorillonite.
Montmorillonite is a member of the general mineral group the clays. It typically forms microscopic or at least very small platy micaceous crystals. The water content is variable. Some types of Montmorillonite are identifiable by means of ASTM crystallographic tables.
A typical chemical formula of Montmorillonite may be:

(Na,Ca)0.3(Al,Mg)2(Si4O10)(OH)2.n(H2O)

The composition of Montmorillonite may be as follows:
Molecular Weight=549.07 gm


















Sodium
0.84%
Na
1.13%
Na2O



Calcium
0.73%
Ca
1.02%
CaO



Aluminum
9.83%
Al
18.57%
Al2O3



Silicon
20.46%
Si
43.77%
SiO2



Hydrogen
4.04%
H
36.09%
H2O



Oxygen
64.11%
O






100.00%

100.58% 
= TOTAL OXIDE









Empirical Formula: Na0.2Ca0.1Al2Si4O10(OH)2(H2O)10 
As far as the present invention is concerned, it is advantageously used a Morillonite having approximately the following formula: Na2O.2MgO.5Al2O3.24SiO2.(6+n)H2O
According to some embodiments, the composition has a weight percentage of phyllosilicate from about 0.4% to about 3.6%, advantageously from about 0.5% to about 3.5%.
In the present text, for “weight percentage” of a component it is intended the percentage of the weight of that component with respect to the entire weight of the composition
Advantageously, the composition has a weight percentage of phyllosilicate from about 0.5% to about 2.5%, in particular from about 1% to about 2%.
According to preferred embodiments, the composition comprises a mineral component. Advantageously, the composition has a weight percentage of the mineral component greater than about 50%, advantageously greater than about 60%, advantageously greater than about 70%, advantageously greater than about 75%, advantageously greater than about 80%.
According to some embodiments, the mineral component comprises (preferably, consists of) a mineral silicate-based cement, advantageously Portland cement.
Portland cement is a type of cement in general usage as a hydraulic material. Usually, it is commercialized as a powder produced by grinding Portland cement clinker (more than 90%), a maximum of about 5% gypsum which controls the set time, and up to 5% minor constituents.
According to some embodiments, Portland cement is defined in accordance with the ASTM classification and/or the EN-197.1 classification. These two classifications are not fully coincident.
Advantageously, with reference to the subject matter of the present text, Portland cement is in accordance with EN-197.1; advantageously, Portland cement belongs to class I of EN-197.1.
Advantageously, Portland clinker and Portland cement have the following compositions:










TABLE 1





Clinker
Mass %
Cement
Mass %







Tricalcium silicate 
45-75%
Calcium oxide, 
61-67%


(CaO)3•SiO2

CaO



Dicalcium silicate 
 7-32%
Silicon oxide, 
19-23%


(CaO)2•SiO2

SiO2



Tricalcium aluminate 
 0-13%
Aluminium oxide, 
 2.5-6%


(CaO)3•Al2O3

Al2O3



Tetracalcium aluminoferrite 
 0-18%
Ferric oxide, 
 0-6%


(CaO)4•Al2O3•Fe2O3

Fe2O3



Gypsum CaSO4
 2-10%
Sulfate









    
    
        According to advantageous embodiments, the Portland cement has substantially the following composition:
    
    











