Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro

Objective: Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. Study Design: Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (Delta E) were compared within and among groups using Analysis of Variance. Results: Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. Delta E values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater Delta E values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). Conclusions: Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.