TABLE 2








SiO2
12.24%



TiO2
0.09%



Al2O3
2.11%



Fe2O3
0.42%



FeO
0.00%



MnO
0.07%



MgO
1.03%



CaO
67.02%



Na2O
0.42%



K2O
0.08%



P2O5
0.00%



LOI (water)
16.51%









Advantageously, the composition comprises CaSO4 and/or CaCl2 and/or Bi2O3 and/or NaF.
According to some embodiments, the composition has a weight percentage of SiO2 lower than 18%, advantageously, lower than 15%.
According to some embodiments, the composition has a weight percentage of Fe2O3 lower than 1%.
According to some embodiments, the composition is in powder form, without added water.
Advantageously, the composition as above defined comprises water.
In accordance with a further aspect of the present invention, there is provided a method of producing a composition as above defined, comprising the following steps: grinding the mineral cement silicate-based; heating the mineral cement silicate-based after grinding; and mixing the mineral cement silicate-based with the phyllosilicate so as to obtain a mixture.
Advantageously, the mixture is ground.
According to some embodiments, the heating is carried out at least 400° C. for at least 3 hours, advantageously at about 500° C. for about 4 hours.
Advantageously, the mixture is mixed with water.
In accordance with a further aspect of the present invention, there is provided a composition as above defined for use in dentistry.
In accordance with further aspects of the present invention, the following are provided. A composition as above defined for endodontics. A composition as above defined for tooth filling. A composition as above defined for endodontic filling. A composition as above defined for tooth root-end filling. A composition as above defined for orthograde endodontic filling. A composition as above defined for provisional tooth filling. A composition as above defined for visional luting-prosthetic tooth filling. A composition as above defined for pulp cupping direct and/or indirect. A composition as above defined for apicogenesis and apecification. A composition as above defined for root canal dressing.
For endodontic orthograde filling is usually meant an endodontic filling carried out from the top of the tooth.
For tooth root-end filling is meant a filling carried out in the area of the bottom (apex) of the tooth, usually after an apicectomy. The composition as above defined experimentally demonstrated good properties to induce a fast and complete apicogenesis and apecification (i.e. a good capability of inducing the production of root apical dentin in the area of the tooth apex and the production of a mature and close apex).
For provisional tooth filling is meant a standard tooth filling, for example as carried out after a simple decay has been treated.
For visional luting-prosthetic tooth filling is meant to fix provisional resin crowns and to permanently fix definitive metal-ceramic and full ceramic crown
For direct pulp cupping is meant to position the composition in direct contact with an exposed and eventually bleeding pulp so as to induce the production of new tertiary dentin.
For indirect pulp cupping is meant to position the composition in contact with deeper dentin tissue close to the pulp chamber so as to induce the production of tertiary dentin.
For root canal dressing is meant to stop bleeding inside the root canal.
In accordance with a further aspect of the present invention, there is provided the use of a phyllosilicate, for manufacturing a composition as above defined for a use as above defined.
In accordance with a further aspect of the present invention there is provided a method for tooth filling as above defined by means of the above defined composition.
In use, the composition as above defined has shown improved handling characteristics (in particular, flow, fluidity, viscosity) and shorter setting time with respect to MTA.
These advantages over the prior art indicate that the composition as above defined is particularly useful in tooth filling and in the other uses as above defined.
It is also important to point out that the composition as above defined has, surprisingly, experimentally shown the capability of inducing production of tertiary dentin.
Moreover, the above defined composition, in particular where it is in powder form and not previously mixed with water, has shown the surprising capability of solidifying in contact with blood and stop the bleeding of living tissues, such as bone and apical tissues.
Further characteristics of the present invention will result from the description of the following illustrative and non-limiting examples:
Example 1
Formulation
A base cement BCt was prepared mixing and grinding 99% (wt) Portland cement [CEMI® 52,5R(1)] and 1% Calcium Sulphate CaSO4 
The obtained powder was treated at 500° C. for 4 hours.
Starting from the BCt several compositions were prepared:
Cement for Root-End Filling

    
    
        79.5% BCt
        14.5% Bismuth Oxide Bi2O3 
        5% Calcium Chloride CaCl2 
        1% Montmorillonite
    
    


The components were mixed and grinded.
Cement for Root-End Filling (TC-1%)

    
    
        84.5% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
    
    


The components were mixed and grinded.
Cement for Root-End Filling (TC-2%)

    
    
        83.5% BCt
        14.5% Bismuth Oxide Bi2O3 
        2% Montmorillonite
    
    


The components were mixed and grinded.
Cement for Endodontic Filling with Antibiotic Activity

    
    
        84.0% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
        0.5% Antibiotic
    
    


The components were mixed and grinded.
Cement for Provisional and Definitive Restoration with
Anticaries Activity. Preventive Therapy Cement.

    
    
        84.2-84.4% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
        0.3-0.1% Sodium Fluoride
    
    


The components were mixed and grinded.
The grinded components had particles size of about 0.01-0.1 mm.
The above identified powders were mixed with water (for each 2 grams of powder up to 1 mL of water) before use.
The quantity of used water could vary according to the intended use and other features (such as particle dimensions) of the composition/s.
The compositions may also be used in powder form without the addition of water.
All the above defined compositions may be mixed with, instead of water, different water solutions.
Cement for Endodontic Filling with Antibacterial Activity

    
    
        84.5% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
    
    


The components were mixed and grinded, afterwards they were mixed with an aqueous solution (for each 2 grams of powder up to 1 mL of solution) of Chlorexidine (0.5-2.5 by weight in water).
Other Examples of Compositions

    
    
        84.5% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
    
    


A)
The components were mixed and grinded, afterwards they were mixed with an aqueous solution (for each 2 grams of powder up to 1 mL of solution) of Articaine (0.4% by weight in water).
(Please Note that Instead of Articaine Other Anaesthetics May be Used)
B)
The components were mixed and grinded, afterwards they were mixed with saline solution (NaCl 0.9% in water) (for each 2 grams of powder up to 1 mL of solution).
C)
The components were mixed and grinded, afterwards they were mixed with aqueous solution of PBS (Phosphate Buffer Solution) (for each 2 grams of powder up to 1 mL of solution).
D)
The components were mixed and grinded, afterwards they were mixed with aqueous solution of DPBS (Dulbecco's Phosphate Buffer Solution) (for each 2 grams of powder up to 1 mL of solution).
E)
The components were mixed and grinded, afterwards they were mixed with aqueous solution of HBBS (Hanks Balanced Buffer Solution) (for each 2 grams of powder up to 1 mL of solution).
F)
The components were mixed and grinded, afterwards they were mixed with FCS (Foetal Calf Serum) for each 2 grams of powder up to 1 mL of FCS).
Example 2
pH Measurement
The cements (TC-1%, TC-2%, white-MTA and Portland cement) were inserted into plastic tubes (1 mm diameter and 10 mm length) using a MacSpadden compactor (Dentsply Maillefer). Five samples were prepared for each composition. Each filled tube was immersed in 10 mL of deionized water and stored at 37° C. in a 100% relative humidity environment. After 4, 24 and 48 h of storage, the tubes were carefully removed and placed into 10 mL of fresh deionized water in order to determine the pH.
The pH of storage water was measured using a pH meter (Phoenix K0201B, Phoenix Electrode Company, Glenmont, Houston, Tex., USA) previously calibrated with standard solutions at pH 4.0 and 7.0 at a temperature of 25° C.
Example 3
Cements Characterization
The composition of white and grey MTA, of Portland cement, of TC-1% and TC-2% was identified using X-ray diffraction (XRD) in an automated powder diffractometer (Philips PW 3719, Philips®, Eindhoven, The Netherlands) using CuKα radiation and a secondary crystal monochromator. Chemical characterization (XRF) was carried out using a quantitative X-ray fluorescence spectrometer (Philips PW 1480, Philips®, The Netherlands). All the samples were analyzed in powder form.
Example 4
Endodontic Sample Preparation
Thirty single-rooted teeth, recently extracted for orthodontic and periodontal reasons were used. All the teeth presented similar length and had not been previously endodontically treated. The crowns were cut at the cementum-enamel junction; the root canals were prepared using a crown-down technique with Gates-Glidden drills (Dentsply Maillefer, Ballaigues, Switzerland) and K-files (Dentsply Maillefer). Instrumentation of the canals was performed with a K-file#30 about 1 mm short of the external apical foramen. This distance was measured by subtracting 1 mm from the length of a K-file#10 just visible at the apex. Copious irrigation with 5 ml NaOCl 5% (Ogna®, Muggiò-Milano, Italy) and 2 ml EDTA 17% (Ogna®) was performed throughout the instrumentation. Finally, the samples were dried with paper points and filled using gutta-percha without sealer and lateral condensation technique. In this way, the gutta-percha could be easily removed after the root-end filling. A horizontal apicectomy was carried out using a cylindrical diamond bur (Intensiv 5424, Grancia Switzerland) mounted on a high-speed hand-piece (Castellini Ceramic, Bologna, Italy) under constant water irrigation at a distance of approximately 3 mm from the apex. Successively, a 3.0 mm small round diamond bur (Intensiv 5424, Switzerland) was used to standardize the cavity dimension. The root samples were randomly divided in three groups of 10 samples each. One group was filled using TC-1%, a second group using TC-2% and another group using MTA. Portland cement was not tested for the sealing ability because it is not considered suitable cement for clinical application.
After the root-end filling, the gutta-percha was removed from the root canals using Gates-Glidden drills (Mailleffer) and the external root surface was covered with nail varnish with the exception of the apical 3 mm. During the intervals between the leakage measurements, the teeth were stored in deionized water at 4° C.
Example 5
Fluid Filtration Method
For the sealing ability tests the root samples were prepared as suggested by Fogel et al. (4). They were first fixed by the cementum-enamel junction, using cyanocrylate (ROCKET Heavy DVA, Corona®, CA, USA) to plexiglass supports (2×2×0.5 cm) crossed by an 18 gauge stainless steel tube and then they were connected to a fluid transporter device. Each root specimen was submitted to 6.9 KPa hydraulic pressure for the evaluation of the sealing ability. The measurements of fluid movement were carried out using a fluid conductive system that incorporated a 2.5 gL capacity micro-capillary glass tube (0.7 mm inside diameter) (Microcaps, Fisher Scientific®, GA, USA) positioned between the pressure reservoir and the root segment horizontally positioned. In the micro-capillary glass tube a 0.5 mm air bubble was created. The progress of the air bubble within the micro-capillary glass tube toward the roots was measured over three 5-min periods at 1 minute intervals and the mean calculated. The results were expressed as microliters/minute. The quality of the seal of each specimen was evaluated after 4, 24, 48 h, 1, 2 and 12 weeks from root-filling treatment.
The mean fluid filtration values obtained from the different root-end filling cements were statistically analyzed using a two-way ANOVA test (at a significance level of p<0.05). Comparisons between the mean filtration values of the different cements at each given time and between the mean filtration values of the cements at each given time were carried out.
Example 6
Interfacial Micromorphology Evaluation
Five samples were prepared for SEM observations in order to evaluate the presence of marginal gaps between the root-end filling composition and the dentin walls.
A SEM-replica technique was used to observe the interface between the root-end filling compositions and the tooth structure and the presence of gaps between the root end filling composition and the root canal walls. Since the conventional sample preparation for SEM involves dehydration that may induce artifacts in water-containing dental compositions, positive replicas were fabricated from the polyvinylsiloxane impressions using a polyether impression material (Permadyne Garant, 3M/ESPE), according to the replica technique reported by Chersoni et al. (14). The polyether positive replicas were coated with gold and examined using a SEM (JEOL 5400, JEOL, Tokyo, Japan) at 5-10 kV.
Example 7
Results of Examples 1-6
XRD structural analyses (example 3) of TC-1% and TC-2% showed their complete crystallinity, with definite peaks attributable to specific phases. The same main constituent elements were observed in white-MTA diffractograms (FIG. 1). TC-1%, TC-2%, MTA and Portland cement showed similar patterns. No reflex of phyllosilicate introduced to optimize the products plasticity and workability was detected in the XRD pattern of the experimental cements (TC-1%, TC-2%).
XRF quantitative analyses showed a different composition between both experimental cements, white-MTA and Portland cement. In particular, in the experimental cements lower amounts of SiO2 and Fe2O3 compounds compared to MTA and Portland cement were found (Table 3).











TABLE 3








white-
PORTLAND


Wt %
TC-1%
TC-2%
MTA
CEMENT



















SiO2 (%)
13.87
13.93
27.31
18.76


TiO2 (%)
0.04
0.07
0.08
0.37


Al2O3 (%)
2.14
2.15
2.12
5.04


Fe2O3 (%)
0.80
0.78
1.11
4.42


FeO (%)
0.00
0.00
0.00
0.00


MnO (%)
0.00
0.00
0.01
0.02


MgO (%)
1.15
1.18
1.10
2.16


CaO (%)
68.71
69.79
65.10
59.07


Na2O(%)
0.51
0.55
0.37
0.27


K2O (%)
0.18
0.17
0.16
1.01


P2O5 (%)
0.03
0.05
0.21
0.08


LOI (%)
12.57
12.55
2.43
8.81









Table 3 shows the quantitative XRF analysis values for of experimental cements, white MTA and Portland cement groups.
Table 4 shows the pH measurements (example 2) of MTA, Portland cement and experimental cements. TC-1% and TC-2% showed a pH slightly inferior to that of MTA and Portland cement. An evident increase of pH during the first 24 and 48 hours was observed for all the cements, indicating the OH− release from the compositions.












TABLE 4







Compositions
pH after 4 h
pH after 24 h
pH after 48 h





















TC-1%
10.5
11.3
12.1



TC-2%
10.5
11.2
12.2



white-MTA
11.2
12.1
12.7



Portland
12
12.8
13



Cement










All cements presented a reduction of the fluid filtration rate over time (example 5) (Table 5). Both experimental cements showed a statistically lower fluid filtration rate than MTA after 4 hours from filling. There were no statistical differences over time between the two experimental cements and MTA at the successive evaluation times.










TABLE 5






TC-1%
TC-2%
white-MTA



















4
h
0.8 ± 0.2A-1
0.8 ± 0.4A-1
0.9 ± 0.2A-1


24
h
0.4 ± 0.3A-1
0.3 ± 0.3A-2
0.8 ± 0.5B-2


48
h
0.2 ± 0.3A-2
0.3 ± 0.2A-2
0.4 ± 0.3A-2


1
week
0.1 ± 0.1A-2
0.1 ± 0.1A-3
0.1 ± 0.2A-3


2
weeks
0.0 ± 0A-3
0.0 ± 0A-4
0.1 ± 0.6A-3


12
weeks
0.0 ± 0A-3
0.0 ± 0A-4
0.0 ± 0A-4









Apical fluid filtration values of experimental cements and white-MTA groups at the fixed analysis times after root-filling. The values are expressed as means±standard deviations.
Statistical analyses were carried out among different cement type at the same time (superscript letters A-B) and among different times for a single cement (superscript number 1-4).
SEM observations of marginal interfaces between both TC-1% and TC-2% and the root canal walls (example 6) showed a good marginal adaptation to dentinal walls with limited marginal gaps and only sporadic voids along the interface (FIGS. 2 and 3). Specimens treated with MTA indicated the presence of marginal gaps (FIG. 4).
XRD structural analysis results showed that both experimental cements, white and grey MTA and Portland cement were completely crystalline. Furthermore, the experimental cements showed similar patterns to Portland and MTA because their low percentage of the phyllosilicate is not detectable with traditional X-Ray analyses. The XRD analyses of MTA cement is in agreement with previous results reported by Santos et al. (16) and Camilleri et al. (17).
XRF quantitative analysis showed that the experimental cements had constituent elements similar to white-MTA and Portland. Furthermore, it was interesting to highlight the lower amounts of SiO2 and Fe2O3 compounds in the experimental phyllosilicate-containing cements compared to MTA and Portland cement and the absence, in the experimental cements of other large and chromophore elements.
The pH measurement of TC-1% and TC-2% showed results comparable to those of white-MTA.
The method used in the present study for measuring the fluid filtration of retrograde root filling compositions is a modified version of Pashley's model system for determining fluid transport through dentinal tubules (4, 18). Water transport through existing voids in the obturated canals was measured reproducibly in this way (19). Moreover the fluid filtration system is a non-destructive method, hence the quality of the apical sealing can be observed as function of time.
The results of the sealing ability evaluations showed a similar fluid flow rate for TC-1%, TC-2% and white-MTA. Nevertheless a lower fluid flow rate for both TC-1% and TC-2% after 4 and 24 hours tests was observed. No significant differences were found between the cements at the end of the 12 weeks test.
All cements showed a fluid flow rate reduction over time demonstrating their reliable and stable sealing ability.
The lower fluid filtration observed after 24 hours test in the root samples filled with the TC-1% and TC-2% compared to white-MTA is due to the addition of phyllosilicate to their composition. Probably the phyllosilicate is responsible for high water absorption ability and swelling during water immersion with consequent volume expansion. This characteristic seems to be responsible for an increased adaptation of the cements to the dentinal walls. Hence, the presence of the phyllosilicate seems to increase the water absorption compared to MTA thus reducing the total time of water absorption. TC-1% and TC-2% reached water saturation in a relatively shorter time, while white-MTA uptakes water for a longer time.
The present study demonstrates that both experimental phyllosilicate-containing cements (TC-1%, TC-2%) showed better marginal adaptation than white-MTA, free from gaps and voids. Despite their hydrophilic nature (20) all tested cements showed low porosity of the composition bulk. This feature further decreases the water-pathways and consequently prevent bacterial recontamination and ensure long-term clinical success (1, 2, 21). The addition of the phyllosilicate improved the working properties.
Example 8
Compositions Sterilization
The compositions were sterilized treating them for 1:30 h with antibiotic/antimycotic (10.000 U penicillin, 10 mg streptomycin, 25 μg amphoterycin B/ml H2O), diluted 1:1000 with water; after the samples were washed twice with sterile media and pre-wetted (for 1 h at 37° C.) using culture medium with FBS.
Example 9
Extracts Preparation
The compositions were extracted in D-MEM culture medium for cells according to the International Standard for Biological Testing of Medical devices (1 g/5 mL of medium for 72 h at 37° C.). The control for the composition extracts was provided by D-MEM stored in a polystyrene flask for cell culture.
Example 10
Cell Culture
The human osteosarcoma cell line SaOS-2 (Istituto Zooprofilattico Brescia, Italy) derived from an osteosarcoma was used. SaOS-2 is an immortalized cell line with the phenotipe of mature osteoblasts. SaOS-2 are bone-forming cells and are widely used in bone cell differentiation, proliferation and metabolism studies.
SaOS-2 cells were cultured in D-MEM medium (Dulbecco's Modified Essential Medium-Sigma) supplemented with 10% v/v heat-inactivated fetal bovine serum FBS, 100 units/mL penicillin and 10 μg/mL streptomycin and 2 mM L-Glutamine (acido L-glutammic) in humidified 5% carbon dioxide in 95% air, at 37° C.
For the experiments with solid samples, 1×104 cells for cm2 were seeded on the cement surface and cultured in complete medium for 3 days (endpoints time at 72 hours); with the extracts, 1×104 cells for cm2 were seeded in the wells and then the extracts were added (1 mL per well) after 24 h.
After 24 and 72 h (endpoint times), the supernatants were removed entirely from the wells and separately collected and stored at  ̃20° C. ALP (Alkaline Phosphatase Production) and collagen release were evaluated on supernatant.
Example 11
Cytotoxicity Tests
Testing for cytotoxicity was performed by adding compositions extracts to the SaOS-2 cell culture.
The used extracts consisted of culture medium kept in contact with assayed compositions for 24 and 72 h. For tests, SaOS-2 cells were seeded at a density of 30.000/well and cultured in complete D-MEM medium; after 24 h the medium was removed and replaced with supernatants (extracts of compositions). At fixed endpoints time (24 and 72 h) cultures were tried out for Alamar blue vitality test.
Example 12
Alamar Blue Assay
Viability Test
Alamar blue staining was used for cell viability. The Alamar blue assay measures the products of the redox reactions occurring in mitochondria of viable cells and it is used as index of both viability and metabolic activity of cells (21).
At the fixed endpoint time, the conditioned media was removed and the samples were washed with PBS (Phosphate Buffer Solution). 100 μl of dye (Alamar Blue solution, Biosource International-CA) were added in the wells. And the cells were incubated for 4 h at 37° C. Then the medium was transferred to a 96-well plate in triplicates and the fluorescence was measured using a cytofluorimeter CytoFluor 2350 (Millipore Corporation, Bedford, Mass., USA) with 490 nm excitation wavelength and 530 nm emission wavelength. Cells cultured on plastic were used as control. Results were expressed (as a fraction of the cell activity measured on plastic) as relative fluorescence units (RFU) [Pelliccioni G A, Ciapetti G, Cenni E, Granchi D, Nanni M, Pagani S, Giunti A. Evaluation of osteoblast-like cell response to Proroot MTA (mineral trioxide aggregate) cement. J Mater Sci. Materials in Medicine 2004; 15: 167-73].
Cells osteoblastic-like Saos-2 were seeded on experimental cements (50.000 per cm2) and the test was performed after 72 hours.
Statistical analysis of the results was performed with the StatViewTM 5.0.1 software for Windows (SAS Institute Inc., Cary, N.C., USA) and is shown in FIG. 5 [viability of Saos-2 cells treated with cement extracts (example 11)] and 6 [viability of Saos-2 cells on solid cements (example 10)]. The results from viability were reported as mean±standard error and the differences between the samples were analyzed using the Wilcoxon test with a significance level of p<0.05.
In FIG. 6:
** p=0.0051 AHplus vs all
o p<0.05 MTA vs TC, TC 1%, TCf, TCf 1%,
# p<0.05 CTR vs TC, TC 1%, TCf, TCf 1%.
In FIG. 5:
** p=0.0022 AHplus vs all
o p<0.05 TCf 1% vs all,
# p<0.05 TCf vs all.
In both FIGS. 5 and 6:
AH plus indicates a commercial sealer (epoxy-resin based sealer)
TCPS indicates control plastic for cells cultures
TC 1% indicates TC-1%
TC is a composition differing from TC-1% only in that it does not contain phyllosilicates
TCf 1% indicates a composition which differs from TC 1% only in that it is mixed with a polymer (CEM latex 600 Benfer Chimica, which is a latex aqueous solution) as fluidifying agent instead of water
TCf is a composition differing from TCf 1% only in that it does not contain phyllosilicates.
The results of FIGS. 5 and 6 obtained for TC 1% and TCf 1% show that the compositions are substantially non-toxic and osteoconductive (allows the growth of osteoblasts and thus of bone).
Example 13
Alkaline Phosphatase Activity (ALP)
The metabolic activity of the cells was assayed evaluating the alkaline phosphatase produced and released on supernatants. The ALP assay employed was based on the observation that ALP at alkaline pH catalyses the transformation of colourless p-nitrophenol phosphate to yellow p-nitrophenol. ALP activity was measured following incubation of 100 μl of the cell supernatants with 100 μl of p-nitrophenylphosphate 16 mM solution, (SIGMA diagnostics, 245-10) in glycine buffer for 15 min at 37° C. The production of p-nitrophenol in the presence of ALP was measured by monitoring light absorbance by the solution at 405 nm using a spectrophotometer Spectra III, Tecan. Results are expressed as mmol/L and are shown in FIG. 7.
In FIG. 7:
AH plus indicates a commercial sealer (epoxy-resin based sealer)
TCPS indicates control plastic for cells cultures
TC 1%-a indicates composition A of example 1
TC-a is a composition differing from TC 1%-a only in that it does not contain phyllo silicates
F-TC 1%-a is a composition differing from TC 1%-a only in that it has the following starting formulation:

    
    
        84.3% BCt
        14.5% Bismuth Oxide Bi2O3 
        1% Montmorillonite
        0.2% Sodium Fluoride
    
    


Enzimatic production is indicative of osteoinductivity (capability of inducing osteoblast growth) and osteoconductivity (capability of allowing osteoblast growth). The results shown in FIG. 7 give evidence that TC 1%-a and F-TC 1%-a are osteoinductive and osteoconductive.
Example 14
SEM Morphological Analysis
Each sample was examined using SEM to observe surface characteristics and cell morphology. FIG. 7 shows SEM images of composition surface morphology after storage in medium culture DMEM (Dulbecco's Modified Eagle's Medium) for 72 hours at 37° C.
TC 1%-a, TC-a, and F-TC 1%-a are as defined in example 13.
TC-a shows a coral-like structure and appears uneven and granular with porosities and aggregates of different size (SEM 500×). TC 1%-a appears granular with some porosities (SEM 500×). F-TC 1%-a shows a fairly homogeneous surfaces with many precipitated crystals (SEM 500×). MTA surface shows a coral like structure with thin limited porosity and small voids (SEM 500×).
REFERENCES


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## Claims

1. Composition for use in dentistry comprising a weight percentage of phyllosilicates from 0.5% to 3.5% and at least 60% of a mineral component, in which the mineral component is Portland cement and the phyllosilicates are Montmorillonite having the following formulation:


Na2O.2MgO.5Al2O3.24SiO2.(6+n)H2O


wherein n is an integer from 1 to 10.

2. Composition according to claim 1, having a weight percentage of Montmorillonite from 0.5 to 2.5%.

3. Composition according to claim 1, having a weight percentage of Montmorillonite from 1 to 2%.

4. Composition according to claim 1, having a weight percentage of Portland cement greater than 70%.

5. Composition according to claim 1, comprising one or more additives selected from the group consisting of: CaSO4, CaCl2, Bi2O3, NaF.

6. Composition according to claim 1, having a weight percentage of water lower than 13%.

7. Composition according to claim 1, having a weight percentage of SiO2 lower than 18% and a weight percentage of Fe2O3 lower than 1%.

8. Composition according to claim 1, in powder form.

9. Method for producing a composition according to claim 1, comprising the following steps: grinding the mineral component; heating the mineral component after grinding; mixing the mineral component with the phyllosilicate so as to obtain a mixture.

10. Method according to claim 9, wherein the mixture is ground.

11. Method according to claim 9, wherein the heating is carried out at least 400° C. for at least 3 hours.

12. Composition according to claim 1 for tooth filling.

13. Composition according to claim 1 for tooth root end filling.

14. Composition according to claim 1 for orthograde endodontic filling.

15. Composition according to claim 1 for pulp cupping.

16. Composition according to claim 1 for root canal dressing.

17. Method of tooth filling providing the use of a composition according to claim 1.